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Inspection on 17/11/08 for Northview Lodge Nursing Home

Also see our care home review for Northview Lodge Nursing Home for more information

This inspection was carried out on 17th November 2008.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service is good at supporting and encouraging the residents to make independent decisions and choices for themselves. The means for supporting inviduals are detailed in the care plans and other revelvant documents that are kept in the home. This applies to both the younger adults residents and the residents on the dementia unit. Residents meetings are regularly held and these are used as a means for seeking their views and addressing any concerns that they may have about the day to day running of the home. The home is divided into three separate units and these are staffed separately. There are always sufficient staff on each unit to meet the needs of the residents. Some residents have enjoyed holidays at home and abroad. The environment on the dementia unit is stimulating and enables the residents to orientate themselves. Handrails have been painted in brighter colour to help people with poor vision and memory problems to notice them. Bedroom doors and toilets have different colours and this helps people find their way round the home more easily. The service is good at providing a therapeutic environment for the residents. At the time of the inspection the nurses were having a sleep therapy session with a group of residents. This was arranged as a result of some residents expressing difficulties with sleeping. The idea was to help them to find various techniques to help them to sleep rather than rely of medication. The home works closely with other healthcare professionals and agencies for planning and meeting the healthcare needs of the residents.These include the local healthcare trust, occupationals therapist, psychologist and people with special knowledge of working with people with dementia. There is a positive emphasis on staff training and development. All staff have had the statutory training and other specialist training such as dementia awareness, disability awareness training and Mental Capacity Act training. The manager confirmed that some of the senior staff have started their training on Deprivation of Liberty, and that it is hoped that all staff would eventually receive this training.

What has improved since the last inspection?

At the last key inspection, no requirements or recommendations for improvement were made.

What the care home could do better:

The staff were noticed to be carrying lunch to the residents in their rooms. The food should have been placed on a tray and covered.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Northview Lodge Nursing Home Northview Road Castletown Sunderland SR5 3AF     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sam Doku     Date: 1 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Northview Lodge Nursing Home Northview Road Castletown Sunderland SR5 3AF 01915168605 01915168601 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Lynn Bell Type of registration: Number of places registered: Southern Cross Healthcare Services Ltd care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia physical disability Additional conditions: Date of last inspection Brief description of the care home Northview Lodge is a two-storey purpose built nursing home, which was originally designed to provide care for older people with dementia-type illnesses. At the beginning of 2002 the ground floor was converted to provide care for younger adults with acquired brain injury and mental health needs. In July 2004 the upstairs unit was converted to provide a smaller higher staffed unit for older people with a dementiatype illness and a small unit for younger adults with very complex mental health needs. The fees charged at the home range from 531 pounds to 980 pounds per week. The amount of the fee people will pay depends on the financial assessment the social service department has completed. There is a car park and main entrance to Northview Care Homes for Older People Page 4 of 28 Over 65 15 0 7 8 30 10 Brief description of the care home Lodge at the front of the building. Access to this entrance is level. Both floors have dining rooms, lounges, bathrooms, toilets and bedrooms. A passenger lift serves both floors. The administration office is located on the first floor with an additional office area on the ground floor. The home is off the Western Way at the Castletown junction. A short walk from the home is an industrial/business estate with food retailers and a range of stores. The local bus routes provide transport to the local estates and the city centre. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating of this service is 3 Star. This means the people who use the service experience excellent quality outcomes. The inspection was unannounced and commenced on 17 November 2008 and completed on the same day. Before the visit the inspector looked at: Information we have received since the last inspection visit on 15 March 2007. How the service dealt with any complaints and concerns since the last inspection. Any changes to how the home is run. The providers view of how well they care for people, as highlighted in the details provided in the Annual Quality Assurance Assessment (AQAA). During the visit the inspector did the following: Talked to the people who use the Care Homes for Older People Page 6 of 28 service, the manager and the care staff. Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff have the knowledge, skills and training to meet the needs of the people they care for. Looked around the home to make sure it is safe and secure. Checked what improvements have been made since the last inspection. The inspector told the manager what he found. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use the services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 28 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The company provides good information about the home for prospective residents. Furthermore, there is a thorough assessment of needs before admission is arranged. These ensure that prospective residents have all the necessary information availble to them to help make informed decisions about coming to live at the home. Evidence: The homes admissions policy includes giving people the opportunity to visit the home to see for themselves what facilities are available to help care for them. In all the case files that were seen, a pre-admission assessment had been carried out by a trained nurse, and in some cases there had been involvement of other professionals in carrying out the assessments. The assessments are very detailed and they form the basis for developing the care plans for the individuals. There is evidence in some of the files of agreements being reached with individuals about their complex care needs and how they can be supported in the home. Care Homes for Older People Page 11 of 28 Evidence: It is the policy of the home that all prospective residents are offered the the opportunity to visit the home and to spend sometime to speak with other residents and staff about the home. The manager explained that in the case of the residents on the dementia unit, it has not always been possible for them to visit the home and see the place for themselves before admission is arranged. She explained that in such cases, relatives or friends would visit on the propective residents behalf. Staff gave several examples of such visits by residents and or their relatives when they were considering coming to live at North View Lodge. The company has contracts with the residents which provide details of the conditions of residence and the responsibilities of the provider. These have been signed by the residents or their representatives. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents receive care that meet their personal and healthcare needs. Furthermore, the home has good procedures in place for administration and safe handling of medication, thus safeguarding the health of the residents. The residents are treated with dignity and their right to privacy is upheld. Evidence: The staff have prepared detailed care plans which set out the health and social care needs of the individuals. All the four care plans that were examined contained very good information about their needs and provided detailed informtion to staff on how those needs are to be addressed. Staff have completed life histories for all of the people with dementia. These are written in a narrative style and provide good information about peoples life histories. The home works in partnership with other healthcare agencies and professionals, some of whom have been employed directly by Southern Cross Healthcare. The directly Care Homes for Older People Page 13 of 28 Evidence: employed healthcare professionals provide extra support to the home, particularly in managing the mental health needs of the residents. There is a great deal of involvement by an occupational therapist, a psychiatrist and a clinical psychologist who specialises in dementia care. The residents benefit, not just from the involvement of the local healthcare trust and the NHS, but also get good support from healthcare professionals who are directly employed by the company to support the home. The involvement of a psychologist with special interest in dememtia care has benefitted the residents on the dementia unit. The residents have also benefitted from the alterations to the environment whch has helped them with orientation. Hand rails along the corridors have been painted with brighter colours to assist people with poor vision and memory poblems. Smilarly, residents orientation in the home has been greatly enhanced by the props on bedroom doors, toilet doors, bathroom doors and also on selected walls in the corridors. The manager indicated that these ideas were thoroughly researched by the nursing staff and they visited other homes where such methods were being used before they put the ideas in place. A nurse indicated that the ideas of colour coding of doors and corridors have greatly reduced the level of confusion amongst the residents and they are able to find their way around the unit more easily. She also said that the residents respond positively to the props, pictures and everyday items that had been placed on the walls along the corridors. She said that residents would often talk about these items which have become discussion points with them. The psychologist who has been employed by the company was instrumental in making the dementia unit such a stimulating and rewarding environment for the residents. The residents who were spoken with confirmed that they have access to healthcare facilities including GP support and other healthcare professionals including psychiatrist, specialist nurses, optician, chiropodist, dentist, occupational therapist and dietician. The views of the residents are supported by the details in the daily report records which provide details of the visits from or visits to healthcare professionals and the treatment they receive from them. The home provides more than adequate healthcare for the residents. The nurses are very proactive in supporting the residents, especially the younger adults who have mental health needs. The nurses conduct individual and group counselling sessions with the residents. Residents who were spoken with said that the staff help them with their problems. One senior nurse said that the active role of the nurses in preventative medicine has prevented a lot of people with mental health problems from going back into hospital for treatment. The nurses often arrange therapeutic workshops for the younger adult residents. Some Care Homes for Older People Page 14 of 28 Evidence: of these include Well men and Well women therapeutic groups. On the day of the inspection, the staff had organised a workshop for a few residents who had expressed diffculties with sleeping. The idea was to help those affected by sleep difficulties to manage their problems without resorting to medication to help them to sleep. The home has details policies on the storage and administration of medicines. These are followed by the nursing staff who have overall responsibility for the administration of medicines in the home. A random check of the medicines administration system was undertaken by the inspector. There were no discrepancies noted. All the drugs administration records were appropriately maintained. At the time of the inspection the staff were noted to relate very well with the residents and there was obvious respect between staff and the residents. The residents confirmed that the staff treat them with respect and dignity. The staff were friendly and professionals in the way they interacted with the residents. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides meaningful and fulfilling activities which enhance the wellbeing of the residents. Furthermore, the residents are provided with good variety of wholesome and nutritious meals, which promote their health and wellbeing. Evidence: The residents commented that there is always something to do in the home. They described some of the activities that staff organise for them. The notice boards on the various floors inform residents of the activities for the day. There are various workshops organised for the younger adult residents. Some of these include Well men and Well women therapeutic groups. The workshops offer residents the opportunity to develop interests and to be creative. There are some residents who go out and are supported to maintain their outside interests. One residents said he has always been interested in landscape painting and he was happy with the help and support he receives from the staff to continue to enjoy his past time activities. The residents are able to make choices and make independent decisions about their care and the way they wish to be looked after. Residents described how they are able to do the things they like to do with the support of the staff. Staff also described how Care Homes for Older People Page 16 of 28 Evidence: they support and encourage residents to maintain their preferred lifestyle. Supporting evidence in the care plans and daily report book show that the staff are proactive in supporting people to remain independent and to engage in activities of their choosing. The dining areas on each of the floors are adequately decorated and furnished. Dining table were appropriately set and residents had their meals in a pleasant and comfortable environment. Examination of past menus show that the home provides choice of menu for the residents. Those residents with special dietary needs are catered for. The home is supported by a doctor who provides good advice on the dietary needs of the residents. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and relatives have information about how to make a complaint and are confident that any concerns raised would be acted on by the home, thus promoting their right to express their views about the service. Staff are aware of safeguarding adults procedures and have received suitable training which safeguard the safety and welfare of the residents. Evidence: The complaints procedure is posted in the reception area and a summary of the procedure is in the service user guide. Details in the complaints book shows that the home takes complaints seriously. The complaints procedure is regularly updated and relects the current view on the management of complaints by the home. A number of residents and staff were spoken with about the homes complaints procedure. Residents said they are aware of the procedure and feel confident about raising any concerns with the manager if they were unhappy about something. Residents also said the the regular meetings with the staff give then the opportunity to raise any concerns if they were unhappy about anything. Staff have had training in safeguarding adults. Staff who were spoken with were familiar with the homes policy on safeguarding vulnerable people. The manager Care Homes for Older People Page 18 of 28 Evidence: confirmed that the staff have received training in the Mental Capacity Act and that some of the staff have commenced their training in the Deprivation of Liberty. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally, the home provides safe, secure, clean, warm and pleasant environment for the residents to live in. However, some areas of the home are suffering from wear and tear and need attention. Evidence: There is a programme of decoration and refurbishment work going on in the home. The home is generally clean and the maintenance and decoration work is going on in some bedrooms. The lighting in some parts of the home is not very good. This is particularly the case in the corridors on the younger adult units. The reception area needs to be brighter and the lighing should be improved to make the area look brighter, warm and welcoming. The corridors are narrow and can present some dificulties for people on the younger adults units, especially those with physical disabilities who require wheelchairs or electric chairs to mobilise. The door ways, inclduing those of the bedrooms are only just wide enough for residents with wheelchairs to navigate through. The home has suitable infection control policies in place. Staff have had training in infection control and records show that the home has adhered to effective infection control procedures. The kitchen was noted to be clean and maintained to good a Care Homes for Older People Page 20 of 28 Evidence: standard. There is a cleaning rota showing how the domestic staff keep up with the cleaning activities in the kitchen. Records relating to food temperatures and other food hygiene measures are maintained. The laundry was found to be well ordered, and appropriate COSSH notices are in place. The laundry machines are suitable for cleaning foul linen. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels at the home meet the personal, social and emotional needs of the service users. Evidence: The home employs sufficient numbers of staff to meet the needs of the residents. The inspector had discussions with staff and the residents about the staffing levels and there is a general view that there are always sufficient staff on duty to meet their needs. At the time of the inspection, all the units had been staffed with a minimum of 3 care staff and a trained nurse. The staff have had appropriate training to equip them for their roles. The manager confirmed that the staff have received training in moving and handling, first aid, protection of vulnerable adults, fire safety, food hygiene and health and safety training. This was confirmed in the staff training log that was available in the home which shows the number of staff with relevant training. Four staff files were examined to check on the recruitment process by the manager. The files show that the home has been following the company policy on recruitment. All the files contain completed job applications, copy of job description, appropriate references, evidence of CRB checks and record of training. Care Homes for Older People Page 22 of 28 Evidence: The manager confirmed that all the care staff hold an NVQ level 2 award or above. The training officer who is based in the home is extremely enthusiastic about staff training and she frequently access training materials on the Internet and from the Department of Health website which informs her training plans for the home. There is a history of staff from the home gaining access to nurse training. Student nurses are also placed in the home by the local Universities as part of their practical nurse training. Residents were extremely complimentary about the quality of the staff and also about the service offered at Northview Lodge. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in a way that promotes the health and welfare of the residents. Furthermore, the home provides supervision to staff which helps to promote the quality of the service that the residents receive. Evidence: The manager has recently been appointed to the post. Before that she was a unit manager in the home. She has good experience of working in a residential care home. Her management ability was commented on positively by the staff. Staff feel that she is approachable and supportive of them. There is a quality assurance system in place for seeking the views of the residents and visitors to the home. The manager described the procedure for ensuring that the service is under constant review taking into consideration the views from area manager, residents and relatives. Care Homes for Older People Page 24 of 28 Evidence: There are suitable arrangements for staff to receive one-to-one supervision from the manager. Staff records show that the manager and the qualified nurses have provided individual supervision for the care staff on regular basis. Staff commented that they find the supervision sessions useful. The company Health and Safety policies remain in place. These cover policy areas such as fire prevention and Care of Substances Hazardous to Health (COSHH). There is evidence that staff adhere to the policies as set by the company. Servicing records confirm that all portable appliances have been tested. A record is maintained of regular water temperature tests are maintained in the home. Regular servicing of fire equipment, passenger lift, bath lifts and hoists, gas and electrical appliances have been carried out by the contracted companies. All the servicing records that were examined were up to date. Records examined indicate that fire precautions relating to weekly fire alarm testing and record of inspection takes place. There are records in the home indicating fire drills and fire instructions with staff. A robust quality assurance system is in place that meets the needs of Northview Lodge. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 15 The staff should ensure that food that is being taken to people in their rooms are covered to promote good food hygiene. The lighting in some parts of the building need to be improved to make it safer for people with poor vision, and also to make the home look lighter and brighter. 2 20 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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