Inspection on 20/10/08 for Red Brick House

This inspection was carried out on 20th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Red Brick House 22/04/08

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Red Brick House Victoria Terrace Prudhoe Northumberland NE42 5AE     The quality rating for this care home is:   one star adequate 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: Janet Thompson     Date: 2 0 1 0 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 27 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 27 Information about the care home Name of care home: Address: Red Brick House Victoria Terrace Prudhoe Northumberland NE42 5AE 01661830677 01661830681 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Clare Dowling Type of registration: Number of places registered: Southern Cross BC OpCo Ltd care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 50 The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 50 Date of last inspection Brief description of the care home Red Brick House is a purpose built care home that provides nursing and personal care for up to 50 older people. This includes 14 NHS/GP beds for rehabilitation/short stay care. The home is in a residential area of Prudhoe in Northumberland and is close to the local shopping area and other amenities. It is a three-storey building with a passenger lift. Good size communal lounge and dining areas are available. There are 46 single bedrooms and 2 doubles. 31 bedrooms have en-suite facilities. Separate bathrooms, shower and toilets are provided. The home has a garden and conservatory, Care Homes for Older People Page 4 of 27 Over 65 50 0 Brief description of the care home and car parking space at the front of the building. Fees are currently being negotiated with Northumberland County Council. Details are available from the home on request. Further information about the home can be found in the service users guide. This is available in the main entrance. Care Homes for Older People Page 5 of 27 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: one star adequate 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 for this service is 1 star. This means the people who use the service experience adequate quality outcomes. 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. This will only happen when it is considered that people who use the service 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. This was an unannounced inspection. The previous manager for the home has left. An Care Homes for Older People Page 6 of 27 acting manager is looking after the home two days per week. Recruitment for a full time permanent manager is ongoing. Before the visit we looked at: Information we have received since the last inspection visit. How the service dealt with any complaints or concerns since the last visit. Any changes to how the home is run. We always seek the views of people who use the service. This is usually given to us in the form of questionnaires. At the time of the inspection the questionnaires we had sent to the home had not been given out. They were still in the managers office. During the unannounced visit we: Talked with people who use the service and some of the staff. Looked at the information about people who use the service and how well their needs are met. Looked at other records the home is required to keep. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building to make sure it was clean, comfortable and safe. Checked what improvements had been made since the last inspection visit. The acting manager was not available to attend the inspection. The provider sent another manager from a different home to attend. He was able to find all of the documentation needed. We found a number of things that needed urgent attention. The visiting manager dealt with these swiftly. We visited the home again a week later to check that these things had been done. What the care home does well: What has improved since the last inspection? What they could do better: The home has not had a permanent manager for some time. An acting manager has lately been in the home for two days per week. This is not enough. The lack of anyone to lead the home and provide direction for staff has had a number of effects. Several repairs needed in the home have been reported but not followed up. We found some issues that required prompt attention. These were: One residents had been washing in Care Homes for Older People Page 8 of 27 cold water for two weeks as the thermostat had broken on his tap. There were no bathing facilities on the ground floor. There is only one bath that residents are able to use and it was broken. A window restrictor was not in place on a window overlooking a big drop onto the local high street. A bedroom carpet needed to be replaced as the cleaning staff could no longer keep it smelling fresh. The manager who visited on the day of the inspection took immediate steps to address these issues. We visited the home a week later and found that the residents tap had been fixed and hot water was available. The window restrictor was in place. The decorators and carpet fitters were in the home and the carpet in question had been renewed. The ground floor bath had received attention by engineers who had not been able to fix it but were stating that it could be done within a few days. We also found that there was no hot water in the small kitchen on the first floor. The microwave and one hot trolley were not working in the main kitchen. The first floor bathroom floor was split and fixed with tape. The laundry was not clean enough or tidy enough and a part was missing from the laundry press. The provider will respond to these issues as part of an action plan to this report. There was evidence that staff needed more direction and leadership to encourage them to give person centred care. In the absence of the activities organiser staff had not provided any social care for residents. Staff were using an occupied bedroom nearest to the lounge to store wheelchairs in through the day. Staff said they had been receiving their mandatory training but records showed that some of this was out of date. Training was planned to address this. Internal health and safety checks relating to fire prevention had not been carried out at the correct intervals. Thee was no evidence to show that staff had received enough fire drills and instruction. Other checks on window restrictors, bedrails, hot water, staff call and wheelchairs had not been carried out at regular intervals. There was no certificate for the chlorination of water. This is needed to prevent the spread of waterborne infections. 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. 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 27 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 27 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. People are properly assessed, taking account of their needs and wishes, so that they can be assured this is a suitable home and receive an individual care service. Evidence: Three pre-admission assessments were seen. They contained enough information to enable staff to assess if they could meet individual needs before admission. Information from other health professionals and carers was included in the assessment. One resident told us his relative had looked around the home before admission. He chose this home because it was close to where he had lived previously. He said that when he looked around he had coffee at the home and was asked to stay for lunch. Some residents in the home occupied hospital beds, these are beds contracted by the NHS and overseen by hospital consultants. Care Homes for Older People Page 11 of 27 Evidence: Care Homes for Older People Page 12 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal care that is well planned and takes account of their diverse needs. Evidence: Five care plans were examined and two were case tracked. This means that we spoke to the individual residents or observed their care then matched our observations to what was written in the care plan. Both case tracked care plans did reflect the actual care needed by the residents. Care plans took account of peoples diverse and differing needs. People were supported to achieve independence and meet individual goals. Other health professionals contributed to the planning of care. These contributions were clearly recorded. One of the case tracked residents had problems with continence. This was made worse by a medical condition which resulted in her having unrealistic expectations and an inability to co-operate with staff. Staff spoken to expressed concern that they were unable to deal with her continence problems well enough to keep her room smelling Care Homes for Older People Page 13 of 27 Evidence: fresh. The care plan did document her behaviour patterns, which were sometimes challenging. There were risk assessments in place and records of any incidents. The information was good enough to enable staff to meet her needs. However there was further information, from a mental health professional, in a letter in the back of the file. This, if used as a training tool, or incorporated into the care plan would help staff to understand why the behaviour occurred. Only three staff had signed to say they had read the instructions in this letter which was received some time ago. One care record showed particularly good recording of a very small pressure wound on a persons face caused by spectacles. Although the wound was almost insignificant it had been measured, photographed and recorded on a body map. This shows very good attention to detail and professional practice from the nurses at the home. Residents looked clean and well cared for. Residents said they were well looked after. Medication ordering, administration, storage and disposal were examined. A hospital pharmacist checks the medicines for the NHS patients every week. All medicines are audited by the nurse every week. All medicines were accounted for and all those administered were signed for. Three amounts of controlled drug were checked and were correct. Staff were seen to speak to residents politely and respectfully. Staff did not always knock on peoples doors when they entered their bedrooms, though always did if it was a bathroom or toilet. When residents were taken to the lounge on the ground floor in a wheelchair, staff then stored the wheelchair in a bedroom closest to the lounge. This was not an empty room. It did belong to someone, although she was not sitting in the room at the time, it shows a lack of respect for that persons privacy. Care Homes for Older People Page 14 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not fully supported to lead a healthy and fulfilling personal lifestyle. Evidence: An activities coordinator is employed at the home five days per week. She supports residents to use a range of services within the local community. The activities coordinator was on holiday at the time of the inspection. Staff were not continuing activities in her absence. When staff had quiet spells in the day they were not using that time to interact with residents. This indicates that staff do not see themselves as responsible for the social care of residents, and that care is not person centered. The last entries in the activities record were for 3rd October. These were mostly saying that residents had refused activities such as cooking and art. Some one to one interactions were recorded. Residents told us that they could see their visitors at any time. There were several groups of visitors in the home on the day of inspection. Staff greeted them in a friendly manner and visitors seemed relaxed and familiar with the home. Residents also said they liked the food. We ate the food at the home. It was risotto or Care Homes for Older People Page 15 of 27 Evidence: cottage pie, followed by stewed apple and custard. It was well presented. The food was hot enough and tasty. The home has a nutritional system in place. This is an independent nutritional tool that devises balanced menus and promotes healthy living. As a result of this the cooked breakfast had been taken off the menu but was available on request. We were concerned that, as the resident group were all fairly dependant, they would not request this and it should be offered regularly to prompt their interest. Care Homes for Older People Page 16 of 27 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. People who use the service are protected from harm through thorough policies, procedures and staff training. Evidence: Staff follow the home’s policies and procedures relating to the management of complaints and allegations of abuse. 64 of staff have had training in the protection of vulnerable adults. More training on this is about to take place. Residents are told how to complain through the complaints procedure. This was clearly visible within the home. Residents spoken to said they would complain if they needed to. The complaints record showed that one complaint had been recorded in the last few months. This was about lack of maintenance, decoration and the lack of a permanent manager in the home. These issues are still ongoing. Care Homes for Older People Page 17 of 27 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. Residents do not live in a home that is safe enough or well maintained. Evidence: Some areas of the home are in need of redecoration. On the ground floor the corridors, bathrooms and dining room walls were scuffed and torn. The place was generally clean but there were some odours from a bedroom carpet. The cleaners reported that this room is cleaned regularly but they can no longer remove the smell. This was immediately reported to the providers estates department and within a week the decorators were busy in the home and the carpet was replaced. The window in the first floor dining room had been overridden or was broken. This window overlooked a large drop to the local high street. This was reported immediately and within days the window restrictor was in place. This had been overridden by staff and disciplinary action will be taken by the provider. There was only one bathroom that residents are able to use on the ground floor and this had been broken for twelve days. Staff had to leave the floor and take residents upstairs for a bath or shower. This was reported immediately. The contractors are waiting for a part for the bath and it is anticipated that this will be back in use in the next week. There are no other bathing or showering facilities on the ground floor which Care Homes for Older People Page 18 of 27 Evidence: restricts residents choice. On the first floor the bathroom floor was split down the middle. The split was covered with tape but was still a trip hazard. One of the residents told us that he had no hot water in his room for two weeks. He had been getting washed in cold water. Further his tap was dripping and had been held closed by an elastic band fitted by his relative. This was reported immediately and, at our second visit to the home a week later, we saw it was fixed. There was also no hot water in the small kitchen attached to the first floor dining room. In the main kitchen staff reported that the microwave was not working. One of the two hot food trolleys was also not working correctly. This meant staff were unable to keep food hot enough to enable it to be served at the correct temperature. The laundry was not clean enough or tidy enough. The surfaces were not impermeable and the walls could not be easily washed. There was a lot of fluff coming from under radiators where residents slippers were drying. A bar had snapped off the large press. The laundry assistant was still using it but it was not clear if this was a safety bar. The visiting manager took immediate action on this. We were told that this was only a feeder bar and did not pose a health and safety risk. Residents bedrooms were well personalised. They looked clean, tidy and comfortable. Some residents had brought items of furniture from home and these looked particularly homely. Outside space was tidy and well maintained. The provider acted very quickly to address our immediate concerns about the premises. This resulted in an improvement in washing and living facilities for residents. We visited the home a week later to satisfy ourselves that the immediate problems were addressed. Had the management of the home been more consistent we would not have had so many issues to address. This has been highlighted in the management section of this report. Care Homes for Older People Page 19 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported and protected through staff numbers. Staff skill and ability does not fully meet residents needs. Evidence: There were sufficient numbers of staff on duty. The current staffing levels are: Daytime- Four care staff upstairs, four care staff downstairs and two qualified nurses. Night time. Three care staff and two qualified nurses. Training records showed and staff confirmed that 65 of staff had achieved NVQ level 2. Some essential training had lapsed. For example, only 14 of staff were up to date with moving and handling. Some staff have just trained as moving and handling facilitators and will be training other staff within the home soon. Infection control and adult protection training is also planned. The training statistics showed that currently none of the staff are trained in infection control, nutrition or health and safety. It has been recommended in other parts of this report that staff also receive training in person centered care. Four staff recruitment files were examined. These were for one new carer, one long term employed carer. and two new domestics. All contained good information. Thorough background checks had been carried out before employment. Residents were Care Homes for Older People Page 20 of 27 Evidence: protected through checking of criminal records information for all employees. Interviews were conducted against a person specification list to ensure fair and equal employment. An equality and diversity monitoring form is also used to demonstrate fairness in employment. Care Homes for Older People Page 21 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are not protected through reflective management that takes account of the diverse needs of the service. Evidence: The home has been without a permanent registered manager for some time. There has, recently, been an acting manager coming to the home two days per week. This is not enough and there was evidence that staff are lacking a clear sense of direction and leadership. The home does operate a quality assurance system. A series of management audits and monitoring have been carried out. The number of issues raised in this report would indicate that this has not been effective and again demonstrates the need for a registered manager. The organisation have tried to keep residents and relatives informed of the management difficulties. Meetings have been arranged to do this and so far residents and their relatives have been understanding. We sent a number of Care Homes for Older People Page 22 of 27 Evidence: surveys to the home to be given out to residents. On the day of inspection these were still in the managers office and had not been given out. Residents personal monies were well accounted for. Records were examined and showed that two signatures were obtained for all transactions. Southern Cross policy is that monies are pooled into one bank account therefore individual amounts could not be checked. Monies are audited monthly. Records of internal health and safety checks were not up to date and had not been carried out consistently over the past six months. Records of hot water checks showed that water is often running too cold in the home. This has been reported in the environment section of this report. Checks of the fire system had not taken place at the correct intervals and there was not enough evidence that staff had received fire instruction and drills at the required intervals. External health and safety checks were up to date for gas, electrical systems, portable electrical appliances and passenger lifts. There was no water chlorination certificate available. Care Homes for Older People Page 23 of 27 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 24 of 27 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 1 19 23 Keep all areas of the home 01/01/2009 in a good state of decoration and repair. Residents have access to sitting, dining, bathing and sleeping areas that are clean and comfortable. 2 21 23 Provide a choice of bathing facilities on each floor. Ensure that these are kept well maintained and in good working order. Residents must have access to hot water to wash in. Residents have a choice of bathing facilities that meet their individual needs and requirements. 01/12/2008 3 26 13 Ensure all laundry facilities are in good working order and that the laundry is kept clean. Steps are taken to prevent the spread of infection within the home. 01/12/2008 Care Homes for Older People Page 25 of 27 4 30 18 Ensure that essential training for staff is up to date. Residents are cared for by well informed trained staff. 01/01/2009 5 38 13 Ensure that internal health and safety checks are up to date. Ensure that staff are provided with health and safety instruction relating to the prevention and management of fires. Residents are protected through thorough checking and testing of health and safety procedures. 01/12/2008 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 10 Staff should receive training in person centered care which prompts them to respect residents personal space and belongings. Staff should receive support to enable them to understand the challenging behaviour presented by some residents. 2 3 4 5 6 7 12 15 19 30 31 33 Care given to residents on a daily basis should meet their social and personal needs. The cooked breakfast is offered to residents as an option on a regular basis. Ensure that staff have access to fully operative equipment with which to carry out their duties. Provide staff with vocational training related to care of elderly people. Provide a permanent registered manager for the home. Ensure that any quality surveys provided by CSCI are distributed to residents. Care Homes for Older People Page 26 of 27 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 27 of 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!