Inspection on 16/12/08 for Rosehurst

This inspection was carried out on 16th December 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosehurst 21/02/08

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rosehurst 162 Church Path Deal Kent CT14 9TJ     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: Penny McMullan     Date: 1 6 1 2 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 © (2009) 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: Rosehurst 162 Church Path Deal Kent CT14 9TJ 01304372312 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Rosehurst Care Ltd care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 22. The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Date of last inspection Brief description of the care home Rosehurst is a registered residential care home for up to 22 older people. The registration of this home permits that people may live here if they have been diagnosed with dementia. The building is a detached property with a patio garden to the side and a large (soon to be lawn) garden at the rear. Both gardens are secluded and surrounded by a high brick wall. Car parking is available at the rear of the property accessed via Middle Deal Road, there is also limited street parking. The home is located within a busy residential area of Deal, and is within a few minutes walk of the local hospital. The home is within walking distance of several local shops and public transport, but is some distance from Deal town centre. Accommodation comprises of 16 single rooms and three double rooms situated over two floors. Double rooms are mainly used for people who have additional care needs, such as needing hoist equipment. The first floor is accessed via a stair lift. Each bedroom has a private washCare Homes for Older People Page 4 of 27 22 Over 65 0 Brief description of the care home hand basin and call bell. There are no en-suite facilities provided in the bedrooms, although there are adequate communal bathroom and toilets. On the ground floor there is a large lounge and two smaller lounges, one of which opens up onto the patio area. The dining area opens directly onto the kitchen, so the cook is directly involved with residents during meal times. The current fees for the service at the time of the visit are 320 pounds to 386 pounds per week. There are additional charges for chiropody, toiletries and hairdressing. This is the first CSCI key inspection for the home under its new ownership. Information on the homes services and the CSCI reports for prospective service users/relatives will be referred to in the Service User Guide. The email address for the home is rosehurstcare@yahoo.co.uk 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: This key inspection was carried out over a period of time and concluded with an unannounced visit to the home on 16 December 2008. The proposed Registered Manager assisted throughout the visit. Surveys were sent to the home for the owners to distribute to people that use the service, staff and professionals who have contact with the service. There was minimal response from the residents, two staff members and no professionals. All comments received are positive and have been included throughout this report. The care of three people was tracked to help gain evidence as to what its like to receive a service from the agency. Various records were viewed during the inspection. Care Homes for Older People Page 6 of 27 The home returned the Annual Quality Assurance Assessment (AQAA) within the required timescale. Information within the AQAA was not very detailed to give a good indication of what the home has achieved or how they intend to improve their service. The current Manager was not in post when the AQAA was completed, so therefore did not complete this document. Improvements will need to be made when submitting the next assessment. It is acknowledged that the Manager has only been in post since November and has achieved significant improvements in that short time, however further improvements in the home are required which are detailed in this report. The Manager is aware of what needs to be improved and is working hard to achieve this. An improvement plan will be requested from the home outlining the issues with timescales as to when the work will be completed. What the care home does well: What has improved since the last inspection? What they could do better: The new manager is aware of what improvements need to be made in the home and is working with her staff to achieve this. The home needs to review the Assessment Form to ensure that full care details are recorded so that the home can meet prospective residents needs. Some care plans require further detail to identify what the word assistance means to an individual and moving and handling risk assessments do not provide staff with clear guidelines of how to move residents safely. Medication record sheets need to have hand written entries countersigned to reduce the risk of error. A formal programme of activities would enhance the daily lives of the residents. The Laundry Room requires new flooring and redecoration to minmise the risk of infection. Staffing levels need to be reviewed to ensure there is sufficient staff on duty to meet residents needs. Care Homes for Older People Page 8 of 27 Staff files would benefit from an audit to ensure that all the required documentation is in place. The fire tests had not been carried out on a weekly basis and records were not up to date. A requirement with a timescale of one week was given at the time of the inspection. This has been discussed with the home since the site visit and the new system has been implemented to ensure that residents and staff are safe. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are required in the assessment procedure so that prospective residents can be confident their needs will be met. Evidence: The Manager of the home has been in post since 1st November and is in the process of implementing new assessment forms. One assessment had been completed by a previous manager and lacked the required detail to identify how the home was to meet the needs of the residents. The home has implemented a new form, which covers all of the relevant details required to meet individuals needs. However two forms were not completed fully, not signed and dated. This does not identify who completed the form and that all aspects of care have been taken account of to meet the individuals needs. For example further detail is required when identifying medication, personal care needs and preferences. The process does not clearly show resident, relative or representative participation in the assessment and the documents had not been Care Homes for Older People Page 11 of 27 Evidence: reviewed, as stated, after 24 to 48 hours. Care plans from the placing authority are on file. The home needs to improve the assessment process so that the residents can be confident their needs will be met. A recommendation will be made in this report. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New care plans will ensure that residents can be confident their health and care needs will be met. Improvements are requireved in the moving and handling risk assessments to ensure that staff and residents are safe. Health care needs including medication are being met and privacy and dignity upheld. Evidence: The home is in the process of implementing new care plans, which covers all aspects of health and social care. This will give staff clear guidelines of how to support and care for the residents. In some cases the plans had clear detailed information identifying choices and preferences. For example there are clear instructions of how to calm someone who consistently wakes in the night by offering milky coffee and reassurance, which was very individual to that person. There is also clear information of how to promote and support independence by identifying exactly what the resident Care Homes for Older People Page 13 of 27 Evidence: can do for himself or herself. In some care plans the word assistance is used to describe the care to be given, further detail is required to clarify just what this means to the individual. A recommendation will be made in this report. The moving and handling risk assessments detailed dependency but lack information of specific manoeuvres to provide staff with clear written guidelines of how to move the person. Care staff demonstrated that they knew exactly how to move one person and a carer quite clearly stated that she would not do anything which may harm the resident or herself. A requirement will be made in this report to implement full risk assessments to ensure that staff and residents are safe. The Registered Manager acknowledges the shortfalls in this area, and is working towards improving all aspects of the care plans. The plans are reviewed on a regular basis. Further evidence of relative and resident participation needs to be recorded together with the individuals full life history. All care staff have received training in care planning and the home is in the process of implementing a new care plan for each person. Health care needs are monitored through the care plan and there is evidence recorded for all appointments, visits from doctors, nurses, and chiropodist. Appropriate equipment to maintain skin integrity is in place, to help prevent pressures sores. Medication storage is satisfactory and all staff administering medication have received the appropriate training. Medication records are in good order and audited on a monthly basis. The Manager states that the local Primary Care Trust has also audited the medication. There are guidelines in the care plans of how residents may present pain and require the as and when prescribed pain relief. Hand written entries on the medication administration sheets need to be countersigned to minimise the risk of error. A recommendation will be made in this report. Staff were observed supporting and talking to the residents in a sensitive caring manner. Staff were seen knocking on doors before entering, and offering choices to the residents of where they would like to sit or what they would like to do. There was an emergency at the time of the site visit which was handled in a respectful professional manner ensuring the home remained calm and the residents were supported through this difficult time. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A formal prgamme of meaningful activites would enhance the daily lives of the residents. Residents preferences are recorded in their individual care plans and they enjoy a healthly balanced diet with choices and variety. Evidence: The home does not have a dedicated activity co-ordinator. At the time of the site visit there were three care staff on duty. If one carer is taken off to complete activities this only leaves two care staff providing direct care. This may result in some residents having to wait to receive the service. Activities are being provided as there is a regular visit from a musician, church services, excercise sessions and one to one sessions. However there is no formal programme in place. The Manager states that it is intended to provide more outings in the summer. Care Homes for Older People Page 15 of 27 Evidence: A recommnedation will be made in this report to implement a formal activity programme to provide stimulating activities to enhance the residents daily lives. Relatives are made welcome in the home and can visit at any time. They can go to the residents bedroom, dining room or sun room. If required the home support residents with their finances and have recording systems in place together with the safe keeping of valuables. Advocacy services are also on display. Residents choice is promoted in all aspects of their care and staff were observed offering choices as to what meals, drinks they would prefer. The cook talks to residents every day with regard to their choice of the menu. The meal served on the day of the site visit looked appetising and alternatives were available. One resident tried several different dishes before eating and the staff dealt with this in a patient manner. There were a variety of drinks available. Nutrition is fully assessed and recorded in the care plan and records are kept of choices and meals eaten. There are four weekly menus in place. As a result of listening to the residents and staff the kitchen hours were extended to 5.30 pm. Fruit and snacks are available throughout the day. 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. Residents living in the home can feel confident that their complaints will be listed to and acted upon and they are safeguarding from abuse. Evidence: During the last six months the home has experienced a period of unstable management and staffing issues. This has resulted in complaints and safeguarding issues. The home has worked closely with social services with an action plan to address these issues. A new Manager has now been appointed and the staff group has settled. There have been no complaints since the current Manager took over in November and staff say how much the home has improved since her appointment to the post. Staff showed a good understanding of ensuring that residents with demenita are observed for their behaviour to assess whether they have concerns or may be unhappy about something. If this was the case they say they would have no hesitation in speaking to the Manager to resolve the issue. The adult protection issues have now been closed and all staff have received appropriate training. Staff spoken to demonstrated that they are aware of the protocols and the importance of reporting such matters. 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. The home continues to be redecorated and refurbished and is comfortable and homely. The laundry needs to be redecorated including new flooring to ensure that safe infecton control measures are in place. Evidence: The home has a new call system and non slip flooring is being fitted in the dining room on 27th December, 2008. The gardens have been secured and there is a key pad entry for the laundry and back door to the garden. The Registered Provider has agreed to replace bedroom furniture and this will commence one room per month starting in February 2009. The downstairs has been painted and there are locks on all COSHH cupboards. The home has future plans to convert a bathroom into a wet room but does not have any dates to start this project. Recommendations from the Environmental Health Office visit have been addressed and the home is in the process of completing Safer Food Better Business Programme. The fire risk assessment in place needs to be checked with the local Fire and Rescue Service. The laundry room is in need of repair, especially the floor and the walls are not easily cleaned. Although there is some infection control measures in place the room looked untidy and in need of redecoration. A recommendation will be made in this report. Care Homes for Older People Page 18 of 27 Evidence: There is no dedicated laundry person, the one domestic staff on duty is also responsible for the laundry and the cleaning of the home on a daily basis. This may need to be reviewed to ensure that the laundry room and service has effective infection control measures in place. The home now has a sluice in place. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can feel confident that their needs will be met by trained experienced staff. Evidence: At the time of the site visit there were three carers on duty together with the Manager, one cook, and one domestic. There was 18 residents living in the home. There are three residents who require support from two carers with their personal care. This means that there could be times when two carers are providing personal care and there is only one carer left on the floor to meet the needs of the other residents. It is acknowledged that the Manager assists the carers at busy times but there are periods in the day, for instance early evening when the manager, domestic and cook have gone home, that only three members of care staff are on duty. The manager says that the home usually have four members of staff on duty in the morning and two new members of staff have been recruited and will commence duty in the new year. It is recommended that the Manager reassess the dependency of the residents and ensures that there is sufficient staff on duty to meet their needs. With only three care staff on duty it seems difficult to provide a formal activity programme for the residents without having a dedicated activity person. A staff member comments: Sometimes during sickness there is not enough staff to meet needs. Care Homes for Older People Page 20 of 27 Evidence: Recruitment records were examined and although police and protection of vulnerable adult checks have been carried out there are shortfalls in the documentation. The home needs to ensure that there is evidence of how they make decisions to employ a person who has not received a satisfactory reference. The application form needs to list full employment history. The Manager has only been in post since November and is in the process of auditing the files to identify any further shortfalls. This will ensure that residents are receiving care from carers who are safe to provide care services. A requirement will therefore not be made in this report however a recommendation will be made to ensure that the audit is completed. All of the members of staff have or are in the process of achieving their National Vocational Qualified (NVQ) 2 or above. There is an ongoing NVQ programme for all staff to access. There is an ongoing training programme in place to ensure that all staff have received mandatory training. All of the staff have received in depth dementia training, and care plan training. Ten staff have also received risk assessment training. Evidence of this training is on individual staff files. 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. The home is being run in the best interest of the residents, however improvements are required to ensure that there is clear evidence that they have an influence on the development of the home. The home is providing a safe environment for residents and staff, however improvements are required when carrying out weekly fire tests. Evidence: The management of the home has changed over the last six months. A new Manager has been appointed in November 2008. She was the Deputy Manager previously and does have some experience in the home. She holds NVQ 3 in Adult Care Services and Level 2 in Dementia Care. She is currently completing combined HSC, NVQ4 and Leadership and Management for Care Services. She has many years previous care experience before commencing in the home and has recently updated all mandatory training including First Aid. It is the intention that she applies to the Commission to be Care Homes for Older People Page 22 of 27 Evidence: considered as the Registered Manager. The Manager acknowledges the shortfalls in the service and is fully aware of what needs to be achieved. She demonstrated her commitment to implementing new systems and records to address these issues. There is no formal programme of quality assurance in place. The Manager says that questionnaires were sent out to the residents and relatives in July this year, but there is no evidence to confirm this at the time of the site visit. Residents and staff meetings are being held and minutes are in place. The Manager states that she visits every resident daily when she arrives and again before she leaves to ensure everything is satisfactory. There is no written evidence however from other stakeholders, such as health care professionals, to confirm that they are involved in the quality assurance programme. The home does not have enough evidence in place to confirm that all people using the services have their say as to how the service is run or may be improved. A recommendation will be made in this report. The home has a financial accounting system in place, which is audited on a regular basis. Receipts for all transactions are on file and copies of the accounts are sent to relatives, representatives when required. Some relatives sign the records on behalf of the residents, and the home needs to encourage and support residents who are able to sign for their monies and be more involved with their finances. An ongoing programme of mandatory training is being provided including induction training. The relevant safety checks in the home have been carried out. Accidents are being recorded appropriately and were tracked though to service user plans, recorded and any action required had been taken. The recording in the fire book needs to be improved. The fire testing is not being recorded weekly and a requirement to do this will be made in this report. One resident did not have a fire door guard fitted and was requesting her bedroom door to remain open so the Manager took action, purchased and fitted a new fire door guard. 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 7 13 The Registered Provider to 31/01/2009 ensure that moving and handling risk assessments identify a safe practice of work with guidelines for staff to move residents safely. To ensure that residents and staff are safe when carrying out moving and handling requirements. 2 38 13 To ensure that fire tests are carried out weekly using a different call point at each test. To ensure that the fire system is tested to ensure resdients and staff are safe. 23/12/2008 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 3 The home needs to ensure that a detailed and thorough assessment is completed so that residents can be confident their needs will be met. Page 25 of 27 Care Homes for Older People 2 7 The home to clarify in the care plan what the word assistance means to the individual. To ensure that the plan evidences resident or relative participation and the life history is completed for each resident. To ensure that all hand written entries on the medical administration sheets are countersigned to reduce the risk of error. The home needs to implement a formal activity programme taking into account each residents choices and preferences. To redecorate the laundry room and replace the floor to prevent the risk of infection. To review staffing levels to ensure that sufficient staff are on duty to meet residents needs. To audit staff recruitment files to address any shorfalls in the documentation. 3 9 4 5 6 7 12 26 27 29 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 © (2009) 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!