Inspection on 28/10/08 for The Shrubbery Nursing Home

This inspection was carried out on 28th October 2008.

CSCI found this care home to be providing an Good 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.

Other inspections for this house

The Shrubbery Nursing Home 30/07/07

The Shrubbery Nursing Home 28/09/06

The Shrubbery Nursing Home 29/11/05

The Shrubbery Nursing Home 08/08/05

The Shrubbery Nursing Home 14/12/04

The Shrubbery Nursing Home 03/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Shrubbery Nursing Home, The 27 Shrubbery Avenue Worcester Worcestershire WR1 1QN     The quality rating for this care home is:   two star good 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: Keith Salmon     Date: 2 8 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 © (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: Shrubbery Nursing Home, The 27 Shrubbery Avenue Worcester Worcestershire WR1 1QN 0190528916 01905610986 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sandra Jane Mayne Type of registration: Number of places registered: Dove Care Homes Ltd care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability terminally ill Additional conditions: Date of last inspection Brief description of the care home The Shrubbery Nursing Home occupies a prominent position in Shrubbery Avenue in central Worcester. The Home is easily accessible from the city centre via The Tything and Barbourne Road. The home can be reached by public transport. A large car park is situated behind the home. The home has three floors serviced by two lifts, and provides single and double accommodation. The Home can accommodate up to 36 residents. Communal facilities include a large lounge / dining area, another large lounge primarily used for activities and two smaller lounges. The Home is registered to provide twenty-four hour nursing and personal care. The registered manager, Mrs Care Homes for Older People Page 4 of 27 Over 65 3 36 36 0 0 0 0 2 Brief description of the care home Sandra Mayne, who is a first level registered nurse, oversees the day-to-day running of the home. The reader is referred to the provider for information about fees. 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: two star good 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: We last carried out a key inspection of the Shrubbery Nursing Home on 2 August 2008. This unannounced key inspection of the service commenced at 9.30 am, concluded at 5 pm, and was conducted by Mr. Keith Salmon, representing the Commission for Social Care Inspection (CSCI). Present on behalf of the home was the Registered Manager Mrs Sandra Mayne. Unannounced Key Inspections address all essential aspects of operating a care home, and seek to establish evidence, which shows continued safety and positive outcomes for residents. Relevant information is gathered through observations made during a tour of the Care Homes for Older People Page 6 of 27 home, a review of care related documentation, staff files and duty rotas, plus a range of other documents/records reflecting the general operation of the home. The report also utilises information submitted by the home to CSCI, prior to the inspection, through the homes Annual Quality Assurance document (AQAA). The content of this, which includes information relating to the homes policies, procedures, achievements and plans for improvement, provides a useful framework for us to evaluate quality of service and progress made. We received one completed questionnaire (as provided by CSCI), and were also able to consider information viewed in a small number of questionnaires completed by residents and relatives, as part of the homes own quality assurance activities. All questionnaires were anonymous. 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. 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 8 of 27 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 wishing to move into the home may readily access information relating to the home, which is easy to understand, and up to date. Prospective residents can be confident the home will be able to provide care which will meet their needs, as a assessed at the time of admission. Evidence: Review of documentation relating to five residents showed all had care needs assessed, prior to decision to offer a place at the home, by the manager or by a Registered Nurse. Documentation recording this is kept in each residents file. We also saw evidence that prior to admission the resident (or relative) will receive a letter informing them of the homes ability to fully meet their care needs as assessed at the time of admission. Care Homes for Older People Page 11 of 27 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. Residents can be confident their assessed care needs will be clearly stated in a written care plan, reviewed regularly, and fully met through care delivered considerately, effectively and with residents privacy and dignity being respected. Residents can be confident the process of administering medicines will be completed in a safe manner. Evidence: Since the previous key inspection (July 2007) the care plan used by the home has undergone review and revision. This includes a more person centred approach and improvements to documentation relating to risk assessment, incidents and accidents, and personal hygiene. All residents records have now been transferred to the new model. The care related records of five residents were reviewed - three of which were examined in detail with direct reference to the resident (by discussion with the resident). The documentation now provides a comprehensive view of identified care needs and record of care provided. Evidence was seen of input to care plan development by the resident and/or relative and of review by the manager on at least a monthly basis. Care Homes for Older People Page 13 of 27 Evidence: Areas addressed by the documentation include; a recent photograph of the resident, agreement with relative(s) regarding urgent contact should it be necessary, a preadmission draft care plan, records of attendance by visiting clinical professionals and discussion with relatives, dependency assessments (based on Activities of Daily Living), risk assessment documents e.g. mobility, bed rails use, skin integrity,continence, nutritional state and weight. The 24-hour information records viewed showed relevant and informative entries. Also, the quality of care provided since the previous inspection, has been enhanced in a number of ways e.g. by the purchase of additional pressure relieving mattresses, more direct involvement of the tissue viability nurse (including submission of monthly audits to that post holder), and a new shower/wet room on the ground floor. A requirement made at the time of the previous inspection in relation to this aspect of care provision is considered fully met. We undertook a full review of the homes practices in respect of the ordering, reception, disposal and record keeping relating to medicines administration. We found these practices to be in accordance with accepted good practice. This included the regular audit by the manager of medicines administration records (MAR sheets). Two Registered nurses have responsibility for completing daily checks of controlled drugs stocks and records. A requirement made at the previous inspection in respect of medicines administration was to Ensure that records regarding medication and its administration are clear, accurate and up to date to ensure residents receive items as prescribed therefore ensuring their health, safety and welfare. Records examined by us, and our own direct observations of medicines administration practices showed, at the time of this inspection, the requirement was being fully met. During the tour of the home we saw that staff knocked bedroom and bathroom doors before entry, privacy screens were in use in wet room showers and in shared bedrooms. These observations, together with comments made by residents and relatives, suggested residents privacy and dignity is respected at all times. 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. Those residents who are able choose their lifestyle, social activity and pursue religious preferences as they wish. Opportunities for contact with family, friends, and the wider community, and pursuance of religious activities, are established and encouraged. Evidence: The home has an activities coordinator who provides nine hours input per week. In response to the requirement made at the previous inspection - i.e. Activity organiser hours must be reviewed to ensure that the provision of activities (including 1:1 time) is effective in meeting the social care needs of people within the home - the activity organisers time is now provided on a more flexible basis in that the post holder attends the home outside the hours of 9am to 5 pm when necessary i.e. dependent on activities planned. An example of this is when local choirs attend at weekends or evenings the coordinator is present. In addition the proportion of time given over to 1:1 discussions with residents unable to leave their rooms has been increased residents confirmed this to be so. Evidence was also seen which showed the activities programme is regularly discussed at meetings (minuted) of residents/relatives groups Care Homes for Older People Page 15 of 27 Evidence: and staff groups. The outcome of this, as deduced by discussion with residents and with relatives is that they perceive a change in the provision of this aspect of care, and declare themselves satisfied. As such the requirement is considered met. Specific items of activities, gleaned from conversation with residents/relatives and staff, and from printed programme and a monthly newsletter, have included; social activities such as crafts, quizzes, bingo, music and videos, outside entertainers (including musical performances by pupils from the local school). A special mention from several residents was in relation to regular visits from Jazza PAT dog. The home also has weekly visits from the local vicar who holds Holy Communion once a week, in addition to 1:1 visits for individual residents as requested. We saw during the tour of the home that each table (set for lunch) had a menus which offered two choices of main course. Residents also told us the cook knows what they like/dislike personally and meals provide are therefore adjusted as required. Similarly a table top menu is also offered at supper time. Residents commented that they liked the variety of food offered and the ways in which it is presented. They also said they have input to menu changes via residents meetings. 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 and their relatives can be confident their views are listened to and acted upon, and that residents are safe and protected from abuse. Evidence: The home has a well-organised, well documented system for receiving and responding to complaints. The complaints procedure is contained within the service user guide, a copy of which is to be found in each residents bedroom. To make information regarding the complaints process readily available to all persons e.g. visitors to the home, we recommended copies of the policy/procedure be placed on some of the homes notice boards - the manager agreed to do this. Residents and visitors told us they knew who to raise any concerns or complaints with (i.e. the matron or nurse in charge) and that they were confident issues raised would receive thorough and effective attention. The homes incidents and accidents records were examined. These appeared up to date and nothing was seen which caused us concern. We interviewed two staff, both of whom were able to describe action they should take if they received a complaint or observed abuse of a resident. The sample of training records viewed (three), and a staff training matrix, confirmed staff had received training in respect of safeguarding adults matters. Care Homes for Older People Page 17 of 27 Care Homes for Older People Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment in which the residents live is pleasant, safe, and clean, with satisfactory standards of hygiene, and the home provides equipment consistent with providing necessary care. Evidence: A tour of the home, which included all communal areas, all toilets and bathrooms, laundry, kitchen, and 10 bedrooms showed the home provides a safe, pleasantly decorated and well maintained environment for residents to live in. Specifically we saw communal areas which were clean, tidy and generally well decorated. One exception to this overall good standard was the lounge carpet which will soon be in need of replacement (clean but a bit faded). However, evidence that this is being actively addressed was seen in that a new replacement carpet has been delivered and is awaiting fitting - expected to be laid before the Christmas period. Ambient temperature throughout the home was comfortable, and, as a resident and two visitors commented ..there are no unpleasant odours. Bedrooms were found to be homely and comfortable with furnishings and fittings being in good order with evidence of personal belongings, photos, televisions, audio systems etc. Some bedrooms had benefited from recent redecoration (on an as and when necessary basis - the need usually being considered when one becomes vacant). Residents told us they enjoyed their bedrooms and could remain in them if Care Homes for Older People Page 19 of 27 Evidence: they wished, including taking their meals there. Access to the upper floors is by passenger lift, of which there are two, one at each end of the building. The laundry is spacious, well organised, locked when not attended, with sufficient machines, a dedicated hand wash facility, and effective systems for returning laundered clothes to rightful owner (residents & relatives confirmed no problems in respect of this). At the previous inspection a requirement was made that suitable and sufficient bathing facilities must be available within the home. In response to this a ground floor bathroom, at the front of the house, has been converted to a wet room, very well lit by natural light (two large windows, privacy protected by obscure glass, blinds and in the room itself by a folding glass screen). Considering the overall provision of this and other existing bathrooms, when set against the needs of the client group, the requirement is considered to be met. At the previous inspection a recommendation was made That a mechanical disinfector is provided on the ground floor. The home does in fact have a mechanical bedpan washer (which was out of order and awaiting a visit from the engineer that day) - what it does not have is a disinfecting cycle beyond that achieved by simple automated washing. The recommendation remains with rewording i.e. ...a machine for sluicing bedpans/commode pots and which has an integral disinfecting cycle. The Home employs a full time Maintenance Officer who has the experience and skills to undertake most of the maintenance and refurbishment/redecorating work at the home. The home has good provision of specialist care equipment consistent with meeting the assessed care needs of residents, and the demands of care tasks carried out by staff. Records demonstrated maintenance and servicing of care related equipment (e.g. passenger lift, hoists wheel chairs, call bells) is regularly undertaken and appropriately documented. The home also employs a contract gardener who attends once per week. The gardens are well maintained and incorporate a very spacious car park) Care Homes for Older People Page 20 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 be confident staff numbers on duty, and the mix of trained nurses and care staff, are sufficient to provide good quality care to meet their assessed care needs, and that recruitment and employment practices are consistent with safeguarding them from abuse. The commitment of the home in providing training for care staff is good, and in accordance with individual staff members learning needs. Evidence: A review of staff duty rosters, plus staff numbers on duty at the time of the inspection, demonstrated staff numbers, skill mix and deployment to be sufficient to meet the assessed care needs of current residents. The home also employs seventeen staff in ancillary roles, who provide all necessary support services including administration/ business management, catering, laundry, domestic, maintenance and gardening. Review of a sample of staff employment files (four most recently employed care staff plus one RGN) demonstrated recruitment practices to be satisfactory, with all elements required by Care Homes Regulations being completed, and the necessary evidence retained on file. Discussion with three members of care staff, with whom we had discussion, all described the robust recruitment process they had gone through prior to appointment, and to commencement of work, at the home. Staff training records showed all staff have a thorough orientation/induction to working Care Homes for Older People Page 21 of 27 Evidence: at the home. Care staff undergo training relevant to the duties they are expected to complete e.g. in relation to handling and lifting, fire safety, health and safety, basic food handling, use of bed rails and bed protectors and management of accidents/incidents. Senior staff also receive training in respect of carrying out audits (medication, care plans, infection control, tissue viability, bed rails use, weights and measurements of residents). Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from effective management provided by an experienced manager, who ensures the focus of care provision is in meeting individual residents care needs, and enabling realisation of their aspirations wherever possible. Residents, relatives, and other visitors to the home, and staff, can be confident their health, safety and welfare are safeguarded. Evidence: The manager, who is a Registered General Nurse, is very experienced in nursing home management having been at The Shrubbery for nearly eight years, six as manager, and prior to that two years as deputy manager. The manager leads a team of staff who provide care with a strong focus on meeting individual residents care needs and lifestyle preferences. This was reflected in our observations, in the comments of people with whom we had discussions (residents, relatives, staff) as well as evidence provided by observance of care practice, and record keeping. All presented a picture suggesting thorough, thoughtful and effective management, which was further borne out by Care Homes for Older People Page 23 of 27 Evidence: comments seen in questionnaires completed by relatives. These included comments such as I am very happy with all aspects of the care and service my relative receives (a response echoed by two relatives interviewed during the inspection). Also - the staff are very welcoming; ...clean and tidy.;(my relative) is treated like a human being; her thoughts are always respected. The home holds monthly residents meetings to which relatives are invited (minutes seen). Monthly staff meetings of specific staff groups are also held and minutes kept (e.g. Registered Nurses, care staff, ancillary staff). Residents personal monies are not handled by the home. Staff personal files showed evidence of regular review (at least 6 times per year) - this was confirmed in discussion with staff who felt well supported by the manager. The administrative/business aspects of management are very effectively managed by the business manager who has been employed at the home, in various capacities, for over 25 years. Evidence of this was seen in well organised records, and where relevant current certificates in respect of the testing and maintenance of systems such as fire alarms, emergency lighting, passenger lifts, gas and electricity plant and portable equipment, water (Legionellae prevention). Also records showing regular testing of hot water temperature at outlets accessible to residents were viewed - these demonstrated temperatures to be in accordance with regulation i.e about 43 degrees Celsius - also a daily record of hot water temperature is maintained in each bathroom. Accidents are reported appropriately and there are risk assessments in place to ensure safe working practices, including those relating to control of substances harmful to health (COSHH). A requirement made at the previous inspection was systems must be in place to protect the health, safety and welfare of people using the service - this arose due to the gaps in entries in the fire log regarding the visual checking of fire fighting equipment. We saw at this inspection that full records are now kept. This requirement is therefore met. Care Homes for Older People Page 24 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 25 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 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 16 It is recommended, that in addition to copies of the homes policy and procedure relating to complaints being located in each residents bedroom (as a component of the service user guide), copies are also posted in the communal parts of the home so as to be readily accessible to visitors to the home. That a machine for sluicing bedpans/commode pots, and which has an integral disinfecting cycle, is provided on the ground floor. 2 26 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. 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