Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Silver Birches 85 Lutterworth Road Aylestone Leicester LE2 8PJ 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: Kim Cowley
Date: 1 9 0 2 2 0 0 9 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home
Name of care home: Address: Silver Birches 85 Lutterworth Road Aylestone Leicester LE2 8PJ 01162832018 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Pine View Care Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 16 Number of places (if applicable): Under 65 Over 65 16 16 dementia old age, not falling within any other category Additional conditions: 0 0 The maximum number of service users who can be accommodated is: 16 The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE(E) Old Age, not falling into any other category - Code OP Date of last inspection Brief description of the care home Silver Birches provides care and accommodation for up to sixteen older people, some of whom are diagnosed with dementia. It is situated in Aylestone, about four miles from the city of Leicester, and close to bus stops, shops, and parks. The home is on two floors and with a passenger lift and stairs. There are a variety of aids and adaptations in the home to assist residents with limited mobility. There are twelve single bedrooms, six with en-suite facilities, and two double bedrooms, both with enCare Homes for Older People
Page 4 of 28 Brief description of the care home suite facilities. There is a garden to the rear of the premises which is accessed via a passage at the side of the home. The weekly fees range from 350 to 450 pounds per week. There are additional charges for hairdressing, private chiropody, toiletries, and newspapers. Further information about the home is available from the Owner and staff. Care Homes for Older People Page 5 of 28 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was a key inspection that included a visit to the home and inspection planning. Prior to the visit, we (throughout the report the use of we indicates the Commission for Social Care Inspection) spent half a day reviewing information relating to the home. During the course of the inspection, which lasted five and a half hours, we checked the key standards as identified in the National Minimum Standards. This was achieved through a method called case tracking. Case tracking means we looked at the care provided to three residents living at the home by meeting them; talking with the staff Care Homes for Older People
Page 6 of 28 who support their care; checking records relating to their health and welfare; and viewing their personal accommodation as well as communal living areas. Other issues relating to the running of the home, including health and safety and management issues, were examined. We also talked to four other residents, the Owner, a senior carer, and three care assistants. Please note: A random inspection of this service was carried out on 15 April 2009. The reason for this inspection was to follow up concerns raised by an anonymous person. As a result of this inspection requirements were made to bring about improvements to the home. These have been met. What the care home does well: What has improved since the last inspection? Residents getting up times have been made more flexible and residents can get up when they want to over a two to three hour period. This shows residents choices are respected and the homes routine reflects this. A policy for reducing falls and other accidents has been implemented. This will help to ensure that accidents are prevented, as far as possible, and that if they do occur staff know what to do and who to contact. The home has been refurbished and the environment is much improved. We toured the home and all areas inspected were well decorated and furnished to a good standard. A member of staff said, The environments got better since Dinesh (the Owner) took over. A cleaner has also been employed and the home was clean, tidy, and fresh throughout. The environment has been made more suitable for people with dementia. For example Care Homes for Older People Page 8 of 28 white boards are used in residents rooms to remind they when meals and drinks are served, and directions to the lounges are displayed in corridors. This makes it easier for residents to understand the homes routines and to find their way about. The staff training programme has been improved and extended. NVQs are in place (recognised qualifications for those working in care homes), and a wide range of short courses are availabe to staff. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings
Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Residents needs are assessed prior to admission to ensure the home is suitable for them. The homes statement of purpose needs updating. This judgement has been made using available evidence including a visit to this service. (Standards 2 and 3 was inspected.) Evidence: People who are interested in coming to Silver Birches are invited to visit prior to making a decision. A senior member of staff assesses all prospective residents in their own homes, in hospital, or during a visit to Silver Birches. The assessment process helps to ensure the home is suitable for residents who are considering living there. One resident told us, My son picked this home out of the yellow pages. He came to
Care Homes for Older People Page 11 of 28 Evidence: look at it and he liked it so I moved in. Records relating to three recent admissions were examined. All were of a good standard and the views of relatives, and assessments carried out by health and social services staff, had been taken into account. The Statement of Purpose, which is given to all residents on admission, needs updating so potential residents are made aware of the homes smoking policy. Standard 6 was not inspected, as this home does not provide intermediate care. Care Homes for Older People Page 12 of 28 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Staff in the home, and in the wider community, meet residents health and personal care needs. This judgement has been made using available evidence including a visit to this service. (Standards 7, 8, 9, and 10 were inspected.) Evidence: All residents have care plans, which set out how their health, personal and social needs are to be met. Residents and their relatives, where appropriate, are consulted when care plans are written and sign to say they are in agreement with them. A member of staff told us, I can look in care plans at any time and they are useful. Those care plans inspected were well-written and gave clear instructions to staff about how best to meet residents needs. Case tracked residents talked to us about their preferences with regard to personal care, likes/dislikes, and interests, and it was
Care Homes for Older People Page 13 of 28 Evidence: positive to note that this information was in their care plans. Residents are registered with GPs at a local practice and District Nurses visit the home where necessary to provide treatment. Records showed that residents have access to a full range of health care treatment including input from chiropodists, dentists, and opticians. At the last (random) inspection we were concerned that residents were being got up early for the convenience of staff, and not at their own request. Substantial improvements have been made in this area since them. Records showed that residents now get up whenever they want to over a two to three hour period. This shows residents choices are respected and a flexible routine is in place. A policy for reducing falls and other accidents has also been implemented. Staff have received training on this, and the policy to displayed in the office to act as a reminder to them. This policy will help to ensure that accidents are prevented, as far as possible, and that if they do occur staff know what to do and who to contact. Medicines are properly stored and only staff trained in medication administration give them out. The Owner carries out random audits to help ensure that medication records are properly completed and accurate. No residents self-medicate at present. It was observed during the inspection that staff treat residents with respect and help to maintain their dignity by providing care discreetly and sensitively. Care Homes for Older People Page 14 of 28 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Residents social and cultural needs are identified and met. Thhe activity programme would benefit from improvement. This judgement has been made using available evidence including a visit to this service. (Standards 12, 13, 14, and 15 were inspected.) Evidence: Some activities are provided for residents and these usually take place in the lounge in the morning or afternoon. Current activities include chairobics (armchair exercises), bingo, sing a longs, jigsaws, and arts and crafts. One resident told us, I like all the activities. We have chairobics and last week we made Valentines cards. Another said, I like reading and theres quite a lot of books here. We talked to staff about activities and they told us they liked helping with them, but didnt always know what activities to do, or whether those on offer were suitable for the residents. We discussed this with the Owner and it was decided that one member of staff should be made Activities Organiser, and given the training and resources
Care Homes for Older People Page 15 of 28 Evidence: necessary to provide a good range of activities for residents. This will help to ensure that residents recreational interests are met. Visitors are welcome at the home at any time and can see residents in their rooms or in one of the homes two lounges. One full-time cook is employed. Meals are served in the dining rooms where residents sit in small groups at individual tables. Some residents prefer to eat in the lounge so staff bring their meals to them. A meal served during the inspection consisted of braising steak, boiled potatoes, cauliflower, and carrots, with rice pudding for dessert. All the residents we spoke to said they liked the food. One told us, The foods fine and theres always plenty. Another resident told us that there was always a choice of dishes. She said, If you dont want something theyll give you something else. Last night we had spaghetti for tea and I didnt fancy it. They offered me lots of different things but in the end I decided I just wanted bread and cheese so they got that for me. Care Homes for Older People Page 16 of 28 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Residents and their representatives are encouraged to talk to staff about any concerns they might have. The safeguarding procedure is in need of improvement. This judgement has been made using available evidence including a visit to this service. (Standards 16 and 18 were inspected.) Evidence: The residents we talked to all said they would speak out if they had a complaint. One commented, If I had any problems at all I would tell Dinesh (the Owner) or the staff. The Complaints Procedure was displayed in the home where it is accessible to residents and their relatives. We saw that the procedure needed improving as it stated that complaints should be reported to the Manager or person in charge of the shift. This limited the people complainants could raise concerns with. For example, they may prefer to speak a carers not in charge of a shift. We discussed this with the Owner and he re-wrote the procedure during the inspection to say complainants to talk to any member of staff. We discussed safeguarding with the Owner and the staff, all of whom understood what they should do if they were concerned about a residents well being. We looked
Care Homes for Older People Page 17 of 28 Evidence: at the Safeguarding Procedure and saw that it needed amending as it stated that residents must give their consent for safeguarding incidents to be referred to social services. This is not the case, social services must be informed of all safeguarding concerns under the local safeguarding protocol. The Safeguarding Procedure must be changed to state this. This will help to ensure that social services are able to take the lead in any safeguarding investigation. Care Homes for Older People Page 18 of 28 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Residents live in an environment that is mostly safe, comfortable, and well maintained. Some improvements are needed to the premises. This judgement has been made using available evidence including a visit to this service. (Standards 19 and 26 were inspected.) Evidence: The home has been refurbished since the last (key) inspection and the environment is much improved. We toured the home and all the areas inspected were well decorated and furnished to a good standard. A member of staff said, The environments got better since Dinesh (the Owner) took over. A cleaner has also been employed and the home was clean, tidy, and fresh throughout. A resident told us, The home is clean. My ensuite gets done twice a week and they put clean towels in every day. Im very particular about the ensuite so thats good. We looked at three residents bedrooms, with the permission of their occupants, and saw they were personalised and homely. At the last (key) inspection we recommended that the environment should be made more suitable for people with dementia. Staff had acted on this suggestion, for example white boards were being used in residents rooms to remind they when meals
Care Homes for Older People Page 19 of 28 Evidence: and drinks were served, and directions to the lounge were displayed in the corridors. This will make it easier for residents to understand the homes routines and to find their way about. The entrance to the home is through an enclosed porch which is currently being used by residents who smoke. Despite staff efforts to keep the porch clean and fresh it smelt strongly of smoke and there were discarded cigarette ends in an ashtray on the table. We discussed this with the Owner who acknowledged it was a problem, but said there was nowhere else suitable for residents to smoke on the premises. Residents and staff should be consulted and a solution found as at present non-smokers are being subjected to a degree of passive smoking. The toilet just inside the front door is in a poor state. The paintwork is shabby and the toilet has a broken seat. The door, which has no sign on it, was frequently left open during the inspection. We also discussed this with the Owner. He agreed that this toilet was not in a good position, being just inside the front door, but said that a few of the residents liked to use it, although there are two other toilets on the ground floor. He agreed to discuss the situation with the residents to see if they would mind using the other toilets so he could turn the one by the front door into a storeroom. This would improve the entrance to the home. At present the small, second lounge is used to store the homes hoists. This spoils the look of the room and gives it an institutional feel. An alternative storage facility should be found for the hoists. At the back of the home is a large secluded garden with lawns, walkways, and seating areas. At present it is difficult to access this garden as the only way out from the rear of the home is down steep steps which are not suitable for residents with limited mobility. If they do want to use the garden, they have to be taken in wheelchairs down a narrow passage at the side of house. A member of staff commented, Its such a shame. Its a lovely garden but it difficult to get the residents out there. We discussed this with the Owner who said he recognised the problem and when finances permitted he would consider having a ramp built. Care Homes for Older People Page 20 of 28 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. An established staff team meets residents needs. Relationships between staff and residents are warm and caring. This judgement has been made using available evidence including a visit to this service. (Standards 27, 28, 29, and 30 were inspected.) Evidence: Staff were observed as being friendly and warm and to have good relationships with everyone who lives in the home. All the residents we talked to praised the staff team. Comments included, The staff are nice. You can have a laugh with them, The people who put me to bed and get me up are lovely. I wouldnt want anyone else, The staff are lovely - they cant do enough for you, and, The staff are always checking if I am OK. We looked at two staff files and saw that all the required documentation was in place including references and CRB checks. This will help to ensure that only suitable staff are employed and residents are safeguarded. Since the last inspection the homes staff training programme has been improved and
Care Homes for Older People Page 21 of 28 Evidence: extended. All staff now have NVQ Level 2 in Care (a recognised qualification for those working in care homes), and some are going on to study for Level 3. The homes training matrix showed that staff had also attended a range of short courses including Safeguarding and Dementia Care. A programme of appraisal and supervision is in place to help ensure staff have the support and skills they need to carry out their work. Some staff said they felt they needed a little more support due to the recent changes and improvements that have taken place in the home. This was discussed with the Owner who said he was increasing the amount of staff support by basing himself in the home and being there for the staff on a day to day basis. Care Homes for Older People Page 22 of 28 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Residents live in a home that is mostly safe and well managed. A Registered Manager must be put in place and fire doors made good where necessary. This judgement has been made using available evidence including a visit to this service. (Standards 31, 33, 35, and 38 were inspected.) Evidence: Although the home is currently running effectively, it is still without a Registered Manager and has been since the new Owner took over in 2007. This is unacceptable as a Registered Manager is needed to provide continuity of care to the residents, and to comply with the law. We discussed this with the Owner, who is currently the Acting Manager, and he told us he is in the process of submitting an application to become Registered Manager himself. This must be done as a matter or priority. Care Homes for Older People Page 23 of 28 Evidence: Residents are involved in the running of the home on a day to day basis and at residents meetings. The Owner told us he talks regularly to residents to get their views on the service provided. A resident confirmed this saying, Dinesh (the Owner) is very friendly and he is here every day and makes a point of talking to us all. Suggestions made at residents meetings have been acted on and resulted in new net curtains in the lounge, an improved teatime menu, and a meal out. Questionnaires are sent out to residents and relatives annually to get their feedback on the home. Residents look after their own finances or their representatives look after it for them. If money is needed for a resident, for example for toiletries or hairdressing, an invoice is sent to whoever looks after their finances. This ensures proper records are kept when money is spent on behalf of residents. When we looked round the home we found that some bedroom doors didnt self-close properly. As these are fire doors an urgent solution must be found. During the inspection the Owner asked the homes handyman to check the doors to see what the problem was. He found that that some of the mechanisms that made the doors selfclose were in need of adjustment. We discussed this with the Owner and it was agreed that he check all doors and have them repaired as necessary within two weeks of this inspection. In the meantime he said he would ensure staff checked that all fire doors were shut as necessary both day and night. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 1 4 The Statement of Purpose must be updated to include the homes smoking policy. To ensure prospective residents have the information they need to make an informed choice about moving in. 19/05/2009 2 18 13 The homes safeguarding 19/05/2009 procedure must be amended so it explains the role of social services in any safeguarding investigation. To ensure that social services are able to take in the lead in any safeguarding investigation. 3 19 23 The toilet in entrance hall is in need of refurbishment. To ensure that all parts of the home are well decorated and maintained. 19/05/2009 Care Homes for Older People Page 26 of 28 4 26 23 Residents and staff should be consulted and a solution found to the use of the porch as a smoking area. To ensure that all parts of the home are clean and fresh. 19/05/2009 5 31 8 A suitable Manager must be put forward for registration. To ensure residents receive continuity of care and staff are supported. 19/05/2009 6 38 23 Fire doors must be checked 19/05/2009 to ensure they close properly, and repairs carried out where necessary. To ensure the risk of fire in the home is reduced. 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 12 Staff should be given the time, training, and resources, necessary to provide a full activity programme for residents. An alternative storage area should be found for the two hoists which are currently kept in one of the lounges. Consideration should be given to the provision of a ramp or other access to the rear garden. 2 3 19 19 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!
