Inspection on 31/07/09 for Silverdale Care Home

This inspection was carried out on 31st July 2009.

CQC 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

Silverdale Care Home 21/07/08

Silverdale Care Home 14/02/08

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 14/03/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Silverdale Care Home 49-51 Egerton Park Rock Ferry Wirral CH42 4RA     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: Patricia Thomas     Date: 3 1 0 7 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: Silverdale Care Home 49-51 Egerton Park Rock Ferry Wirral CH42 4RA 01516446696 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Silverdale Care Home Ltd care home 20 Number of places (if applicable): Under 65 Over 65 20 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of people who can be accommodated is 20. Date of last inspection Brief description of the care home Silverdale is a care home for twenty elderly people. The home is a converted dwelling house in a quiet residential area, having a car park at the front of the premises and surrounding gardens. The home is close to bus routes and local shops. There is a ramp at the front of the building, assisted bathing facilities and a passenger lift to assist people who are frail. There are bedrooms on three floors, a first floor lounge/dining room and on the ground floor, two lounges, a smoking room and dining room. Silverdale provides twenty-four hour care, home cooked meals and a laundry service for the people who live there. Care Homes for Older People Page 4 of 28 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means that people who use this service experience adequate quality outcomes. The visit was just one part of the inspection. Before the visit took place, we (the commission) asked the manager to complete a questionnaire that we call an Annual Quality Assurance Assessment or AQAA. It gives us information about how the home is meeting the needs of the people who use the service and includes future plans for further developments. During our visit, we walked around the home and we checked various records to see what care people living there receive. We spoke with people who live at the home and Care Homes for Older People Page 6 of 28 they told us what they thought about it. We also spoke with staff and with the manager who gave us their views about Silverdale. We have included their views throughout the report. We use a method called case tracking. This is a way of inspecting that helps us to look at services from the point of view of some of the people who use them. We track peoples care to see whether the service meets their individual needs. Silverdale is currently in the hands of receivers who will apply to the commission to become registered providers of the home as required by the Care Standards Act 2000. The receivers have appointed a firm of consultants in care to oversee the home and ensure that people living there are not placed at risk and continue to receive the support they need. During our visit, we spoke with the manager about how the home is now being run and of how people living there and staff were informed of the current situation and plans for the future of this home. The weekly charge for the service is £361.41 per week. There are extra charges for chiropody and hairdressing. What the care home does well: What has improved since the last inspection? What they could do better: The manager of the home is not registered with the Care Quality Commission as required by the Care Standards Act 2000. The manager has experience of working in this home. She is well known to the people who live and work there and we think her registration with the commission will give stability and continuity to the service. Although there are good systems in place to assess peoples needs before they move in to the home, there was no up to date service user guide to give them. People need this information to help them make a decision about whether this will make a suitable home for them. Staff had good guidance in care plans to support people properly, however they need to take more care when writing risk assessments to ensure that the persons name is on the document and it has been dated. This will help to ensure that staff have up to date information available on which to base the persons care plan. Medication audits need to be carried out at least monthly, to ensure that all medication accepted into the home is accounted for and being managed properly and safely. A lot of training has been planned for staff to update their knowledge and skills and the manager is due to start a management qualification. We advise that training and guidance on deprivation of liberty safeguarding be provided for staff. This will help ensure that they will have the knowledge they need to further promote and protect peoples freedom and rights in their home. Also staff should receive regular one to one meetings with the manager to discuss all aspects of best practice in care giving and their career development. The manager should write a pandemic influenza plan for Silverdale. This is to ensure that the home will be managed and staffed properly and people will get the support they need in the event of a pandemic affecting the home. We saw that some people have had grab rails fitted to their beds to help them sit up more easily. The use of these fittings on beds should be risk assessed and updated to Care Homes for Older People Page 8 of 28 ensure they continue to be the right option for the person. Also they should be checked regularly by staff to ensure that people are not at risk of being trapped in the rails. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have had their needs assessed before moving in to Silverdale so they know whether their needs can be met at the home but the information about the home needs to be updated so that people have accurate information to help them make a decision about moving in. Evidence: We looked at two care files and found there is a good system in place to assess peoples needs before they move in. Two members of staff visit the person to find out about what they can do for themselves and what they need help with as well as their state of health, religion and the things they enjoy doing. Staff need a lot of information about peoples needs and preferences before accepting them into the home to ensure the service is able to meet their needs. Likewise, people hoping to move in to the home need information about the services Care Homes for Older People Page 11 of 28 Evidence: so that they will know about the facilities on offer and accommodation. Because there have been changes to ownership and improvements to the building and grounds, the service user guide (brochure) for Silverdale needs updating. This is to give people information so they can make an informed decision about whether or not to move in. 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. The health care and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice so people living at the home can be confident they will be well cared for. Evidence: We looked at two peoples care files, we tracked the care they receive and spoke with them to get their views on their home. We found that staff had good guidance in the care plans about how to support people properly and in the way they prefer. There were care plans in place to meet the persons care needs, health and social support. We found that peoples care plans have been reviewed and updated at least monthly. This means that any change in the persons condition will be identified, the care plan adjusted and that they will receive the right level of support from staff. There were good records about the persons mobility and any aids they need to help them move around the home safely or when being assisted by staff. To help keep people safe, there were detailed risk assessments in place; however one of these did not have the persons name and the document was not dated. Risk assessments need to be dated Care Homes for Older People Page 13 of 28 Evidence: and the person identified, to ensure that staff are able to refer to the most recent risk assessment on which to base the persons care. People who live in Silverdale are registered with local doctors and records are kept of doctors visits and treatment from specialist nurses and paramedical service such as chiropodists and opticians. This helps to make sure that people who live at the home are receiving the healthcare they need. Staff also help people to attend clinics and hospital appointments which means they have good access to their community health services. People we spoke with said they think they are well looked after saying the staff are good, kind, help me a lot. There is a procedure for managing peoples medication and staff who give out medication have had some training with more planned during the year. We found that medication was secured and for the people whose care was tracked, there were stocks of their prescribed drugs and the records of doses they had been given were up to date. There is a procedure in place for returning unwanted drugs to the pharmacy and we tracked refused medication back to the returns book, where they had been signed for as returns which showed us the correct procedure is being followed. Staff told us that homes medication audits had not been carried out recently and we advise that these audits be resumed to ensure that all medication accepted into the home is accounted for and is being managed safely. People are given the opportunity to look after their own medicines subject to a risk assessment as to their capacity to do this safely. Those whose medication is managed by staff are asked to sign a form giving permission for this. Two people said they thought staff manage their medication very well. All of the people we spoke with in the home said their visitors are made welcome by staff and they are left in private when they are entertaining them. We did not see any lack of privacy in care giving during the visit and people told us their privacy is always respected in this. There was a pleasant atmosphere in the home and staff were seen speaking respectfully to people and offering them choices. 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. Social activities and meals are both well managed so they provide daily variation and interest for people living in the home. Evidence: Staff had obtained a lot of information about the social, cultural and leisure needs of people living in the home. This means that staff have the information they need to make sure the care and support provided is right for that person. Information is kept about each persons spiritual needs and representatives from local churches are invited to visit the home to support people who want this. The diary shows that some communal activities such as memory bingo and board games are enjoyed and a party takes place on Friday evenings. Some people told us they like to stay in their bedrooms during the day, others like to go out or be involved in activities. Staff said they try to meet everybodys needs and preferences as to how they will spend their time. People told us they entertain their visitors in their bedrooms or in the lounges and there are no unreasonable restrictions on the times people can visit them. There was Care Homes for Older People Page 15 of 28 Evidence: good evidence in care plans that peoples families stay involved in decisions about their relatives care and are kept informed about changes to their health or wellbeing. People told us the food is tasty and well presented. They said they are asked what they want to eat every day and there are alternatives to the main menu. We spoke with the chef and looked at food stocks and catering records. There is a four weekly menu which is regularly reviewed with the people who live in the home. There were clear records of all the meals served in the home, including for special diets. People are offered a wide range of choices for all meals, including a cooked breakfast. There were good stocks of food in store and all catering records were up to date. The kitchen has been fitted with a very good extractor system which has improved ventilation when meals are being cooked. 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. There are good procedures so that the people living at Silverdale can be confident their concerns will be listened to and that they will be protected from harm. Evidence: There is a complaints procedure which is displayed in the porch and a system to record any complaints and the action taken. In this way people know about their right to complain and that their complaints will be taken seriously. There are safeguarding procedures in the home to help ensure that people who live there will remain safe. Staff who were spoken with understood the procedures and updated safeguarding training for staff is scheduled. This will help to make sure they know what to do to protect the people who live at Silverdale from abuse or harm. Care Homes for Older People Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clean, pleasant and comfortable environment is provided and improvements to decoration and fittings are ongoing so that people living at Silverdale will do so in surroundings that are safe and suit them. Evidence: The home is a large converted dwelling house surrounded by well maintained gardens in a quiet street. The building is generally in good condition and a programme of decoration is in progress. There are bedrooms on three floors and a lift to all floors to help people get around more easily. There are toilets throughout the home and assisted baths and a shower. Most of the bedrooms are for single use and for people sharing the larger rooms, screens are provided for privacy. Bedrooms are highly personalised and people said they were satisfied with their personal accommodation. There are two lounges and a smoking room on the ground floor and a dining room. On the first floor is a lounge/ dining room which is used by some of the people accommodated upstairs. Domestic staff are employed and people told us the home is kept in clean. There are systems for control of substances hazardous to health and infection control to guide staff on how to keep the home safe and hygienic. We were invited to visit all the bedrooms and bathrooms, which were clean and odour free. Some of the bathrooms Care Homes for Older People Page 18 of 28 Evidence: are in need of decoration and a ground floor toilet was being refurbished and tiled during our visit as part of the maintenance programme. Work was in progress in the ground floor dining room which was being plastered, decorated and a new carpet was to be fitted. The work was being well managed as the areas being worked on were organised and dust was controlled to keep the areas safe. Care Homes for Older People Page 19 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. Recruitment processes and training for staff are good so that people living in the home receive care and support from staff who are suitable and have the skills to support them correctly. Evidence: The staff rosters showed us that staffing levels are being maintained and there was a good skill mix of management, care and ancillary staff on duty at the time of our visit. We looked at training records and staff files to see how people are trained and recruited in the home. We found that updates in mandatory training have been planned, some further training on dementia has been scheduled and some more staff are taking their National Vocational Qualifications in care. It is recommended that staff receive training in deprivation of liberty safeguarding to ensure they have the knowledge and guidance to further promote and protect peoples freedom and rights in their home. We received six completed staff surveys and the majority of responses received about training and management support were positive. They all confirmed that a rigorous recruitment procedure is followed by the home when employing staff. This is to help ensure that only people who are suitable will be employed in the home. The two staff files we looked at showed us that satisfactory criminal records bureau clearances and up to date references were in place for people and that details of their employment Care Homes for Older People Page 20 of 28 Evidence: histories had been obtained. Staff were able to describe how to support the needs of people who live in the home and the procedures to be followed to protect them. People who lived in Silverdale described staff as helpful and kind. Care Homes for Older People Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Silverdale needs the manager to become registered with the commission to help make sure there is continuity to the service and ensure the home will be managed in the best interests of the people who live there. Evidence: Silverdale is in the hands of receivers who have appointed a firm of care consultants to oversee the management of the home. The receivers intend to apply to the commission as registered providers of Silverdale, depending on how long the home stays in its current situation. We have been informed that all the people living in the home, their relatives and staff employed have been told about the receivership. A manager is employed to run the home but had not been registered with the commission at the time of our visit. The manager needs to apply for registration as required by the Care Standards Act 2000 and we have made a requirement that this be done. The manager has several years experience of working in the home and is due to take a management qualification. She said she is receiving very good support from Care Homes for Older People Page 22 of 28 Evidence: the firm of consultants who are overseeing the home. She told us there is a better food budget and training for staff has been arranged. She told us that there have been no restrictions on the maintenance and decoration programme so it has been possible to carry on with keeping the home maintained to make sure it is safe and comfortable for the people living there. The manager has good knowledge of the support needs of people living in the home and arranges for their care plans to be regularly reviewed to ensure the service is meeting their needs. Also, peoples opinions are sought through distribution of quality questionnaires to find out their views on their home that are then acted upon where areas for improvement are identified. We have advised that the manager puts into place a pandemic influenza plan to ensure that the home will be staffed and managed properly and people will get the support they need in the event of a pandemic affecting the home. To ensure peoples money is safe in their home, we looked at arrangements for managing peoples personal allowances held in safekeeping. We checked the records of two people who were selected randomly. There is a system by which all transactions are recorded with two signatures obtained and receipts kept for any purchases made. The two accounts we checked had been well maintained and were satisfactory. We asked staff about the support they receive from the manager and they described an open door policy and said the manager is available and helpful when needed. This was supported in six surveys we received from staff. However staff on duty said they have not received formal supervision (one to ones) for some time and the manager confirmed this has fallen behind. Although five people stated satisfaction with training in surveys, one person told us they did not feel the training received relevant to the job role, did not keep staff up to date with new ways of working or give enough knowledge about health care and medication. The manager needs to carry out regular formal supervisions with staff to give them the opportunity to discuss all aspects of practice, the philosophy of care in the home and their individual career development needs. To ensure the home is safe and suitable for people to work and live in, a number of checks are carried out on the building and equipment by staff and qualified engineers. We looked at the health & safety records and these were either up to date or the work had been scheduled and was awaiting certification. During our visit we saw that grab rails have been fitted to some peoples beds to help them sit up more easily. Risk assessments should be carried out for use of the rails and updated to ensure they remain the right option for the person. The rails should be checked regularly to ensure the gaps are safe and people are not at risk of becoming trapped in them. Care Homes for Older People Page 23 of 28 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 31 8 The manager should apply for registration with CQC as required by the Care Standards Act 2000. In meeting the requirement the manager will demonstrate she has the necessary skills, experience and is a suitable person to manage the home properly. 18/09/2009 2 38 13 Risk assessments should be carried out for the use of grab rails on the sides of beds. The rails should also be checked regularly. In meeting the requirement the home will be able to demonstrate that the grab rails are suitable for the person and they are not at risk of becoming trapped in the rails. 18/09/2009 Recommendations These recommendations are taken from the best practice described in the National Care Homes for Older People Page 26 of 28 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 1 The service user guide (brochure) for Silverdale should be updated to ensure people have the information they need to make a decision about moving in to the home. Peoples assessment records should have their name on them and the date, to ensure staff have up to date information about how to support each person properly and safely. Monthly audits of medication should be resumed to ensure that all medication accepted into the home is accounted for and is being managed properly and safely. The manager should ensure there is a pandemic influenza plan in place to help ensure the home will be staffed and managed properly and people will receive the support they need in the event of the home being affected by a pandemic. The manager should continually provide staff with formal supervision (one to ones) to ensure they are developing the skills they need to support people properly and safely. 2 7 3 9 4 31 5 36 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!