Inspection on 27/01/09 for Sister Dora Nursing Home

This inspection was carried out on 27th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Aston Court Nursing Home

Breme

Ravenhurst

Ashcroft Hollow Nursing Home

Westmead

Bricklehampton Hall Nursing Home

Briar Hill House

Radbrook Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sister Dora Nursing Home Brocton Road Milford Stafford Staffordshire ST17 0UH     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: Joanna Wooller     Date: 2 7 0 1 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 29 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 29 Information about the care home Name of care home: Address: Sister Dora Nursing Home Brocton Road Milford Stafford Staffordshire ST17 0UH 01785661024 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Leyton Healthcare (No 8) Limited Name of registered manager (if applicable) Ms Jayne Margaret Lilley Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia physical disability Additional conditions: The maximum number of users who can be accommodated is 47 The registered person may provide the following category of service only: Care home with nursing: - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD, maximum number of places, 47 Dementia - Code DE, maximum number of places, 47 Physical disability Code PD, maximum number of places, 47 Date of last inspection Brief description of the care home Sister Dora is situated on the edge of Cannock Chase in beautiful countryside with very pleasant views. It provides nursing care for 47 people, within a mixture of single and Care Homes for Older People Page 4 of 29 care home 47 Over 65 0 0 0 47 47 47 Brief description of the care home shared accommodation. The home is a victorian building with modern extensions. There are two lounges and one dining room in the main block with a smaller lounge and dining area in a small annex, this can provide accommodation for four elderly people. There is a hairdressing facility and extensive social facilities available for the benefit of those who live in the home. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that that people who use this service experience adequate quality outcomes. This unannounced key inspection was carried out by one inspector over one day between 09.00 and 16.00 hours. As it was unannounced the service did not know we were going. The manager was involved in the inspection process. The inspection included the following elements, a walk around the building, observation and inspection of records relating to provision of care, discussions with people who use the service, case tracking whereby we select several people who use the service, chat to them and look at their care plans and lifestyle in the home. discussions with several Care Homes for Older People Page 6 of 29 of the staff members on duty, observation and sampling of other services provided such as catering and laundry, and an inspection of the managerial aspects such as staffing issues, training, recruitment and health and safety. We were made welcome in the home and all assistance was given to gain the evidence required for the report. We had dealt with no complaints since the last inspection. People living in the home told us The staff are like my family, they are very kind. My son chose the home for me, I knew as soon as I came here I would be happy. The staff are very patient with me, I never ask for much help but when I do they always make sure I get some. They come to the room as soon as I press the buzzer. The home manager sent us their annual quality assurance assessment (AQAA) when we asked for it. This document was completed to a good standard and gave us all the information we asked for. The fee information was documented within the Statement of Purpose and applied at the time of the inspection; persons may wish to obtain more up to date information from the service. 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 29 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 9 of 29 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 who use the service have their needs fully assessed to ensure they can be met. People are admitted to the home that require intermediate care and this is well managed. Evidence: The AQAA document completed by the home manager told us A full assessment is undertaken by a trained nurse from Sr Dora prior to any new Service User being admitted. We saw that the people admitted to the home were pre-assessed by the manager prior to admission. There was evidence within the individuals documentation of full assessments taking place and a record of past medical and personal history was recorded. Care Homes for Older People Page 10 of 29 Evidence: One lady told us that she was asked to visit the home however her husband visited for her, as she was in hospital. She went on to say The staff are always warm and welcoming and very approachable. I consider Sister Dora to be a first class home. Other comments received during the visit included In my opinion the home is superb and cannot be improved. High standards are evident no matter when I visit the home. Its homely and welcoming and nothing is too much trouble for the wonderful staff. People requiring intermediate care are admitted to the home and they commence a reablement plan to assist them to return to their own home. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service each have an individual plan care which sets out their health, and most of their personal and social care needs. The health care needs of the people are met and they are protected by the homes medication policies and procedures. Individuals living at the home are treated with respect and their right to privacy is upheld. Evidence: The AQAA document completed by the home manager told us We liaise with the intermediate care team when service users are admitted, in order to ensure that visits and reviews are arranged.Each service user has a plan of care generated from the initial assessment that was undertaken. Care Plans are reviewed at least once a month.The promotion and maintenance of service users health is maintained and where needed, access to external health services are accessed to meet any shortfall.There is a comprehensive policy on the handling of medications.All Service Users are treated with dignity with most rooms having en suite facilities. Care Homes for Older People Page 12 of 29 Evidence: We saw that the care plans were in place for each individual person living in the home. All the relevant information required was evidenced within the care records. Four people were case tracked and their records were found to be well reviewed. Some of the documentation could be improved by personalising it further for example, including within it their individual wishes with regard to personal hygiene and their need for assistance. Some improvements within the care records were noted since the last inspection and the manager assured us that further progress is expected to be made in the near future. Comments received whilst in the home included: The home is difficult to improve. I feel safe living here, the manager is lovely and very helpful, my family visit regularly which is nice. Two relatives told us We are generally happy with the care that our mother receives, we did have some concerns initially about one or two care issues but this has been rectified by the manager. We visit regularly and the staff are welcoming. Visiting professionals commented on feedback cards and their comments included, The staff are always aware of the individual patients needs and try to meet them where possible. The staff are always eager to learn and carry out any instructions for the benefit of the patient. I believe that the patients cared for in Sister Dora are accommodated in their personal choices. People living at the home had signed their care plans and were aware of them and the need to document their care details. One gentleman told us I am impressed with the level of care my mother receives here, the staff are very attentive and professional. I looked at a few homes prior to coming here and this was by far the best, I knew as soon as I walked in the building that it was a good home. Medication for each person case tracked was in order with no discrepancies noted. The dispensing pharmacy supports the manager and the supply of medicines to the home. The staff have received recent update training for administering medicines and the manager regularly audits the administration sheets. Privacy and dignity are observed by the manager to ensure staff are respectful to the people living in the home, training is given to new staff and this continues to be discussed within supervision. One lady told us The staff are respectful, sometimes they seem busy and dont have time to chat but they do come and sit with me when they can. I prefer to stay in my room and they respect that, they knock if the door is shut before they come in. Care Homes for Older People Page 13 of 29 Care Homes for Older People Page 14 of 29 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. People who use the service experience the lifestyle, which matches their individual expectations. They have contact with relatives and friends as they wish. People who use the service exercise choice and control over their lives and they receive a balanced and wholesome diet. Evidence: The AQAA document completed by the home manager told us Service users are treated with respect and dignity when nearing the end of life. Their representatives are supported during the process.Service users have no set routines and are given as much choice as possible in all areas of daily living.The Home has an extensive choice of activities for service users. Service users relatives are encouraged to visit and residents are assisted to attend clubs and social events. Feed back has been taken on board from service users and their representatives in compiling a new nutritious menu. Those people spoken to were more than happy with their lifestyle in the home, someone people told us that it was much better than expected. Several visitors Care Homes for Older People Page 15 of 29 Evidence: supported these comments My mother has been livelier since coming to the home, she is very content and likes joining in the activities. One lady told me I have come on leaps and bounds since being here, I still go to Womens Institute meetings and my friends visit me when they can. Another lady told us I make decisions all the time about what I am going to do, or eat, or what I want to wear, the staff assist me but dont tell me what to do. The activities are marvelous, such a kind lady organises the sessions. One relative told us that Since coming to the home her mother has been really well and quite able. She joined in activities and enjoyed the company of others, she eats well, see the doctor when necessary and speaks highly of the staff. Staff spoken to told us that We give the people living in the home a choice at all times to maintain their Independence, we are encouraged to assist people but not do things for them. Some people enjoy a chat others like to be quite private and we respect that. We evidenced that staff were attentive and they approached people calmly. Some staff were seen interacting with a group of people which they seemed to be enjoying. Discreet assistance was offered to those who required it at meal times. We saw that the activities were carried out by an activity organiser, she ensures that the people know which activities or entertainment are planned for which day, by distributing a poster to each bedroom and notice board throughout the home. A photograph album was displayed to show all the activities that have taken place. The activities offered were varied to meet peoples diverse needs and abilities. Relatives commented that the activities were well organised and suitable. The Christian Fellowship visit monthly, and religious services take place on a Sunday and first Wednesday of the month. The kitchen have received a four star rating from the visiting environmental health officer. The meals are cooked by a trained chef and there is a four week menu displayed around the home. People living in the home told us that the meals were lovely, served hot and there was plenty of choice. One lady told us If I chose beef and then didnt fancy it when it was served, the staff would get me something else, its better than a hotel. I can have breakfast in bed if I want to. The meals are lovely, just the right amount and well presented. Contact with relatives, friends and the community were encouraged, visitors were welcome in the home at any reasonable time, some relatives liked to visit at meal times to assist their loved ones, others visited when activities were happening. Visiting can take place in the privacy of their own rooms or in communal areas. Care Homes for Older People Page 16 of 29 Care Homes for Older People Page 17 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are aware that their complaints will be listened to and acted upon. To better protect people from abuse safeguarding processes need to be improved upon. Evidence: The AQAA document completed by the home manager told us, The home has a simple comprehensive complaints policy. The Home has a company policy on protecting service users from abuse. We saw that generally complaints were dealt with appropriately. The manager had dealt with three complaints and one was yet to be resolved. We looked at the outstanding complaint and advised that it was referred to the social services through the vulnerable adults procedure. A member of staff was subsequently suspended as part of the procedure. The issue has now been discussed within a strategy meeting. Further discussion with the area manager led to the complaints process being appropriately followed for this issue. Failure to report safeguarding issues such as this one place the vulnerable people who use this service at risk of harm. No other concerns were raised, staff and relatives were able to discuss the process of making a complaints or expressing a concern. People living in the home felt confident Care Homes for Older People Page 18 of 29 Evidence: that any complaints would be listened to. One lady told us The manager comes to see us all when she is in the home and has a chat, I would tell her if I had any worries. One man told us I do think that people should be given a chance to put things right but if all else fails I would complain. Care Homes for Older People Page 19 of 29 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. People who use the service live in a safe, well-maintained environment that is clean, pleasant and hygienic. Evidence: The AQAA document completed by the home manager told us The Home employs a maintenance man to deal with minor maintenance issues promptly and we also have a maintenance programme.Laundry management complies with the infection control policy. The home was evidenced to be well maintained, clean and tidy. Bedrooms were personalised, clutter free and tidy. The home was hygienically maintained and relatives told us The home is spotless whenever you visit, it smells fresh and is warm and welcoming. My mothers room is always well looked after and tidy. One man told us The home is a credit to the cleaning staff. Suitable protective clothing was available for all the staff to wear for certain tasks and staff were aware of when to use the equipment provided and why it was necessary to do so. The domestic staff were suitably trained and aware of cautions to be taken using the cleaning equipment provided. Care Homes for Older People Page 20 of 29 Care Homes for Older People Page 21 of 29 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. People who use the service are in safe hands and have their needs met by the numbers and skill mix of staff. People who use the service are supported and protected by the homes recruitment policy and procedure. The staff are now trained and competent to do their jobs. Evidence: The AQAA document completed by the home manager told us Off duty is planned in advance taking into consideration the skill mix of staff on duty at any one time with staffing levels reviewed on a frequent basis. Over 50 of staff have N.V.Q level 2 with others having or in the process of completing level 3. The home has a rigorous recruitment procedure for prospective employees. Staff receive all mandatory training and a training programme is in place. Staff training was generally held at the home, but to ensure compliance the manager did arrange for staff to attend other study sessions. All the mandatory training was up to date and certificates were held in the staff files. We looked at the staff files and these were well organised and held all the appropriate information. Care Homes for Older People Page 22 of 29 Evidence: Staff recruitment processes were in place to ensure appropriate staff being employed at the home, however staff retention had been good over the last year and there were no vacancies at present. The staff told us We have supervision sessions with the nurse or manager, which is when we look at our training needs and we can discuss any personal issues. We are encouraged to complete the NVQ training and most of us are level 2 trained now. Visiting professionals commented that the staff are very helpful and professional ensuring the peoples needs are met. People living at the home told us The staff are kind kind and friendly, the manager is marvelous. Nothing is too much trouble for some staff. One relative told us The staff take time to chat even if they are really busy. Sometimes I chat to the manager in her office. One lady told us I knew that I would be happy in the home because the staff were so kind and helpful. Care Homes for Older People Page 23 of 29 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. People who use the service live in a home, which is well managed by a responsible manager. The home is run in the best interests of the people who live in it.People who use the service have their finances safeguarded by the homes procedures. The health, safety and welfare of people who use the service and the staff are promoted and protected. Evidence: The AQAA document completed by the home manager told us The Home manager has the registered managers award. The Home manager works along side care staff giving advice and guidance on a daily basis. Views and feedback from service users, their representatives and all grades of staff are welcomed. Service users and representatives have three monthly meetings in order to discuss any general aspects with more specific concerns being held in private on a one to one basis upon request. Service users have their own pocket money on the premises with access to their account details upon request. Service users can keep money personally if they wish or Care Homes for Older People Page 24 of 29 Evidence: can have it kept safe in the safe on site with access to in office hours, receipts are given for any moneys kept for safe keeping. The manager is a registered nurse and she holds the registered managers award. The operations manager supports the manager in her role at the home. Quality Assurance is monitored by the home and audits are sent out to families throughout the year comments were mainly positive and included: - Difficult to improve - The decor is clean and tidy and smells fresh, its homely and happy. - In my opinion the home is superb. - High standards evident no matter when you visit the home. - More outside lighting needed. - Completely satisfied with the care provided, words cannot compliment the home and staff enough. The operations manager completes Regulation 26 visits, where she reports to us about the home and her findings. There were many thank you cards and complimentary letters visible in the home, the latest pinned to a notice board in the entrance hall. Visitors and people living in the home made many comments to us during the visit and some of these included: The standard of care and attention in all areas of the home is second to none. The home is kept beautifully, the only smell in the home is from the kitchen and it always make me feel hungry, its so nice. The manager keeps the home in good order, she is very professional and caring, a credit to the home. The managers ensures she is available for relatives and people who live in the home to go to her and discuss any issues, evidence of this was documented. The manager also holds relatives meetings in the home. Finances are all set up with a robust system managed by the administrator. This was checked and found to be in order. There was evidence that Health and Safety issues are priority within the home. We saw that the corridors were free from obstruction and the people were able to move around the home safely. Aids were available to assist Independence of those less mobile. One lady told us I could hardly walk when I moved in here, now I walk around the home with my frame. The staff encourage me to be independent but make sure I am safe. We saw that the accident Book was completed correctly and signed by the manager. A quarterly audit of accidents is completed. Fire records and the maintenance file were up to date and well documented. We saw individuals risk assessments in care records which were updated and reviewed monthly. Care Homes for Older People Page 25 of 29 Care Homes for Older People Page 26 of 29 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 27 of 29 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 18 13 The protection of Vulnerable 18/03/2010 Adults policy and procedure must be followed correctly when information is received with regard to abuse of people living in the home. Staff must be appropriately trained and confident in reporting any forms of abuse by using the homes procedure so protecting people living in it. This will ensure that people using the service are safeguarded and protected from harm. 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 7 Extended personalisation of the individual care plans will further improve the care records. Actual choices should be documented regarding daily life. Care Homes for Older People Page 28 of 29 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 29 of 29 - 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!