Inspection on 24/11/08 for Sonesta Nursing Home

This inspection was carried out on 24th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sonesta Nursing Home 16/05/06

Sonesta Nursing Home 03/11/05

Sonesta Nursing Home 19/05/05

Sonesta Nursing Home 02/12/04

Sonesta Nursing Home 27/05/04

Sonesta Nursing Home 10/03/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sonesta Nursing Home 797 Finchley Road Golders Green London NW11 8DP     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: Sheila Lycholit     Date: 2 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Sonesta Nursing Home 797 Finchley Road Golders Green London NW11 8DP 02084583459 02089055235 sonestanursing@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Farzana Kauser Chowdhury Type of registration: Number of places registered: Sonesta Nursing Home Limited care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Specific service user One specific service user who currently resides in the home and is under 65 years of age can reside in this home. This condition will need to be reviewed when s/he vacates the home. Date of last inspection Brief description of the care home Sonesta is a privately owned registered care home with nursing for up to thirty-two older people. It is situated on the Finchley Road in Golders Green, close to local shops and public transport. Accommodation in the home is provided in eighteen single and seven double rooms. The home has a large ground floor sitting/dining room, central kitchen and a smaller first floor lounge. There is a large garden to the rear of the home. The stated aims of the home are to provide a comfortable and safe environment, and the specialist care that service users in the home need. The current fees range from £575. This report is available through the internet. Copies may also be obtained from the provider of this service. Care Homes for Older People Page 4 of 27 Over 65 32 0 Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced inspection took place on Monday 24th November 2008 from 10:55am until 6pm. The Registered Manager, who had completed an Annual Quality Assurance Assessment, was present and made herself available during the inspection. The Nurse Manager was also on duty. In addition to the Manager and Nurse Manager, one RGN, one care assistant and the Chef were spoken with in private to hear their views of the service. There were 26 residents at the time of the inspection, 2 of whom were in hospital. Thirteen surveys were received from residents, many of whom had been assisted to complete the form by relatives or friends. One resident was spoken with in his room. A tour of the building was carried out with the Nurse Manager. Care Homes for Older People Page 6 of 27 Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 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 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear information about the home is available, which will be further enhanced when the web site is completed. A sound assessment procedure is followed. Evidence: Information about the service is available in the service users guide, which is regularly updated. A web site is being developed, though not all aspects were complete at the time of the inspection. Copies of contracts were seen in the office. Thirteen residents returned survey forms, with the majority confirming that they had received sufficient information about the home before deciding to move in and that they or their family had received a contract. Seven residents files were looked at. Each contained a copy of an assessment undertaken by senior staff at the home, usually the Nurse Manager, as well as other information such as a needs assessment by the Care Manager and hospital discharge Care Homes for Older People Page 10 of 27 Evidence: notes. Assessments undertaken by the home contained all relevant information, including details of the prospective residents cultural and religious background. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive care plans are available. Senior staff work closely with the homes GP and other multi-professional colleagues to ensure that residents health care needs are met. Systems are in place to promote the safe handling of medication. Evidence: The care plans of 7 residents were looked at, including recently admitted and short stay residents. All of the care plans were of a good standard, covering all aspects of the residents care and support and showed that the resident and their families had been involved in drawing up the plan. It is recommended that mouth care is given a higher priority in the care plan, so that staff are clear about supporting residents with cleaning teeth or dentures and with any issues such as a dry mouth. Although records show that care plans are regularly reviewed, few entries contained any further information than no change, even though other records indicated a number of changes to the care plan. Staff must ensure that care plan reviews cover all changes. Risk assessments for moving and handling and falls prevention were available on each Care Homes for Older People Page 12 of 27 Evidence: of the 7 files. No risk assessments were available for bedside rails, which are extensively used. The use of bedside rails is discussed further under standard 38. Where a hoist is used, the type of hoist and sling must be noted in the risk assessment. The Nurse Manager said that she had recently reminded key workers to record this information. The home retains the services of a local GP, who visits weekly, or more frequently if requested. Records show that staff work closely with the multi-professional team to meet residents health care needs. Staff have attended training in tissue viability provided by the local PCT. A Waterlow assessment is undertaken for each resident and preventative action taken if necessary to prevent skin breakdown. Any concerns are recorded using a body chart and a record kept through the use of Polaroid photos. Records show that the skin of one resident who was admitted from hospital with a pressure sore has since healed as a result of the care and treatment provided. The home uses a measured dosage system of dispensing medication provided by Boots. All RGNs have received training by Boots in the last 12 months. Medication is stored securely. The small supply of controlled drugs is stored securely in a wall mounted metal cabinet, with clear records kept. A weekly audit of medication is carried out. MAR sheets seen were up to date, with no gaps. The home has a medication policy, which needs to be reviewed to reflect current guidance on crushing tablets and covert medication. Staff were observed to speak courteously to residents. Feedback from the 13 residents who returned surveys was positive. Residents and their relatives commented on the good care provided by staff. Commented included she is very well cared for; very happy with the care and the staff have been very helpful and courteous. One resident spoken with in private also commented on the good care he receives. Only one of the 6 shared rooms was occupied by two people at the time of the inspection. Screens were available in the shared room to assist privacy. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A varied timetable of activities is available. A choice of freshly prepared food is provided by the catering staff, who know residents likes and dislikes. Special diets, including vegetarian and Halal are available. Staff carefully monitor the food and fluid intake of the frailer residents. Evidence: A programme of activities is displayed in the sitting/dining room. The administrator, who clearly knew the residents well, was running a Bingo session on the morning of the inspection. In their feedback, the majority of residents and their families confirmed that they were happy with the activities provided. The visitors book confirms that relatives and friends regularly visit. Visitors were observed to be made welcome by the administrator, whose desk is by the main entrance. Feedback surveys note that relatives receive regular updates when they phone or visit. Catering at Sonesta is of a high standard. The Food Standards Agency visited on 5th December 2007 and assessed the home as having a 5 star rating. Discussion with the Chef showed that he knows the residents likes and dislikes, as well as their need for special diets, such as vegetarian or diabetic. Menus include a choice of main meal each Care Homes for Older People Page 14 of 27 Evidence: day and an Asian vegetarian option. Non-Asian vegetarian choices are also available. The Chef often serves breakfast himself, when he discusses with residents the choices available for lunch. The majority of dishes are freshly prepared. At lunchtime staff were observed to support residents sensitively. Pureed food was well presented, as were the other dishes. Residents were provided with ample drinks. Food and fluid intake charts are completed where there are concerns about weight loss or fluid intake. It is recommended that staff always state the amount of fluid, rather than a cup and that fluid intake is totalled daily. Records show that prompt referrals to the Speech and Language Therapy team (SALT) have been made, for example where there were concerns about the risk of choking. Triggers for referral to the GP or SALT team should be noted in guidance to staff. Records show that staff have made good progress in maintaining the weight of some residents where there were previous concerns. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an established complaints procedure. Steps are taken to safeguard residents from abuse. Evidence: Sonesta has an established complaints procedure which is displayed in the home and included in the service users guide. The complaints record shows that two complaints were received in the past 12 months , which were resolved. Steps are taken to elicit any concerns through regular surveys. Feedback surveys sent out for this inspection indicated that residents and relatives felt able to raise any issues with the Manager. CSCI received an anonymous written complaint in October. Issues raised were, in the main, not substantiated at this inspection. Two safeguarding referrals regarding residents were made during the past 12 months, one referral was made by staff at the home. Training records and discussion with staff show that they have received training in safeguarding adults. Staff awareness of safeguarding issues is confirmed by the recent appropriate referral to the local safeguarding team. Care Homes for Older People Page 16 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well located, with parking facilities and close to public transport and other services. A good standard of cleanliness is maintained. The en suite bathrooms need to be made more usable and radiators protected or other heating installed. Evidence: The building consists of two large semi-detached houses, which have been adapted to provide accommodation over 4 floors. The building is accessible to wheelchair users, with level access at the main entrance and a lift that serves each floor. A large sitting/dining room overlooks the rear garden. Parking is available at the front of the house, which is close to Golders Green tube station and on a number of bus routes. The majority of bedrooms seen contained few personal possessions, such as photos, pictures or the residents own furniture. One residents room contained no personal possessions, other than his clothes. The Nurse Manager said that discussions were taking place with his family to bring more of his possessions to personalise his room. In discussion, one resident confirmed that although he had no TV or radio, he was very comfortable in his room. The ceiling in one bedroom needed re-decorating, following a water leak that had been repaired. All but two bedrooms have en suite lavatories and washbasins, though these are small Care Homes for Older People Page 17 of 27 Evidence: and not accessible for wheelchairs, nor is there sufficient space for staff to assist residents. Larger assisted bathrooms, which have recently been refurbished are available on each floor. Six of the bedrooms are shared rooms, although at the time of the inspection only one room was occupied by two people, who had shared for a number of years. During a tour of the building, radiators in en suite bathrooms were found to be unguarded. Although not posing any risk to residents as the radiators are turned off, a permanent solution needs to be found. The Manager explained that she had found it difficult to obtain guards which did not get in the way of residents or staff in the small space. Records show that the hot water is tested weekly and was recorded as below 43C, however on the day of the inspection hot water in a number of bathrooms was very hot to the touch. The Manager said that she would ensure that the handyman checked the system again when he came on duty the next day. Bath thermometers are available in each bathroom and the Nurse Manager confirmed that staff check the temperature of the water before assisting a resident with a bath. Two domestic staff were cleaning the building during the inspection. The building was clean and tidy and odour free. Comments from relatives confirmed that they were happy with the standard of cleanliness. Care Homes for Older People Page 18 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sonesta has good staffing levels, both during the day and at night. Steps have been taken to ensure that all staff receive core training, including refresher training. Good staff communication is maintained through regular staff meetings, hand overs and twice yearly staff surveys. Evidence: Rotas show that good staffing levels are maintained. Registered Nurses work a 12 hour shift from 8am until 8pm. They are supported by 4 care assistants on the early shift and 3 on the late shift. Night staff consist of 1 RGN and 2 care assistants. The Manager confirmed that staffing levels have remained the same even though the home has a number of vacant places. In addition the Administrator works office hours Monday to Friday and there are catering and domestic staff. The laundry is undertaken by care staff on a rota basis. The home currently uses no bank or agency staff. The home employs a training agency to provide NVQ and other training. The majority of care staff have achieved at least NVQ2 or an equivalent and a number are enrolled on NVQ3. Three staff files were looked at and two staff spoken with in private, in addition to the Manager and Nurse Manager. Staff files were in good order, with evidence that all recruitment checks had been carried out and that staff had been issued with a contract Care Homes for Older People Page 19 of 27 Evidence: of employment. It is recommended that notes of interviews are kept on staff files. Training records showed that all staff had undertaken core training, including health and safety, food handling and moving and handling. The majority of in-house training is led by the Nurse Manager, who is an NVQ Assessor. She has access to a range of training manuals and DVDs. In discussion staff said that they felt well supported and found the training provided both internally and by the training agency and PCT helpful. Records show that regular staff meetings take place, with notes available. The Owner/Manager carries out a staff survey twice a year. Copies of the previous two surveys were seen. The replies are anonymous and indicate that staff are happy with the support and training provided. Care Homes for Older People Page 20 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is effectively managed by the Owner/Manager and Nurse Manager. The views of residents and their relatives are given a high priority. Record keeping is generally of a good standard. While the health and safety of residents is given a high priority, senior staff must review the routine use of bed rails. Evidence: The Registered Manager and Nurse Manager have both achieved NVQ level 4 and the Registered Managers Award. It is clear from discussion and the AQAA that the Manager works to continuously improve the service. A high priority is given to meeting the cultural and religious needs of residents who reflect the diversity of the North London catchment area. Regular surveys of the views of residents and their families are undertaken. The last two surveys were looked at and showed that, in line with feedback obtained for this inspection, there is a high level of satisfaction with the service. Care Homes for Older People Page 21 of 27 Evidence: The home does not manage residents finances, which if not handled by the resident, are managed by the local authority or relatives. Records of residents finances were not checked at this inspection. Records and discussion with staff show that staff have 1:1 supervision sessions with the Nurse Manager at least six times a year. One of these sessions includes an annual appraisal. Fire safety records show that the fire detection and fire fighting equipment is serviced twice a year. A fire risk assessment is available. Weekly tests of the fire alarm are made at different points. Staff are expected to assemble at the designated areas during each test. The London Fire Brigade had recently visited the home. No report was available. A number of regular health and safety checks are undertaken including fridge and freezer temperatures and testing of the hot water, as discussed earlier. New laundry equipment has been purchased, although the drier had broken down on the day of the inspection. Staff confirmed that sufficient clean linen was available. Accidents and incidents are recorded, though no record could be found of the injury to a residents hand which occurred earlier this year. The incident was clearly recalled by the Manager who had asked the GP to visit to prevent the resident from having to spend a long period in A and E. The Manager undertook to obtain the record from the GP and forward it to CSCI. This accident should have been reported to CSCI under regulation 37. As discussed under standard 7 the use of bed rails is high. Staff monitor residents while they are in bed at frequent intervals to check they are comfortable and safe. The Nurse Manager confirmed that she was aware of the literature on the use of bedside rails and associated risk of injury and of restraint. No risk assessments were available for bedside rails, though relatives had been asked to give their written consent. The use of bedside rails must be reviewed for each resident. Where bed rails are used a detailed risk assessment, which is discussed with the resident and relatives, must be available. The risk assessment must be regularly reviewed. Care Homes for Older People Page 22 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plan reviews must note 31/12/2008 all changes to the residents care and support. To ensure that all staff are clear about how current care is to be provided. 2 7 13 Where a hoist is used to transfer a resident, the type of hoist and sling must be noted in the risk assessment. To ensure that the correct equipment is used. 31/12/2008 3 21 16 En suite bathrooms must be accessible to residents and allow sufficient space for staff to provide assistance. En suite bathrooms must be suitable for residents and for staff assisting them. 31/03/2009 4 25 13 A permanent solution to the unprotected radiators in en suite bathrooms must be found. Hot water must be maintained at a safe 31/12/2008 Care Homes for Older People Page 24 of 27 temperature at all outlets accessible to residents. To ensure that residents are not accidentally burnt or scalded. 5 38 13 The extensive use of bed rails must be reviewed, with risk assessments in place where it is decided that rails are needed. to ensure the safety of residents, who may become injured by the use of bed rails. 6 38 37 CSCI must be notified of any 31/12/2008 event adversely affecting the well-being of residents and any serious injury. To alert CSCI to any concerns. 31/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 While care plans are generally of a good standard, further detail on mouth care would ensure that residents receive appropriate support and dental care and treatment. The medication policy would benefit from updating to ensure that it reflects current guidance on crushing tablets and covert medication. Where staff are monitoring a residents fluid intake, daily intake should be totalled. Exact amounts of fluid should be stated, rather than a cup. Guidance for staff should note triggers for further action, for example if fluid intake falls below 1000ml on 2 consecutive days. Residents and their families should be encouraged to bring in sufficient possessions to personalise bedrooms. Residents bedrooms should be redecorated promptly Page 25 of 27 2 9 3 15 4 5 24 24 Care Homes for Older People following any leaks. 6 29 Copies of interview notes should be retained on staff files. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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