Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: St Helens Hall and Lodge Elephant Lane Thatto Heath St Helens Merseyside WA9 5EL 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: Michael Perry
Date: 2 0 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: St Helens Hall and Lodge Elephant Lane Thatto Heath St Helens Merseyside WA9 5EL 08456006432 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) : Orchard Care Homes.Com Limited care home 94 Number of places (if applicable): Under 65 Over 65 0 94 dementia old age, not falling within any other category Additional conditions: 94 0 The registered provider may provide the following category of service only: Care home only - Code PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Old age, not falling within any other category - Code OP The maximum number of people who can be accommodated is: 94. Date of last inspection Brief description of the care home St Helens hall and Lodge is a purpose built care home that was registered in July 2007. It can accomodate up to 94 people who have care needs around general elderly and dementia. The care is managed on two seperate units. The home in a residential setting. The home is owned by Orchard Care Homes Ltd and the Registered Manager is Ms Chris Wood. The current fees for the service are 520 pounds to 550 pounds per week. Care Homes for Older People Page 4 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: 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: Before we visited the home the manager filled out a form (Annual Quality Self Assessment, or AQAA) we sent and returned this. It had a lot of information about the home and how the people are supported to live their lives. We also sent out survey forms to both staff and people who live in the home so that we could get their views. We visited the home without telling the staff we were coming so that we could see how things work normally. We spoke with many of the people who live there and watched how they spend their day and how the staff support them. We also spoke with visitors. Care Homes for Older People
Page 5 of 29 We looked at the records kept on people who live in the home and other records to do with how the home is run. We looked around the home to see if it was clean and a nice place to live and some of the people living in the home showed us their bedrooms. We spoke with staff and the managers of the home to get their views and understanding of are issues and how the home is run. What the care home does well: We looked at the information supplied by the home at the point of people moving in. Those residents spoken with said that the information supplied had helped them to settle into the home. We also looked at the assessments carried out prior to and during the admission phase. These were comprehensive and included all aspects of the persons care. This sort of assessment helps the staff in the home to meet the persons needs. We spoke to one relative who said that nothing was to much trouble and that staff had been very informative during the admission stage. We spoke to residents and looked at care records and found that health care is assessed and supported in the home. Care records evidenced that people are supported to attend GP appointments and also to attend for other health checks such as dentist and opticians. All of the residents have a plan of care. Reviews of the plan are carried out with the resident or relative so that they are kept up to date with their care and can also feel more involved. We found that the home help to cater for residents with diverse care needs. For example one resident had physical care needs and was being cared for with regular input by the district nursing team. We found the care to be well managed and there were good records indicated good liaison with professionals as well as the persons family. The family member felt the care was very good and that staff were kind and supportive. Another person had care needs around challenging behavior due to confusion and this was well recorded and staff were able to support the person during these episodes. This demonstrates that the home are considering a wide range and diversity of care need. Also the home meets with current legislation by providing disability access at all areas as well as the grounds. The home is purpose built and has excellent aids and adaptations so that people with disability are enabled to live their lives. Residents spoken with said that staff where helpful and respected their privacy. Relatives also reported that they are always kept informed of the care. One relative said: Its great here. Im very pleased. [Resident] has settled well. Staff are very accommodating and nothing is to much trouble.They are always offering food and drink. I can visit any time. All feedback from residents and relatives was positive with respect to the daily life in the home and particularly the relaxed and friendly atmosphere. Care Homes for Older People Page 7 of 29 On the dementia care unit we observed that the managers and staff are developing the environment on this unit in line with many good practice principals such as orientation aids and placement of furnishings to assist with interaction and socialization. We found the home to be relaxed and welcoming and residents spoken to and observed were clearly at home and enjoyed the positive atmosphere. Bedrooms are personalized and well maintained so that individual lifestyles were reflected. Staff reported that the home is settled in terms of consistency of staff numbers and staff records confirmed this so that there is a good continuity of care for residents. We observed the staff to be warm and supportive in their interactions with the residents and this was confirmed as consistent by speaking to residents. We found the general management of the home to be good. All senior staff and the manager were open and work well as team. There are appropriate management systems in place so that the care in the home is constantly reviewed and managers are keen to get feedback from people in the home so that they can improve things further. What has improved since the last inspection? What they could do better: The assessments carried out by staff are detailed and help identify care needs but we would recommend that are signed and dated for accuracy of reference. Some people who had been referred by social services did not have a copy of the social worker assessment available in their care file. This would further identify any care needs the person may have. We found some errors in the recording of medicines in the home. For example in one instance it was not clear whether a person had received their medicines for the past two days. Full and clear records must be kept of all medicines received, administered and leaving the home as this will ensure that medicines are managed appropriately and all people in the home are getting there medicines correctly. Currently their are no residents in the home who are managing their own medicines to any degree. It is strongly recommended that the homes written policy around residents self medication is positively applied so that Independence is encouraged and promoted. There must be a planned activities program developed so that people living in the home can be more engaged and stimulated. This is particularly so on the dementia care unit. We looked at the way the service identifies and deals with allegations of abuse or mistreatment. We saw that copies of the locally agreed procedures were available although these were in loose format and it is recommended that they are bound and circulated more freely in the home so that staff are familiar with them. Care Homes for Older People Page 8 of 29 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 9 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 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides useful information on admission to the home and carries out assessments so that peoples care needs are known. Evidence: We looked at the assessments carried out for two of the people using the service on the dementia care unit. Both of these contained good detail so that it was easy to see each persons care needs. One of the assessments was for somebody who was being admitted for a short period of respite care and included an initial care plan completed soon after the assessment. One of the assessments included details of the social worker assessment but there was no such assessment for the other person admitted. This is important information as it informs the assessment process and helps to get a clearer understanding of the persons needs.
Care Homes for Older People Page 11 of 29 Evidence: Both assessments were not signed or dated at the end which causes some confusion as to when the assessments were carried out. We spoke to a relative of a person on the dementia unit who said that they had received good information at the time of the first contact with the home and that managers and staff had been very helpful at he time so that their relative was able to settle in effectively. Care Homes for Older People Page 12 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. Health and personal care is managed so that peoples privacy and dignity is respected. Evidence: We looked at care records for people living in the home. All residents have a care plan and these are completed well and are very detailed. They are written with reference to the care needs at different times of the day. We spoke with relatives of people on the dementia care unit and they felt that they were included in the care and that staff always kept them up to date with any changes to the plan and these are reviewed. This is good practice and ensures that people are included in their care. One care plan covered care needs around a person with a pressure sore. This was very detailed with clear records so that the care could be easily tracked. There was reference to visiting nurse professionals who were supervising the care of the wound. We saw the person being nursed in bed and the home had taken care to supply specialist equipment such as a pressure relief mattress. There were also good records of staff giving diet and fluids and regular personal care.
Care Homes for Older People Page 13 of 29 Evidence: The relative gave a positive account of the care in general: [My relative] is always clean and well cared for. Shes happy here. They got her walking soon after admission and she improved mentally and was much more responsive. Staff are very caring and helpful. I feel included in the care. Records contained numerous references to medical referrals and GP and hospital visits. Those spoken with reported that staff were quick to refer and liaise as necessary with health professionals. People spoken with said that they receive their medication on time. Staff were observed administering medicines from the medication trolley. We looked at medication administration records [MAR] and also the homes policies around self administration. Overall we found satisfactory safe practice but there are areas that need to be tightened up and also further developed: * There are no residents self medicating to any degree. This was discussed with reference especially to people on the general residential unit. Staff reported that nobody really asks for this. The homes policy is very specific about the need to encourage as much Independence in this area as possible and gives appropriate good practice guidance. There is also reference to a risk assessment tool which was seen. The homes managers should review the culture of the home in this area of care which currently does not facilitate any level of Independence and aim to introduce appropriate practice. * We looked at one persons record of medicines and it was not clear wether any medication had been given for the past two days as this was not recorded. *Records were not always clear so that in one instance it was difficult to audit medicine which was a controlled medication and by law has to be monitored very tightly. In this instance the controlled drug register was accurate but the stock had not been entered on the daily Mar sheet. This is important as it provides a double audit for accurate monitoring. The medications are subject to auditing by the manager and we would require that these audits are conducted more stringently so that recording errors are reduced. All staff administering medicines are receiving appropriate training and further updates
Care Homes for Older People Page 14 of 29 Evidence: have been booked. This shows that staff have a good level of competence in managing medicines and the manager was open to the improvements discussed. We looked at the general level of personal hygiene for the people on the dementia unit and saw they were appropriately dressed and comfortable and clean. Relatives spoken with said that this was a consistent standard and that residents privacy and dignity were respected. Care Homes for Older People Page 15 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The social life of people living in the home needs to continue to be developed so that they can feel more engaged in the daily life. Evidence: We found the home to have a very open and relaxed atmosphere. There is ample space in the home with respect to people being able to move about freely and to have a good choice of day facilities. When staff interact with residents we observed good communication skills. This was observed during the lunch time meal on the dementia unit which was relaxed and sociable with people being supported by good staff numbers. Relatives can visit the home at any time and are always made welcome. One commented: Its great here. Very pleased. [Resident] has settled well. Staff are very accommodating and nothing is to much trouble.They are always offering food and drink. i can visit any time. another said: Care Homes for Older People Page 16 of 29 Evidence: My Gran is very happy in the home. She is full of praise for the staff and their kindness. they are all lovely, kind and very patient. We spoke to staff who felt that they have some time during the afternoon to talk and socialize with residents and we saw one example of an activity on offer. Generally though staff felt that more could be done in this area and that we tend to make it up as we go along with no real planning of activities. Some comments from relatives and residents from the surveys returned also indicate this. One resident commented that there needs to be more trips out of the home. Particularly on the dementia care unit there needs to be a more active, planned program so that residents are more engaged. We looked at the record of social activities for one resident for example and saw that only two social activities had been recorded for the past few months. This was discussed with the manager. Currently there is no designated members of staff who are responsible for the overall provision of activities and this may be the way forward. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures and staff are trained so that peoples concerns are listened to and reported and they are protected Evidence: There is a complaints procedure available for people in the home. Those spoken with were very relaxed around staff and said that they were listened to so that any concerns could be addressed. The complaints procedure is displayed in the entrance foyer as well as being available in the information supplied in each bedroom so this is easily accessible. We looked at the complaints recorded. There were complaints recorded around missing clothing and the complainant had been appropriately responded to so that redress was evident. We were shown policies and procedures around the recognition and management of allegations of abuse. Copies of the locally agreed procedures were available although these were in loose format and it is recommended that they are bound and circulated more freely in the home so that staff are familiar with them. Staff spoken with have received training in how to recognize and report abuse and were knowledgeable about identifying abuse and said were confident about reporting this to the manager. Care Homes for Older People Page 18 of 29 Evidence: Managers displayed an understanding of what to report through the safeguarding process and were aware of who to contact in such circumstances so that people in the home are protected. 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 excellent 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 planned and maintained and clean so that people living there enjoy comfortable surroundings. Evidence: We toured the home and visited some residents in their bedrooms and spoke to other people living in the home. We found the home to be relaxed and welcoming and residents spoken to and observed were clearly at home and enjoyed the positive atmosphere. The home has been purpose built and has an excellent range of facilities including well designed bedrooms and good choice of day space. The bathrooms and en suite facilities in bedrooms have been designed to accommodate various levels of disability and to encourage both Independence and good care standards. This attention to detail ensures the home can accommodate a range of diverse care needs. Areas seen were clean and well maintained. We were invited to look at some of the residents bedrooms and found these to be very personalized and well maintained so that individual lifestyles were reflected. Those people spoken with said that privacy was respected. Care Homes for Older People Page 20 of 29 Evidence: The external grounds are accessible for people with mobility needs. The dementia care unit is being designed and developed along good practice guidelines and we observed good use of orientation aids such as signs and boards and the manager of the unit is keen to develop themes further so that residents can walk around and feel comfortable and stimulated. The manager is aware of the work that needs to be done and has accessed a range of good practice material and has also attended training sessions around dementia care. We spoke to one relative who said that the appearance of the unit was very reassuring and this had been a factor in choosing the home. 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. Staff are recruited and trained appropriately so that the care needs of residents can be met. Evidence: At the time of the inspection visit the dementia unit had 35 residents. Staffing consisted of 2 seniors and 4 carers. [1:6 ratio]. The general unit also had 17 residents and had the deputy manager one senior and 3 carers. [1:3 ratio]. The manager is supernumerary to these figures. Staff reported that the home is generally settled in terms of consistency and staff records confirmed this so that there is a good continuity of care for residents. The care staff are supported by domestic staff on a daily basis as well as staff working in the kitchen and laundry. Staff spoken with felt that they were supported by the management and that there was enough staff to carry out the care needs of the residents. Staff spoken with clearly understood the care needs of the people in the home and could explain their role in providing support. We observed the staff to be warm and supportive in their interactions with the residents and this was confirmed as consistent by speaking to residents and getting feedback from surveys.
Care Homes for Older People Page 22 of 29 Evidence: Most staff are involved with some training. The pre inspection information states that 75 percent of staff have achieved a National vocational Qualification [ NVQ], and most other staff are on these courses. Staff files seen and staff spoken with evidenced ongoing support around training which is monitored through regular supervision sessions with the manager. Some of the senior staff on the dementia care unit have attended training courses around providing care for people with dementia and carers have attended company led training. Staff commented on the quality of the training especially the induction program. This shows that the staff have the basic skills to care for people in the home. We looked at some staff files and found that the checks required for each staff prior to employment had been made and that staff were recruited thoroughly and this ensures that staff who work in the home are fit to do so. 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. There are management systems in place to ensure standards are monitored and the home is run in the best interests of the residents. Evidence: The manager is Chris Wood. We spoke at length and she was able to give a clear outline of the current needs of the service in supporting residents with elderly care needs and also outline how future developments would fit in with best practice with particular reference to dementia care. She was able to give evidence of continued update and is now working towards an NVQ 5 in management. We asked how the service promotes peoples views and suggestions and was told about the regular meetings so that residents can air any views or concerns. The service also canvases opinions of residents through surveys so that people can provide feedback about the service and feel more involved in the running of the home. Care Homes for Older People Page 24 of 29 Evidence: The manager discussed the various internal audits that are carried out including regular environmental checks and also visits by the service managers for the company who also complete a regular inspection and report [Regulation 26 report] which provides further feedback for the manager. We found that the management of health and safety in the home was good. The pre inspection information completed states that all safety certificates are up to date and some of these were spot checked on the inspection. This ensures that the environment for people is safe and maintained. The Health and Safety policy is available. Staff receive basic raining in Health and Safety and this was confirmed by the available training records as well as staff interviews. Care Homes for Older People Page 25 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 26 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 9 17 Full and clear records must be kept of all medicines received, administered and leaving the home including those disposed of. This ensures no mishandling of medicines and that all medicines can be easily audited. 02/03/2009 2 12 16 There must be a planned 01/04/2009 activities program developed so that people living in the home can be more engaged and stimulated. This is particularly so on the dementia care unit. This ensures a better quality of daily life. 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 Care Homes for Older People Page 27 of 29 1 3 All of the assessments carried out by staff need to be signed and dated for accuracy of reference. All people referred by social service should have assessments on file by referring social workers. It is strongly recommended that the homes written policy around residents self medication is positively applied so that Independence is encouraged and promoted. Copies of the locally agreed procedures were available although these were in loose format and it is recommended that they are bound and circulated more freely in the home so that staff are familiar with them. 2 9 3 18 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!
