Inspection on 18/03/09 for Summercourt

This inspection was carried out on 18th March 2009.

CSCI found this care home to be providing an Excellent 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

Summercourt 07/02/07

Summercourt 14/03/06

Summercourt 09/11/05

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Summercourt Shute Hill Teignmouth Devon TQ14 8JD     The quality rating for this care home is:   three star excellent 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: Wendy Baines     Date: 1 9 0 3 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Summercourt Shute Hill Teignmouth Devon TQ14 8JD 01626778580 01626778782 summercourt1@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Classic Care Homes (Devon) Ltd care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Summercourt is registered to provide care to elderly people from the age of sixty-five. It is a detached house (listed building) that has been extended, situated less than half a mile from the town centre. There are two residents lounges and a separate dining room, and the home has a shaft passenger lift. All of the bedrooms are single rooms with the exception of one double, and all have an en suite WC. There are good views of the sea from several of the bedrooms. There is level access from the home?s front door onto a sizeable patio area. The garden is landscaped that includes a seating area and a level walk leading to a small pond. The home has its own car parking, and it is also possible to park in the street nearby. The weekly cost of care at Summercourt ranges from the lowest at #306.00 to #436.00. 0 Over 65 20 Care Homes for Older People Page 4 of 29 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: three star excellent 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 3 star. This means the people who use the service experience excellent quality outcomes. The inspection was unannounced and took place over one full day on the 18th March 2009. Summercourt is owned and co-managed on a day to day basis by Rebecca Coulson (Registered Manager) and Henrietta Coxon, both were present throughout the inspection. Prior to the inspection the Commission had sent surveys to people living in the home to ascertain their views regarding the quality of the service provided. All the surveys returned contained positive feedback about the services people receive. Care Homes for Older People Page 6 of 29 The Inspector completed a tour of the premises and was able to meet with residents in private or less formally in the communal parts of the home. All the staff on duty were spoken to and a sample of staff records were inspected. A sample of records were inspected, which related to the day to day running of the home and specific to the care needs of the people who live there. The Inspector was able to meet and talk to relatives visiting on the day of the visit, and also spoke with a GP and representative from Social Services. 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. Care Homes for Older People Page 8 of 29 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving to SummerCourt are provided with sufficient information to help them make an informed choice about where they live and the services they receive. The homes admission process ensures that people are assessed prior to moving in to ensure that their needs can be sufficiently met. Evidence: The files of three people most recently admitted to the home were examined in detail during the inspection visit. The manager said that when a person expresses an interest in moving to the home she would go out along with another senior member of staff and undertake a full assessment of their needs. They would do this by meeting the individual and their family within their home and by gathering information from other professionals such Care Homes for Older People Page 11 of 29 Evidence: as hospital and Social Services staff. This information would assist the home in making a decision about whether or not they can meet the persons needs. The Pre-admission assessment for one person was examined and found to provide a clear description of the individuals needs and how these would be met at SummerCourt. The assessment included information about the persons personal and healthcare needs, their social and religious interests as well as their preferred routines. A service user guide and residents handbook is available for people who may be considering moving into the home. This information includes details of the environment, staffing and services available as well as a copy of the homes complaints procedure and residents contract. Intermediate care is provided if a room is available. One resident spoken to had been staying in the home for a short time with a view to returning home. A full preadmission assessment had been competed and the care plan had information about supporting the resident to maintain independence and skills. A representative from Social Services said that the home is always very quick to respond to any emergency requests from their department, and will undertake a prompt and professional assessment of need. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Summercourt can be assured that they will receive excellent personal care and healthcare support. Their healthcare needs will be regularly monitored and any changes dealt with promptly. Evidence: The inspector had access to all records during the visit. Six of the care records for people currently living in the home were looked at in more detail. Each of the residents files had a written care plan detailing their needs and how these would be met by the home. Where an area of need was more complex this information had been written in more detail and included the individuals preference about how they wanted to be supported. An example of this referred to one resident who was a diabetic. The care plan clearly stated the needs relating to this persons health and how the home and other agencies would provide support and care. The plans had been reviewed regularly and staff spoken to said they were able to access the information they needed to meet the needs of the people they care for. Care Homes for Older People Page 13 of 29 Evidence: Examples of recording included a falls assessment, nutritional screening and weight monitoring. Individual care plans stated when particular monitoring processes were in place such as fluid intake, and monitoring charts were found to be up to date. Risk assessments were found in each care plan for different areas of care including Prevention of falls, Moving and Handling and Pressure care. Discussion took place with the manager regarding the need to include a plan to minimize any risks that have been identified as part of these assessments. All residents are registered with the local GP and are able to see health workers in the privacy of their own rooms. The inspector was able to meet with a visiting GP who provided very positive feedback about the service, comments included; Staff are always able to assist with my visits and are very aware of the needs of the people they care for. The management are always available and people would appear to enjoy living in the home. The homes systems for the administration of medication was examined. Requirements made at the last inspection relating to the signing of administration sheets had been addressed and staff had received training on the review undertaken by the home regarding this matter. Residents are supported by the home to manage their own medication if they are able to do so. The home undertakes a risk assessment to identify any risks and needs a person may have when administering their own medication and storage facilities are provided to ensure the safety of all people in the home. A medication trolley is used for safe storage and administration of medication and separate storage and recording processes are in place for controlled medication. Records of the administration of medication were sampled, these were found to be in good order and up to date. All staff receive training in the safe handling of medication and are only expected to undertake this role in the home if they are considered confident and competent enough to do so. Throughout the inspection staff were observed knocking on residents bedrooms before entering and speaking to residents in a respectful manner at all times. Examples within care plans and daily records further confirmed that the home considers the rights and dignity of people they care for. One care plan detailed information for staff about the need to ensure an individuals dignity when supporting them with continence care. One resident spoken to said, The staff are excellent, always kind and respectful. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Summercourt are able to partake if they choose in a range of leisure activities. The home has sought the views of the residents and considered their varied interests when planning activities both in the home and the community. People can enjoy a healthy and well balanced diet that meets their specific dietary needs. Evidence: The inspector was able to discuss daily life and social activities with staff, residents and visitors.It was also possible to observe how people were spending their time and the interaction between staff and the people they were supporting. The home employs an activities coordinator who spends time with residents looking at the different type of activities they may enjoy either individually or in a group. Individual social care plans are completed for each resident and these are regularly reviewed to ensure that people are partaking in activities that meet their needs and wishes. Care Homes for Older People Page 15 of 29 Evidence: The social care plan for one younger resident described the need to explore local voluntary groups to ensure that the individual was having access to local, age appropriate community activities. Information about local events and in-house activities were advertised on the homes notice boards.These events included visits from local clergy, in-house activities and a sherry morning. Staff and residents said that they also enjoy trips to the local town, theatre trips and afternoon cream tea. Throughout the visit the atmosphere in the home was warm and welcoming. The layout and size of the home allows for people to spend time sitting quietly on their own or with others if they so choose. Some of the residents were waiting to have their hair cut by the visiting hairdresser. Staff spoken to said that not all residents choose to join in the planned activities and this choice is respected. Throughout the two day visit the Inspector observed a number of friends and relatives visiting the home. All said that they are able to visit at any time and are always made to feel welcome. Family and friends were able to spend time with their relative in their own room but due to the size of the home could also have privacy whilst sitting in one of the quiet communal areas. The Inspector was able to see the daily menu, speak with kitchen staff and join residents for a midday meal. Staff and the cook were very aware of the likes and dislikes of individual residents and this information as well as special dietary requirements were also recorded in care plans. Due to the size of the home and differing needs of residents the dining areas have been organized to allow for people to eat their meals in smaller groups. The dining area was very attractive and the food served was of a very high standard. The mealtime was relaxed and unrushed and staff responded promptly and respectively to any specific requests made by residents. One resident spoken to said that she had only recently moved into the home and felt that she was being so well looked after and was eating so well that she had gained weight, The meals are wonderful, the staff are excellent and treat me like a friend. Care Homes for Older People Page 16 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. People who live at Summercourt can feel confident that their concerns will be listened to and taken seriously. The Registered manager and staff have a good understanding about abuse and are aware of the procedures to follow should they suspect an incident of abuse has occurred in the home. Evidence: Summercourt has a written complaints procedure. A copy of this information is provided to residents at the time of admission and is also available on the homes notice board. Residents spoken to during the inspection said that management and senior staff are always available and that there is a very open atmosphere in the home. Feedback received within questionnaires from residents, their families and other agencies confirmed that they felt confident that their concerns would be taken seriously by staff and Management. Residents financial affairs are generally handled by relatives. Small amounts of money are securely stored for residents in the home. Receipts are kept of all transactions recorded. These records were sampled and found to be in good order. The manager Care Homes for Older People Page 17 of 29 Evidence: said that if residents choose to manage their own finances then this is fully supported and encouraged by the home. Discussion took place with the manager for the need to ensure that any agreed arrangements to support residents with their personal finances is agreed and documented as part of their care plan. Care Homes for Older People Page 18 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 live at Summercourt benefit from a clean, comfortable and well maintained environment. People are provided with aids and adaptations to maintain and enhance their independence, however the lack of level access into the main part of the home may not be suitable for people with mobility difficulties. Evidence: Summercourt is a large detached property situated less than half a mile from Teignmouth town centre. It is a listed building, which has been attractively extended. Summercourt is registered for 20 residents and has 19 bedrooms, 18 of which are single and one double. All rooms have en-suite facilities. The home also has two bathrooms, one located on each floor, which incorporate hydraulic bath hoists and one jacuzzi, a passenger lift, two well appointed dining rooms, two lounges, one with TV and video facilities and one quiet lounge with a small library area. The home also has a patio area with sea views, and landscaped private garden. A complete tour of the building was undertaken as part of the inspection visit. All rooms were well maintained, decorated and furnished to a high standard. Residents spoken to said that they liked the home and that it had a comfortable and homely feel. Care Homes for Older People Page 19 of 29 Evidence: One resident said that he was not easily able to access the garden area through the main front door. On inspection it was noted that the front door to the property did not have level access and would therefore not be suitable for people with mobility difficulties or those requiring a wheelchair or other walking aid. The kitchen area was found to be clean and tidy. This area was well arranged into two sections, one for the cooking of main meals and the other for staff to prepare drinks and snacks throughout the day. Information received by the home prior to the visit confirmed that following comments received by residents the home had replaced some of the older bedroom and dining room chairs as well as renewing some of the residents beds and bedroom furniture. The home was found to be clean throughout with high standards of hygiene evident. Care Homes for Older People Page 20 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 live at Summercourt will receive care from a skilled group of staff who will be sufficient in number to meet their current and changing needs. The service has a robust recruitment procedure that meets the regulations and National minimum standards. The procedure is followed in practice and sufficient checks are carried out to ensure that people appointed are appropriate to work with vulnerable people. Evidence: Staff were described by people living in the home and those visiting as Very kind and caring with nothing being too much trouble. People said they were supported promptly indicating that staff were employed in sufficient numbers to meet the needs of those currently living in the home. On the day of the inspection there were four care staff, a cleaner, cook, Registered manager and other Director and co-owner of the home. The rota and Registered manager confirmed that this would be a normal shift in the home with the addition of one waking and one sleeping night staff. The manager said that staffing levels are increased during the busy times of the day when residents require higher levels of care and support. Throughout the inspection staff were attending to chores, assisting to residents and Care Homes for Older People Page 21 of 29 Evidence: spending time with residents in the communal parts of the home. One resident who had recently moved into the home said that the staff had been a great comfort to her particularly during a time of personal grief and loss. Another resident said that the staff were particularly sensitive and respectful to his request and need for privacy and independence. The files of three members of staff recently appointed to work in the home were looked at in detail during the inspection. All these files contained the necessary preemployment checks including two written references and a Criminal records disclosure (CRB). New staff were provided with in-house induction training to ensure they are given information about the care home and the people living there, this was evidenced in a number of staff files. Feedback within staff questionnaires confirmed that new staff feel well supported and are encouraged to attend and update their training. Staff files confirmed that staff complete and update training in health and safety, fire safety, moving and handling, and first aid. The Registered manager confirmed that all staff attend specialist training relevant to the needs of the people they care for. Staff spoken to confirmed that they also have opportunities to attend regular staff handover meetings and 1:1 supervision sessions. All the staff on duty were spoken with and all said they felt well supported to undertake their work and found the owners and Registered manager approachable and supportive. Care Homes for Older People Page 22 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Summercourt benefit from a positive, inclusive and open style of management. The manager is well supported by the senior staff in providing clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. The home regularly reviews aspects of its performance through a good programme of self-review and consultations, which include seeking the views of residents, staff and relatives. Evidence: Summercourt has been established for over 17 years and is now owned by the Coulson and Coxon families. It is managed on a day to day basis by the Registered Manager Rebecca Coulson and Henrietta Coxon. Care Homes for Older People Page 23 of 29 Evidence: Rebecca is a Registered nurse (RGN) who has experience of working with the acute elderly care in the Royal Devon and Exeter Foundation Trust, as well as working in homes for the elderly mentally ill. She also holds a NVQ level 4 qualification and a Registered managers award. Henrietta is a graduate with over ten years experience in Human Resources within the NHS and is qualified in personal and general management. Both keep themselves regularly updated with training relevant to their role and the people they provide a service to. The Registered manager said that they have an open door policy in the home, and feel that staff and residents feel comfortable enough to talk about any issues. Residents spoken to said that the management and staff are always available if they have a problem and nothing seems to be too much trouble. Feedback from staff questionnaires confirmed that staff feel supported by management to fulfill their role within the home and to raise any issues they may have. A local GP stated that Standards of Care are consistently high with a strong caring ethos. Systems are in place to promote and improve the quality of the service.For example regular staff and residents meetings enable people to contribute their views about the home. Annual questionnaires are sent to residents, relatives and other agencies and the results are published and made available. Results of these questionnaires are analysed and discussed in team meetings and this information then forms part of the annual business plan for the home. Staff spoken to said they felt well supported and records confirmed that all staff have the opportunity to discuss their role, and personal development within 1:1 supervision sessions. A sample of the homes records were inspected including care records, risk assessments, staff files and health and safety information. All the records seen were found to be up to date and safely stored. Health and safety issues were examined. Staff training records confirmed that staff have access to the Registered Providers training programme in health and safety. This training is kept up to date, and includes topics such as infection control, moving and Care Homes for Older People Page 24 of 29 Evidence: handling and first aid. Information provided prior to the inspection confirmed that there are up to date maintenance and servicing of systems and equipment.Risk assessments for the building and fire safety were available for inspection. The manager stated that all radiators are covered and window restrictors are in place for all bedrooms above ground level. Records confirmed that a record is kept of any accidents,injuries or incidents, which may affect the well being of a person living in the home and these incidents are reported to the appropriate agencies. 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 22 23 The Registered provider must ensure that all residents have access to all parts of the building. People requiring the use of wheelchairs and/or other walking aids should be able to access the garden and outdoors safely and independently as possible. All residents should have access to all parts of the building, through the provision of ramps ect where required to achieve this. 18/08/2009 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 18 The home should document any agreements to support residents with their personal finances. These agreements should be documented and reviewed as part of the residents care plan. Page 27 of 29 Care Homes for Older People Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 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!