Inspection on 25/09/08 for Sunnycliffe House

This inspection was carried out on 25th September 2008.

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

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

Other inspections for this house

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Winton House

Newbeech House

Treloar College

Rush Court

Extracts from inspection reports are licensed from CQC, this page was updated on 05/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sunnycliffe House 20/22 Broadway Sandown Isle Of Wight PO36 9DQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Annie Kentfield     Date: 2 5 0 9 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 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 28 Information about the care home Name of care home: Address: Sunnycliffe House 20/22 Broadway Sandown Isle Of Wight PO36 9DQ 01983403844 01983401020 sarahsunnycliffe@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Sarah-Jane Collins Type of registration: Number of places registered: St Vincent Care Homes Ltd care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 46. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) Physical disability (PD). Date of last inspection Brief description of the care home The home is a large detached building in Sandown with gardens and car parking. A new extension is near to completion that will provide additional well appointed bedrooms (some with sea views) a hairdressing room and a new lounge/conservatory. The bedrooms vary in size and the weekly fees depend on the room to be occupied. There are additional charges for hairdressing and chiropody. The home provides two Care Homes for Older People Page 4 of 28 46 0 46 Over 65 0 46 0 Brief description of the care home large sitting rooms and a large dining room. The building is accessible and there is a passenger lift to access the upper floors. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is the outcome of the first inspection of the service under new ownership. We made an unannounced visit to the home on 25th September 2008, this was with one inspector (Annie Kentfield) and lasted for 7 hours. We sent surveys to 10 residents and 10 staff, and 5 health and social care professionals who visit the home. We received completed surveys from 5 residents, 4 staff and 3 professional visitors. During the visit we spoke to 7 residents in the privacy of their own rooms, we also spoke to 2 visitors and members of staff. The registered manager was on holiday but we spoke to a representative of the company who own the home. This person is known as the responsible individual and regularly visits the home and was standing in for the registered manager. Care Homes for Older People Page 6 of 28 The home sent us the Annual Quality Assurance Assessment (AQAA) when we asked for it. The AQAA is a self assessment that all services have to complete and gives us numerical information about the service and also self assessment details of what the service does well, what they could do better and where further improvements are planned. All of the feedback that we received about the service is positive and demonstrated confidence in the new ownership of the service. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 28 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 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents do not move into the home until their care needs have been assessed and the home is confident that identified care needs can be met. However, records that evidence the assessment process must be available for inspection. The manager should ensure that information about the home is kept up to date and made available to prospective residents in suitable formats (to meet the communication needs of the residents). Evidence: We looked at some of the care records, and looked at what people have told us in the surveys. We spoke to some of the residents and some visitors who were in the home. Some of the residents and visitors told us they had received enough information about the home before making a decision to move in. Prospective residents are invited to Care Homes for Older People Page 11 of 28 Evidence: visit the home and stay for a meal if they want to. New residents are offered a trial period before signing a contract; this sets out what the home will be providing for the weekly fee. The service is in the process of updating the information about the home, to include new information about the number of rooms, and details of the new ownership of the home. The manager makes an assessment of the care needs of each resident and also seeks relevant information from others involved in the care of the resident. However, because the records of care assessments were not available when we visited we did not see evidence of this. The written care plans indicate that the manager is clear about the level of care that the home can offer. We received surveys from a GP and District Nurse who confirmed that the manager and staff work well with health care services to ensure that residents health care needs are met. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents in the home have access to health care services and have their health care needs met with privacy and dignity. The homes policy and procedures for the safe storage and administration of residents medication must be reviewed and updated to ensure that residents receive their medication as prescribed, at all times. The manager must ensure that staff follow the medication policy and procedures at all times. Evidence: We looked at three care plans and spoke to residents, relatives and staff. We also looked at the storage of residents medication and the medication records. We received surveys from a GP, District Nurse and Care manager, and 5 residents. The manager was on holiday but we spoke to a representative of the company who own the home, this person is in the home each week. The care plans for each resident provide a summary of care needs and a record of care Care Homes for Older People Page 13 of 28 Evidence: given and provide guidance for staff on how care is to be provided. The care plans are regularly reviewed to update changing care needs. The home has a communication system so that staff are aware of any changes to the care plan. Individual risks are assessed and recorded and there are records of contact with other health services such as the residents GP, District Nurse, chiropodist etc. We received feedback from health and social care professionals that demonstrate that the home are prompt to request visits from health care services when required and we were told that the manager and staff work well in liaison with community health care services to make sure that residents receive health care support as needed. We spoke to one resident who told us that the staff are very kind and caring. The resident told us that staff listen and are polite, also that they see their GP whenever they need to. Comments from residents in the surveys confirmed that people always or usually receive the care and support they need. We also spoke to some visitors who were very happy with the care and support received by their relative. The responsible individual for the home told us that they are in the process of introducing a new system for assessing and planning residents care needs. It is hoped that this system will provide a more person centred care plan and co-ordinate the care records in a more organised way. The records in the current care planning system are stored in different places and this could be confusing for new care staff. For example, bathing, weight checks and continence care plans are not in the care file for each resident but are separately stored. The current care plans are task orientated and should be person centred ie reflecting all care needs that may be social, emotional, psychological and physical. Although it was evident from discussion with residents and staff that staff work in a person centred way, the care plans should also reflect this. The benefits of the new system for the residents will be assessed when the new care planning system is embedded into practice in the home. Residents medication is stored in a trolley in the office with separate storage for controlled drugs. The trolley is usually locked to the wall for security but when we visited the home this had not been done. We found some errors in the medication records; this meant that the records did not always demonstrate whether a medicine had been given or not. It was therefore not possible to determine if people were receiving their medication as prescribed or not, putting them at risk of harm. We looked at the homes written policy and procedures for the safe administration of medication and some parts of the policy need to be reviewed and updated to reflect current best practice. In particular, the manager must update the procedures for dispensing medicine that is to be taken as required or PRN for each resident, the correct procedures for dispensing eye-drops, guidance for staff on what they must do if an error is made in the medication records, and seek guidance to confirm that the Care Homes for Older People Page 14 of 28 Evidence: storage of controlled drugs meets current regulatory requirements (as amended). The home has a drug cabinet fixed to the wall, however, they must ensure that this storage meets current legal requirements because the regulations have been recently amended. Following the inspection visit, we were told by the manager that action has been taken to improve practice in the home in some of these areas. The manager also told us that the medication records are being checked every day to make sure that residents are receiving their medication, as prescribed, at all times. However, the manager should already have had monitoring systems in place to recognise when practice issues were arising that could affect the outcomes for people living in the home. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home aims to provide a programme of social and leisure activities to meet the individual preferences of each resident. Residents are offered a choice of freshly prepared meals each day, in an attractive setting. Evidence: We spoke to some of the residents and visitors and looked at what people have told us in the surveys. The home offers a programme of different social and leisure activities including musical entertainment, games and quizzes and aromatherapy hand massage. The home has two sitting rooms so that residents can choose to take part in activities that are on offer, or not. Some of the residents told us that there are always activities that they like doing and some residents told us not always. Three residents told us they would like the opportunity to go on outings or trips outside of the home. Some residents prefer the privacy of their own room; it is evident that the preferences of each resident are respected by the manager and staff. Visitors are always welcome in the home and we spoke to two visitors who were positive in their feedback about the warm and friendly atmosphere that they find in the home. Care Homes for Older People Page 16 of 28 Evidence: The new owners of the home have almost completed an extension to the building; this will provide additional bedrooms, a hairdessing room, and a large conservatory that will link the old and new building. This will offer residents more choice of communal space. When the building work is completed, it is planned for the gardens to be landscaped, offering residents level access to the grounds and outdoor seating areas. We received positive comments from residents and visitors on the way that the manager and staff have worked to make sure of minimum disruption to the daily running of the home during the period of construction of the new building. Residents and visitors were also very positive about the improvements to the home since the new owners were registered in April 2008. A visitor told us that the new owners had arranged meetings with residents and relatives to discuss planned changes and improvements to the building. Residents that we spoke to told us that the food in the home is good and they were happy with the choices offered. The home has a spacious and sunny dining room that overlooks the front of the building. We were told that there are plans to refurbish the kitchen and organise the kitchen storage more efficiently. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are protected from the risk of harm, however, the service must ensure that staff have access to up to date and written information on their role and legal responsibility to protect people. The views of people using the service are listened to and action taken. Evidence: We spoke to some of the residents and some visitors. We also looked at what residents and others have told us in the surveys. The home has a formal complaints procedure and this is made available to read in the homes service user guide. However, some residents told us that they know about the complaints procedure and some residents said they did not know how to make a complaint. The home has a number of ways to seek feedback from people using the service, for example, meetings with residents and relatives, or asking people to fill in satisfaction questionnaires, as well as informal feedback. We were told that as a result of listening to people, the home have installed a shower room, and decorated the first floor sitting room for residents to use. Staff told us that they are aware of their responsibilities to protect residents in the Care Homes for Older People Page 18 of 28 Evidence: home from the risk of harm or abuse. However, staff do not have access to an up to date code of practice or written policy to give them guidance. Staff told us that they receive training in how to recognise the risks of harm or abuse but we were not able to confirm this as the training records were not available. There have been two reported concerns about practice in the home; these allegations have been fully investigated and the allegations were not substantiated. The manager notified us of the concerns as this is a legal requirement. The manager and owners of the home co-operated fully with the investigations in an open and positive way. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service offers residents a comfortable, clean and homely environment that meets their needs. There is an ongoing programme to improve the fabric of the building and refurbish the interior, for the benefit of the residents in the home. Evidence: We looked at all of the communal areas of the home and spoke to some of the residents in the privacy of their own rooms. We also received feedback from visitors and staff and looked at what the service have told us in the annual quality assurance assessment. Since the new owners purchased the home in April 2008 there have been immediate repairs and improvements to the fabric of the building. Internally, some of the bedrooms and sitting rooms have been decorated and new carpet fitted. The new owners have taken on a commitment to complete a partly built extension to the home that will provide more bedrooms and communal space and it is anticipated that this will be completed in the very near future. During the visit we spoke to the representative of the new owners and we were told about further improvements that are planned for the home, including refurbishment of the kitchen and the laundry room, and either replacement or repair of the passenger lift. Many of the internal doors are being replaced and a new fire alarm system is being installed. All of the Care Homes for Older People Page 20 of 28 Evidence: planned refurbishment work is designed to improve the facilities for the benefit of the residents. The home employs cleaning staff and feedback from residents and visitors confirms that the home is always clean. Some people told us that this has been very difficult to maintain during the period of building work but that staff have worked hard to achieve this. The home have told us that 75 of staff have completed training in good practice for infection control and maintaining good hygiene in the home. Staff told us that they have access to gloves and aprons as good practice in the control of infection. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a stated commitment to making sure that the staff team have the necessary skills and qualifications in care practice to meet the needs of the residents. However, the service must ensure that records that demonstrate that the home is meeting regulatory requirements in the areas of staff recruitment and staff training, be available for inspection. Evidence: We received surveys from 4 members of staff and spoke in private to three of the staff who were on duty. We also looked at what the home told us in the annual quality assurance assessment. The manager was on holiday when we visited and we were not able to look at staff training or recruitment records. Comments from staff confirmed that the home is committed to making sure that staff receive relevant training and supervision for the work they do. Staff told us that the training programme covers all of the mandatory training in safe working practice and some staff have either achieved a National Vocational Qualification (NVQ) in care, or are planning to. The AQAA told us that 12 out of 16 care staff have achieved the national minimum qualification in care (NVQ level 2) and 4 people are working towards this. The AQAA also told us that 75 of care staff have completed training in the management of infection or infection control. However, we were not able to look at the Care Homes for Older People Page 22 of 28 Evidence: records of staff training to confirm this. Discussion with members of staff confirmed that appropriate recruitment checks are in place to demonstrate that staff are suitable to work in the home. However, we were not able to check this because some of the homes confidential records were not available for inspection; as the manager was on holiday. There are usually 5 carers on duty during the day, 4 carers in the afternoon/evening and two wakeful staff on duty at night. The manager and domestic staff (cook and cleaners) are in addition to care staff. Comments from residents and staff confirm that usually there are sufficient staff to meet the needs of the residents, however, some of the residents and staff said that they wish staff had more time to chat to the residents or spend time in social activities. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by a person who has relevant skills and experience and in general the health, safety and welfare of the residents is promoted and protected. However, the manager must ensure that there are systems in place to ensure that residents receive their medication, as prescribed, at all times. The quality assurance system for the home needs to be developed to demonstrate effective systems for monitoring practice in the home to protect the safety and welfare of the residents. Evidence: We looked at comments that we received from residents, visitors and staff and we looked at what the home has told us in the annual quality assurance assessment. Comments and feedback confirm that the management approach of the home is open and positive and the new owners have given people using the service confidence that the service is being improved for the benefit of the residents. Care Homes for Older People Page 24 of 28 Evidence: Systems to review the quality of the service are being developed and need to be more robust and include regular monitoring of practice in the home, particularly the policies and procedures for the safe administration of medication. The manager must ensure that all written policies and procedures are in place and be regularly reviewed to reflect best practice and meet current legal requirements. When we looked at the AQAA, the information indicated that the service does not have all of the required policy and procedures in place and available for staff to read. For example, there is no written policy/procedure/code of practice for; access to files for service users, contact/visits by family or friends, recruitment and employment, safeguarding adults or prevention of abuse, working with volunteers. Records that are kept by the home must be kept up to date and be available for inspection. When we visited the home some of the records were not available because the manager was on holiday. However, there was no procedure to access the records in the managers absence and the home does not have a deputy manager. This means that if records are needed in an emergency situation, there could be a delay in accessing them. Feedback from people using the service demonstrates that the home is committed to promoting equality and diversity through the practice of the home and the home told us that their ethos is to create a home from home atmosphere and we do this by treating residents with respect and dignity, recognising their rights and promoting independence, whilst also safeguarding people. Residents financial interests are protected by the homes policy and procedures; staff in the home do not take responsibility for residents finances, or act as appointee or have power of attorney. The health, safety and welfare of the residents is protected in some areas because the home employs a health and safety consultant to audit health and safety risk assessments. The home also confirmed that they meet current fire safety requirements. The most recent food safety inspection gave the home a 4 star food hygiene rating. However, there were not enough systems in place to demonstrate that practice in the home is regularly monitored to make sure that staff are following safe working practice at all times, particularly in the area of medication practice. The responsible individual told us that the service is making improvements to ensure that practice in the home is safe and is meeting all regulatory and legal requirements. The service must demonstrate that these improvements will be sustained and embedded in practice. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person must 17/11/2008 review and update the policy and procedures for the safe administration of residents medication and ensure that staff follow the homes policy and procedures at all times. Residents must receive their medication as prescribed, at all times. 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 9 The medication policy and procedures should be reviewed and updated in line with best practice guidance in The Handling of Medicines in Social Care, (The Royal Pharmaceutical Society of Great Britain), and guidance on the safe management of controlled drugs in care homes. All guidance is available on the Commission website. Care Homes for Older People Page 27 of 28 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 © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!