Inspection on 26/10/08 for Sunnyside Nursing Home

This inspection was carried out on 26th October 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Sunnyside Nursing Home 30/10/06

Sunnyside Nursing Home 17/11/05

Sunnyside Nursing Home 22/11/04

Sunnyside Nursing Home 28/09/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sunnyside Nursing Home 140 High Street Iver Buckinghamshire SL0 9QA     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: Barbara Mulligan     Date: 2 6 1 0 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 © (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 28 Information about the care home Name of care home: Address: Sunnyside Nursing Home 140 High Street Iver Buckinghamshire SL0 9QA 01753653920 01753790005 enquiries@trustworth.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Arshad Gamiet,Mrs Mariam Gamiet care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 40. The registered person may provide the following category/ies of service only: Care home with nursing - (N) 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) Date of last inspection Brief description of the care home Sunnyside Nursing home is a privately owned home registered to provide accommodation and 24hr nursing care for up to forty elderly persons who may be physically or mentally frail. The home offers a respite care service when vacant beds are available. The home is a detached large Victorian style building with a modern extension to the rear of the property. Major refurbishment recently undertaken now means that the home can provide ensuite facilities in all rooms and 80 of the rooms are for single occupancy. The home has pleasant gardens and there is car parking to the front. The home is situated close to the local amenities within the village of Iver. Care Homes for Older People Page 4 of 28 Over 65 0 40 40 0 Brief description of the care home Available communal space consists of two lounge areas on the ground floor and another lounge on the first floor. There are bright and spacious dinng rooms on the lower and upper floor. Access to the upper floor is by passenger lift. Fees range from £650 to £950 per week. 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: 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: This unannounced key inspection was conducted over the course of a day and covered all the key National Minimum Standards for older people. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion. Information received by the Commission since the last inspection was also taken into account. Surveys forms were sent to people who use service and these were received before the site visit was completed. The inspection officer was Barbara Mulligan. The registered manager was not available on the day of the inspection, however the Managing Director, Khaled Gamiet was available to assist with the inspection. The visit consisted of discussion with the Managing Director and other staff, opportunities to meet with some people who use the service, examination of some of Care Homes for Older People Page 6 of 28 the homes required records, observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings was given to the Managing Director at the end of the inspection. The Managing Director, staff and service users are thanked for their co-operation and hospitality during this unannounced visit. What the care home does well: What has improved since the last inspection? There has been a major rebuild and refurbishment undertaken of the home which has improved the environment, provided en-suite bedrooms, a passenger lift, new dining areas, a reception area, a new kitchen, newly refurbished and more spacious lounges and extra bathrooms, toilets and a new laundry area. Care Homes for Older People Page 8 of 28 Training records are now dated to ensure that all staff have the required basic training with mandatory annual updates. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users needs are thoroughly assessed prior to admission ensuring that staff are prepared for admission. Evidence: The inspector case tracked the care of four people using the service, including those new to the service. The registered manager or qualified nurses are responsible for completing the initial needs assessments. Each file had a completed assessment of need. This assessment tool covers the activities of daily living which are communication, breathing, eating, controlling body temperature, mobilising, elimination, personal care needs, maintaining a safe environment, working and playing, expressing sexuality, sleeping and dying. Each assessment was found to be detailed, informative and fully completed. In addition to this the home had obtained detailed information from the Primary Care Trust, families and the home also complete a dependency assessment. Care Homes for Older People Page 11 of 28 Evidence: The person completing the initial assessment has signed and dated the completed assessment documentation. The completed needs assessments observed by the inspector demonstrate that prospective service users, family members or representatives are included in the assessment process if this is appropriate. The home does not admit people for intermediate care. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people using the service are well met, with personal care delivered in a way that promotes respect and dignity, ensuring that peoples health and wellbeing is promoted and protected. Evidence: The care of four residents was case tracked and care plans were examined during this inspection, including those most newly admitted to the home. All files examined contain a signed agreement to the care plan, which is signed by either the service users or their representative. All care plans examined are informative and reflect the changing needs of the individual. There is written details of the residents preferred daily living routines and individual likes and dislikes. These are drawn up with the involvement of the service users whenever possible or their representatives and this is evidenced in each care plan. Care needs are identified with a very detailed action plan setting out guidelines detailing how staff will meet those needs. These are to be commended. All care plans observed are of a high standard. There is evidence to demonstrate that care plans are reviewed and updated on a monthly basis and it is Care Homes for Older People Page 13 of 28 Evidence: noted that this is a thorough process and not just no change written. Daily notes are detailed and informative and an activity sheet is completed that records the activities that the individual has undertaken through out the day. Chiropody Services visit the home on a four weekly basis. Additional support is accessed through the local GP surgery, where service users can access physiotherapists, occupational therapists and speech therapists. The home receives district nurse support and they are available for advice regarding pressure area care and can assist in the provision of pressure relieving equipment. Visits to the home from healthcare professionals take place in the service users bedrooms. The inspector was informed that optical screening is undertaken by a domiciliary service that visits the home annually or if they wish to do so service users can use a local opticians. Tissue viability assessments are in place for each service user. One residents had pressure damage at the time of the visit and a plan of care was in place and the appropriate interventions had been undertaken. The care plans set out in detail the service users preferred routines, likes and dislikes and partnerships with families, friends and relevant professionals outside of the unit. The nutritional needs of service users are identified and their weight is monitored on a monthly basis. Referrals to the dietitian are made via the individuals GP. The home has an agreement with the local hospital whereby residents can access the dental department if they need to. Advice regarding continence care is accessed via the district nurse and the home complete their own continence assessment. Healthcare information is recorded in detail in all files looked at. There are no service users who are able to administer their own medication at the time of the visit. Medication is kept in two secure trolleys, one on the lower floor and the second on the upper floor. There is a fridge in the clinical room for the storage of certain medicines and regular temperature records are kept for this. Photographs of service users, on medication charts, are used for identification. Qualified nurses administer all medications in the home. Blister packs were checked and indicated that either medication has been administered or disposed of. Staff are using codes to indicate what has happened to this medication. There were no out of date medications held in the home with a returns procedure in place. There are systems in place to ensure the procedures to administer controlled drugs are adhered to and these were observed to be fully complied with on the day of the visit. Medication records show no omissions. However, there are numerous handwritten entries on the medication administration records and it is strongly recommended that these are dated and signed by two staff. Preferred terms of address are identified at the initial assessment and the inspector Care Homes for Older People Page 14 of 28 Evidence: saw evidence of this in care plans. The homes induction programme includes training regarding privacy and dignity. The Statement of Purpose and Service Users Guide include information about maintaining the privacy of service users. Service users can have a key to their rooms if they wish to use this facility and it is felt to be safe. 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. Systems in the home ensure that where appropriate people who use the service are supported to exercise choice and control over their lives and are able to receive visitors at the home, with no restrictions imposed on visiting unless requested by the individual. The presentation and standard of food is good and meets the nutritional needs of people who use the service. Evidence: Care plans show individual routines of daily living and include bathing, rising and retiring times. Religious observance is recorded in care plans and service users interests are recorded in the initial assessment and there is a social needs care plan. As part of the admission process, the home complete a life history of the individual, to give staff information about previous leisure pursuits, hobbies and other interests. Staff spoken to on the day said that there is an activities programme in place and activities are carried out on a daily basis depending on what the service users wish to do. Service users confirmed that they were encouraged to participate in activities as they choose. On the day of the visit the inspector observed people who use the service being taken out into the village for personal shopping. This was carried out in a respectful and courteous manner. Care Homes for Older People Page 16 of 28 Evidence: Service users are able to receive visitors in the privacy of their own rooms, and are able to choose whom they see and do not see. There are no restrictions on visiting, and this is documented in the Service Users Guide. Examples of involvement in the home by local community groups and individuals are visits by mobile hairdressers, various visiting entertainers and a monthly church service. Family and friends are invited to participate in some of the social event organised. Residents and/or their families are encouraged to look after their own financial affairs whenever possible. The home does not act as appointee for any residents. Service users are offered three meals a day. The menu is rotated on a four weekly cycle. The inspector was told that service users can take their meals in their rooms if they wish. The home offers drinks and snacks throughout the day in accordance with needs of the service users.The nutritional needs of service users are assessed and there is good detailed evidence of regular monitoring in all care plans seen. All of the comments received from people who responded to the CSCI survey indicated a high level of satisfaction with the food. One comment received said, the food is very good and there is always a choice if mum doesnt like whats been served. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints and safeguarding policies and procedures work well and residents feel that their concerns would be addressed. Evidence: The home has a complaints procedure and this includes timescales for responding to complaints and information for the complainant on how to contact the Commission for Social Care Inspection. The complaints procedure has been included in the Service Users Guide which has recently been updated. The inspector examined the homes complaint log and this shows that three complaints have been received by the home since the previous inspection. These are well recorded and have been responded to within the stated timescales. Seven family members returned the comment cards and all were aware of the complaints procedure. The Commission has received no complaints about this service. The home uses the Bucks Multi Agency POVA policy and an organisational policy in conjunction with this. This includes guidelines for staff about the responsibilities of the staff, types and signs of abuse and what to do if you suspect abuse. Training records show that all care staff receive training about Adult Abuse and this forms part of their induction. The registered manager does not act as appointee for any service users. Care Homes for Older People Page 18 of 28 Evidence: There are systems in place to look after small amounts of personal allowance or for the safekeeping of service users valuables. The Commission has not received details of any safeguarding referrals regarding this home. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe, well maintained and clean environment providing people who use the service with an attractive and homely place to live. Evidence: Sunnyside Nursing home is a privately owned home registered to provide accommodation and 24hr nursing care to older people. The home offers a respite care service when vacant beds are available. The home was originally a large Victorian House which has been internally refurbished and extended extensively to the rear and sides of t he building. It has pleasant gardens and there is car parking to the front. The home is situated close to the local amenities within the village of Iver. A tour of the premises was undertaken by the inspector. Major refurbishment and upgrading of the home has been completed. This has included the refurbishment of exisiting bedrooms, developement of 28 new ensuite bedrooms and two dining rooms, a new reception area, a new kitchen and laundry room and some additional bath and shower rooms. A passenger lift has also been installed. There is a lounge and dining room on the lower floor and the upper floor, and an extra quiet smaller lounge on the lower floor. These are nicely decorated, bright and spacious. The internal decoration of the home is of a good standard and there are personal touches around the home such as flowers, plants, books and pictures. Care Homes for Older People Page 20 of 28 Evidence: The kitchen is large, clean, spacious and well looked after. There are accessible toilets available for service users throughout the home and several are close to the lounges and dining areas. There are paved areas with appropriate garden furniture in place. The gardens are well maintained and there is ample parking available. There are good adaptations to the home to support service users mobility that includes grab rails, assisted baths, raised toilets and and bath aids. The home has good protocols in place to ensure that it is kept clean and hygienic. The laundry area is new and sited away from food preparation areas. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient, trained staff to meet service users needs in a supportive and flexible way. Recruitment procedures are thorough ensuring that people who use the service are protected from unsuitable carers. Evidence: Staff rotas confirm that there are adequate staff on duty to meet the needs of service users. Normal staffing levels include two qualified nurses plus six carers in the morning, one qualified nurse plus six carers in the afternoon and one qualified nurse plus two carers at night. These can be adjusted according to resident dependency levels, for example if a resident requires one-to-one care. There is a regular staff team and the home do not need to use agency staff. There are additional staff providing housekeeping, maintenance and catering support to people using the service. Staffing levels have been increased to reflect the increased number of residents and the size of the home. The home continues to support staff on NVQ training and at the time of this inspection there were 70 of care staff (not qualified nurses) who have achieved NVQ Level two or equivalent in care and 52 have achieved NVQ Level three or equivalent. A random selection of staff files were made available for inspection purposes, including Care Homes for Older People Page 22 of 28 Evidence: those new to the service. The four staff files include the care workers personal details, including next of kin details. All of the staff files seen contain an application form and copy of terms and conditions relating to the post. There is evidence of POVA and CRB checks and each had evidence that references and Criminal Records Bureau disclosures had been obtained before the staff member commenced work. Face to face interviews were held and interview records kept. The homes approach to training and development has been accredited by an external consultant and has achieved Investors in People status. There is an induction programme in place that will ensure new care workers are familiarised with the organisation and their roles and responsibilities and provides the staff member with a personal development portfolio. Training records show that care staff have received mandatory training and examples of further training include dementia training, PEG feeds, male and female catheterisation and managing challenging behavior. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Evidence: The service has had a a registered manager in post since August 2007. He has attained the Registered Managers Award and holds an MBA from Kingston University. The manager has nine years of experience in managing care homes of different registrations, different sizes and different ownership structures. His post comes with a job description outlining duties and responsibilities. The Home Manager is supernumerary, works at Sunnyside five days a week and does not manage any other home. There are clear lines of accountability within the home and with the external management. There is a Quality Assurance system in place which is consistently carried out. The home has developed a simple database tool that allows them to audit themselves Care Homes for Older People Page 24 of 28 Evidence: against the National Minimum Standards (NMS). The tool contains all of the NMS data, previous inspection comments and scores, NMS guidance (both CSCI and internal) and KLORA information. The person carrying out the audit is able to use the tool to call up and draw on this information in order to guide them when carrying out their audit. Questionnaires were sent out in July 2008 and a summary of the comments received have been collated into a summary which have been sent to relevant people involved with the home. Other self-monitoring systems in place include, health & safety audits,staff feedback and an audit of staff files, annual plan, policy & procedure review, staff supervision, drug audits, documentation audits, maintenance file and residents/relative meetings. There are various forums available for staff, relatives and residents to provide feedback including staff meetings, handover meetings, supervisions, residents meetings, care reviews and surveys. The home prefers not to keep residents money and does not act as an appointee for any one using the service. Where it is necessary to keep personal money, there are secure facilities available for the safe-keeping of money and valuables and record and receipts are kept of any financial transactions. A range of health and safety checks are in place and these are carried out on a daily, weekly or monthly basis. Fire safety records show that the fire risk assessment s fully completed and is up date. Weekly fire checks are carried out and recorded. There is written evidence of water and fridge and freezer temperatures. There are service certificates available for PAT testing dated Feb 2008; electrical installation 07/11/07; gas appliances 08/11/07. Training records demonstrate that care staff have completed mandatory, health and safety training. 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 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 It is strongly recommended that all hand written entries on medication administration records are dated and signed by two staff. 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 © (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 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!