Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Sutton Manor Care Home Priestsic Road Sutton In Ashfield Nottinghamshire NG17 2AH The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Richardson
Date: 2 8 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 29 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home
Name of care home: Address: Sutton Manor Care Home Priestsic Road Sutton In Ashfield Nottinghamshire NG17 2AH 01623551215 01623441150 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Barbara Ann Guinnane Type of registration: Number of places registered: Ashmere Care Homes care home 45 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 Sutton Manor Residential Home is part of the Ashmere Care Group. The home is situated on Priestic Rd Sutton In Ashfield, Nottinghamshire. One of three Care Homes based on the site close to the town centre and community facilities, the home provides 45 beds offering personal care for older people 65 plus. The home provides en suite facilities to the majority of rooms. The accommodation is provided on two floors. The home offers an intermediate care service with 5-10 beds for rehabilitation. The aim of the residential intermediate care scheme is to provide a safe environment within a residential setting for people who would otherwise face unnecessary prolonged hospital stay, inappropriate acute hospital admission or long term care. Through the provision of specialist interventions by a multidisciplinary team individuals are given the opportunity to maximise their potential when carrying out activities of daily living. The home has large garden facilities that are well maintained and easily accessible to the Care Homes for Older People
Page 4 of 29 Over 65 45 0 Brief description of the care home service users. The fees currently charge at the home are #380 per week which includes podiatry services, hairdressing services and daily newspapers. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a key inspection of this service and it took place over 8 hours and 30 minutes as an unannounced visit to the premises. It was spent talking to the manager and staff working in the home, talking to people who live there and observing the interaction between them and the staff, and examining records and documents. One requirement from the last inspection has been met, one requirement has not been met. There has been 2 further requirements and 3 recommendations made as a result of this inspection. Information obtained from the Annual Quality Assurance Assessment Care Homes for Older People
Page 6 of 29 (AQAA) and from returned surveys was used in this report. We received 4 surveys from people living at the home. We receive no surveys from staff at the home. What the care home does well: What has improved since the last inspection? At the last inspection the home was told they must improve the training that is given to staff at the home and they were asked to send us an action plan. They sent us information to show how they were going to improve and provide training. However, since the Annual Service Review in January 2008 mandatory training levels have fallen Care Homes for Older People Page 8 of 29 again. This is talked about in the section below, what the service could do better. 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 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. Assessments are completed before people move in to the home, which means staff know whether they can look after the person before they move there. Evidence: Half of the people who we received surveys from said they had received a contract and three quarters said they had enough information before moving to the home. Assessments are completed before people move into the home and assessments by health and social care teams are also obtained if possible to provide more information. We looked at the care records of 2 people who had moved into the home since the last inspection. There was a written assessment completed by the home for one person, and an assessment completed by the intermediate care team for the other person. The assessment completed by the home staff contained enough information to show staff what the person needs help with, but not how much help that is or what they can do for themselves.
Care Homes for Older People Page 11 of 29 Evidence: The home provides accommodation specifically for intermediate care and rehabilitation purposes. There are specific rooms where people who stay at the home are accommodated and they also have specific members of staff caring for them. People who stay at the home for this care, only stay for a maximum of 6 weeks. An intermediate care team from the local PCT, that includes an Occupational Therapist (OT), Physiotherapist and a nurse, is based at the home. This means they can provide help easily to those people who extra assistance before returning to their own homes. We spoke with the OT, who said their relationship with the home works well and everyone who uses the service goes back to their own homes. Care Homes for Older People Page 12 of 29 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care records are not updated or completed in enough detail, which means staff have to rely on information being passed on. Evidence: People who commented in surveys said they get the care and support they need from staff members and during the inspection people told us care staff are nice, are polite and treat them with dignity and respect. We saw this during the inspection and that staff knock on doors before entering rooms. Care plans for 4 people were looked at as part of this inspection. They show that each person has a plan that gives staff members brief information about what they need to do to meet most of the identified needs. Risk assessments, for things like falls and moving and handling, are completed and reviewed regularly. We found the care plans did not give staff members enough advice about how to meet most of peoples needs or what help people need. This is especially important for new
Care Homes for Older People Page 13 of 29 Evidence: staff members, or staff who have been away from work for a while. Staff need more information than simply, needs assistance, if they are to be able to consistently help people continue doing things themselves. Plans are not always updated when there are changes. The plans in two peoples records had not been changed at all since August 2006 and January 2007, except for a plan for falls in one persons records and a plan in the other persons records for mouth care. Staff told us that one of these people had become unable to walk without help and now needs two staff members with him. They also told us that although his records show he has fallen, this is usually a controlled lowering to the floor when he is walking. His care plan for falls has been updated to show there needs to be 2 staff members with him, although the moving and handling risk assessment does not mention this information or that staff have to lower him to the floor to prevent him from falling. Staff members said this is because of a worsening of his medical condition, although none of the other care plans show this person is any less able than when he first started living at the home. Only one persons plan that we looked at had information about preferences, although this was about their food likes only and there was little, if any details, about how people like to be washed and dressed. We talked to staff members about one person whose care records we had looked at. They were able to tell us about the person and show they have a good understanding of the people they look after. We also talked to a member of the intermediate care team about how people are looked after at the home. She said people at this home stay mobile for longer than other homes and staff seem to apply the principles of intermediate care to everyone that lives at the home. Plans are reviewed monthly, although many entries are recorded as no change, which doesnt show how that decision has been made. We saw that some needs had changed and this is recorded differently. Staff are referred to another record, although there is no review or evaluation of that information and plans are often not revised. Most of the people (3 out of 4) who returned surveys said they receive medical attention when they need it. There is information in care records to show health care professionals, such as specialist nurses, opticians and chiropodists, are contacted for advice and treatment. We looked at medication administration records (MAR) for half of the people who live at the home. These are completed and there are no records with entries missing. Entries for medications that have not been given show the reason for this. Amounts of medication remaining in blister packs of medication tally with the amount the MAR indicates are remaining. MAR sheet with variable dose medication have the amount that has been given clearly recorded. We watched a staff member giving out medication at lunch time. She did this
Care Homes for Older People Page 14 of 29 Evidence: appropriately, taking medication to each person, staying with them until they had taken their medications and explaining what the medications were for. However, the medication trolley was left unattended and open, although still in the open medication room while she did this. While we walking around the home we found a prescribed medicated shampoo and cream in an unlocked cupboard in one of the bathrooms. Cupboards in the other bathrooms we saw were all locked. Medication fridge and storage room temperatures are taken and recorded as being at an acceptable level for the safe storage of medication. We talked to staff about also recording minimum and maximum temperatures for the fridge and the time that the room temperature is taken. These are also important because records show the room temperature is close to the maximum storage temperature recommended for most medications. The fridge temperature was recorded as the same each day, and doesnt show how high or low the fridge temperature becomes. We expect staff to be able to improve these areas in safe medication handling without the need for a requirement. Care Homes for Older People Page 15 of 29 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff members have a good understanding of peoples needs, but there are limited activities available and people are not able to always live as they would choose. Evidence: Staff at the home arrange for entertainers to visit the home, activities and events in the home. Half of the people who returned surveys (2 out of 4) to us said there are activities that they can take part in, but the other two people said that activities are only sometimes available to them. One relative told us, it would be helpful if there were enough staff to take out residents on an individual basis - if only for a few minutes walk around the outside of the home. We spoke to staff members who said all staff have responsibility for arranging and carrying out activities with people who live there. We saw a staff member playing bingo in the main lounge room in the morning, and staff told us they find most people want to do this in the late morning. However, they also told us there is no activity programme, which means that there is little planning for activities to meet peoples individual preferences and abilities. We talked to staff members while they were writing their care notes in the dining room in the afternoon. There were no staff
Care Homes for Older People Page 16 of 29 Evidence: available in the lounge room and no activities available to people, apart from watching television. We saw care plans for social interests and hobbies in two peoples care records. One care plan said the person enjoys watching television and enjoys other activities and that he should be made aware of activities so that he can join in. There is no information in the plan to show which programmes or activities he particularly enjoys, or how staff members should help him take part. Staff members told us that this person now has difficulty walking or helping with his personal care. Information in the other persons care records show they have taken part in activities on just 3 different occasions in 2008. Neither persons plan has been updated since it was written, one in 2006 and the other in 2007, both over 18 months before this inspection. People are generally able to make everyday choices about when to get up and go to bed, and where to spend their days, whether that is in their own room, or in the main lounge area. One person we spoke to said he can get up and go to bed when he wants, but would have to wait for a carer to help him. He wasnt sure if he could easily get up at a particular time. We saw and listened to how staff members interact with people and found they ask what people would like and how they would like it rather than telling people or giving limited options. The home has an open visiting policy and people can have visitors at any time of the day. The main meal is served at lunchtime and there is a choice of two hot meals every day. One person said they can ask for an alternative if they dont like what is on the menu. We saw lunch being served in the main dining room; food was served appropriately and drinks were offered throughout the meal. Half of the people who returned surveys said they like the meals and the food is good, the other 2 people said they only sometimes like the meals that are provided. Staff help people if they need this and we saw them being attentive and concentrating on what they were doing without being distracted. There was a social atmosphere during the meal, there were a number of different conversations and some singing to music that was playing. Care Homes for Older People Page 17 of 29 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know how to make complaints and concerns known and can be confident that these will be listened to. Evidence: All of the people returning surveys said they know who to speak to and know how to make a complaint if they have to. 3 out of the 4 people who returned surveys said that staff listen to what they say and act on it. Although one person said, because of the staff shortage there is often delay in actions taken. People we spoke to during the inspection also said they know what to do if theyre not happy about something. Everyone we spoke to during this inspection said they are happy with the service given to them. The home has a complaints procedure and keeps a complaint log to show how they have looked at and the outcome of complaints that have been made. We were told before the inspection there have been 3 complaints made to the home in the last 12 months. Two complaints have been investigated and both were answered in the correct timeframe. One complaint is still being looked at. We were told of one of these complaints and passed it back to the provider of the home as they were already investigating. We talked to care staff, who said they had received training in safeguarding people
Care Homes for Older People Page 18 of 29 Evidence: (adult protection), and cover the subject in National Vocational Qualification training. One staff member we spoke to was able to tell us what should be done if abuse was suspected. Information provided to CSCI before the inspection shows there have been no safeguarding referrals in the last 12 months. Care Homes for Older People Page 19 of 29 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and provides a safe environment, giving people a pleasant place to live. Evidence: The home is a large purpose built property on the main road through Ashfield in Sutton. People living at the home have access to a large lounge room, a dining room and a small area in the foyer of the home. The building is set in its own grounds, which includes two other care homes and a small garden. The general decor is good, and it was clean and tidy, with no offensive smells. 3 out of the 4 people returning surveys said the home is always or usually clean and tidy. Although one person made the comment that, at times the rooms (bedrooms) would benefit from being freshened. We looked around the home but found that this was the case, and all areas were clean and pleasant. We did find personal toiletries in one unlocked cupboard in a bathroom, although this was the only one in the home. None of these toiletries had peoples names on them, which means they could be used by more than one person. Toiletries should not be for communal use, which would not give people choice and runs the risk of cross infection. If toiletries are stored in a communal area they should be individually named. Care Homes for Older People Page 20 of 29 Care Homes for Older People Page 21 of 29 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff members most of the time with the training and skills to be able to care for people properly. Evidence: The training matrix shows new staff members are given induction training, which includes mandatory health and safety training. We spoke to three staff members who told us they have National Vocational Qualifications at level 2 or above. Information in the AQAA tells us that almost 94 of care staff have the qualification. However, the training matrix given to us during the inspections shows 64 of care staff have the qualification with another 6 (24 ) staff members working towards it. The training matrix shows nearly all staff have received required mandatory training. However, there are no dates for when 3 care staff last received moving and handling training, or when 7 staff last received fire training. Of the care staff who had received moving and handling training, 9 of them had not been updated within the last year. 6 of these dates were as long ago as 2006. Five of these people are to attend moving and handling training scheduled for November 2008. However, moving and handling, and fire training are mandatory and must be given on an annual basis. A requirement was made at a previous inspection regarding training. This requirement
Care Homes for Older People Page 22 of 29 Evidence: had a timescale of 31/01/07 and 31/01/06, which has not been met. Enforcement action is now being considered. Half of the people who returned surveys said staff members are usually available when they are needed and that they get the care and support they need. The other 2 people said this was only the case sometimes. One comment from the surveys was, there are times - particularly at change over times when there is not enough cover to deal with the needs of the residents. People we spoke to during the inspection said there is usually enough staff on duty. The 3 staff members we spoke to said they think there are usually enough staff members to manage, although there are times when it is busier. When we spoke to these staff members they were writing care notes in the dining room. There were no people who live at the home there at the time, they were all in their own rooms or in the lounge area. There were few other staff members available as it was during the handover period. We think there are enough staff available to help people most of the time, although there are times, such as during the afternoon and when people are off sick, when people have to wait. We think this because of the information we received from the intermediate care team who said people at this home are mobile for longer than other homes they visit. However, there are not enough staff to provide people with meaningful activities. We looked at recruitment records for two staff members employed since the last inspection and they both contain the appropriate recruitment documents including references, application forms, and Protection of Vulnerable Asults and Criminal Records Bureau checks. Care Homes for Older People Page 23 of 29 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is a safe place to live and people are asked their opinion so that things they are not happy with are changed. Evidence: The manager has been managing the home since December 2004. She obtained a City and Guilds qualification in Advanced Management and Care in 1997 and also has the D32 and D33 NVQ assessors award. A quality assurance survey is carried out by the home every month. This includes a staff questionnaire, meetings and surveys for people who live at the home and an audit of practices in the home. The results are reported back to the manager in a report by the senior management team. We asked the home to complete and return an Annual Quality Assurance Assessment (AQAA) before the inspection. They did this, but did not return it within the time we
Care Homes for Older People Page 24 of 29 Evidence: asked for it. They gave us information we asked for, although many sections were completed with one sentence answers. The home keeps some money on behalf of people who live there. Accounts are kept of transactions of money put in and taken out. We looked at 3 of these records; all three are clearly written and show how money has been spent. Information provided before this inspection shows equipment, like hoists, lifts and firefighting equipment has been serviced or tested as recommended by the manufacturer. We looked at fire equipment around the home; this has been tested within the last 12 months. We talked to a member of staff who was checking equipment during the inspection. He told us about the routine checks he carries out and how often this is done. This level of checking makes sure that equipment is safe and the home is a safe place for people to live and staff to work in. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 30 18 (1) (a) The registered person shall 31/01/2007 ensure that all persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform. Outstanding from 31/01/06 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 7 15 Care plans must be revised and updated when changes to needs have been identified. This is so there is a record of care that needs to be given and staff have clear guidance on how to provide that care. 31/01/2009 2 12 16 People must be asked what activities they would like to take part in. This is so that this matches their expectations, preferences and abilities, and provides meaningful activities. 31/01/2009 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 7 Reviews of care plans should be evaluations of how the decision has been made, and therefore an evaluation of whether the care identified in the care plans is effective or
Page 27 of 29 Care Homes for Older People not. 2 3 12 27 People should be consulted about their social interests and what they would like to do to fill their time. There should be enough staff to provide meaningful activities to people if they are also expected to carry out this role. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
