Inspection on 14/10/08 for Swimbridge House Nursing Home

This inspection was carried out on 14th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Swimbridge House Nursing Home 09/02/10

Swimbridge House Nursing Home 15/10/09

Swimbridge House Nursing Home 01/10/09

Swimbridge House Nursing Home 03/10/07

Swimbridge House Nursing Home 22/06/06

Swimbridge House Nursing Home 23/11/05

Swimbridge House Nursing Home 19/01/05

Swimbridge House Nursing Home 26/08/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Swimbridge House Nursing Home Swimbridge Welcombe Lane Barnstaple Devon EX32 0QT     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: Sue Dewis     Date: 1 4 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: Swimbridge House Nursing Home Swimbridge Welcombe Lane Barnstaple Devon EX32 0QT 01271830599 01271830107 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Margaret Myers Type of registration: Number of places registered: Mr John Kushmira Singh care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 24 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: None Date of last inspection Brief description of the care home Swimbridge House is a modern, detached two-storied purpose built building situated in the rural area of Swimbridge in North Devon, it is registered to provide care with nursing for up to 24 older people. There is level access throughout the home with a passenger lift to the first floor. Swimbridge House has 20 single bedrooms, most with en-suite facilities, 2 double/shared rooms are available if requested. There is a communal lounge and dining room on the ground floor and access to the garden area. The home has a car park and is set in lovely grounds surrounded by fields and Care Homes for Older People Page 4 of 29 Over 65 24 0 Brief description of the care home countryside. The home is situated in an area which is not served by public transport and therefore can be accessed by private vehicles only. A pre-school nursery has been opened adjacent to the home in part of the surrounding grounds. The cost of care ranges from 475 to 575 pounds per week at the time of inspection, this information was correct on 14 October 2008. Chiropody, hairdressing, personal toiletry items and newspapers/magazines are not included in the fees. The home also makes a charge if any people need a member of staff to escort them anywhere. Current information about the service, including the CSCI inspection reports is available upon request from the manager and displayed in the hallway for those people that may wish to look at it. 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: This unannounced visit took place over 8 hours, one day in the middle of October 2008. The last Key Inspection visit was made on 03 October 2008. The home had been notified that a review of the home was due and had been asked to complete and return an AQAA (Annual Quality Assurance Assessment). This shows us how the home has managed the quality of the service provided over the previous year. It also confirms the dates of maintenance of equipment and what policies and procedures are in place. Information from this document was used to write this report. Although only one inspector undertook this inspection, throughout the report there will be reference to what we found and what we were told. This is because the report is Care Homes for Older People Page 6 of 29 written on behalf of the Commission for Social Care Inspection. During the visit 3 people were case tracked. This involves looking at peoples individual plans of care, and, where possible speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process CSCI likes to ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to some people living at the home, health care professionals and some staff. At the time of writing the report, responses had been received from 8 people living at the home (some had been completed by their representatives, 3 health care professionals and 6 staff. Their comments and views have been included in this report and helped us to make a judgement about the service provided. During the inspection 3 people living at the home were spoken with individually and 3 others in a group setting, as well as observing staff and people living at the home throughout the day. The interaction between the people living at the home and those who care for them was also closely observed. We also spoke with 3 staff and the manager. A tour of the building was made and a sample of records was looked at, including medications, care plans, the fire log book and staff files. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 29 The report of this inspection is available from our website www.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. The admission procedure ensures that there is a proper assessment prior to people moving into the home, and that they can be assured that their care needs can be met. Evidence: There is a Statement of Purpose, Service User Guide and Brochure available to people thinking of moving into the home. One person commented via a survey they had completed on behalf of their relative XXX had spent a couple of weeks respite care so we had a lot of information about the home. The files of three people now living in the home were looked at. The Manager told us the procedure that she follows when people have been referred for possible admission to the home. We were told that this included visiting the person whether they were at home or in hospital to complete a pre-admission assessment. We were told that although people are always invited to visit the home, in general it is their family that Care Homes for Older People Page 11 of 29 Evidence: looks at the home on their behalf. All three files looked at showed that a detailed assessment had been completed prior to the person moving into the home. However, although the home confirms peoples needs can be met via the telephone, it does not write to people to confirm that their assessed needs can be met before they move in. The manager assured us that this would be done in future. The home does not provide intermediate care. 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 plans are detailed and generally provide staff with clear information that enables them to meet peoples health and social care needs on a day to day basis. The management of medication is good and helps ensure people are protected from the risk of not receiving their prescribed medication. Evidence: All people living at the home have an individual plan of care. We looked at the care plans for three people. The care plan format has changed since the last visit and there was some evidence that people and their representatives had been involved in reviewing and updating them. Care plans are drawn up using the pre-admission assessments completed before people move into the home. Daily records on each individual were generally objective and descriptive enabling the reader to have sense of the persons day. Recordings were generally non-judgemental and showed that people are thought of as individuals. The records are usually written by the registered nurse on duty using information gathered from care assistants. Care Homes for Older People Page 13 of 29 Evidence: Care plans are organised into 3 sections: Description of Need, Goals of Care and Care instructions. These contain good details of what care is to be provided, but little detail of how the care is to be delivered. This means that care staff may deliver the care in different ways and could lead to inconsistency of care. However, this is minimised to some extent by everyone having a Preferred Routine folder that does contain some more detail for some individuals. Care plans contain a variety of risk assessments, including assessment of pressure areas, moving and handling and nutritional requirements. However, there was no risk assessment for the use of bed rails for one person. The manager said that they had not done this because the individual had themselves requested bed rails be used. Information about visits from district nurses (for residential placements) and doctors had been recorded in individual care plans, showing clear evidence that people are supported to maintain access to specialist medical services. It was possible to see where concerns had been identified, the GP contacted and antibiotics prescribed. Positive comments were received from health care professionals and included Supports the individual in maintaining their health in an appropriate way and Always good at discussing patients/clients they are worried about. People who wish to look after their own medicines are supported to do so. Policies and procedures relating to medication administration were seen and we spent some time talking with the nurse on duty and observing them administering the medication. Medication administration records show that medicines are counted when received into the home and records relating to Controlled Drugs were well maintained. There were several hand written entries on the MAR (Medication Administration Record) sheets from when extra medication had been prescribed. The entries had been signed by two members of staff, which is recommended good practice. All people we saw during this visit looked well cared for and they were treated with respect by the staff and their right to privacy was upheld. Personal care was offered in a discreet manner. Staff told us how they respect peoples privacy when helping them with personal care. We heard staff speaking with people in a kindly, friendly way. The home has signed up to the Gold Standard for end of life care and have submitted information for their first audit. This will help to ensure people receive high quality care and that their dignity is maintained at the end of their life. Care Homes for Older People Page 14 of 29 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. Social interaction and activities are available and there is good daily variation and stimulation for people living in the home, although this may vary with the number of staff available. Evidence: Everyone living at the home has an Activity Care plan, which details their communication needs and their physical abilities as well as what activities they enjoy. However, whilst the plans detail what people like to do there is little evidence that they are being supported to pursue their interests. We were told, and some evidence was seen on care plans, that a variety of entertainment and social interaction is offered to people. Activities include, Bingo, skittles, Beetle Drives and hand massages. People were seen thoughout the day reading, doing crosswords and watching TV. One person told us that they liked to be outside a lot and that during the warmer months they tend a small patch of garden. There was a mixture of comments received via survey forms. Some people felt that there was plenty for them to do, whilst others felt that they would have liked to do more. Staff told us that they were usually able to provide activities each day, but that Care Homes for Older People Page 16 of 29 Evidence: on occasions they were not able to. This was generally because of a shortage of staff. Church services are held at the home, but are only held when the church can visit and not on a regular basis. We were told that the home would be celebrating Diwali (the Indian Festival of Light) so that people living there can gain an insight into the culture of many of the staff who work at the home. People living at the home told us that their family and friends can visit them at any time and that they are always made welcome. Some survey forms sent out to people living at the home had been completed by their representatives, who commented that they felt the home kept them informed, but one representative said they would like a weekly update on their relatives progress. So that people can be involved in the running of their home, regular Focus Groups are held and representatives are also encouraged to attend. The minutes of the meeting held in August were seen, when the menu was looked at and a forthcoming party was discussed. The next group planned for November will focus on privacy. People told us that the food was very good at the home and that there was always an alternative if they didnt want what was on the menu. Though the cook normally prepares the menus, we were told that they know everyones likes and dislikes and prepares the menu around these. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good complaints procedure in place and people can be confident that their concerns will be listened to and acted on. Adequate procedures are in place to ensure that people are protected from abuse. Evidence: There is a clear and simple complaints procedure that is displayed around the home. However, the contact details for CSCI need to be updated on this procedure. A complaints log is kept where details are kept of the complaint, any action taken and the outcome of the investigation. The manager told us that through the regular Focus Groups, people are encouraged to raise any concerns they may have and that these are addressed as soon as possible. Some people living at the home who were spoken with during this visit were unable to tell us whether they knew about the homes complaint procedure or whether they would feel comfortable making a complaint. However, those who were spoken with were able to tell us who they would speak with if they were unhappy about anything. One persons relatives commented via a survey form that I have found the staff to be so helpful, always ready to listen to concerns. Records show and staff told us that they have received training in Protection Of Care Homes for Older People Page 18 of 29 Evidence: Vulnerable Adults (POVA) issues. They were able to discuss different forms of abuse and said that they would report any suspicions they had. They were also clear about who they would report any concerns to, outside of the home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the home generally provides a comfortable and safe environment for those living in, working at and visiting the home, it does not reflect the standard of care that people receive at the home. Evidence: A full tour of the communal areas of the home was made and some of the bedrooms were looked at. We saw some bedroom doors being wedged open. The manager removed the wedges immediately, but told us that the people in those rooms did not like their doors being shut. Where people do not want fire doors kept shut, suitable devices must be fitted to ensure that the door would close immediately the firm alarm sounded. The communal areas of the home were light and airy and the seating was arranged to provide small areas where people could sit and chat or read, if they wished. Peoples bedrooms contained many individual items and reflected the personality of the occupant. People told us that they had been able to bring things from their home when they had first moved in. The house was generally clean and free from unpleasant smells, although carpets throughout the home were very badly stained, as were the dining room chairs. The home was very cluttered, with piles of items stacked in corners around the home. We were told that the home had not been decorated since it had opened, many years Care Homes for Older People Page 20 of 29 Evidence: before. Curtains in some areas were falling down from their rails. All of these matters gave the home a general uncared for feel. There is an easily accessible garden where many people spend time during the warmer months and some enjoy being out in all weathers. Radiators throughout the home are those with a low surface temperature which helps reduce the risk of people suffering burns from falling against them. Windows above ground floor level are not fitted with restrictors which means there is a risk that people may fall from them. The manager told us that that someone was going to look at fitting restrictors the following week. Thermostatic valves are fitted to the hot water system to ensure people are protected from burns from water that may be too hot. Staff said that they have received training in infection control matters and were seen following good control procedures. Disposable gloves and aprons were readily available around the home. The laundry area, though small, was clean and tidy and has an impervious floor covering that helps prevent cross contamination from soiled articles. Washing machines have the ability to meet disinfection standards and sluice machines are provided for disposal of bodily waste and clearing commode pots. Care and nursing staff are responsible for ensuring that the laundry for people living at the home is satisfactorily managed. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers and skill mix of staff on duty are sufficient to meet the needs of people currently living at the home. People are protected by robust recruitment procedures to ensure people who may be unsuitable to work with vulnerable people are not employed. Evidence: On the day of the visit there were 4 carers and 1 nurse on duty in the morning and 2 carers and 1 nurse on duty in the afternoon. We were told there would normally be 3 carers on duty each afternoon, but that someone had rung in sick that morning and agency staff could not be supplied. Records show and staff confirmed that they receive a wide variety of training including a comprehensive induction for all new staff. Other training includes Fire procedures, Moving and Handling, Tissue Viability, Dementia and Infection Control. Staff were praised by people living at the home when we spoke with them and also via surveys we received, some of which were completed by relatives. Comments included The staff always have time to talk to my mum and myself and will always be available when you need them, and I must add in good humour. Care Homes for Older People Page 22 of 29 Evidence: Three staff files were looked at and all contained the required information including, references, proof of identity and satisfactory CRB (Criminal Records Bureau) checks. This ensures that only people who are suitable to work with vulnerable people are employed at the home. 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 well managed resulting in practices that promote and safeguard the health, safety and welfare of people who live and work in the home. Evidence: The Registered Manager is a qualified nurse who has also obtained the Registered Managers Award. She has worked at the home for many years and works hard to ensure there is an open and transparent atmosphere within the home. Staff told us that they felt supported by the manager to do a good job. Comments received via survey forms included The home is very well run and The manager obviously is keen to keep high quality care/clinical staff and this seems to be the case. The manager told us that she is currently changing the quality assurance system over to another system. The last round of consultation was undertaken using the Essence of Care system, which is a nursing based tool. A action plan was produced showing areas for improvement. Focus Groups are held regularly to encourage people to have a Care Homes for Older People Page 24 of 29 Evidence: say in how their home is run. No monies are managed by the home on behalf of people living there. The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit, provided evidence that Swimbridge House complies with health and safety legislation in relation to maintenance of equipment, storage of hazardous substances, fire precautions, health and safety checks and risk assessments. Policies and procedures are not always inspected during the visit but the information provided on the AQAA helps us form a judgement as to whether the home has the correct policies to keep people living and working at the home safe. Information provided by the home, evidenced that policies and procedures are in place and along with risk assessments are reviewed regularly and updated where necessary, to ensure they remain appropriate and reduce risks to people living and working at the home. So that the risk of burning from hot surfaces is minimised, radiators within the home have low surface temperatures and so that the risk of burning from hot water is minimised temperature controls are fitted to taps. There are no restrictors fitted to windows above ground floor to minimise the risk of anyone falling from these windows. However we were told by the manager that someone was coming to look to fit these the following week. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 13 Suitable devices must be fitted to doors where people wish to have their doors open. This is so doors will close and people are kept safe if there is a fire. 10/02/2009 2 38 13 Restrictors must be fitted to windows above ground floor level. So that the risk of people falling from them is minimised. 10/02/2009 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 3 The home should write to people to confirm that their needs can be met, so that people can be assured they will receive the care they need. Risk assessments for the safe use of bed rails need to be completed so that the risk to people either climbing over or slipping through the rails is minimised. 2 7 Care Homes for Older People Page 27 of 29 3 7 More detail needs to be added to the care plans to show staff how assessed needs are met, rather than just what the assessed needs are, so that people can receive care in a consistent manner. The complaints procedure needs to be amended to show the correct details of CSCI so that people can contact us if they need to. The home should be kept clean and well maintained so that people have a comfortable place in which to live. 4 16 5 19 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!