Inspection on 10/03/09 for The Hawthorns Care Home

This inspection was carried out on 10th March 2009.

CSCI found this care home to be providing an Good 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

The Hawthorns Care Home 16/01/07

The Hawthorns Care Home 26/09/05

The Hawthorns Care Home 06/09/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Hawthorns Care Home 5 Burlington Road Buxton Derbyshire SK17 9AR     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: Rose Moffatt     Date: 1 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: The Hawthorns Care Home 5 Burlington Road Buxton Derbyshire SK17 9AR (01298)23700 Telephone number: Fax number: Email address: Provider web address: elaine.holder@salvationarmy.org.uk Name of registered provider(s): Type of registration: Number of places registered: Salvation Army care home 34 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 The Hawthorns provides personal care and accommodation for up to 34 older people. It is situated in the town of Buxton in the Peak District. It is close to a park and formal gardens and there is access to local amenities such as the theatre and shopping centre. The home is on three floors and has a passenger lift, 34 single bedrooms, 23 of which are en suite. There are 3 lounges, 2 of which are on the ground floor and 1 on the second floor. Gardens are provided including a sensory garden. The weekly fee is GBP484.34. People in the home pay additional charges for hairdressing, private chiropody, toiletries, magazines, name tapes and personal telephone calls. This information was provided by the manager on 10th March 2009. Information about the home, including CSCI inspection reports, is available from the manager. 0 Over 65 34 Care Homes for Older People Page 4 of 26 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 the service experience good quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. We looked at all the information we have received, or asked for, since the last key inspection or annual service review. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also has some numerical information about the service; surveys returned to us by people Care Homes for Older People Page 5 of 26 using the service and from other people with an interest in the service; information we have about how the service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. The previous key inspection of the home was on 16th January 2007. We carried out an annual service review (ASR) of the home in February 2008. The ASR looked at all the above information. The ASR showed us the home continued to provide good outcomes for people living there. We carried out an unannounced inspection visit that took place over 7 hours on 10th March 2009. The inspection visit focused on assessing compliance with requirements made at the previous inspection and assessing all the key standards. We sent out 10 surveys to people living in the home and received 8 completed responses. We sent out 10 surveys to relatives of people in the home and received 7 completed responses. We sent out 10 surveys to staff employed at the home and received 9 completed responses. There were 29 people accommodated in the home on the day of the inspection visit. We spoke with people in the home, visitors, and staff. Some people in the home were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Case tracking was used during the inspection visit to look at the quality of care received by people living in the home. 4 people in the home were selected and the quality of the care they received was assessed by speaking to them/their relatives, observation, reading their records, and talking to staff. 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. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 26 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 8 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had sufficient information and their needs were properly assessed so that they were confident the home could meet their needs. Evidence: All of the people we spoke with and those who responded to our surveys said their needs were met at the home. Most people said they had received enough information about the home so they could make a choice about living there. Some people had been able to visit the home before deciding to live there. At the previous inspection visit a requirement was made for the Statement of Purpose to be updated to show changes in the management structure. We found at this inspection visit that the requirement had been met. We looked at the records of 3 people living in the home. Each person had a comprehensive assessment carried out before admission that covered all areas of the Care Homes for Older People Page 9 of 26 Evidence: persons life and needs. There was also information from social services and hospital staff about the persons needs and abilities. The AQAA said that all prospective residents and their families are invited to view the home prior to admission, and that there is a 3 month trial period following admission. The AQAA said the home had improved in the last 12 months by reviewing and updating the assessment process. The AQAA said the home could improve by allocating and introducing keyworkers to people prior to admission. Standard 6 did not apply as there were no people receiving intermediate care in the home. Care Homes for Older People Page 10 of 26 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. People received care that was responsive to their individual needs and preferences, though this was not always evident from the care plans. Evidence: People we spoke with and those who returned our surveys said they always received the care and attention they needed at the home, including medical support. They all said that staff listened to them and acted on what they said. Most people said there were always staff available to meet their needs. The records we looked at each had a care plan. The care plans covered areas relating to the persons needs. There were details of the persons preferences regarding their daily routines, such as what time they liked to get up and go to bed. The care plans were reviewed every month by the keyworker. As noted at previous inspections, care plans were not routinely updated with any changes noted at reviews. One of the three care plans seen had been signed by the person to indicate their involvement and agreement. Care Homes for Older People Page 11 of 26 Evidence: People told us they had access to healthcare services, such as their GP, District Nurse, chiropodist, dentist and optician. Relatives told us they were kept up to date with any health concerns about the person. One relative told us they were pleased the staff had acted promptly to get the GP when the person was unwell. The care records showed that people had access to more specialist services as necessary, such as ophthalmic and audiology services. There were risk assessments relating to specific needs around the persons diet and any problems with eating. The risk assessments included brief details of the action required by staff. Records showed that each persons weight was monitored. The care records seen did not include a full assessment of the persons nutritional needs. The care records seen did not include assessments of the persons needs relating to continence, skin integrity, or moving and handling. Staff were aware of the needs and preferences of people in the home. The keyworker system in place appeared to work well as people knew who their keyworker was and described positive relationships. People told us staff are all superb, very friendly and caring, nothing is too much trouble for them, they are very good and helpful, and, they cant do enough for us. We observed that staff treated people with respect. The daily records seen showed that appropriate action was taken to meet the needs of people in the home. The daily records did not always follow current good practice in record keeping. Medication was securely stored in the home and was administered by senior care staff who had received appropriate training. There were good records of all medication received into the home and of all medication returned to the pharmacy. The medication administration records seen were correctly completed. People who wished to manage their own medication had a risk assessment in place and suitable storage in their bedroom. The medication reference book used was several years out of date. The AQAA said the home had improved in the last 12 months by ensuring all staff involved in administering medication had received appropriate training. The AQAA said that the care plans could be improved by streamlining information to provide more user-friendly records. Care Homes for Older People Page 12 of 26 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. The activities programme lacked range and structure so people had limited choices available. People were not regularly consulted about life in the home so could not fully exercise choice and control over their lives. Evidence: 5 of the people who returned our surveys said there were always activities they could take part in, 3 said there usually were. People we spoke with said there were activities they could take part in, though they would like a wider range offered. Some relatives and staff who returned our surveys said there should be more activities available. There was no activities coordinator employed at the home. The care staff took responsibility for organising activities, usually in the afternoons as there were more staff available. A volunteer from the homes League of Friends organised a weekly arts and crafts session and some of the items created were displayed in the dining room. The manager said there was an entertainer every month. 2 staff had received training to be able to lead gentle exercises and were in the process of organising a weekly session. In good weather, staff took people to the local park or into the town centre. Morning prayers took place in the main lounge every day and there was a Sunday worship service. Care Homes for Older People Page 13 of 26 Evidence: There were no meetings for people in the home and/or their relatives to express their views and opinions. People told us they could get up and go to bed when they wanted to. They said staff respected their choices, such as staying in their rooms or using the quieter top floor lounge and dining room. People were offered keys to their bedrooms. They were able to bring furniture and possessions to personalise their bedrooms. The relatives who returned our surveys and those we spoke with said they were always kept up to date with important issues affecting the person in the home. Visitors said they were always made welcome. Most people who returned our surveys and who we spoke with said they always enjoyed the meals at the home. One person said, I particularly enjoy the breakfasts. People told us there were always choices at each meal time. The menu for the week was displayed in the main ground floor corridor. The menu was placed too high to be read by someone seated in a wheelchair and was not in large print. The dining rooms were bright and pleasant. We observed lunchtime in the main dining room. The tables were laid with cloths, flowers, condiments, and paper napkins. People were offered cold drinks with their meal and also had a pot of tea on each table. Staff helped people as needed in a quiet and unobtrusive way, though one member of staff remained standing whilst helping a person to eat. The meals appeared well presented. The AQAA said the home provides a friendly and welcoming atmosphere and that routines are as flexible as possible. The AQAA said the home had improved by providing staff with training in creating a therapeutic environment for people with cognitive difficulties. The AQAA said the home could improve by providing a more structured programme of activities, and by involving people more in decisions on how the home is run. Care Homes for Older People Page 14 of 26 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 were satisfactory policies in place and good staff awareness so that people were protected and their concerns were dealt with effectively. Evidence: 3 of the people who returned our surveys said they knew how to make a complaint about the home if they needed to, 5 said they did not know the procedure. People spoken with said they would go to their keyworkers or senior staff with any complaints and they were confident that appropriate action would be taken. 6 of the relatives who returned our surveys said they knew how to make a complaint, 1 did not. All of the staff who returned surveys and who we spoke with knew the procedure to follow if anyone wanted to make a complaint. There was a satisfactory complaints procedure in place that was included in the Service User Guide given to all people in the home. There were records of complaints with details of the action taken and the outcome. No complaints had been received by CSCI about the home since the last inspection. Compliments received were also kept and were passed on to staff. There were satisfactory policies and procedures in place about safeguarding vulnerable adults. The manager and senior care staff had attended relevant training provided by the local authority. The manager said that other staff would attend this training when places were available. The manager said that staff had some training about Care Homes for Older People Page 15 of 26 Evidence: safeguarding vulnerable adults as part of their induction and as part of National Vocational Qualifications (NVQ). Staff spoken with were aware of types of abuse and the correct procedures to follow if abuse was suspected. Care Homes for Older People Page 16 of 26 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 was suitably equipped and well maintained so that people lived in a safe, clean, comfortable and pleasant environment that met their needs and expectations. Evidence: All the people we spoke with and those who returned our surveys said the home was always clean. People told us they liked their bedrooms and the communal rooms some people appreciated the views over the park. One person said the home was warm, comfortable, and smells fresh. The lounges and dining rooms were bright, clean, and suitably furnished. The main staircase carpet looked worn in places - the manager said the staircase would be completely refurbished following the planned installation of a new passenger lift this year. The shower room needed redecoration. A maintenance person was employed at the home and repairs were carried out promptly. Suitable equipment was provided, such as stair lifts, lifting hoists, specialist baths, and handrails. The home appeared clean throughout and free from any offensive odours on the day of the inspection visit. Staff spoken with were aware of infection control practices, such as hand-washing, using disposable gloves, and disposing of waste correctly. Staff Care Homes for Older People Page 17 of 26 Evidence: had received training about infection control. The laundry was suitably equipped. All the laundry was done by a contracted service. People told us they usually had their clothes returned to them in reasonable time and their clothes were well cared for. The AQAA said there was a programme of planned redecoration and renewal at the home. Care Homes for Older People Page 18 of 26 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 were satisfactory recruitment practices, a good staff training programme and appropriate staffing levels so that people were protected and well supported. Evidence: Most people we spoke with and who returned our surveys said staff were always available when needed. Most of the staff we spoke with and those who returned our surveys said there were usually enough staff available to ensure peoples needs could be met. The staff rotas showed there were usually 4 care staff for the morning shift and 3 in the afternoon with an overlap of some staff between 1:15pm and 4pm. We observed that there appeared to be sufficient staff available on the day of the inspection visit. The use of a contracted service for all cleaning, laundry, and kitchen staff ensured good support for the care staff. One member of staff said that this arrangement takes the pressure off us. We looked at the records of 3 members of staff. All the records had the required information and documents, except for one that did not have a photograph of the member of staff. New staff had an induction that included a period of shadowing more experienced Care Homes for Older People Page 19 of 26 Evidence: staff. The induction was in line with Skills For Care standards. Staff started working towards a National Vocational Qualification (NVQ) once they had completed their induction. The staff training records showed that most staff were up to date with required training, such as manual handling. Most staff had received training about the care of people with dementia. All of the staff we spoke with and those who returned our surveys said they had training to help them understand and meet the needs of people in the home. The AQAA said that out of 25 care staff, 20 had already achieved a relevant NVQ at level 2 or above. The AQAA said the home had improved by increasing the number of relief staff to ensure adequate cover in case of staff sickness. They planned to improve by introducing more flexible staffing and by developing further the staff training and development programme. Care Homes for Older People Page 20 of 26 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 was well managed with good systems in place so that the health, safety and welfare of people was promoted and protected. Evidence: We received positive comments about the home from the people we spoke with and those who returned our surveys. People said, a safe home with very good caring staff, a good home with a happy atmosphere, and, my mother is in the best home possible. Two relatives told us the manager and staff were good at communicating with relatives and ensuring they were kept up to date with any concerns about the person in the home. The manager was suitably qualified and experienced to run the home. She was supported by an administrator and three senior care staff. People told us the manager was approachable and they had confidence in her to take appropriate action on any concerns raised. Care Homes for Older People Page 21 of 26 Evidence: The quality assurance system included internal audits and annual surveys sent out to relatives/representatives of people in the home. The analysis of the surveys and any action taken was included in the annual report given to people in the home and their relatives/representatives. Surveys of the views of people in the home were not carried out. There were no meetings for people in the home and their relatives/representatives. Most people in the home had a small amount of personal money held and managed for them. The money was securely kept and there were good records with receipts and two signatures for each transaction. The AQAA was completed by the manager and contained clear, relevant information supported by a good range of evidence. Information provided showed that most policies and procedures had been reviewed in 2007 or 2008, though a few had not been reviewed since 2002 and some had no dates of review given. The AQAA showed that all equipment and systems had been maintained up to date. We looked at records of the checking and maintenance of fire safety equipment and systems and found these were all up to date. Care Homes for Older People Page 22 of 26 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 23 of 26 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 7 Daily records should be completed in black ink with no spaces left at the end of entries. The time of the entry should be recorded. This will help to protect people by ensuring records are kept in line with current good practice guidance. Care plans should be more detailed and use a more person centred approach, and should be signed by the person, or their representative, to show their involvement and agreement. This will help to ensure a consistent, person led approach to the care provided. There should be assessments of each persons needs and abilities in relation to nutrition, skin integrity, continence, and moving and handling. This will help to ensure a more robust approach to ensuring peoples needs are recognised and met. There should be an up to date medication reference book in the home so that staff, and people in the home, have access to current information. In consultation with people living in the home, their families, and staff, a programme of activities should be Page 24 of 26 2 7 3 8 4 9 5 12 Care Homes for Older People 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 developed that meets the needs and expectations of people in the home. 6 14 There should be regular meetings for people in the home, and / or their representatives, so that people are helped to exercise choice and control over their lives. Daily menus should be provided in a format and place so that people can easily read them. This will help to ensure that people know what choices are available to them. The quality assurance system should be further developed to include the views of people in the home. This will help to ensure their views are taken into account and the home is run in their best interests. Policies and procedures should be reviewed annually, or more often if there are significant changes. This will help to ensure that people in the home and staff have correct and current information. 7 15 8 33 9 38 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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!