Inspection on 22/07/09 for The Langston

This inspection was carried out on 22nd July 2009.

CQC found this care home to be providing an Adequate 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 Langston 12/07/07

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: The Langston Station Road Kingham Oxfordshire OX7 6UP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Andy McGuckin     Date: 2 2 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 Langston Station Road Kingham Oxfordshire OX7 6UP 01608658233 01608731732 Langston@jsai.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): J Sai Country Home Limited The registered provider is responsible for running the service care home 36 Name of registered manager (if applicable): Type of registration: Number of places registered: 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 to be accommodated is 36 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The Langston is a privately owned care home providing nursing and personal care for 36 older people. It is located in the Oxfordshire countryside, near Kingham village railway station, and the market town of Chipping Norton. The home is a Grade 2 listed building of Cotswold stone dating from the 1870s, is set in spacious grounds and enjoys extensive views over open countryside. Care Homes for Older People Page 4 of 26 Over 65 36 0 Brief description of the care home The house is a large four-storey building and the accommodation is arranged over two floors, with a passenger lift and stairs leading from the hallway. The home has been extended to provide the nursing wing. There are 28 single rooms, 16 of which have ensuite facilities, and four shared rooms, two having en-suite facilities. There is adequate car parking to the side and front of the house. A Registered Nurse is in attendance at all times. Fees charged by the home can be obtained directly from them. Care Homes for Older People Page 5 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We undertook a site visit to the home accompanied by an expert by experience. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. We toured the building, spoke to the manager, residents and staff. Inspected core documentation to ensure compliance with regulation. Included comments sent to us by the home in the form of an AQAA. Observations were made about the interaction of staff with residents and comments have been made as to how the home can make improvements to these areas. Care Homes for Older People Page 6 of 26 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 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. The home provides prospective residents with sufficient information on which to make an informed decision. Evidence: The homes Statement of Purpose and Service User Guide have been updated and contain information about what the home can offer and what their terms of business are. Privately funded service users will have a contract direct with the home. For funded or part funded service user the home will have a contract with the local purchasing authority. The expert by experience commented that The brochure picture needs updating as it doesnt reflect how the home looks now . Evidence was found that the home undertakes an assessment of need prior to residents joining the home. Where an emergency admission is the only alternative, the home completes an assessment as soon as possible. The assessment covers a wide range of activities including the physical, emotional and daily needs of the individual. Information is on file as to the past history of the resident and what their likes and dislikes are. Care Homes for Older People Page 9 of 26 Evidence: Residents are encouraged to visit the home prior to final admission. This can take the form of a visit to have lunch or a short stay. The home does not offer an intermediate care service. 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. Residents health and personal care needs are usually recognised and met. Evidence: We looked at six residents files to assess compliance with the above standards. Each residents health and personal care needs were found to be met. This starts of with contact details and basic information as to the needs of the individual. These needs are expanded into a plan of care which will be a more detailed account of the persons needs including past history, any cultural or faith needs and information as to how the individual wants the care to be given. This will include times for getting up and going to bed and also any preferences around food. A comprehensive assessment of the health care needs of the individual will have been supplied by the residents General Practitioner and any specialist health care needs will be met by the district nursing service. Many of the homes residents have dementia or are confused which means that in the main medication is managed by the home. The home has a robust system for the management and administration of medication. The home operates a key worker system where a carer is assigned to a small group of residents. This ensures a certain amount of consistency and one to one time spent with residents. During the Care Homes for Older People Page 11 of 26 Evidence: inspection we only witnessed residents being treated with respect and dignity. Doors were knocked on prior to entry, and residents were addressed in a manner which had been agreed and was noted on file. Evidence was found at the inspection that residents wishes regarding serious illness or death,where expressed, were clearly noted on the file. Some residents had completed a living will. 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. Improvements are needed to develop a varied and interesting programme of activities. The home need to enhance the dining experience for its residents. Evidence: The home has an activities co-ordinator who works as a carer in the morning and moves to activities in the afternoon. On the day of the inspection she left the home at 2 pm so no activities took place that day. We asked to see the last 2 months activity programmes but these could not be produced.The inspector requested a copy of the following months activities to be sent to him. The expert by experience made the following observations: The activities organiser had no budget but the Residents Fund is used to cover outings. Bingo and quizzes were staples, and a new venture called Movement and Music had begun. Comments made to the expert by residents included the following: Its alright, I would not choose it I dont think much of it I watch the television there is not much else to do Care Homes for Older People Page 13 of 26 Evidence: There is not much to do here , so I get bored Its fairly comfortable here, we are looked after quite well I could not improve on it. it suits me fine The expert made the following observations: The main living room doubles up as a lounge and a dining room. The dining furniture is new and of good quality, but the carnations on the table were faded. Armchairs are placed around the lounge area, which has a large television. Throughout her time in the lounge the television was on at high volume. Initially there was no stimulus from staff, but just after 11 o clock the manager came round for 10 minutes talking to each resident. A high proportion of the residents in this room were confused or had difficulty in ordering their thoughts. There were no books in the lounge. The expert by experience spent some time in what was described as the nursing lounge where she observed that there were four women. One was constantly talking, one sang songs occasionally, and the third was quite frail and the fourth kept shouting at intervals. The noise had so upset one resident that he had gone back to his room. There were uncovered drinks on the floor. The expert spent time in the two lounges to observe the lunchtime routine. Her comments are as follows: Staff serving drinks had a brief word with each resident, but did not follow this up, so some drinks got cold because residents were unaware, or had forgotten that they had been delivered. The expert by experience was informed that there is a four week menu. When she asked which week they were on are on she was told I do not know the kitchen just sends out what they have prepared On the day of the inspection the expert observed that there was a choice between fresh chicken and leek pie and Cornish pasties from the freezer, followed by banana custard. The expert examined the four-week indicative menu. She noted that there was a shortage of fresh fruit and salad, with salad on the menu once a week and fruit salad three times a month. The inspector and expert by experience were told that fresh fruit was available throughout the day, but none was in evidence. The expert spoke to the Chef, who was going home early because of a transport problem. She was informed that previously the chef had been a housekeeper and was promoted when the previous chef left. The cook informed the expert by experience that she knows how to cook, but not the rest . The cook buys meat, fruit, vegetables, bread and milk locally, and otherwise uses a catering supply company. She has no budget, and the owners have not objected to her costs. I just buy what I Care Homes for Older People Page 14 of 26 Evidence: need for the menu However, a chef from another home is coming to give guidance. On that chefs advice, she has already changed the method of serving food, from plating each portion to having it served in the dining room by carers. The chef also has to deal with record keeping and cleaning rotas. There was considerable variation between the nursing wing and the main lounge/ diner. In the nursing wing a member of staff was lovingly feeding a frail resident. In the main dining room a carer brought a tissue to a resident saying Can I just tidy you up At the other end of the scale, food was delivered on one tray without cutlery until the expert asked for cutlery to be brought. Food for those using trays was delivered briskly with the words OK with rarely a check to see that it was being eaten. Some residents complained that the television was too loud. Care Homes for Older People Page 15 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints process was found to be good, residents and those visiting the home were encouraged to make comment both positive and negative. To protect vulnerable people from unwelcome visitors the secuity arrangements at the front door needs to be tightened up. Evidence: On the day of the inspection we were let into the home and left to wait in the hallway. We were not asked who we were. It took some time to establish who was in charge and eventually we were introduced to the deputy manager. The deputy explained that the manager would be in shortly. We were not asked to sign the visitors book. The system of establishing who visitors are and signing then in needs to be tightened up as it could expose residents to harm. Staff also need to know who is in charge at any given time. The home has a complaints procedure which is open and available to those who visit the home. A copy of the complaints procedure is available in the entrance hall of the home. The complaints procedure can be made available in large print if required. The complaints procedure is given out with the Service User Guide and Statement of Purpose. Complaints inspected had been dealt with in a timely manner with agreed outcomes recorded. Where a complaint cannot be addressed to the satisfaction of the individual, the complainant has recourse to an independent body. Staff spoken to were aware of their responsibility in terms of protection and were aware of the policy on whistle blowing. All staff have been trained in identification and action required when Care Homes for Older People Page 16 of 26 Evidence: possible abuse has been identified or suspected. Staff are aware of the restrictions on the restraint of the individual and where steps need to be taken to protect the resident from harm a comprehensive professional assessment of this risk is undertaken and included in the care plan. Staff have also received training on The Mental Capacity Act. Care Homes for Older People Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents need to be assured that the home is safe and free from unpleasant smells. Evidence: The home is a large Victorian house which has been adapted and added to throughout the time it has been used as a residential home. The home is therefore not purpose built and many of the facilities you would find in a modern purpose built house are not in evidence. There are currently 28 residents in the home which is registered for 36 The residential accommodation is located on the ground and first floors. Above that is staff accommodation which houses six staff. The comments of the expert are as follows: Residents requiring nursing are based in a new wing, with corridor windows looking out onto a small courtyard. Four armchairs are placed in a conservatory bay, but these were unoccupied during my visit, and a member of staff told me that this area was very cold. The brochure picture needs updating. There were no book collections on my tour. The lounge for the nursing wing is an unattractive room, with a small window at one end. We were shown bedrooms on both floors. Those on the first floor are of a good size and look out on the surrounding countryside. However, the expert judged their furnishing to be poor. In some rooms there is a bedside cabinet, in some a chair, and the impression is of rooms being furnished with whatever was to hand. There was no Care Homes for Older People Page 18 of 26 Evidence: evidence of color scheming. Television sets and phones are provided by residents. Radiators in rooms have individual thermostats. There are some shared rooms, mostly used by couples. Several rooms smelt of urine, probably because there is no toilet close at hand. We were told that an extra cleaning programme has been organised to reduce the smell, but this does not address the root problem , lack of easy access during the night to a toilet. Commodes are not usually provided. One reason given was We like to encourage our residents to be independent On the tour of the building I was shown a bedroom which had a polystyrene ceiling. Some of the bedroom doors deemed to be fire doors were missing elecronic door closers. The home will take advice from the fire department as to the safety of this ceiling and doors in case of fire. As has been previously mentioned the home smelt of urine in places and the home are addressing this by the provision of 18 hours per week for carpet cleaning. The home felt that many of the residents prefer carpet to permeable flooring.The home in the main was well maintained and many of the rooms had been redecorated. There were however some of the older rooms which needed to be upgraded. A rolling programme of improvement is ongoing. Overall the home has sufficient toilets and bathrooms with some rooms having their own toilets plus the homes communal facilities. The home has provided specialist equipment where this is required, it has been provided following an assessment by a qualified person. Equipment is maintained by the supplier by means of a service contract. The home has a working lift which is able to accommodate a wheelchair. Some rooms inspected showed that residents had their own possessions around them while one or two of the other rooms inspected seemed rather sparse in comparison. Care Homes for Older People Page 19 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. The home employs staff in sufficient numbers to meet the assessed needs of its residents. Evidence: The staff rota showed that staff were available in sufficient numbers to meet the needs of the current residents. The home is operating below their registered numbers but have not reduced the number of staff on duty. Staff informed me that checks and references had been taken up and they were not allowed to work until checks had been completed. Residents were satisfied with the staff group and felt that there was enough people on duty to meet their needs. The home ensures that it has more staff on a busy times and reduces staff time where it is not needed. Staff are given a thorough induction in the basic requirements of the job. During their time at the home, they will be required to attend further training and are given the opportunity to gain a professional qualification in care.The home is staffed by a manager, senior carers and 30 care staff, it also employs cleaning and catering staff. A deputy manager post will be created in the near future to cover for the manager and strengthen the management of the home. Staff are recruited from home and abroad and represent a cross section of society. A qualified nurse is on duty at all times. Staff files were inspected and staff spoken to evidenced that the home has a robust recruitment procedure which includes providing a job description, taking up references, police checks and providing information to prove they are who they say Care Homes for Older People Page 20 of 26 Evidence: they are. Evidence was found at inspection and through talking to staff that they are being supported and supervised to do a good job. The manager is catching up with staff who have not been supervised for some time and will ensure that all staff have had a recent supervision. Supervision covers developmental issues and where there is a gap in knowledge or expertise this is dealt with in a way that results in the member of staff learning and putting this knowledge into their practice. The home are currently ensuring that staff are being trained in the care of people with dementia. The home produces a staff handbook, which staff work through and are assessed at various stages of their career and forms part of the annual staff assessment. Staff supervision is formal and recorded. Supervision now takes place on a regular basis and is planned in advance. Supervision is now regarded as an important part of staff development by both parties. Care Homes for Older People Page 21 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 is managed in the best interests of its residentsand has identified areas where it needs to improve. Evidence: The manager is new in the post and is still identifying areas which she has inherited and needs to make changes on. The manager brings with her a good level of experience in the provision of care for the elderly. She has experience of dementia care and would like to make the rear of the home, identified as nursing care to become a specialist dementia unit. The manager informed us that she is given a free hand to manage the home and where she makes requests for extra resources or an increase in budget these requests are mostly met. The home provided us with its annual quality assessment audit which informs us what the home has improved since the last inspection, any changes to the management or structure of the home and what plans the home have for the future. The homes manager promotes equality of opportunity and fairness and keeps up to date and ensures that her training needs are met. The home has access to the Internet and use the C.Q.C website as a reference Care Homes for Older People Page 22 of 26 Evidence: point. The home has policies and procedures which staff are trained in and are expected to follow. A shortened version of these policies are to be found in the staff handbook. These policies are key to the thinking and ethos of the home and are updated regularly. The home works to its health and safety policies and staff are made aware of their responsibility in this respect. The proprietor makes regular checks on the home to ensure compliance with these policies. Records required for the safe and professional running of the home were inspected and found to be relevant and up to date. The home has robust procedures for managing residents money and will only do so where there is no one else to undertake this task. Financial transactions are kept to small amounts and for essential items to be purchased. These transactions are clearly recorded and audited independently. Care Homes for Older People Page 23 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 24 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 1 24 13 Doors deemed as fire doors 15/09/2009 wedged open and polystyrene ceiling tiles in areas of home that pose a high risk in the event of a fire. Advice from the fire officer must be sought and followed without delay to ensure that the home is free from hazards and the commsission informed of the outcome. The home must ensure the safety of its residents in the event of fire 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 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC 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!