Inspection on 07/01/09 for The Manor, Exminster

This inspection was carried out on 7th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Manor, Exminster 04/12/07

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Manor, Exminster Main Road Exminster Exeter Devon EX6 8AP     The quality rating for this care home is:   one star adequate 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: Teresa Anderson     Date: 0 7 0 1 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. 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: The Manor, Exminster Main Road Exminster Exeter Devon EX6 8AP 01392824063 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) The Manor, Exminster Ltd Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 25. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability (Code PD) Date of last inspection Brief description of the care home The Manor is a Georgian house set in its own grounds in the village of Exminster, Devon. The home provides service for up to twenty-five people who are aged over 65 years of age. The premises have been extended to include 7 single ensuite bedrooms, all located on the ground floor with level access. Bedrooms on the first floor are accessed via stairs or a stair lift and have toilet and bathing facilities within close Care Homes for Older People Page 4 of 29 Over 65 25 0 0 25 Brief description of the care home proximity. There are two lounges and a separate dining area. The garden area is situated at the front of the building. It is block-paved with an attractive fountain and seating. Local amenities are a short walk away and local bus services into the city of Exeter are within easy access. The homes current level of fees are available direct from the home. Fees do not include personal items, such as non prescribed medicines, hairdressing, chiropody, dentist fees, optician fees, newspapers and other personal items. 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: 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: The last key inspection of this service took place on 4th December 2007. In April 2008 we (the commission) carried out an unannounced random inspection to check on what progress had been made in relation to the requirements set at that inspection, and to find out more about the management arrangements following the departure of the Registered Manager. This inspection took place as part of the normal programme of inspection. The visit to the home was undertaken by one inspector over one weekday. During the inspection we spoke with approximately 10 of the people living here, with 3 members of staff, with the Company Director, with visiting healthcare staff and with 3 Care Homes for Older People Page 6 of 29 visitors. We saw all of the communal areas of the home and some of the bedrooms. We looked closely at the care, environment and records relating to three people living here. We do this case tracking as a way of judging the experiences of people with different needs living here and as a way of judging the overall quality of care. Records seen including care needs assessments, care plans, medication records, training and recruitment records. Prior to the visit to the home information was provided to the commission in an Annual Quality Assurance Assessment (AQAA). In addition we sent surveys, asking for feedback and comments to 10 people living here and 9 were returned, to 5 members of staff and none were returned, to 7 relatives and 2 were returned and 2 health care staff and none were returned. Where feedback was provided, this has been included in the report. What the care home does well: What has improved since the last inspection? What they could do better: During this inspection the following areas for improvement were highlighted: Although a manager is due to start working here in February, the home does not have Care Homes for Older People Page 8 of 29 a manager registered with the commission. Assessments and care plans do not yet fully identify needs and risks or the actions needed to address these risks and meet needs. These documents are not stored securely. The way that medicines are managed is not yet fully robust. Work should continue to improve the arrangements for cooking meals for people living here. The home does not have a copy of the locally agreed procedures relating to safeguarding people (The Alerters Guidance) and staff (including senior staff) are not familiar with the procedures to be followed. The laundry does not have handwashing facilities and this may lead to the spread of infection. Fire checks, environmental risk assessments and action plans are not as robust as they might be with the home using unprotected heaters and some fire doors not closing fully (although the latter was addressed during our visit). If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have information they need about this home. More in depth assessments would help to improve the care planned and given. Evidence: In surveys people told us that they had enough information about the home before moving in and that they all had contracts. We talked to people who had recently been admitted. One said they had come to the home following an emergency and had not had any information. However, since then they had had lots of information and were happy with that. We also saw someone who is looking to move into a home temporarily being shown around the home. They were shown a number of areas, encouraged to ask questions and were given written information to take away. Care Homes for Older People Page 11 of 29 Evidence: We were told that this person had decided to come to the home for two weeks respite. This person had not had an assessment of their needs as they should have. We looked in care plans and saw that usually the most senior person undertakes an assessment of each persons need before they come to live here, (and the home write to each person confirming their needs can be met). We saw that a lot of information is collected. However, we also saw that some important information is not collected or used in a plan of care. For example one person admitted has a condition which means they are at risk of choking. This, and how it should be prevented or managed, had not been assessed prior to (or since) admission. 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. Further improvements to the planning of care would further reduce the level of risk of people becoming unwell and would further enhance the quality of care given. People are treated with respect and their dignity and individuality is maintained. Evidence: In surveys people told us they usually or always get the care and support they need. One person (admitted to the home for respite) wrote excellent support during the brief time I was there. Another person recently admitted said they take good care of me. Healthcare staff told us that this home has significantly improved in relation to the management and delivery of care over the past six months. We were told that, with the support of the Primary Care Team, this home is now more able to care for people with more complex needs. We looked at care plans and found that each person has a plan of care. Staff say they Care Homes for Older People Page 13 of 29 Evidence: look at these every couple of weeks but do not contribute to them in writing. However, we overheard staff contributing to plans of care verbally and saw that they are delivering the care as directed in the care plan. However, the care plans are not as specific or as detailed as they should be. For example, one person has a complex medical condition which means they are at risk of choking and potentially developing pressure sores. This persons care plan does not detail how choking might be prevented or managed. In addition a base line assessment of this persons vulnerability to pressure sores has not been carried out. In care plans where assessments of a persons vulnerability to developing pressure sores have been completed, actions to minimise the risk identified have not been recorded and the plan of care does not direct staff how to minimise the risk. We spoke with staff about this and were told that pressure relieving equipment is usually used when redness or damage to skin has occurred. No one living here has a pressure sore. We observed that staff know the people living here really well. They understand their likes and dislikes, preferences and idiosyncrasies, and we observed people being treated respectfully and with dignity. All personal care was delivered in private and staff discreetly offered assistance or support when needed. Staff were observed being friendly and helpful whilst maintaining a professional respect and distance. We looked at how medicines are managed and saw that improvements have been made since the last inspection. The person who showed us the system understands it well and also has a good understanding of the importance of keeping medicines safely and securely. Staff who manage medicines have received training from a national pharmacy. All medicines are stored safely. Secure and appropriate arrangements are in place for the storage of medicines that need special arrangements (controlled drugs, medicines managed by individuals and medicines needing to be refrigerated). The home does not currently have a trolley for staff to use when giving out medicines, meaning that the administration of medicines takes a long time. However, this is on order and should be arriving soon. We looked at records relating to medicines and found them to be up to date and accurate. We did also notice that some staff are not signing for medicines as soon as they give them, but do this at a later time. This is not good practice. Care Homes for Older People Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from being able to continue with their lifestyle and from flexible routines. Improvements to the way food is managed will further enhance the quality of life the people living here experience. Evidence: In surveys and during conversations people told us that they do not wish to have daily activities organised for them. They say they like to be social at times and to choose for themselves when they do this and who they do this with. Some people have developed friendships with the people living here, and some people know each other because they have come to live here from the village in which the home is situated. We noticed that people spend time in their own rooms, or in the lounge where a few people watched the large screen TV. We saw that staff told people when lunch was ready and helped those who needed help and wished to come to the dining room to do so. People sat in groups and chatted. The home also has two budgerigars which are chatty and which people watch and told us they enjoy as part of the home. Some people told us they like the outings, but in the bad weather prefer to stay in the Care Homes for Older People Page 15 of 29 Evidence: warm. We saw photographs displayed on one wall of the events which have taken place recently. Recent events have included a craft session, a cheese and wine party, the Christmas party and a play acted out by a visiting theatre group. In addition a member of staff plays the keyboard and is planning a Valentines Day recital. We saw visitors coming and going throughout the day. They told us they feel part of the furniture and they are free to come and go. They say they are offered refreshments and are kept up to date and informed. Some people who visit the home live locally and come to have lunch. We received mixed reviews about the food served at this home. One person commented this is the only disappointing thing. The home is having difficulty recruiting a cook and care staff are undertaking this task. People say some carers are good cooks and others not so good. On the day we visited one person living here had suggested that they have a fry up, instead of what was planned. The cook for the day offered this, and an alternative, to the people living here. Everyone seemed to enjoy their meal and people we spoke to said lovely and nice fresh egg. In surveys people say they would like more fruit and the option of brown bread. We noticed during this inspection that fresh fruit, as well as bowls of sweets were set out in the lounge and we heard people being offered a choice between brown or white bread. People also told us that routine in the home is flexible. They say that there are some routines, which are needed, such as meal times, but that otherwise their days are our own. Each care plan details what time the person likes to go to bed and get up and other preferences. However, people told us they change their minds frequently and that this is fine. One person told us they had decided to stay in bed longer that day because the temperature outside was minus 2 and they were so cosy and comfortable. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are listened to. They would be better protected from harm if staff received further training and were familiar with local procedures relating to safeguarding adults. Evidence: The commission have received some concerns about this home since the last key inspection. These have related to a lack of continuity of staff and changes to the way the home is managed. We have found evidence that the home is trying to address these issues (see staffing and management). The home have also received some concerns regarding the quality of food and staffing arrangements and can evidence they have, and are trying, to address these issues. In surveys people say they know who to make a complaint to if needed. In recent surveys people say they dont have complaints, only suggestions or queries and that these are listened to. Some senior staff have been named as being particularly helpful in addressing any minor issues and having the right temperament to do this. People say they feel safe and well cared for. We observed staff being kind and gentle. We looked at training files and saw that staff have received training in safeguarding people (preventing abuse). However, when we spoke with staff they were not sure about the local procedures which should be followed if an allegation of abuse were made. When we checked we found that the home does not have a copy of the local Care Homes for Older People Page 17 of 29 Evidence: guidance relating to this, that no-one at the home has attended the local training delivered by Devon County Council and that senior staff were not familiar with procedure or contact details. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy living in a relaxed and clean home. Evidence: People we spoke with, and in surveys, were very positive about the environment of this home. They say that now we have a permanent cleaner all parts of the home are clean. They say they like the relaxed and homely feel and that it feels like home from home. The home is well maintained, both inside and out, and a maintenance man has recently been appointed for this and for carrying out small repairs and redecoration. The bedrooms we saw are well furnished and decorated and are large enough to take any special equipment that is needed for those people with mobility problems. Each room is personalised to the taste of the person using it. The home has a large lounge, a dining room and a smaller room off the lounge used for a variety of purposes. Each room is traditionally furnished with good quality furnishings, fittings and decor. Two of the rooms are not centrally heated and the home reports this is going to be added in the near future. We visited the home on one of the coldest days of the year and found it to be warm throughout. Care Homes for Older People Page 19 of 29 Evidence: We saw staff following guidance relating to preventing the spread of infection. For example they washed their hands using the easily accessible liquid soap and paper towels. However, the provision of a handwashing basin in the laundry remains outstanding since March 2008. Care Homes for Older People Page 20 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. People are supported by staff who have the skills and training needed and who are recruited in a way that helps keep them safe from inappropriate staff. Evidence: In conversations and in surveys people told us the staff are lovely, kind and thoughtful. They say they are always or usually available when needed. We were told that there are usually 3 carers on duty in the morning (to care for up to 18 people), 2 or 3 in the afternoon and 2 at night (one waking and one sleeping). In addition one of the Company Directors is based at the home whilst a manager is being recruited, and the home has a cleaner each week day. The person cooking (one of the care staff) is extra to these numbers. However, there have been many movements within the staff group over the past year. Many staff known to some of the long term residents have left and some of the newer staff have only stayed a short time. The management group had to deal with a loss of five staff at the same time. Staff were bought in from other homes and people say that staff were well meaning but didnt know them or how the home was run. Since then the staff group has stabilised and new staff have been recruited. Health staff who visit the home say that since further and recent recruitment took place, staff Care Homes for Older People Page 21 of 29 Evidence: have or are developing the skills needed to care for people with higher needs and that standards of care and relationships have improved. Records show that recently recruited staff have received induction training based on Skills for Care and additional training in for example, administering medication, first aid and moving and handling people. The information sent by the home before this site visit shows that more than 50 of the care staff working here hold a National Vocational Certificate (NVQ) in care to level 2 or above. We looked at the staff files of three recently recruited staff. We found that each has undergone the checks recommended to help keep people safe from inappropriate staff. For example each has undergone an enhanced police check, has provided proof of identity and has two written references. Care Homes for Older People Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the way this home is managed will further improve the quality of life and safety of the people living here. Evidence: This home has not had a Registered Manager for nearly a year. Since the time that the Registered Manager left one of the Company Directors has been overseeing the home. A manager was recruited, but this person has since left. The home has now recruited a manager who plans to commence work in February 2009. As a consequence of this, the evidence shows that the home has not been able to achieve all of the planned improvements or address the shortcomings identified by the commission in December 2007 and in April 2008. Improvements have been seen in the management of medications, care delivery and customer satisfaction. However, further improvements are needed and the home and Care Homes for Older People Page 23 of 29 Evidence: people living here would benefit from consistent leadership and staffing. Improvements already highlighted in this report are the need to improve care planning and reduce risks, further improve the management of medicines and ensure that staff are familiar with local procedures relating to safeguarding people. In addition we found that the management of fire checks and risks could be improved. For example some of the fire doors in the home are not closing properly (although the Director arranged for this to be addressed whilst we were at the home). We also found that two heaters were hot to the touch and that a number of people living here who are near to these are at risk of falling. We found that confidential information (in care plans) is being stored unlocked in an area open to the public. We talked to the Director about how quality assurance is managed in the home. She told us that frequent meetings are held with the people who live here and their feedback is acted upon. She also told us that the company carry out their own surveys at least annually and that comments received are collated and acted upon. She is aware of the level of dissatisfaction around the staffing and managements arrangements and believes that this is now improving. We asked the Director how peoples monies are managed in the home. She told us that the majority of people living here either manage their own monies or that their families manage this on their behalf. People or supporters are billed for monies spent on behalf of people (such as hairdressing or chiropody) and receipts are provided. Care Homes for Older People Page 24 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 25 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 (1) (2) Each person living 27/03/2009 here should have a plan of care that details what their needs are and how these are to be met. This will help to ensure that peoples needs are met in a way that is appropriate, and is consistent. It will also help to ensure that reviews carried out are based on the care that is planned and given. 2 18 13 (6) Staff at the home should 27/03/2009 be familiar with the local procedures to follow if abuse were suspected or alleged. By doing this, it is more likely that appropriate actions will be taken to protect people living at the home. 3 31 9 The providers must make an 24/04/2009 application to register a manager with the commission. Care Homes for Older People Page 26 of 29 This will help to ensure that the overall management of this home is such that outcomes for the people living here improve, risks are managed or reduced and that staff benefit from consistent leadership. 4 37 17 (1) (b) Care plans relating to 06/03/2009 people using this service must be kept securely. This will ensure that all information about people is held in a confidential manner. 5 38 13 (4) (e) Risk assessments in relation to the hot to touch fire and the free standing heater in the dining room must be carried out and action taken to ensure that these risks are managed. This will help to ensure that people are safe from accidental burns. 13/03/2009 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 People should undergo thorough assessments prior to being accepted to live at the home to ensure that their needs can be met. These should form the basis of a care plan. When medicines are given they should be signed for immediately after being given, so that there is no confusion and no risk that the medicine might be given again. The home should continue trying to recruit a suitable cook so that people can further enjoy the experience of eating. Staff would benefit from training in local safeguarding Page 27 of 29 2 9 3 4 15 18 Care Homes for Older People procedures which is delivered by Devon County Council. 5 26 The home should follow the recommendation made by the Environmental Health Agency and supply hand washing facilities in the laundry. 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!