Inspection on 14/04/09 for The Meadows Care Home

This inspection was carried out on 14th April 2009.

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

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

Other inspections for this house

The Meadows Care Home 11/03/10

The Meadows Care Home 17/12/08

The Meadows Care Home 14/10/08

The Meadows Care Home 21/12/05

The Meadows Care Home 04/08/05

The Meadows Care Home 05/10/04

The Meadows Care Home 22/06/04

The Meadows Care Home 19/02/04

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 Meadows Care Home 48 Moorend Road Yardley Gobion Towcester Northants NN12 7UF     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: Ansuya Chudasama     Date: 1 4 0 4 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 27 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 27 Information about the care home Name of care home: Address: The Meadows Care Home 48 Moorend Road Yardley Gobion Towcester Northants NN12 7UF 01908543251 01908543234 meadowscarehome@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Downing (Meadows) Limited care home 34 Number of places (if applicable): Under 65 Over 65 34 old age, not falling within any other category Additional conditions: 0 That the home continues to be registered to accommodate 34 service users in the category of OP, for either Personal or Nursing Care Date of last inspection Brief description of the care home The Meadows is situated in Yardley Gobion a village location midway between Northampton and Milton Keynes. There are local shops and amenities and the home has good links with the community. The home is an extended original building set in its own grounds with extensive views of the local countryside from the rear of the property. It is registered for up to 30 service users with nursing needs and up to 10 service users requiring personal care, with a total of 34 service users accommodated. Accommodation is over two floors with a passenger lift and staircase for access to the first floor. There are a range of communal areas including two lounges and service users are able to enjoy the garden areas. Bedrooms are located on both floors and there are 21 single rooms with ensuite facilities, a further 2 single rooms with was hand basins and 5 double rooms available. Care Homes for Older People Page 4 of 27 1 8 1 2 2 0 0 8 Care Homes for Older People Page 5 of 27 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: This inspection was carried out in accordance with the Care Quality Commission (CQC) policy and methodologies which require review of key standards for the provision of a care home for older people that takes account of the peoples views and information received about the service since the last inspection. Evidence used and judgments made within the main body of the report include information from this visit. The report refers to we this is because the report is written on behalf of the Care Quality Commission. We last inspected this service on the 14th and 16th of October and 18th of December 09. This key inspection was carried out on the 14/04/09. The registered manager and Care Homes for Older People Page 6 of 27 the proprietor of the home helped out with the inspection process. During this inspection we tracked the care of three people who use this service. This involved reading their care records and also talking to them wherever possible to obtain their views on the service. We also spoke to some of the other people who live in the home. Documentation relating to staff recruitment, training and supervision, medication administration, complaints and health and safety were also examined. We had the opportunity to talk to some of the staff who were on duty and a tour of the home was also conducted. The current weekly fees range from 500.00 pounds for residential care and 620.00 pounds for nursing care. Additional charges are required to pay for hairdressing, news papers, magazines, chiropody, dry cleaning and podiatry. Information on the cost for these services can be obtained from the home. What the care home does well: What has improved since the last inspection? What they could do better: The home should ensure all staff receive at least 6 supervisions per year to find out how they are developing and working in the home to meet the needs of the people being looked after. Ensure that there are systems in place for bills to be paid to the people providing the service to the home. Ensure that the paperwork in the office is better managed so the information is easy for all staff to find easily. Ensure that the medication records are properly completed to minimise the risk of any accidents from occurring. The home needs to ensure that the food people enjoy is put on the menu so their needs can be met Provide brighter lights in the lounge area so the people do not strain their eyes and they are better able to read their books. Care Homes for Older People Page 8 of 27 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 9 of 27 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 27 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. Needs assessments and visits to the home are carried out for all the people admitted to the home to ensure that their needs will be met. Evidence: The people spoken to tell us that their family had chosen the home for them to live in. It was also said that they were given information about the home when they visited the place. One visitor told us when they visited the home, it looked clean and every one was nice and friendly and the bedroom seen was nice. One person told us that they knew about the home prior to their admission and they had lived nearby. Some people had also previously visited people in the home before coming to live at the home. The peoples files looked at showed that there were admission details of the person being admitted to the home so the staff had information to tell them how to meet the Care Homes for Older People Page 11 of 27 Evidence: peoples needs. All the people in the home have contracts and the people or their representative had signed this document so they are aware of their rights. Care Homes for Older People Page 12 of 27 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. The peoples personal and health care needs are met by the home Evidence: We looked at three peoples care plans in detail and discussed their care needs with staff on duty. The staff showed that they had very good understanding of the care needs of the people. We were told that all the care plans had been rewritten in a new format. Evidence showed that these plans were being reviewed on a monthly basis and some of them had been signed by the people. The care plans we saw clearly set out the peoples support needs and preferences in receiving personal care. We observed staff interaction and noticed that they talked to people in a respectful manner and were careful to preserve their dignity. The people we spoke to informed us that the staff knocked on their doors and maintained their privacy and dignity when doing personal care. Evidence read in the care records showed that the people are offered support for their Care Homes for Older People Page 13 of 27 Evidence: physical and emotional health needs. There were records of general practitioner, and hospital appointments, and people have access to the opticians, dentists, and other health care professionals. The people told us that if they did not feel well, they would tell the staff. One person said the nurses are looking after us well and always says goodnight. Compliment letters read showed that families were happy with the care provided at the home. For example one letter stated that their family member looked very well because they had put on weight from receiving good food and care from staff. One person informed us that they were diabetic and the nurses kept a check on them to make sure they were fine. We were told we get good medical care. The home was keeping charts for fluids and turning people in bed in one document. As discussed at the inspection that it would be good to look at other options of recording. One care plan for a new person admitted to the home had some information that was not completed fully. We were told that this would be done soon. The staff we spoke to were able to tell us how the persons needs were being met by them. The nurses at the home gave out medication and had received the accredited training. We observed staff giving out medication and this was done nicely by talking to the people. We were told that a senior staff member carried out a weekly audit of medication and they worked hard to ensure medication is managed satisfactory. The records completed for this audit was seen. There were medication profiles for each person and these had been updated. The medication records looked at showed that there were some times gaps in the record where staff had not signed to say that the person had been given their medication. The manager was aware of this and stated that agency staff did not always complete records properly, however the senior staff monitoring the medication was dealing with this. The home had controlled drugs and these were kept in the controlled drugs cupboard. The records and medication checked was satisfactory. Some care staff spoken to have done the training on dying and death. We were told that the nurses on duty would support care staff to carry out this task. A compliment letter received from a family member stated that the home had provided good care for their family member when they had passed away. A range of risk assessments are in place that enables the people to take risks as part of an independent lifestyle. Care Homes for Older People Page 14 of 27 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. Meals served are nutritious and plentiful with a menu which changes each week so that the people have a balanced diet with some choice Evidence: We observed the people in the home having their lunch. This was eaten in a relaxed atmosphere with staff talking to the people and encouraging them to eat in a kind manner. There was music playing in the background which was relaxing. All the people spoken to said that the food cooked on the day was lovely. A variety of comments were received about the food. One person told us that they have good and bad food and it was said that the lady cook was better than the chef. We were told by another person that they enjoyed curries but this was not recorded in the menus. It was also said that they enjoyed pasta but this was also not often recorded on the menus. Other people told us the food was very nice. We were told that two options are offered at meal times and if they did not like what was on the menu, they were given another choice. The meals recorded were healthy and staff had good understanding of the peoples likes and dislikes of food and this information was recorded in the kitchen. This was also recorded in the peoples files. Care Homes for Older People Page 15 of 27 Evidence: The people told us that they liked their bedroom, and each persons bedroom seen was individualised to their taste. Some people enjoyed spending time in their rooms as they preferred this. We were also told that if they want any thing staff will help me and i have a buzzer and I can use it any time. Most of the people in the home maintain contact with their families/friends. One person told us that it was not too bad living here and their family took them out for a meal. Another person said that they had not been out since they came to the home except when they had to go to hospital. The manager informed the person that the staff would take them out when the weather got warmer. The home had employed a new activity organiser and they worked five days a week. A copy of the weekly activities was displayed so the people knew what was happening each day. Some of the activities include, playing bingo, quizzes, painting flowers, games, and crafts and having a one to one with a person. One person informed us that they enjoyed playing quizzes and had made cakes. An activity sheet was completed for individual people and this was kept in their files. We were told that the seating in the lounge had been changed and this was so impersonal. It was said that this lounge was cosy before the change because the people sat in small groups but now they sit in a large circle. This was observed on the day of the inspection. We were also told that the people who are able to have a conservation should be able to sit next to each other. We observed people struggling to read their book because the light in the lounge was very dim. On the day of the inspection the front lounge was used as a hairdressing room. The room had a strong smell of hairdressing products. The visitors in the home and other people could observe this activity taking place. This was not good practice because the peoples dignity was not maintained. This was discussed with management and it was acknowledged that another room was needed to carry out this activity. The garden was pleasant and we were told that the people enjoyed sitting in the garden when the weather is warm. Care Homes for Older People Page 16 of 27 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. The staff have good understanding of the peoples behaviours to ensure they are protected from any abuse. Evidence: The home has a complaints policy, and the procedures for making a complaint is recorded in the service user guide and displayed on the notice board. The home has not received any complaints since the last inspection. The staff spoken to informed us that they had completed the safe guarding of vulnerable adults procedures training. They had good understanding of this and understood the peoples behaviours to know if they were unhappy or not feeling well. The home has not made any referrals to the safe guarding team of social services. Some of the people spoken to were capable of informing staff if they had any concerns. They told us that they would tell the manager or staff if they were not happy. However there were some people that we spoke to and they did not know who to tell if they were unhappy. Families spoken to informed us that they would tell the staff or the manager if they had any concerns. The peoples finances inspected showed that this was managed well. Care Homes for Older People Page 17 of 27 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. The home is clean and has a relaxing atmosphere and the programme of redecoration is on going to meet the needs of the people. Evidence: A tour of the home showed that the place is clean and homely. The bedrooms seen were individualized to the people and those spoken to tell us that they like their rooms. The rear lounge/dinning area was pleasant and had the views of the pleasant gardens. We were told that the people like to sit outside in the garden in the summer months. The path leading into the garden was wheelchair friendly. The hand rails leading into the garden needed painting. The grass and the hedges in the garden had over grown. We were told by the proprietor that he had bought a new tractor to cut the grass. This was to be done when the weather got better. New lights have been put in the lower entrance corridor and this gives a brighter look to the place. Upstairs in the new building, the walls were being painted and the people had chosen the colour. The lights were also replaced and we were told by staff that this made the place much brighter and better. The stair carpet needed replacing on one part of the stairs because the carpet was worn out and old. The front lounge had been decorated and painted. However the seating arrangements and lights in the lounge which were very dim did not meet the peoples needs. The visitors toilet floor Care Homes for Older People Page 18 of 27 Evidence: needed replacing as it is worn out. We were told that the home did not have enough storage space. This was observed on the day of the inspection because a hoist was being stored in the lounge area and the room did not feel homely. Two wheelchairs were also kept in the shower room. The manager said that they would look into this Care Homes for Older People Page 19 of 27 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 staff have good understanding of the needs of the people to ensure their care needs are met fully. Evidence: The staff recruitment files were looked at in detail. Evidence showed that the home was obtaining all the relevant information required to safe guard the people in the home. However they did not take copies of the peoples birth certificate or passport when staff brings this to the home to get their Criminal Records Burea check(CRB). We were told that they just make a note to say that this was seen. The manager is aware that this information is needed to be kept in the staff files for inspection purpose. Staff spoken to and records seen showed that not all the staff were receiving supervision on a regular basis. We were told that this was due to getting all the care plans updated and the home had been short staffed. The manager was going to monitor this. The people told us that they find it harder to bond with agency staff but got on well with the homes staff. The staff working rota and staff spoken to said that there were enought staff on duty. The manager informed us that they had recruited care staff and bank staff and had one vacancy for a full time nurse. The home has been trying hard Care Homes for Older People Page 20 of 27 Evidence: to get this position filled. This position was being covered by an agency staff who has been coming to the home on a regular basis to provide some continuity to the people. The staff say that they enjoy working at the home, and it was said that they looked after the peoples needs well. We were told that the home has staff meetings and these are good because they know what is happening in the home. It was said that they all get on well as a team. We were told that the staff training has got better and the staff get more involved in care planning. New staff files looked at, and new staff spoken to said that they received an induction at the home. They also attended college for one week and completed the skills in care induction training. This included undertaking all the statutory training such as manual handling, first aid, safe guarding of vulnerable adults, values in health ad social care, diversity, confidentiality, health and safety, infection control, communication and developing as a worker. The staff told us that this training was very good. We were told that six people were doing the dementia training and other six staff were to do this after the others had completed the training. All the staff had completed the Mental Capacity Act and safe guarding of vulnerable adults training. A few staff had completed the death and dying training, and most of the staff had completed the fire training. 4 staff were doing the palliative care training. The staff had completed the food hygiene training in house and now they were doing the accredited training. Care Homes for Older People Page 21 of 27 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. The home is run in the best interest of the people and management is aware of the areas where they need to make improvements to meet the needs of the people. Evidence: The manager of the home is qualified and has many years experience of running a home. She has good understanding of the areas that needed improving in the home. The staff tell us that the manager is supportive and lovely and listens to them. We observed that the home has worked hard and has made improvements in the home, and some of these are on going. We were told by the proprietor that the bills were being paid for the services provided to the home. However it was said that this had lapsed when the proprietor was on holiday and therefore payments were delayed. We were sent invoices from the home on the next day after the inspection to show evidence that all the bills had been paid. Care Homes for Older People Page 22 of 27 Evidence: We had a discussion with the proprietor regarding having a system put in place to ensure that all the bills are paid out on time. The proprietor was going to do this with the administrator of the home. A room needs to be allocated so the people can have their hair done in private. The home has a computer and this is used by the administrator. The manager informed us that they needed a computer so they are able to manage more of their tasks on the computer. This was discussed with the proprietor who agreed to look into this. It was stated that the manger would be able to look up information on the changes taking place with the Care quality Commission. Discussion with staff and records showed that they were not all receiving supervision on a regular basis but there was evidence to show that this has started. The manager also needed to have supervision on a monthly basis from the proprietor and this needs to be recorded. The accident and incident records show that these were being recorded appropriately. The last regulation 26 visit report read for the home showed that many good changes were taking place and the people were happy. Where improvements were needed, these were on going. The last survey for the people was carried out in May 08 and we were told that this was very positive. The paperwork in the office needed to be better managed because information was difficult to find. This was acknowledged by management The fire alarm system was being tested on a weekly basis. The emergency light testing was done on a monthly basis. We were told that fire drill practice was also happening on a weekly basis. Care Homes for Older People Page 23 of 27 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 27 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 19 23 Brighter lights must be provided in the lounge area. This is to ensure the people do not strain their eyes and they are able to read their book in the evenings. 25/06/2009 2 19 23 The hoist must not be stored 11/06/2009 in the lounge. This is to ensure that the people are kept safe and the lounge is kept homely 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 2 3 7 9 10 Ensure all care plans are fully completed. Ensure all staff signs the medication MAR sheets to minimise any mistakes from happening. An alternative room needs to be used when carrying out hairdressing activity in the lounge area. This is to ensure the peoples dignity is maintained. Provide a meeting for the people and any relatives who Page 25 of 27 4 14 Care Homes for Older People wants to attend to discuss the seating arrangements in the lounge to meet the peoples needs. 5 6 7 15 19 36 Ensure that the food the people enjoy is put on the menu to meet their needs. Replace the flooring in the visitors toilet because the floor looks old and worn out. Provide staff supervision on a regular basis to monitor how they are working in the home. Care Homes for Older People Page 26 of 27 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 27 of 27 - 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!