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Inspection on 04/04/09 for The Old Rectory

Also see our care home review for The Old Rectory for more information

This inspection was carried out on 4th April 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is well maintained and repairs are carried out as well as any redecoration within the home. The home was generally found to be in good order, warm, clean and tidy. The home welcomes visitors at any time, there were no restrictions as to when people can visit. Feedback surveys told us that in the main people appeared happy living at the home, one resident commented, " Since moving here I have found friends and most of all I feel secure having someone available twenty four hours a day".

What has improved since the last inspection?

There have been no significant changes or major improvements at the home since the last inspection.

What the care home could do better:

At the last inspection improvements were noted, however these have not been sustained. The care plan reviews had not been completed, other gaps in personal care records were noted. The activity records had not been completed. On the day of the visit not enough staff were on duty. Residents choices and expectations with regard to activities and food preferences are not taken in to account. Residents and their relatives must feel comfortable in approaching the manager if they have any concerns or complaints. The approach and manner of the manager in dealing with residents and relatives needs to be improved.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Old Rectory 195 Wigan Road Standish Wigan Greater Manchester WN6 0AE     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: Judith Stanley     Date: 0 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 25 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 25 Information about the care home Name of care home: Address: The Old Rectory 195 Wigan Road Standish Wigan Greater Manchester WN6 0AE 01257421635 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) : Mr Megraj Jingree,Mrs Premila Jingree care home 10 Number of places (if applicable): Under 65 Over 65 10 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 10. Date of last inspection Brief description of the care home The Old Rectory is a large detached property in Standish. The home is situated on the main road to Wigan and Standish town centres and is approximately five minutes drive from local amenities. The home offers 8 single rooms on the first floor, of which 3 have en suite facilities and 1 shared room on the ground floor. Bathrooms and toilets are on the first floor and toilets are on the ground floor. There is limited parking at the front of the home and a small garden area at the rear. Care Homes for Older People Page 4 of 25 Brief description of the care home The Old Rectory Care Home provides care and support for 10 older people. The current scale of fees per week ranges from 300 pounds and 11 pence to 425 pounds with a top up fee that varies up to eighty five pounds per month. Additional charges are made for hairdressing, newspapers, trips out, chiropody, alternative therapy and toiletries. Care Homes for Older People Page 5 of 25 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 was a key inspection, which included a site visit and was carried out over a period of five and half hours. The service did not know when the inspector was going to visit. During the visit we spent time looking at care records as well as information about the staff and health and safety including how the home and the equipment were kept safe. We also looked around the home to check overall cleanliness and decoration. As part of the inspection process, the provider was asked to complete a self assessment survey information document (Annual Quality Assurance Assessment). This was sent to the home before the inspection and had been returned to us prior to the site visit. Other information was gathered from feedback surveys we sent out. We received surveys from five residents, one relative and six staff. We also spoke at length to four residents and one relative. Some of the comments made have been added to the report. Care Homes for Older People Page 6 of 25 Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 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 9 of 25 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 are given information, and have their needs assessed before deciding to move into the home so they know that their needs can be met. Evidence: The home has a statement of purpose and a service user guide. This information is available in the foyer and tells people who are looking to move in to the home, what they can expect. It tells them about the services and facilities available and about the meals and activities offered. The information also informs people of the management and staffing structure within the home. Five residents returned completed surveys, these indicated that they were happy with the information they received prior to moving in to the home. We, the Care Quality Commission (CQC) checked the contracts/terms and conditions of all ten residents currently living at the home. It was noted that most of the contracts varied on the weekly fees charged and on the top up fees incurred per month. Fees Care Homes for Older People Page 10 of 25 Evidence: ranged from 311 pounds and 11 pence to 455 pounds and 40 pence. Top up fees varied from 15 pounds and 15 pence per month to eighty five pounds a month. The manager must make sure that prospective residents and their supporters are fully aware of the fees charged and the reason for the top up fee. The contracts need the address of the CQC printed on them as currently they state the home is registered with the National Care Standards Commission which has long ceased to exist. We looked at two residents files (these are referred to as care plans). On examination both care plans had a pre admission assessment in place. The assessment is carried out by the manager to ensure that the home and staff can fully meet the needs of the individual. The assessment covers areas of mobility, residents well being, continence, nutritional status, medication, areas of risk such as falls and personal preferences etc. Care Homes for Older People Page 11 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs were being met by care staff that respected their privacy and dignity. Evidence: We looked at care files for two people living at the home. Information held on file included a care plan to be followed, risk assessments, medical information, professional visits, record of meals and daily progress notes. On the first file we found details about residents details, such as next of kin, name of doctor, known allergies etc. There was a section on preferences which had not been updated since 08/10/07, this needs to be reviewed as somethings may have changed. There was evidence of when the doctor had last visited. Staff record what meals residents had eaten. When this was cross referenced the record did not correspond to the menu and there was no indication as to the changes. The meal should have been pork chops and rhubarb crumble, the written record stated chicken breast and sago pudding, (this was not an alternative). The records of bathing/washing were not up to date. The record showed that on 24/12/08, unable to bath due to dressing on legs, Care Homes for Older People Page 12 of 25 Evidence: had full wash. There is no other dates or details recorded and the weight or measure of biceps used to check weight loss or gain had not been completed since 24/02/09. The file states the dependency log is to be completed monthly. This had not been done since February 2009. Risk assessments for self medicating, moving and handling, personal risk, nutrition and pressure care were seen on file. The care plan had not been reviewed monthly as required with the last date being 07/01/09. The second file contained residents details including next of kin, name of doctor, any known allergies etc. The daily preferences plan had not been updated since 05/02/08 and this would benefit from being reviewed. There was a record of professional visits recorded and hospital appointments, record of food etc. Bathing records were up to date, however the record of weights were overdue. Relevant risk assessments were on file. Daily progress notes were recorded. The care plan had not been reviewed monthly as required, with the last date being January 2009. We checked the medication for the two residents files we were working with. Both had received their morning medication as prescribed. This was also confirmed by a resident. The home has a small amount of controlled drugs. These were seen to be suitably stored in a controlled drugs cabinet and recorded in a controlled drugs register. Although the register had the two staff signatures as required, it was discussed that one was not clear enough to distinguish and the initials and had overspilled in to the next box. It was discussed with staff that one of the night staff had not had medication training and would therefore not be able to give any painkillers during the night if it was required. The member of staff would have had to wake the staff member who was sleeping in to administer any medication required during the night. It would be beneficial if night staff were trained to administer medication. Information on the five residents surveys indicates that they always receive the medical support they need. One resident said, The doctors and nurses call on a regular basis, which is more than I received when I was living alone. We observed the staff on duty and their manner and approach when speaking with and caring for residents. This was seen to done in appropriate manner. Staff were polite, caring and respectful. Care Homes for Older People Page 13 of 25 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. People were not offered choices about the food served or consulted about the kind of lifestyle they want with regard to activities. Evidence: The home has an activities programme displayed in the hallway. At this inspection, as at the last, the activity provided was a quiz. This was confirmed by a resident to be A token gesture for our benefit. We were told that activities were limited and one resident said that Trips out are few and far between. The care staff have little time to spend with the residents as they are expected to carry out domestic tasks during the course of their shift. There was only one care worker rostered on shift and one in the kitchen cooking until 11.00. As we had arrived to carry out an inspection a senior member of staff was telephoned and came on shift early to assist us. On examination of the activity records there is a lot of watching TV documented. The residents individual activity files were not up to date with nothing recorded for one resident since 22 February 2009, another from 1 March 2009 and the remaining eight from 13 March 2009. Visitors can visit at any time, no restrictions were imposed. We received one survey back from a relative who was generally satisfied with the care her relative received, however a comment was made that more staff would be beneficial. Care Homes for Older People Page 14 of 25 Evidence: Information on the AQAA tells us that, Residents are encouraged to participate and use the facilities in the community, however we observed that most residents living at the home would not be able to do this without transport and staff support. It was also noted that half of the residents prefer to stay in their own rooms all the time, with some having all their meals there. We were told that this was their choice. One resident said, She liked her own company. Another said, There is nothing to go down for. If it is the residents choice to stay in their rooms, staff should have time to be attentive to their needs and be able to spend quality time with them. It has been brought to our attention by a visitor that, when a resident asked for a cup of tea was told by a member of staff, You know you cant have a cup of tea until teatime. This is not acceptable and residents should be able to have drinks at any time. The AQAA also told us that, A four week planned menu is available giving residents choice and preferences. This was seen not to be the case. Choices of a cooked breakfast are available, however this was not offered. On each table in the dining room printed menu cards were displayed. On the day of our visit the lunch time choices should have been chicken breast, vegetables and potatoes or hotpot. There was no hotpot available, all residents were served chicken. The dessert should have been apple pie and custard. There was no apple pie and every resident got a sundae dish with tinned peaches, no offer of cream or any other accompaniment. This appears to be normal practice and one resident when asked said, We never know what we are going to get until it comes. Residents, in the absence of the manager spoke with us more freely about food and choices available than at our last visit. We read the Resident Comments book, one comment dated was on 19 March 2009 and the other comment was dated 10 April 2009 (Good Friday) regarding food. As our visit took place on the 4 April 2009, this comment was a little premature and ahead of 10 April 2009. The dining room is comfortable for residents to enjoy their meals together. There are three tables which are set complete with tablecloths, crockery and cutlery. During our visit one these tables was not used, which was evident from the film of dust accumulating on the cups and saucers. One resident confirmed that no one sits at that table. Residents confirmed that they did not drink out of the cups but were given mugs. On the day of the inspection residents were served wine with their meal, which one resident commented, That does not normally happen. At our last inspection we commented about the clear plastic cloths covering the table cloths and recommended that they be removed. This has not been acted up on and the cloths were still in situ. The tea time meals were discussed with residents and despite the menus, it became apparent that a lot of sandwiches were offered. Some of the meals may not be appropriate or nutritional for older people for example chicken nuggets and hot dogs. We appreciate that a lighter tea is offered, but this must be substantial as for some people who do not have a supper, the gap between the main meal at lunch time to having their breakfast can be over fifteen hours. Residents commented on the lack of fresh fruit and vegetables offered and that yogurts would be nice for a change. The Care Homes for Older People Page 15 of 25 Evidence: home still does not employ a cook, There has been no domestic staff at the home for a number of years. It has been discussed at previous inspections that the home would benefit from a domestic team. Information on the AQAA tells that us that it is in the owners plan of improvement to hire a cook. In the absence of the owners care staff are expected to take over this role and do the best they can with the ingredients available. Care Homes for Older People Page 16 of 25 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. Residents and relatives must able to raise any complaints or concerns and be confident that these would be listened to and appropriate action taken in a suitable manner. Evidence: The home has a complaints procedure in place. On the returned surveys residents indicated that they knew how to make a complaint if they needed to. Information on the AQAA tells us there has been no complaints made to the management of the home since the last inspection. One concern has been made to CQC prior to our visit. This regarded the quality of the food, lack of choices offered at meal times and the attitude of the manager. From discussions with residents they said it was easier not to complain and it wouldnt change anything anyway. There had been no safeguarding referrals or investigations since the last inspection. Staff had undertaken training in protection of vulnerable adults. Care Homes for Older People Page 17 of 25 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. People live in suitably adapted, clean, comfortable and homely surroundings. Evidence: From a tour of the premises the home was seen to be clean and well maintained. We looked at several residents rooms and these were warm and comfortable and it was evident that residents had personalised their rooms with their own possessions and mementos brought with them from home. Externally the home was well maintained and the grounds were neat and tidy. On the day of the visit it was observed that infection procedures were being adhered to. However it has been brought to our attention that on one occasion a visitor observed the person who was cooking come out of the kitchen wearing an apron, assist a resident to the toilet and then return to the kitchen. This is not good practice and steps must be taken to ensure that good hygiene procedures are followed to safeguard the residents from risk of cross infection. It had been discussed previously with the owners about care staff covering the kitchen and providing care to residents during the same shift. Care Homes for Older People Page 18 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The procedures for the recruitment of staff need to be more robust to ensure suitable staff are employed to safeguard people who live at the home. Evidence: We arrived at the home at 08:15. There was only one member of staff working on the floor and one member of staff covering the kitchen. The owners/manager of the home were on annual leave. There were not enough staff on duty until someone rang for a senior member of staff to tell her we were at the home. The senior was not officially on duty until 11:00, but came in at 09:15 to assist us with the inspection. As at previous inspections it has been discussed that there must be two staff on duty working the floor which precludes them from domestic tasks such as cooking and cleaning. The manager must ensure sufficient staff are on duty to meet the needs of the residents. The rotas showed that no cook or cleaners were on shift to cover the weekend. Care staff would therefore have limited time to spend with the residents due to carrying out other tasks such as cooking and cleaning. One resident expressed,That trips out are few and far between. If two staff are working the floor it would be possible for one member of staff to support residents in their preferred interests. It has been recommended at previous inspections that the home would benefit from a domestic team, however this has not happened. Other members of staff do cover some domestic hours as extra shifts. The AQAA provided tells us that staff training is Care Homes for Older People Page 19 of 25 Evidence: ongoing and on checking some staff files there were certificates that verified this. Over 50 of staff have an NVQ level 2 in care. We checked two staff files and files contained: an application form, a Criminal Record Bureau check, medical questionnaires etc. In one of the files there was two character references and the names of the referees on the application form were different from the names on the reference. There must be a professional reference on file, preferably from the last employer, and character references from reliable sources. On the second file looked at there was a professional reference and two verbal references. The manager must try to obtain written references from people that will provide a general overview of the person she is hoping to employ. Staff turn over at the home is high and where possible it is beneficial for residents to have staff that are hoping to remain at the home for some time. This would provide continuity of care, help build relationships and residents would be confident in being cared for by people they know and trust. Care Homes for Older People Page 20 of 25 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 Old Rectory is managed with systems and policies in place to ensure the health and safety of staff and residents are promoted and protected. Evidence: Management arrangements within the home remain the same. Information on the returned AQAA told us that residents care plans are reviewed every month. It was noted in the care plans looked at that reviews had not taken place since January 2009. Feedback from residents told us that trips out of the home do not occur on a regular basis. The AQAA tells us that residents are encouraged to participate and use the facilities in the community. Also that the menus available offer choice and preferences. This was observed not to be the case and residents verified choices were limited. On speaking with residents and a relative we received mixed comments on the attitude and managers approach when dealing with residents and relatives. On the day of the visit the atmosphere within the home was relaxed. This was discussed and a resident made a comment, Its because the bosses are not here. Care Homes for Older People Page 21 of 25 Evidence: Systems were in place with regards to managing the service, which includes seeking the views of residents, family and friends. Within the last twelve months the home has also been inspected by a private company RDB ( this has no connection to CQC) and has been awarded a 5 star status. Where possible the residents and/or their family managed their own money. The home prefers not to be involved with the residents personal allowances. Other information provided in the AQAA was about policies and procedures held at the home and that these had all been updated in February 2008. A random check was carried out on safety certificates. These included the fire equipment and gas, portable appliances, lift and hoists and the electrics. All were up to date and valid. In the event of any accidents or incidents an accident report is completed and the CQC are informed as required. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 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 25 of 25 - 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!