Inspection on 21/10/08 for The Old School House

This inspection was carried out on 21st October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old School House 23/10/07

The Old School House 05/02/07

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Old School House The Old School House Thame Road Longwick Princes Risborough Buckinghamshire HP27 9SF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joan Browne     Date: 2 1 1 0 2 0 0 8 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 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 28 Information about the care home Name of care home: Address: The Old School House Thame Road The Old School House Longwick Princes Risborough Buckinghamshire HP27 9SF 01844343620 01844343620 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Nahida Arif Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The Old School House is a care home providing personal care for up to twelve older people with care needs associated with old age, dementia or mental disorder. The home is a converted building that was originally the village schoolhouse and is situated in Longwick. Accommodation is situated on the ground and first floors of the home. Access to the bedrooms on the first floor is via a stair lift. 3 3 0 Over 65 0 0 12 Care Homes for Older People Page 4 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced site visit which forms part of the key inspection to be undertaken by the Commission for Social Care Inspection (CSCI) was undertaken by Joan Browne on 21 October 2008 and lasted for approximately six and a half hours. The last key inspection on this service was completed on 23 October 2007. The CSCI Inspecting for Better Lives (IBL) involves an annual quality assurance assessment (AQAA) to be completed by the service, which includes information from a variety of sources. This initially helps us to prioritise the order of the inspection process and is referred to in the report. The information contained in this report was gathered mainly from records kept at the Care Homes for Older People Page 5 of 28 service and information contained within the AQAA. We also looked at care plan documentation, staff recruitment files, training records, medicaiton documentation and health and safety records. A tour of the premises was conducted and two visitors to the establishment were spoken to. Comment cards were sent to the home to be distributed to people using the service, health care professionals and staff members. Their comments have been reflected into the report. One requirement and six recommendations of good practice were issued on this visit. Please see health and personal care outcome area for full disclosure. Feedback was given to the manager at the end of the inspection. The fees for this service range from 550.00 pounds to 702.00 pounds. There are additional charges for chiropody, hairdressing, toiletries and newspapers. We (The Commission) would like to thank all staff and people using the service who made the visit so productive and pleasant on the day. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 7 of 28 The home must ensure that any problems or needs identified for people using the service are evaluated in the daily report writing. The home must comply with best practice guidelines to ensure that medication for people using the service is appropriately administered and recorded. 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 8 of 28 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 28 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. Prospective peoples needs are assessed prior to admission to ensure that the home is able to meet their diverse needs. Evidence: A requirement was made at the previous key inspection for the homes statement of purpose and service users guide to be reviewed. The annual quality assurance (AQAA) stated that the documents were recently re-written to include the appropriate information for prospective service users and their relatives to make an informed choice about where to live. The documents were examined and it is pleasing to report that they contained all the required information and were written in plain english. The manager confirmed that the home would be able to provide the documents in an alternative format if it was requested. The AQAA stated that a detailed assessment of prospective residents needs is carried Care Homes for Older People Page 10 of 28 Evidence: out in their home or hospital prior to admission. We examined the care documentation for the most recent admission to the home. Evidence was seen to verify that the individuals care needs were assessed prior to being admitted to the home. A detailed assessment was undertaken covering all areas of needs as outlined in standard 3.3 of the national minimum standards. Care Homes for Older People Page 11 of 28 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 home ensures that peoples health and personal care is based on their individual needs and their privacy and dignity are upheld. Evidence: The home uses a commercially produced care plan format as well as an in-house supplementary format which the manager had recently introduced to ensure that care was provided in a person centred manner. Three service users care was case tracked. The plans seen identified individuals needs and how needs should be met. We noted that there was no evulation on individuals needs and problems in the daily report writing. For example, in one particular care plan examined staff had identified a problem. There was no information recorded in the daily log on the progress made or what action had been taken to address the identified problem. Some care plans were signed by the service user or their representative to confirm their involvement in the care plan process. Evidence seen reflected that the care plans were being reviewed monthly. We observed scribbled over entries and tippex correction liquid used to correct entries recorded by error in the care plan. Because the plans can be used in a Care Homes for Older People Page 12 of 28 Evidence: complaints investigation or coroners inquest this practice should be reviewed. We also noted that staff were not signing their full signature when making entries in the daily log. To comply with best practice guidelines staff should sign their full signature. Two relatives were spoken to during the site visit and they both said that they were very happy with the care provided and felt that it was of a high standard. Evidence was seen in the care plans for the three service users whose care was case tracked reflecting that risk assessments relating to moving and handling and the risk of falls were in place. There was no risk assessment in place for the prevention of pressure sores. We were told that there were no service users with tissue damage. The manager was advised that as a precautionary measure all service users should have a tissue viability assessment on admission and this should be reviewed on a regular basis. Evidence seen demonstrated that service users weights were being monitored monthly. Information in the annual quality assurance assessment (AQAA) stated that the home has a close working relationship with the general practitioner and the district nurse practice. Service users are referred to the dentist, optician and dietitian when required. The home ensures that continence is managed sensitively and in a way that is suited to individuals needs. Arrangement was in place for individuals to have chiropody treatment every two months. People who responded to the Commissions survey said that they were receiving very good care. The home uses a monitored dose medication system. We were told that there were no service users with the capacity to self-medicate. The medication administration record (MAR) sheets were checked and no unexplained gaps were noted. We observed scribbled over entries on the sheets, which is not good practice and should be reviewed. Handwritten entries on the MAR sheets were not countersigned by a second staff member. To comply with best practice guidelines handwritten entries on the MAR sheets should be signed by a second staff member to prevent the potential risk of errors when transcribing. We observed that several service users were in receipt of Alendronic Acid medication, which is given to treat osteoporosis. Special precautions should be taken when administering the medication. There was no clear instruction on the medication packet to assist staff in administering the medication appropriately. Advice was given to the manager to ensure that the dispensing pharmacist writes clearly on the packet how the medication should be adminstered to ensure that it is appropriately administered by staff. Alternatively a protocol on the administration of the medication could be put in place with guidance from the homes pharmacist. The controlled medication register was checked and the records corresponded with the tablets that were in stock. The home has a separate cupboard for storing controlled medication. The manager was advised to check with the homes supplying pharmacist to ensure that it fully meets with the current legislation relating to the safe custody of drugs. There was a clear audit trail in place of all medicines entering and leaving the Care Homes for Older People Page 13 of 28 Evidence: home. Service users spoken to said that they were well treated and their privacy and dignity were upheld. Staff who responded to the Commissions survey were confident that service users dignity was being promoted and individuals were provided with person centred care. Service users were seen to be well groomed with attention to detail. Staff were observed interacting with service users in a respectful and kind manner. Care Homes for Older People Page 14 of 28 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. The home ensures that wherever possible it provides social and cultural activities to meet peoples diverse needs. The food provided is wholesome and served in pleasing surroundings. Evidence: Since the last inspection the home has employed an activity person who works twelve hours a week over four days. There is also a yoga relaxation session provided once a week which is faciliated by an outside facilitator and a pet as therapy (pat) dog that visits the home on a regular basis. An outside entertainer provides an organ music sing a long session on a monthly basis. We were told that the activity person discusses the activity programme with service users. A programme of the activities was displayed in the home. On the day of the site visit service users were observed engaged in a group activity which they were enjoying. People who responded to the Commissions survey said that the home always provide activities. Additonal comments from a respondent said that more outside activities would be appreciated. We were told that special festival dates such as valentine and halloween are celebrated. The annual quality assurance assesment (AQAA) stated that the home held a jazz summer drinks party which was successful and well attended by relatives. Care Homes for Older People Page 15 of 28 Evidence: Service users are encouraged to maintain contact with family and friends. The home does not have any restrictions on visiting and visitors are able to visit at anytime within reason. Two relatives were spoken to on the day of the inspection and they both confirmed that staff always made them feel welcome and provided them with refreshments. The home was able to demonstrate how service users were being supported to exercise choice and control over their lives. We noted that one particular service user was engaged in household chores such as, setting the table at meal times and helping out in the kitchen with the appropriate risk assessment in place. Individuals are made aware of their entitlement to bring personal possessions with them such as chairs, tables, and family pictures to personalise their bedrooms. The home encourages people to look after their financial affairs for as long as they are able to. The midday meal was observed. Lunch consisted of stewed beef, mashed potaotes and vegetables. The meal looked tasty and was served attractively. Service users spoken to said that the food was very nice and tasty. Staff assisted individuals who required assistance in a sensitive way. We observed that hot and cold drinks and snacks were provided to individuals during the site visit. In disucssion with the chef it was clear that she was familiar with service users preferences and would ensure that if individuals did not like what was on offer an alternative would be provided. At the time of the visit the home was not providing any special diets based on individuals religious or cultural needs. However, the chef was confident that if required it would be provided. Care Homes for Older People Page 16 of 28 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 home has policies and procedures in place to ensure that people who use the service are able to express their concerns and are protected from any potential risk of abuse. Evidence: The home has a complaints procedure which is included in the statement of purpose and the service users guide. People who responded to the Commissions survey said that they were aware of how to make a complaint. Two relatives were spoken to during the visit and they said that they had never had to make a complaint because there was nothing to complain about. However, they were confident if they had to raise a concern it would be dealt with appropriately. The annual quality assurance assessment (AQAA) stated that since the last key inspection the home has not received any complaints. The Commission has not been made aware of any complaints about the service. In discussion with the manager she said that she operates an open door policy and encourages service users and relatives to drop in at anytime for a chat, make suggestions or voice any concerns. The home has procedures in place for responding to suspicion or evidence of abuse or neglect to ensure service users safety and protection. Staff training records seen indicated that they had undertaken updated training in the safeguarding of vulnerable adults. The home was able to demonstrate that its recruitment practice was robust to Care Homes for Older People Page 17 of 28 Evidence: ensure that only suitable staff who are fit to work with vulnerable people are recruited. The Commission has not been made aware of any safeguarding referrals or investigation from the service. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is safe and well-maintained to enable people to live in a comfortable, pleasant and hygienic environment to meet their diverse needs. Evidence: The location and layout of the home is suitable for its purpose. The home has a warm and welcoming ambience and is well maintained. The grounds looked attractive and tidy. Information in the annual quality assurance assessment (AQAA) stated that the home had invested in new garden furniture. On the day of the inspection some service users were sitting out in the garden enjoying the Autumn sunshine. The home was recently inspected by the local fire services and as a result of the visit two requirements were made. The manager said that work was in progress to comply with the requirements within the agreed timescales. Bedrooms seen were personalised with family pictures and mementoes which reflected the characters of individuals. Bathrooms and toilets were fitted with the appropriate aids and equipment to promote independence. Communal areas looked warm and welcoming. Effort had been made to add homely touches such as the display of fresh fruit and sweets at the front entrance. Since the last key inspection the homes kitchen has been refurbished with stainless steel units to promote safe hygiene practice. Care Homes for Older People Page 19 of 28 Evidence: The home was clean, pleasant and hygienic with no unpleasant odours. People who responded to the Commissions survey said that the home was always clean and hygienic. The laundry room was clean and tidy. We observed that some tiles were missing from the walls in the laundry room and the manager has agreed to have them replaced to prevent further damage to the walls. The home has policies and procedures in place for the control of infection and the safe handling and disposal of clinical waste. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that staff are trained and skilled to meet people using the service diverse needs and to support the smooth running of the service. Evidence: The home employs a multi-cultural staff team to meet service users diverse needs. Service users who responded to the Commissions survey said that staff were very good and caring. Since the last key inspection the home has employed a part-time domestic and two senior carers. The home aims to ensure that two staff members are on shift during the waking day and one staff member at night. We examined the homes rota for five weeks prior to this inspection and noted that a staff member had been working seven nights continuously. This practice is unsafe because service users should be in safe hands at all times. This was discussed with the manager and provider during the inspection and we were reassured that with the appointment of the two senior carers the practice had been reviewed. Staff who responded to the Commissions survey said that due to staff shortage staff worked long hours which they were happy to work. The manager said that the dependency levels of service users are reviewed monthly and the appropriate level of staffing was in place to meet individuals identified needs. If the home was not able to meet individuals needs arrangement would be made for an alternative placement after consultation with family members and other professionals. Care Homes for Older People Page 21 of 28 Evidence: A sample of three staffs files were examined. All files contained a completed application form with a clear structure, evidence of interview format and answers given, contract of employment and two references. Evidence seen demonstrated that a PoVA first check and a criminal record bureau clearance had been obtained. There was no evidence seen to verify that staff had been issued with a copy of the general social care councils GSCC code of practice. As a good practice staff should be issued with a copy of the code to ensure that they comply with the code of practice at all times when performing their duty. In the sample of files examined evidence seen indicated that staff had undertaken induction training, which was carried out by the manager. Mandatory training such as moving and handling, infection control, health and safety, fire awareness, safeguarding of vulnerable adults, safe handling and administration of medication and emergency first-aid was up to date. The annual quality assurance assessment (AQAA) stated that all staff had undertaken a care skills analysis which would be used in the development of a staff training programme. We were told that the home was part of a cluster training group which enabled staff to have ongoing training as and when required. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has safety systems in place to ensure that people using the service and staff safety is protected and promoted. Evidence: Since the last inspection the home has appointed a manager. The new manager has eight years experience working in the care industry. She holds a degree in company law and was waiting for the results of her registered managers award assessment. Staff who responded to the Commissions survey said that the manager was approachable and since her appointment communication in the home had improved. Regular staff meetings and one to one supervision were taking place. To ensure that the home is run in the best interests of service users the home has developed an annual quality development plan. Questionnaires have been sent to service users and their relatives to seek their views on the service provision. The manager said that the response from the questionnaires would be analysed and an Care Homes for Older People Page 23 of 28 Evidence: action plan developed. We were told that the home does not not look after service users finances. Wherever possible individuals relatives or their representatives undertake this task. A sample of health and safety records were examined and these were seen to be satisfactorily maintained. Evidence seen reflected that the fire building risk assessment was up to date. Fire records seen evidenced that staff had participated in a recent fire drill. The names of staff participating in fire drills were not listed. It is recommended that the names of staff should be listed. We were told that arrangements were being made for the premises electrical circuits to be reviewed and the appropriate certificate issued. Care Homes for Older People Page 24 of 28 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 28 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 Problems/needs identified must be evaluated in the daily report writing. To ensure that there is an audit trail on individuals progress and what action has been taken to address the identified problems. 30/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 To comply with best practice guidelines tippex correction liquid should not be used to correct entries recorded by error in the care plan. A tissue viability assessment should be carried out on all people using the service on admission and it should be reviwed at regular intervals. Advice should be sort from the homes pharmacist to ensure that the control drugs cupboard meets the standard set in the misuse of drugs (safe custody) regulations 1973. The manager should ensure that there are clear instructions from the pharmacist on the packets of Alendronic Acid prescribed for individuals to assist staff in administering the medication appropriately. Page 26 of 28 2 8 3 10 4 10 Care Homes for Older People 5 10 Handwritten entries on the medication administration record (MAR) sheets should be checked by a second staff member to minimise the risk of error when transcribing. To comply with best practice guidelines staff should not write over entries recorded in error on the medication administration record (MAR) sheets. To comply with best practice guidelines the names of those staff participating in fire drills should be listed. 6 10 7 38 Care Homes for Older People Page 27 of 28 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 © (2008) 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 28 of 28 - 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!