Inspection on 17/06/08 for The Stratfords Residential Home

This inspection was carried out on 17th June 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Stratfords Residential Home 20/06/07

The Stratfords Residential Home 08/12/06

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 28/09/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Stratfords Residential Home Anthony Court Russell Street Stony Stratford Milton Keynes Bucks MK11 1BT     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: Date: 1     7 0 6 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 Stratfords Residential Home Anthony Court Russell Street Stony Stratford Milton Keynes Bucks MK11 1BT 01908 262621 01908 262621 vulcanresidential@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Vulcan Residential Limited vacant care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 0 Over 65 11 Date of last inspection Brief description of the care home The Stratfords is a two-storey residential care home, proving care for up to eleven older people, over the age of 65 years.The home is situated in a quiet residential area of Stony Stratford and is within a short walking of the town centre, which offers a variety of shops, restaurants, public houses and other local amenities.It is a two-storey building and has single room accommodation. Residents rooms are located on the ground floor and upper floor. There is lift access to the first floor. Most rooms do not have ensuite facilities. There is a communal lounge/dining room on the ground floor. A cook provides freshly cooked meals on site and special diets can be catered for. There are waking care staff on duty at all times.Public transport is accessible to service users if they wish to use this. Care Homes for Older People Page 4 of 28 Care Homes for Older People Page 5 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: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced key inspection was conducted over the course of a day and covered all the key National Minimum Standards for older people. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion. Information received by the Commission since the last inspection was also taken into account. No surveys were received by the time the report was written. The inspection officer was Barbara Mulligan. The registered provider/manager is Mr Peter Bharj. The inspection consisted of discussion with the registered providers and other staff, Care Homes for Older People Page 6 of 28 opportunities to meet with some people who use the service, examination of some of the home’s required records, observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Twenty-six of the National Minimum Standards for Older people were assessed during this visit. One of these was assessed as almost met and Standard 6 been assessed as not applicable. As a result of this inspection the home has received one requirement. The fees range from £448 per week to £468 per week. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. The manager, staff and service users are thanked for their co-operation and hospitality during this unannounced visit. What the care home does well: What has improved since the last inspection? Care plans have been updated and contain up to date information about residents needs. Opportunities for stimulation through leisure and recreational activities has improved inside and outside the home. The manager and care staff have now recieved training in the safeguarding of vulnerable adults. Care Homes for Older People Page 8 of 28 On going improvements and adaptions to the home, in particular the bathrooms, now meet the needs of physically frail people who live in the home. Recruitment files now contain evidence of all the necessary recruitment checks before the care workers commences employment. The home now has suitable moving and handling aids to meet resident’s needs. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. 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 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. Service users needs are thoroughly assessed prior to admission ensuring that staff are prepared for admission and are given an opportunity to visit the home beforehand to ensure it meets their needs. Evidence: Three completed needs assessments were examined, including those most newly admitted to the home. These are fully completed to a high standard, dated and signed by the author. The assessment tool is a comprehensive document and there is also in place information available from the care manager and the local primary health care team. The assessment documentation prompts staff to ask about specific needs relating to religious and cultural needs. The pre-admission tool covers personal details Care Homes for Older People Page 11 of 28 including the support needed with personal care and physical care, diet, weight, sight, hearing, foot care, mobility and dexterity, history of falls, social interests and hobbies and religious and cultural needs. This information is readily available to staff who are expected to refer to the documentation to meet service users care needs. It is noted that the service users have been asked their preferred name which is indicated throughout any further documentation seen, this is noted as good practice. The assessment demonstrates that prospective service users, family members or representatives are included in the assessment process if this is appropriate. The initial assessment of need should be signed and dated by the author and this is recommended. The home does not admit service users for intermediate care. Care Homes for Older People Page 12 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 health and personal care needs of people using the service are well met, with personal care delivered in a way that promotes respect and dignity, ensuring that people’s health and wellbeing is promoted and protected. Evidence: Three care plans were examined during this inspection, including those most newly admitted to the home. The registered manager has changed the care planning documentation to a new format. Following the previous inspection a requirement was issued for the care plans to contain evidence that residents and their families are involved in drawing them up.They should be updated when necessary and at least monthly to ensure that they contain up to date information about residents needs. It is pleasing to see that this has been complied with. Although care plans are in place they would benefit from further detail in the action plan. For example, in one care plan looked at under the heading, medication the action plan states administered by Care Homes for Older People Page 13 of 28 staff and under the heading continence the action plan says incontinent day and night. These are vague statements and need further detail to provide the staff with specific guidelines to fully meet the needs of people who use the service. This is recommended. There are good examples of risk assessment documentation in each file and these are in place for mental health, physical health, moving and handling, a pressure sore assessment, a falls risk assessment, behaviour assessment, nutritional screening assessment and a general health and safety assessment for each individual. Care plans include records of health care appointments that residents have attended and also visits of specialised health care professionals to the home. The health care professionals include the general practitioners, chiropodists and opticians. During the inspection a visiting relative told that inspector that her relative had recently been ill and the family have been very impressed with the high quality care she has received. Several residents spoken to on the day of the visit said they saw the doctor regularly and were all pleased with the care that they receive from the care staff in the home. The home supports service users to receive the medication that they need by either assisting with medication or providing facilities for service users to self medicated. There is a risk assessment for service users who wish to self medicate and these are reflective of review. There are upto date medication policies and procedures in place. Storage facilities are satisfactory. Records are kept of medication entering and leaving the home. The medication administration records were accurately completed and no omissions were noted. At the time of the inspection there were no controlled drugs in use, however there are systems in place if this is necessary. There is evidence in the staff training records that senior staff have undertaken accredited training in the safe handling of medicines. Staff were observed during the inspection to knock on bedroom doors before entering. Individuals spoken to at the time of the inspection confirmed that care staff ensure their privacy and dignity is maintained at all times. Preferred terms of address are identified at the initial assessment and the inspector saw evidence of this in care plans. The homes induction programme includes training regarding privacy and dignity. The Statement of Purpose and Service Users Guide include information about maintaining the privacy of service users. Service users can have a key to their rooms if they wish to use this facility and it is felt to be safe. 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. Systems in the home ensure that where appropriate service users are supported to exercise choice and control over their lives and are able to receive visitors at the home, with no restrictions imposed on visiting unless requested by the individual. The presentation and standard of food is good and meets the nutritional needs of people who use the service. Evidence: The inspector spent time talking with people who use the service and comments about activities provided by the home were mixed. One comment made to the inspector was not many people want to do activities in the house, but we have been out for lunch and I go out on my own regularly to the town. Nobody wants to play bingo or other games, we like to be left alone. Care Homes for Older People Page 15 of 28 I like to go out and wish I could do this more often, but I need extra help. Care plans show individual routines of daily living and include bathing, rising and retiring times. Religious observance is recorded in care plans and service users interests are recorded in the initial assessment. Following the previous inspection a requirement was issued for residents of the home to be given opportunities for stimulation through leisure and recreational activities, in and outside the home, providing for both mental and physical stimulation, which suit their needs, preferences and capacities. Improvements have been made to the activities provided at the home but this could be developed further and is recommended. Care staff undertake some activities for service users. On the day of the inspection people in the lounge were asked if they would like to do colouring in. Although this doesnt seem to be age appropriate, several individuals took part in this and appeared to enjoy it. A time table of activities is available and includes games, (including skittles and ball games) music, DVD night and nail care. Examples of involvement by the local community groups and individuals are visits by mobile hairdressers, visiting library and the home has recently arranged for a visiting musician to visit. The home promotes peoples spiritual and religious beliefs by providing a church service within the home. Service users are able to receive visitors in the privacy of their own rooms and are able to choose whom they see and do not see. There are no restrictions on visiting, and this is documented in the Service Users Guide. One visiting relative spoken to on the day of the visit said, I am able to visit every day and I often come at lunch time to help my relative with his meal. I am always made to feel welcome. Service users are offered three meals a day. The inspector had the opportunity to join people who use the service for lunch. This was relaxed, unrushed and well organised. Meals were attractively presented and there was a choice of two meals and three sweets. The chef said that she would be able to meet residents cultural dietary needs should the need arise. The inspector was told that service users can take their meals in their rooms if they wish. The home offers drinks and snacks throughout the day in accordance with the needs of the service users. The nutritional needs of service users are assessed and there is good detailed evidence of regular monitoring in all care plans seen. Care Homes for Older People Page 16 of 28 Care Homes for Older People Page 17 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. There are policies and procedures in place to protect people who use the service from harm and the home has an effective complaints procedure to ensure that people who use the service or their representatives are listened to. Evidence: The home has a complaints procedure, which is accessible to service users and their representatives. A record of all complaints is maintained, and this was viewed. Four complaints have been received since the previous inspection and these have been dealt with within the stated timescales, record the investigation and outcomes of complaints raised. The Commission has not received any complaints about this service since the previous report. Procedures are in place for the protection of vulnerable adults and staff have access to a whistle blowing policy. The home has a copy of the local multi agency strategy for the Protection of Vulnerable Adults. Following the previous inspection a requirement was issued for the manager and all staff to have training in the safeguarding of vulnerable adults. Discussions with staff and examination of training records demonstrate that this has been complied with. The Commission for Social Care Inspection has not been notified of any concerns or Care Homes for Older People Page 18 of 28 complaints about the home and has not been notified of any allegations made to the local authority. Care Homes for Older People Page 19 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 standard of the environment within the home is good, providing people who use the service with an attractive and homely place to live. Evidence: During the previous inspection it was identified that the provision of bathroom facilities needed upgrading and a requirement was issued for the proprietor to seek professional advice as to the best way to adapt the home, in particular the bathrooms, to meet the needs of physically frail people. The inspector was informed that an occupational therapist has visited the home and assessed the needs of the people living there. During a tour of the premises it was noted that both bathrooms have been re-fitted. In one bathroom a walk in shower has been installed and in the second bathroom their is now an assisted bath. The home has also purchased new hoists. The garden/courtyard area has been cleared and is in the process of being upgraded. This will provide a private area for residents to use. One individual who uses an electric wheelchair regularly visits the town. She was experiencing difficulties gaining access to the home on her return. The home has been quick to respond to her needs and have installed a ramp and a portable door bell for her individual use. The lounge and dining area and hallways have been redecorated and re-carpeted. This has included new pictures on the walls and other personal touches. The laundry is situated away Care Homes for Older People Page 20 of 28 from the main kitchen and equipped with domestic washing machines and driers. People spoken to said that their clothes were looked after well and ironed. There is an infection control policy in place and staff have undertaken this training. Care Homes for Older People Page 21 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 staffing numbers and skill mix is adequate to meet residents needs, although these should be monitored carefully. Significant improvements have been made in staff training, however there remains some updating of mandatory training to be completed to ensure service users benefit from staff who are who are competent to do their job. There are effective recruitment procedures in place to ensure service users are protected from harm. Evidence: Rotas show that there are two care staff on duty at all times including during the night. In addition to this there is a chef and a housekeeper. Care staff undertake all personal care for people living in the home and organise leisure activities and escort residents to health care appointments. Discussions with staff reveal that this can on occasions be difficult if the other staff member requires assistance. The care staff work hard and feel that whilst in general the staffing levels are sufficient they have difficulty if two staff members are needed to care for individual residents, if their needs are complex or they become unwell. This means that other residents may not be supervised. The registered provider/manager needs to monitor staffing levels Care Homes for Older People Page 22 of 28 carefully and to ensure that if residents’ needs increase that additional staff are in place to meet these and that staffing levels are adequate to provide sufficient leisure activities for people living in the home. There are six staff who have completed NVQ training level 2 or above and five staff are presently completing this. This means that the home have achieved over 50 ratio of staff who are trained in NVQ level 2 or above. Following the previous inspection a requirement was issued for recruitment files to contain all the information specified in Regulation 19 and Schedules 2 and 4 of the Care Homes Regulations 2001 and that two references are sought for all employees and that one is from the last employer where the person has been in employment. Three staff files were made available for inspection purposes, including those most newly recruited. All files looked at contain the necessary documentation as detailed in schedule 2. There is evidence that all staff CRB checks had been obtained, two written references have been obtained, proof of identification is maintained on file including an upto date photograph of the individual. There is an induction programme in place to ensure that new staff members are familiarised with the organisation and their roles and responsibilities and provides the staff member with a personal development portfolio. This is the Common Induction Standards and includes fire safety, moving and handling techniques and core skills training. Training records reflect that staff have received mandatory training, however this needs to be updated for some staff and a requirement has been issued for improvement in this area. This includes fire training, manual handling techniques, basic food hygiene and infection control training. There is specialist training available for staff, an example of this is Dementia Care training, Staff confirmed that there are regular staff meetings and staff receive regular supervision from their line manager. Care Homes for Older People Page 23 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 registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Evidence: The home has two registered proprietors and they are in the home regularly. One acts as the manager of the home and he has obtained the Registered Managers and NVQ level 4 certificate of training. The registered manager feels that the staff team understand and can relate to the aims and purposes of the home. This is usually achieved through regular staff Care Homes for Older People Page 24 of 28 meetings, staff supervision and annual appraisals. This was confirmed in discussions with staff. The proprietors have developed a comprehensive quality assurance system. Questionnaires have recently been sent to people who use the service, their relatives and representatives, visiting GPS and nurses, NVQ assessors, visiting hairdresser and any others who visit the home. These are presently being collated. There are self monitoring systems in place for complaints, staff training, falls, staff sickness and medication administration. All policies and procedures have been updated and copies are made available to staff. The residents spoken to said that they had confidence in the staff and the proprietors. Staff spoken to said there are regular staff meetings and regular formal supervision. During supervision a different topic is chosen to discuss with staff as well as the opportunity to talk about work performance. The proprietors do not act as appointee for any residents and do not manage their financial affairs in any way. A small amount of money may be kept in the home on behalf of residents. Records of money kept by the home include receipts and copies kept, for all money received and expenditure incurred on behalf of residents. There are health and safety policies and procedures and generic health and safety risk assessments in place. These include risk assessments for the use of cot sides, storage heaters, clinical waste, kitchen hygiene and manual handling. There is a need to ensure that all staff have training in basic mandatory health and safety topics as described in the staffing section of this report. A requirement was issued at the previous inspection for take professional advice as to the purchase of suitable moving and handling aids to meet resident’s needs. The home now has two hoists, one on each floor. Service certificates are in place for PAT testing 11/12/2006 and the inspector was informed that this was in progress at the time of the inspection. Care Homes for Older People Page 25 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 26 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 29 18 The registered person is required to ensure all staff receive up to date mandatory training. To ensure staff fulfill the aims of the home and meet the changing needs of people who use the service. 30/08/2008 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 12 13 2 7 It is recommended that the initial assessment of needs signed and dated by the author. It is recommended that the care plans contain further detail to provide staff with specific guidelines to fully meet the needs of the people who use the service. It is recommneded that the home further develops its provision of activities for people living in the home. 14 12 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. 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