Inspection on 29/01/09 for Thorley House

This inspection was carried out on 29th January 2009.

CSCI found this care home to be providing an Excellent 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

Thorley House 05/12/06

Thorley House 05/12/05

Thorley House 23/08/05

Thorley House 22/12/04

Thorley House 02/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Thorley House Hazelmere Gardens Hindley Wigan Greater Manchester WN2 3QD     The quality rating for this care home is:   three star excellent 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: Jeanette Fielding     Date: 2 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Thorley House Hazelmere Gardens Hindley Wigan Greater Manchester WN2 3QD 01942255370 01942525054 rhona.briggs@clsgroup.org.uk 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) : CLS Care Services Limited care home 40 Number of places (if applicable): Under 65 Over 65 40 8 old age, not falling within any other category physical disability Additional conditions: 0 0 The home is registered for a maximum of 40 service users to include: up to 40 service users in the category of OP (Older People over 65 years of age) to include: 8 service users in the category of PD(E) (Physical Disability over 65 years of age). The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief description of the care home Thorley House is a property that was built in the 1950s specifically to accommodate older people and to provide them with residential care. The home has capacity for 40 residents, all of whom have individual bedrooms and has a passenger lift. The home is situated between large council housing estates and privately owned properties, and many residents move here from the local community. It is served by a good bus route and is close to local shops. Parking is available for visitors. Care Homes for Older People Page 4 of 27 Brief description of the care home Thorley House is part of the CLS group of homes. CLS has several homes in the Wigan and Leigh area. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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 inspection took place on 29th January 2009 and a total of five and a half hours were spent in the home. As part of the inspection process, records relating to the care of the service users were viewed to evaluate the level of care required by and afforded to them. Staff files were viewed to ensure that all safety checks had been made on them prior to them commencing at the home and to evaluate the training that they had undertaken. Safety certificates were viewed to ensure that all equipment and facilities within the home assured the health, safety and welfare of the staff and service users. A full tour of the building was undertaken, including some of the service users bedrooms to assess the environment in which service users live. Care Homes for Older People Page 6 of 27 Discussions were held with staff to obtain their views of the home and to evaluate their knowledge and understanding of service users needs, the policies and procedures and their individual role and responsibilities. Service users were spoken to to obtain their views and opinions of the home and to gather information regarding their individual lifestyles within Thorley House. Survey forms were sent to staff and service users to enable them to give their views in writing and a good response was received. 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 –03000 616161. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users are provided with full information regarding the facilities offered by the home to enable them to make an informed decision regarding their care provider. Evidence: The home has a detailed and informative service user guide to inform current and prospective service users regarding the services and facilities provided. This document has recently been reviewed and updated to include details of changes that have taken place within the home. Pre admission assessments are carried out on all prospective service users to identify the individual needs and preferences of the service users to ensure that the home can meet those needs and preferences. The pre admission assessments of the service user most recently admitted to the home was seen and was found to contain detailed Care Homes for Older People Page 10 of 27 Evidence: information regarding their medical, care and social needs. Sufficient information had been gathered at the pre admission assessment to prepare a plan of care. Letters are sent to service users following the assessment to confirm that a place has been offered. Prospective service users and their families are encouraged to visit the home prior to admission, view the room, meet staff and service users and ask questions. Short stays are offered to give prospective service user a trial of the home to further enable them to make an informed choice about their care provider. The home does not offer intermediate care. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed care plans are prepared for each service user to provide staff with full information regarding each service users needs and preferences to enable staff to meet these. Evidence: Comprehensive care plans are prepared for each service user on admission to the home to provide staff with full information regarding the care to be given. The care files of four service users were inspected and showed that their care needs had been identified and actions set in place to meet those needs. Risk assessments had been undertaken and risk management plans put in place to reduce or remove those risks to protect the service users from harm. New care plan documentation has been put in place since the last inspection and this has assisted in providing a format for informing the staff team about the service users. The staff gather information from the service users and their families to prepare a My Life profile. This gives staff a clearer understanding of the service users, their lifestyle Care Homes for Older People Page 12 of 27 Evidence: and preferences to promote a more individual level of care. Visits to and by doctors, dentists and other healthcare professionals are recorded together with any information or recommendations in relation to the service users care provision. The home has an extremely good relationship with district nurses and the community matron and the care files are updated in line with any changes in care that are advised by them. Care files are reviewed and updated on a regular basis to identify changes in care needs and care provision. Some files did not contain a photograph of the service user for identification purposes and the manager said that this had been noted and was being dealt with. The care files clearly show that the service users and their relatives have been actively involved in identifying needs and deciding the level of care that is to be given. Individual abilities are identified to assist the service users in maintaining as much independence as possible. The manager reviews the care files on a regular basis to ensure that they are up to date and contain the correct information. She also conducts regular audits on falls that service users sustain to identify improvements that can be made to further protect them. One service user said The carers are really nice. They look after me and help me to do the things I want to do. A group of ladies were sitting in the entrance area. One lady said I like to sit here to see everyone that is coming and going. Daily reports are completed by the staff to give evidence of the actual care given. Some entries would benefit from more information being recorded. A detailed handover is given to staff at the beginning of each shift to give them information regarding the service users, the tasks required during their shift and to disseminate information. The home has produced a comprehensive policy and procedure for dealing with medications. Some blank spaces were noted in the MAR sheets where staff have failed to sign to indicate that they have administered the medications to the service users. A check of the medications showed that the medications had been administered. The manager was able to demonstrate that these shortfalls had been identified in her regular audit and systems were in place to ensure that further discrepancies did not occur. Records are maintained of all creams and lotions applied to service users and these are completed by the carer who attends to the service user. The storage areas were clean and organised and systems are in place for the disposal of unwanted or refused medications. Medications are stored in a secure room dedicated for this purpose. Medication trolleys were locked and controlled drugs are stored appropriately. The keys for the medications are held by the person responsible for them on the day. Care Homes for Older People Page 13 of 27 Evidence: Support and advice is given by the dispensing pharmacist whenever necessary. Training on medications has been given to those staff who are involved in this. Service users spoken to during the inspection confirmed that their privacy and dignity were respected at all times. Bedroom doors are fitted with a knocker and staff were observed to knock on bedroom doors and wait for a response prior to entering. One service user said Its like my own front door, when I was at home. Its good to be in control. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A high number and range of activities are offered to ensure that service users are stimulated and entertained. Evidence: The care plans include details of individual preferences as well as a Life Profile to inform staff of previous lifestyles and social activities. The home employs two activities co-ordinators who work flexibly to enable activities and entertainment to be provided both in the home and in the local community. A planned programme of activities is prepared, however this can be changed if service users request something different. The programme shows that there is a good range of varied activities and service users spoken to said that they enjoyed them. One service user said Since Ive been here, Ive learned how to do so many different things that I would never have thought of before. Records are held of the activities that service users participate in. Both group and one to one activities are provided and in house entertainers visit the home on a regular basis. The home also provides a computer with internet access for the service users and instructions on how to use it is provided. Trips out are made and some service users are able to go out independently. Service Care Homes for Older People Page 15 of 27 Evidence: users are enrolled on the local Ring and Ride system to further promote their independence. The library service visits the home every month and can provide books in large print. A good selection of books were seen in various parts of the home which service users can help themselves to as they wish. Spiritual needs are met and services are held in the home. Service users who wish to attend church are given assistance to do this. The home also provides a Shop Trolley to enable service users to choose their own toiletries, sweets etc, although they are enabled to visit local shops if they wish. The hairdresser visits twice weekly and the home provides a dedicated hairdressing room which is fully fitted with appropriate washbasin, hairdryers etc. Meals are served in the dining room or in the service users own bedroom as they wish. The menus rotate on a five week basis and the meal served on the day of the inspection looked and smelled appetising. Snacks and drinks are provided between meals and additional snacks are readily available during the night on request. The menus show that a varied and balanced diet is provided. Special diets can be provided on the advice of the GP or dietitian or at the service users request. The cook speaks with service users on admission to identify their individual likes and dislikes. The dining tables are attractively laid with cloths and napkins, condiments and drinks. One service user said If I dont like the main meal or the alternative meal, I tell the staff what I want and they get it for me. The food is lovely. Its home cooked and its the sort of food Im used to. I could have the fancy stuff if I wanted, but I like basic home cooking. A cooked breakfast is available in addition to fruit, cereal and toast and is served to service users when they are ready to take it. Some service users prefer to take a late breakfast whilst some like theirs early. The kitchen is clean and organised and it was evident that fresh goods are used in meal preparation. All catering staff have been given food hygiene training and training in nutrition is ongoing. Visitors are welcome at the home at any time and service users may meet with their visitors in one of the communal areas or in their own bedroom as they wish. Visitors were observed in the home at the time of the inspection and were asked their views of the home. One lady said This is a wonderful place. My relative is so well cared for and this puts me at ease because the home can do more for her than I could manage if she lived at home. She has made a lot of new friends and is very happy. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a robust complaints procedure to ensure that service users are protected. Evidence: The home has a good complaints policy and procedure and information on how to make a complaint is displayed in the foyer and detailed in the service user guide. The home encourages feedback from the service users and their relatives to gather their views, opinions and comments about the home and the service provided. No complaints have been received by the home or by CSCI since the last inspection. Service users said that they knew how to complain and to whom a complaint should be made. One service user said that she liked to complain all the time but that it was never about the home, just about her creaking joints. Another service user said that there was no need to complain because everything was fine, but would have no hesitation in speaking to the manager if something wasnt right. Staff spoken to were able to confirm that they knew the procedure to be followed in the event of a complaint being made. In the surveys sent to staff and service users, all confirmed that they knew how to make a complaint. One member of staff wrote The manager has an open door policy whereby anyone can go in to speak to her. Staff Care Homes for Older People Page 17 of 27 Evidence: were also able to demonstrate that they knew the procedure to be followed if they suspected any abuse within the home. All staff have been given training on the different types of abuse and a record of this training is held on their files. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience 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 decorated and furnished to a high standard to provide service users with a comfortable and homely environment in which to live. Evidence: Thorley House is a purpose built care home which provides accommodation for service users in single bedrooms. The entrance foyer is bright and welcoming and provides sofas and armchairs for those who choose to spend their time there. This area is popular with the service users and is decorated in a very pleasant way. All bedrooms are decorated and furnished in a homely way and provide pleasant rooms for the service users. It was evident that time and effort have been spent by relatives and staff in personalising bedrooms to reflect the lifestyle of the service users. Service users are encouraged to provide pictures, photographs and items of memorabilia and the handyman is readily available to assist with this whenever necessary. Service users are free to use all communal areas within the home and can spend time alone in their room if they wish. Health and safety checks are made on all service users bedrooms to ensure that service users are provided with a risk free environment. All bedrooms are provided with a knocker on the door which were Care Homes for Older People Page 19 of 27 Evidence: observed to be used by staff. Corridors are bright and wide and have been provided with pictures. Lounges are homely and have been provided with new armchairs and carpets. Large screen televisions enable service users with visual problems to see them and the layout of the lounges enables all service users to interact with each other as they wish. The home has a rolling programme of redecoration and refurbishment and new furniture has been provided in bedrooms, lounges and dining room. A programme of replacing bedroom carpets is currently underway. A small lounge is provided where service users can meet with their visitors and drink making facilities are provided. Efforts have been made to brighten bathrooms although the manager explained that plans are in place to tile the bathrooms. At present, they are generally well decorated and homely although some attention is required to the window ledges where the paint has lifted. The home has a minicom system with a loop system in the computer lounge, one of the lounges and a dining room to promote communication and inclusion for people who have hearing difficulties. All areas of the home were warm, well lit, clean and fresh. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home employs a team of well trained, enthusiastic staff who work positively with the service users to improve their quality of life. Evidence: The home has a comprehensive recruitment policy and the staff files inspected showed that the procedure is followed. All prospective staff are required to complete an application form prior to being called for interview. Two references are taken and checks are made on the Criminal Records Bureau and Protection of Vulnerable Adults registers to ensure that service users are not placed at any risk. New staff complete a comprehensive induction training programme, the first week of which is spent with the company whilst they complete their initial compulsory training. This includes moving and handling, first aid, health and safety and basic care. Further induction training is given at the home when they are supervised and their competency assessed. Staff training continues throughout the year and the manager prepares a training matrix to identify where training is to be given or updated in order that staff continue to develop their knowledge and understanding. Recent training events include customer care and care of people with dementia. The registered manager and home services manager are currently undertaking training on equality and diversity which is being provided by ACAS. Care Homes for Older People Page 21 of 27 Evidence: Staff records are well maintained, include all necessary recruitment documentation as well as certification from training events. Staff spoke positively about the training that they had recently undertaken and one member of staff wrote in the survey form There is often new training sessions that I am put forward to attend. Training sessions are mandatory and recap the knowledge that you already have. New training sessions increase your knowledge regarding the care industry and so helps individuals to do their jobs more efficiently. It is evident from this comment that staff understand the need for training and development. The staff rota shows that the home is employing and deploying staff in sufficient numbers to meet the needs of the service users. Additional staff are on duty when the dependency of the service users increases to ensure that they are given all the care needed. Staff from an agency are available to cover sickness and holidays. The home has a strong staffing structure which is headed by the manager. Other staff include a Home Services Manager, Team Leaders, Senior Care Assistants, Care Assistants, Domestic Supervisor, Domestic Staff, Cook, Kitchen Assistants, Laundry Assistants, Activities Coordinators and Handyman. Regular supervision is given to staff and a record of this is held. Staff meetings are held on a regular basis and provide a forum for discussion and the dissemination of information. Discussion was held with a high number of staff during the inspection and all were enthusiastic about their job. One member of staff said that she had worked at the home for a number of years and loved the job. Observation of the interaction between staff and service users was extremely positive with smiles and positive reactions from service users being evident. Staff spoke to service users about personal matters discreetly. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is well supported by staff to ensure that service users are provided with a quality lifestyle within a safe environment. Evidence: The registered manager of the home has considerable experience in managing care services and in providing care to older people. She holds the Registered Managers Award, NVQ level 4 and is an NVQ assessor. She was able to provide evidence that she has continued to undertake training to further develop her knowledge and understanding. The company works with manager and provides a high level of support. A representative of the company visits the home at lease once each month to meet with the manager and to meet Regulation 26 of the Care Homes Regulations which requires that a report is completed on the home. The manager works on a supernumerary basis and is available for service users, staff and visitors to the home through an open door policy. Care Homes for Older People Page 23 of 27 Evidence: The manager undertakes audits on all aspects of the home including medications, falls and care files to ensure that records are kept up to date and that systems can be reviewed to further protect the service users. The manager is also responsible for producing a business plan for the home and for identifying areas that require improvement. The home undertakes an annual survey of service users, relatives and other stakeholders to obtain their views of the home. The responses are collated and are included in the business plan. The company which owns the home, CLS Care Services Limited holds an Investors In People quality award. Regular meetings are held with service users and relatives and minutes of these meetings are held. Service users personal money is held securely and detailed records are held of any purchases made on their behalf. These monies are regularly audited and there are clear policies and procedures in place. Health and safety systems are regularly reviewed and updated to ensure the protection of service users, staff and visitors to the home. Regular checks are made on all equipment within the home and on the premises. Safety certificates are held and were found to be up to date. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!