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Inspection on 24/10/08 for Treetops Residential Home

Also see our care home review for Treetops Residential Home for more information

This inspection was carried out on 24th 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.

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

What the care home does well

People moving into the home can be confident that they will benefit from a full assessment of need which encompasses the full care and support they will need. The assessment process is carried out with sensitivity and people are fully involved in the process. People we spoke to confirmed that when moving in they had been fully supported. There is a varied menu and people were complimentary about the meals. People are well supported with their individual health care needs and a visiting doctor spoke highly of the support provided by the home. Staff treated the people living in the home with courtesy and respect and residents were complimentary about the care they received. Comments made during our visit included: This isn`t home but it is the second best thing. Staff are very good and nothing is too much trouble Bedrooms are comfortable and have been personalised to individual choice.

What has improved since the last inspection?

The recruitment procedures, in making sure that the correct documentation is obtained before staff start work has improved. Staff are supported in accessing courses in a National Vocational Qualification (NVQ). There are ongoing environmental improvements including the redecoration and recarpeting of different areas of the home. A new wide screen LCD television has been purchased. Residents meetings are used to help make improvements in the home.

What the care home could do better:

The Medication Administration Records contained some gaps, and this is not in keeping with the Royal Pharmaceutical guidelines. Care plans and assessments are in depth and detailed, but some historical information means that guidance for staff may not be as clear as it might be. Although the home has promoted staff training in NVQ`s, there were shortfalls in up to date refresher training in other areas of training such as movement and handling, adult protection and fire training. Arrangements have been made by the registered person for this to take place.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Treetops Residential Home 3 Lower Northdown Avenue Cliftonville Margate Kent CT9 2NJ     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: Anne Butts     Date: 2 4 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Treetops Residential Home 3 Lower Northdown Avenue Cliftonville Margate Kent CT9 2NJ 01843220826 F/P01843220826 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) : Gracefind Limited care home 24 Number of places (if applicable): Under 65 Over 65 24 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 24. The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Treetops is a three-storey detached building, with bedroom accommodation on each of the three floors. There are 18 single bedrooms (10 of which have ensuite facilities) and 3 doubles. There is a shaft lift to all floors. Each bedroom has a call bell and television point. There are three separate lounge areas. Treetops is a non smoking environment but there is a secluded garden to the rear, with a covered patio area. The home is situated in a residential part of Cliftonville, close to local shops and all public amenities. Public transport can be easily accessed and there is unrestricted on-street parking. Treetops has been under the same ownership for over 15 years. The staff team consists of a manager and carers who provide 24-hour care, including a member of Care Homes for Older People Page 4 of 27 Brief description of the care home staff awake and one member of staff who does a split night shift that includes 3 hours sleeping in. There are also separate catering and domestic staff. Fees for the home range from £295.00 to £400.00 per week dependent upon the level of care and type of bedroom occupied. Additional charges are made for hairdressing, chiropody, toiletries, travel and escort. 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: 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 was a key unannounced inspection that took place in accordance with the Inspecting For Better Lives (IBL) process. Key inspections are aimed at making sure that the individual homes are meeting the standards and that the outcomes are promoting the best interests of the people living in the home. As part of the inspection process it is a legal requirement that services complete and return an Annual Quality Assurance Assessment (AQAA). This was returned to us before our visit and gave detailed information about the service. Judgments have been made with regards to each outcome area in this report. The judgments have been made based on records viewed, observations and verbal Care Homes for Older People Page 6 of 27 responses from people using the service. These judgments have been made using the Key Lines of Regulatory Assessment (KLORA) which are guidelines that enable us (The Commission For Social Care Inspection) to be able to make an informed decision about each area. The actual site visit was carried out over one day by one inspector. Time was spent touring the building, talking to the people living in the home, talking to staff and reviewing a selection of records including care plans, medication records, menus, staff files and other relevant documents. At all times the manager and staff were helpful and demonstrated a pro-active approach to making sure that people are well supported. 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 Care Homes for Older People Page 8 of 27 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 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they will be provided with information so that they are able to make an informed decision about moving into the home. People benefit from a comprehensive assessment of their needs prior to moving into the home to ensure their assessed needs can be met. Prospective residents have the opportunity to visit prior to moving in. Evidence: There is a Statement of Purpose and Service Users Guide available. These are on display in the main entrance. A copy of the latest report is also on show. People we spoke to during our visit confirmed that they had been given enough information about the home before they moved in. We looked at the pre-assessment documentation for three people. All of the records Care Homes for Older People Page 11 of 27 Evidence: viewed showed that there was a full assessment in place that had been carried out prior to the person moving in. We saw that the assessments had been carried out in conjunction with the person, and that they were fully involved in the process. The information was detailed and individual support needs were clearly defined. The home also obtains assessments from either the care manager or the hospital. When someone moves into the home, this support and assessment process continues to be developed so that the home can meet the needs of the individual. The assessments were carried out with sensitivity and supported the person in moving into the home. For example the assessment and initial care plan for a person who had just moved in described how to support them with settling into the home and getting to know the environment. We spoke to people about their experiences about moving into the home and everyone confirmed that they felt well supported with comments including; I visited first, and had a meal and met people and everyone was very kind when I moved in and the manager visited me and then I was able to visit the home and the staff were very helpful when I moved in. Where possible all moves into the home are carried out on a planned basis. There are occasions when people have to move in on short notice. The Annual Quality Assurance Assessment (AQAA) identified that the home would like to further develop this process. The AQAA also identifies the importance of the emotional support needed. Records we viewed on the day of our visit and people we spoke to who live in the home supported this. The home does not provide intermediate care but does offer short term respite care to people. One person, who was staying on respite at the time of our visit said that they would like to stay. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a consistent care planning process that encompasses individual health, personal and social care needs. They can be confident that their healthcare needs will be fully met. Improved medication record keeping will further safeguard people living in the home. People can be confident that they will be treated with respect. Evidence: There is a written individual plan of care for each person living in the home. Care plans are important as they are one of the ways of making sure that people are supported in a manner that suits their individual needs and give clear guidance for staff. We looked at the care plans for three people living in the home. All contained comprehensive information about individual needs and capabilities. For example they identified how to assist a person with any personal care needs, mobility, healthcare support and social needs amongst others. Care Homes for Older People Page 13 of 27 Evidence: The care plans were supported by detailed risk assessments and the information from these identified how to support each person. Care plans and risk assessments are reviewed on a regular basis. However historical detail of previous care planning and risk assessments remains in the current documentation and it was not always possible to identify the most recent guidance. For example one care plan identified significant changes in need relating to mobility and it was not easy to identify the most current guidance in the care plan. We spoke to people living in the home and they all confirmed that they felt well supported by staff. One person said The girls who work here are proper full time carers who will do anything for you- they really give you confidence. The Annual Quality Assurance Assessment (AQAA) states that people have full access to all professionals in order to promote good health. We saw evidence of this at our visit with good access to the G.P, District Nurses, chiropodist and opticians. We spoke to people who live in the home everyone stated that they were well supported with their healthcare needs. One person told us If I need to go to the doctor, they arrange to take me. We also spoke to a visiting G.P. who stated; This is a first rate home- I never have any problems here. The home recognises individual healthcare needs and people with conditions such as diabetes for example are supported with their needs. We reviewed the medication records. Medication is stored in a lockable medicines cabinet and there is a separate lockable fridge for medication which needs to be stored below a certain temperature. There is a system to check medication into and out of the home. We looked at the Medication Administration Records (MAR) and saw that although they were mainly completed appropriately there were at least three individual records which had a gap on the sheet with no explanation for this. All records need to be maintained accurately and we are recommending that this is addressed. Occasionally a new medication needs to be added to the MAR sheets and these are handwritten, there needs to be a system to check accuracy. The manager confirmed that only staff who are trained to do so assist with the administration of medication. 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. People can be confident that they are able to spend the day as they wish and to exercise choice in their daily lifestyles. Meals are nutritious and balanced and offer a healthy and varied diet for people. Evidence: The Annual Quality Assurance Assessment (AQAA) identifies that people are supported to take part in activities of their choice. Where possible people are supported in going out, joining in larger or smaller group activities and individual preferred pastimes. Different activities include weekly exercise sessions, visiting entertainers, bingo and outings. Individual interests are promoted and people are able to take part in their preferred activities. For example one person is supported to maintain their hobby of painting and another lady is supported to attend a local club. Other people spend time chatting, reading or watching television. People we spoke to all confirmed that they were able to choose what they preferred to do. One lady said I can always choose what I want to do and another person said I enjoy the singers when they visit. Care plans identified peoples preferred preferences and choices of pastimes. Care Homes for Older People Page 15 of 27 Evidence: People are supported with individual religious preferences and people are supported to visit a local church should they so wish and communion is held in the home once a month. Visitors are able to visit at any time and are made welcome. One person told us my family can visit at any time On the day of our visit we saw that visitors were frequently calling into the home. Care plans identified that people are supported in making their own choices with regards to different aspects of their lives. This included preferences of how they have a bath for example and also preferred times of getting up or going to bed. People we spoke to all confirmed that they were able to make their own choices. There are regular residents meetings so that people can air their views and have a say about different aspects of the home. People we spoke to confirmed that they felt listened to. There is a four weekly menu on show and this showed that there was a varied and nutritious menu in place. There were choices for all meals including breakfast, with a full cooked breakfast available every morning if people wished. Lunchtime is the main meal and always offers two choices, with choices of puddings. At the evening meal there is a choice of sandwiches or a hot snack. We spoke to people about the meals and everyone stated that they were very nice. People confirmed that they were asked what they would prefer to eat. One person said If there isnt anything I like on the menu then they will arrange for me to have something different. Special diets are catered for including vegetarian and diabetic. We observed the lunch time meal and saw that this was a social event with people chatting and staff interacting well. Where people needed assistance they were supported in a descreet manner. 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 system and service users and relatives feel their views are listened to and acted upon. Evidence: There is a written complaints procedure in place. This explains how people can raise their concerns. The Annual Quality Assurance Assessment (AQAA) stated that there had been two complaints in the last twelve months and that these had been resolved. We spoke to the manager at the time of our visit who said that they are pro-active in addressing issues with people as soon as they raise any concern or voice any dissatisfaction. We spoke to seven people living in the home and everyone stated that they were confident in being able to say when they were unhappy with anything. The majority of people also said that they had never had to make a complaint. Regular meetings are held for residents and this is also used as a forum for raising any issues. We (The Commission) have not received any complaints about the service. People are supported with the right to vote and have access to available advocacy services. There are procedures in place to safeguard the people living in the home. The manager stated that staff were made aware of safeguarding vulnerable adults through the induction process, and through their National Vocational Qualification training. We Care Homes for Older People Page 17 of 27 Evidence: spoke to three members of staff who were able to describe their awareness of safeguarding vulnerable people and the action they would take. 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. People benefit from living in a safe, clean and well maintained environment and have safe access to comfortable indoor and outdoor communal areas. Evidence: Treetops is set out over three floors and is attractively presented to a good domestic standard. Plants, pictures and a fish tank add to the homely feel of the environment. There are three communal lounge areas and a dining area. People are free to choose where they prefer to sit and when we spoke to people living in the home they all confirmed that they were comfortable in the home. The home is non-smoking but there is a sheltered area in the back garden where people can go if they wish. A selection of bedrooms were viewed and were found to be clean, comfortable and well personalised. People we spoke to confirmed that they could bring in small personal items so that they could maintain a homely atmosphere. The Annual Quality Assurance Assessment (AQAA) identified that the home has continued to make environmental improvements during the last twelve months with the ongoing redecoration of bedrooms, new carpets and a wide screen television for Care Homes for Older People Page 19 of 27 Evidence: one of the lounge areas. The kitchen was clean, and food was stored appropriately. The laundry was well organised and used appropriate infection control procedures. A new washing machine had also been purchased. Appropriate specialist equipment is in place including nursing beds, for people who need them, a stair lift, wheelchairs and hoist. 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. People benefit from being cared for by staff that have a good understanding of their needs. Refresher training will further benefit staff and service users. Evidence: We viewed the rotas and spoke to staff and people living in the home. The rotas showed that there care staff were employed in sufficient numbers to meet the needs of the people living in the home. The manager confirmed that at peak times there was an additional member of staff on duty. Staff stated that they had time to complete their tasks and residents confirmed that there was enough staff to meet their needs and that they were flexible. The home does not use agency staff and regular staff cover the necessary shifts. There is a low turnover of staff, therefore promoting continuity of care. Two staff files were viewed for recruitment procedures. At the last visit a requirement had been made for the home to make sure that the home obtained the information required under Schedule two of the Care Standards Act 2001. At this visit the recruitment files contained the information as required and this requirement had been met. Files viewed contained Criminal Records Bureau (CRB) checks and Protection of Vulnerable Adults (POVA) check. Care Homes for Older People Page 21 of 27 Evidence: At the start of employment staff undergo an induction. They spend time learning about the procedures of the home and the needs of the people living in it. They complete a work book which is based on the Skills For Care standards. Staff are only signed off in each area once they have been deemed as being competent. A high proportion of staff have completed a National Vocational Qualification (NVQ) at either level two or three. There are shortfalls, however, in some areas of training. Best practice indicates that staff should receive appropriate updated mandatory training in areas such as movement and handling, fire training and adult protection, for example. The registered person needs to ensure that regular updates take place. Food hygiene and health and safety training has also not been completed for all members of staff. Staff have been trained in medication and have undertaken specialist training in relation to palliative care and dementia. Training is also being carried out with regards to the Mental Capacity Act. Senior care staff have also had training in risk assessments. People living in the home confirmed that they well supported by staff one person said I am well looked after here, the girls cant do enough for you. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home benefit from a manager who provides clear leadership and understands the needs of the people living in the home. People are able to actively contribute as to how the home is run. Evidence: The manager has the appropriate experience suitable for her role. She was able to display a sound knowledge and understanding of caring for older people. The management of the home was competent and there were clear lines of accountability. Staff stated that they felt well supported. People living in the home also praised the management and stated that the manager was approachable and always available to listen to them. At lunch time the manager helped out with assisting a person with their meal. There are regular residents meetings and action is taken to make any suggested Care Homes for Older People Page 23 of 27 Evidence: changes. Residents and families have the opportunity to feedback through surveys. The latest inspection report is available for people to read. Regular supervision takes place for staff and these are recorded. Records were viewed on file. Staff confirmed that the manager was available. People are supported with their money and records and receipts are kept on behalf of people. The AQAA and comments from the manager on the day of the visit confirmed that maintenance checks are carried out. Environmental risk assessments are carried out and regularly updated. As stated previously there are some shortfalls in training which need addressing to fully protect the health and safety of the people living in the home. 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 1 30 18 The registered person shall 31/03/2009 ensure that the persons employed to work in the care home receive training appropriate to the work they are to perform. In that staff must receive up to date training in Movement and Handling Protection of Vulnerable AdultsFire Training. 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 9 That Medication Administration Record (MAR) sheets are maintained in line with the Royal Pharmaceutical Guidelines. That a training analysis is undertaken so that a programme of training can be developed for staff. 2 30 Care Homes for Older People Page 26 of 27 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 © (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!