Inspection on 07/07/09 for Tyndale Nursing Home

This inspection was carried out on 7th July 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tyndale Nursing Home 04/06/08

Tyndale Nursing Home 10/12/07

Tyndale Nursing Home 27/07/06

Tyndale Nursing Home 29/11/05

Tyndale Nursing Home 07/09/05

Tyndale Nursing Home 10/02/05

Tyndale Nursing Home 07/09/04

Tyndale Nursing Home 31/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Tyndale Nursing Home 36 Preston Road Yeovil Somerset BA21 3AQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Poole     Date: 0 7 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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: Tyndale Nursing Home 36 Preston Road Yeovil Somerset BA21 3AQ 01935472102 01935706624 janipaul@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Christopher Michael Bruce Wharton Name of registered manager (if applicable) Mrs Carol Flowers Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: To provide day care for up to 2 persons per day between the hours of 0700 and 1700 Up to 27 elderly persons of either sex, not less than 60 years, who require general nursing care Up to 3 places for personal care Up to two persons of either sex, between the ages of 18-60 years, who require general nursing care Date of last inspection Brief description of the care home Tyndale is a 27-bedded care home providing nursing and personal care for older people. The home is in Yeovil, which has all the facilities of a medium sized town including hospital, shops, theatre, churches and other leisure facilities. There are smaller shops and a park within walking distance. The home is situated on a site, Care Homes for Older People Page 4 of 27 0 Over 65 27 Brief description of the care home which also includes a sheltered housing complex and residential care home. This affords people from all three facilities the opportunity to socialise and maintain friendships should they move into different areas for care. Tyndale is an old converted house with a purpose built extension, built in 1987, attached by a short walkway/entrance hall. Accommodation is provided in 17 single and 5 double bedrooms on two floors, the first floor being accessible via a shaft lift. There is an attractive, large front garden that looks onto the main road and a quieter courtyard garden accessed from the lounge. Current (7/07/09) fees are 720 pounds per week. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of this inspection visit was to inspect relevant key standards under the Commissions Inspecting for Better Lives 2 framework. This focuses on outcomes for people and measures the quality of the service under 4 general headings. These are :excellent, good, adequate and poor. This inspection was carried out by one one inspector over a one day period. There were 21 people living at the home. We, the Commission, were able to talk with people living, visiting and working at the home, observe care practises, tour the building and view records. The registered manager was available throughout the day, we were given unrestricted access to all areas and all records requested were made available. Before the inspection the manager completed an Annual Quality Assurance Assessment Care Homes for Older People Page 6 of 27 (AQAA) which gave details about the home and their plans for the future. 6 people living at the home completed questionnaires and some of their comments have been incorporated into this report. Care Homes for Older People Page 7 of 27 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 on page 4. Care Homes for Older People Page 8 of 27 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive adequate information about the home before they move in to help them decide if it is the right place for them. To ensure that the home has the appropriate skills and facilities to care for new people everyone has their needs assessed before they move in. Intermediate care is not provided. Evidence: The home has an up to date statement of purpose and service user guide. There is a service user guide in each bedroom and this gives details about the facilities provided and lists what is included in the basic fee. People spoken with said that they had not visited the home before they moved in but had relied on family and friends to view it. The home has produced a small colour Care Homes for Older People Page 11 of 27 Evidence: brochure which enables people who can not visit to see photos of the home. The manager stated that either she, or a senior member of staff, sees and assesses anyone wishing to move in before a place is offered. This ensures that the home has the skills and facilities to meet the persons needs. It also gives people a chance to ask questions about the home to ensure that it will meet their expectations. 5 of the 6 people who completed a questionnaire before the inspection answered YES to the question Did you receive enough information to help you decide if this was the right place for you, before you moved in? A copy of a pre admission assessment was seen for a person who had recently moved in. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home feel that they receive the medical support they require. Care plans would benefit from further development to ensure that they give clear details about peoples needs, wishes and lifestyle choices. Evidence: During this inspection 3 care plans were viewed in detail. All gave information about the persons physical needs and two contained details of likes and dislikes. No care plans contained life histories and therefore there was limited information about peoples interests or lifestyle preferences. Each person has a care plan in their room and there is a further kardex system for medical information. There were risk assessments in place relating to skin care and preventative measures had been put in place to minimise the risk of pressure damage. Although all care plans gave evidence that they had been reviewed regularly instructions were not always clear as some out of date guidance had not been removed from the current file. For example one had a care plan for the care of two pressure sores which had healed in January this year, another gave instructions for how to support the person to reduce their weight by Care Homes for Older People Page 13 of 27 Evidence: reducing snacks although this information was no longer relevant as they also had a care plan stating that they were now fed by a peg feed and were therefore nil by mouth. This person also had a care plan stating that they spent four hours each day in a special chair although staff stated that the person was now being permanently nursed in bed. To ensure that all staff, including any agency staff, offer consistent care to people care plans need to give clear up to date information. Many people at the home have bed rails fitted to their beds. Risk assessments were in place for the use of these but there was no assessments of need and therefore no rationale for there use and no indication that other less restrictive practises had been considered. Everyone asked stated that they had access to health care professionals outside the home and records maintained confirmed that referrals were made according to individual need. 5 of the 6 people who completed questionnaires answered ALWAYS to the question Does the home make sure that you get the medical support that you need? The other person answered SOMETIMES. One person spoken with said that the home was very good at monitoring physical health and that they pick things up and get it seen to. Generally people felt that their privacy was respected. Throughout the day it was observed that staff interacted with people in a friendly respectful manner. Staff were seen knocking on bedroom doors before entering. One person said that staff assisted then in a sensitive manner but that there was sometimes no choice about the gender of the person who assists them with personal care which they felt was embarrassing at times. The home uses a monitored dosage system (MDS) for medication. The dispensing pharmacist visited the home in December 2008 and reported that practises were excellent. All administration records seen at this inspection were well completed and correctly signed when administered or refused. Controlled drugs were checked and stocks held correlated with records. In two instances it was found that excessive stocks were being held and this was discussed with the homes manager. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to a range of activities and are able to choose which ones they join in with. Visitors are always welcome at the home. Evidence: There is a very relaxed and calm atmosphere in the home. People are able to choose to spend time in the communal areas or in the privacy of their rooms. There is a monthly newsletter which gives details of activities and trips out. People said that they are free to choose which activities they join in with. During the inspection there was a gentle exercises class in the morning and in the afternoon some people were helping to make bunting for the summer fete. Other people were spending time in their rooms either reading or watching the TV. People spoken with said that they were happy with the activities provided. The majority of people who completed questionnaires felt that there were usually activities to join in with. A visiting hairdresser comes to the home every week and was there on the day of the inspection. A representative from the local church visits the home monthly to allow people to take communion. People said that they had some choice about what time they got up and when they Care Homes for Older People Page 15 of 27 Evidence: went to bed but they had to fit in with the routines of the home. Staff spoken with felt that they had a good knowledge of peoples preferred routines and tried to accommodate peoples wishes. People living at the home said that they were able to have visitors at anytime and visitors spoken with said that they were always made welcome. One person wrote on their questionnaire that it would be good if there was a small lounge for people to use when they have visitors so that they did not have to see people in their bedroom. Everyone spoken with was very happy with the quality of food in the home. Since the last inspection the home has put in place systems to ensure that everyone has a choice of food and that meals are recorded. A kitchen assistant sees everyone each morning to ask what the would like to eat that day. There is a set menu and alternatives are offered to anyone who would like something different. Everyone spoken to was aware that they were able to make a choice about their meal. The cooks in the home said that they always had access to ample supplies of good quality food. Cupboards appeared well stocked. One cook is currently undertaking a Diploma in nutrition and was able to demonstrate a good knowledge of the nutritional needs of older people and the particular preferences of the people living at the home. Special diets are catered for. 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. People living at the home are able to share worries or concerns with the manager or a member of staff. There is a clear complaints procedure, which is available in the service user guide. Evidence: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. The home does not have a copy of the local policy for the protection of vulnerable adults which gives clear guidance for the local procedure to be followed if an allegation of abuse is made. Staff spoken with stated that they had received training in the protection of vulnerable adults and were aware of the whistle blowing policy. People living at the home said that they would be comfortable to raise any worries or concerns with a member of staff or the manager. People said that staff were always polite. No complaints have been received since the last inspection. The home does not act as a financial appointee or power of attorney for anyone at the home and there is a system in place to ensure that small amounts of personal money is securely stored and recorded. Care Homes for Older People Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Tyndale provides a comfortable homely environment but some areas would benefit from upgrading. Standards of cleanliness throughout the home are very good. Evidence: The home is a large older style house that has been extended over the years. Accommodation is provided on two floors with a passenger lift between. There is one large communal lounge/diner on the ground floor that is accessible to all. There is a small room, which is currently used as an office area and for storage, that could be made into a second lounge to give people more choice about where they spend time. Outside there are well kept gardens that people are able to use in good weather. A sample of bedrooms was viewed all had been personalised to reflect the needs and tastes of the individual. Currently all rooms are used for single occupancy although some are registered as doubles and the second bed has not been removed. There are toilets and bathroom facilities throughout the home but only one bathroom, on the ground floor, is fully assisted and appropriate to the people who live at the home. Most bathrooms appear to be used mainly for storage. Care Homes for Older People Page 18 of 27 Evidence: Since the last inspection the home has decorated some hallways and replaced some chairs. Many areas of the home continue to look tired and some carpets and bedroom furniture would benefit from replacement. This was highlighted as an area in need of improvement in the homes own Annual Quality Assurance Assessment (AQAA) All areas seen on the day of the inspection were clean and fresh. Care Homes for Older People Page 19 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 living at the home are supported by a well trained and committed staff team. Recruitment practises could be improved to ensure that they fully protect people who live at the home. Evidence: The home employs 7 registered nurses and 19 care staff. 78 of care staff have an NVQ at level 2 or above. (Figures taken from AQAA) The home also employs domestic, kitchen and maintenance staff. Everyone spoken with during the inspection felt that there were adequate staff on duty at all times. Usual staffing levels in the home are 1 registered nurse and 5 carers in the morning, 1 registered nurse and 4 carers in the afternoon and evening and 1 registered nurse and 2 carers overnight. We observed that there was a relaxed atmosphere throughout the day and people did not appear to be rushed. People living at the home said that call bells were answered quickly throughout the day and night. People living at the home said that staff were always kind and polite. One person wrote on their questionnaire All staff are cheerful, chatty and helpful another wrote the staff are wonderful. Care Homes for Older People Page 20 of 27 Evidence: Staff spoken with were very happy with the training opportunities provided. They said that they received training in health and safety and in subjects specific to the needs of the people living at the home. Staff felt that everyone worked as a team and that there was good communication. The recruitment files of four people employed since the last inspection were viewed. People had completed application forms and written references had been received. The home should review the application form to ensure that it meets current legal requirements and provides space to provide a 10 year employment history. One person had begun work in the home before they had been checked against the Protection Of Vulnerable Adults (POVA) register, this could potentially place people at risk. Criminal Records Bureau (CRB) had been applied for for all new staff. Care Homes for Older People Page 21 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. The home is being effectively managed taking into account the views of people who live and work there. Evidence: The registered manager of the home is Carol Flowers, she is a registered nurse and has completed the Registered Managers Award (NVQ level 4.) Carol was available throughout the inspection and was able to demonstrate a good knowledge of people living and working at the home. There is also a deputy manager. Both the manager and deputy work alongside other staff to monitor practise and offer advice and support. We saw evidence of annual appraisals for staff and the home has begun to undertake supervised practise sessions with staff. The manager keeps her knowledge up to date by attending training courses and liaising with other professionals. Everyone asked said that the management team were very open and approachable. People said that they would have no hesitation in approaching the manager if they had any concerns. Care Homes for Older People Page 22 of 27 Evidence: There are regular meetings for people living and working at the home to ensure that everyone has an opportunity to share their views. Staff said that meetings were a chance to share information and make suggestions about the running of the home. There are various audits in place to monitor the quality of care and facilities. Surveys are sent out to the people living at the home and their representatives on an annual basis. Surveys returned in October 2008 showed a high level of satisfaction with the service. There was no evidence that results of surveys had been collated to plan future improvements. The AQAA states that the home wish to continue to develop their quality assurance systems and audits. The fire log was viewed. This showed that the fire detection system was tested by outside contractors on the 18/06/09. Records seen showed that there had been no in house tests since April this year. The provider explained that this is because the person who tests the alarms and emergency lighting has been away from the home and as yet no one else has been trained to carry out the tests. All equipment in the home is regularly serviced. All accidents are recorded. As previously stated the home does not act as a power of attorney or financial appointee for anyone living at the home. There are facilities to store small amounts of money for safe keeping. Records are kept of all monies and receipts for all purchases are retained. An up to date certificate of insurance is displayed in the home. Care Homes for Older People Page 23 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 24 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 14 (1) The registered person must ensure that assessments of need are carried out before bed rails are used. To ensure that people receive appropriate care in the least restrictive manner. 07/08/2009 2 7 15 (1) (2) The registered person must ensure that care plans give clear up to date information about individual needs. To ensure that all staff have access to clear information and are able to support people in a consistent manner. 30/09/2009 3 29 19 (1)[b] No new staff must begin work until they have been checked against the POVA register. 30/07/2009 Care Homes for Older People Page 25 of 27 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 To minimise the risk of abuse to people living at the home. 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 2 9 10 Excessive stocks of medication should be returned to the pharmacy. The registered person should ensure that people are given a choice about the gender of the person who assists them with personal care. This should be recorded in care plans. The home should consider creating a second lounge where people could see personal and professional visitors in private or spend time away from the main lounge. The home should obtain a copy of the Somerset Safeguarding Vulnerable Adults policy and ensure that all staff are familiar with the local procedures to follow. The home should have a written plan, with dates, to ensure that it is upgraded to provide a good standard of accommodation and facilities. The home should review the application form to ensure that it meets legal requirements and gives space for a 10 year employment history. The registered person should ensure that there is more than one person who is able to check the safety of the fire detection system. 3 13 4 18 5 19 6 29 7 38 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC 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!