Inspection on 03/02/09 for Venmore Community Care Centre

This inspection was carried out on 3rd February 2009.

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

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

Other inspections for this house

Venmore Community Care Centre 28/02/07

Venmore Community Care Centre 21/02/06

Venmore Community Care Centre 02/12/05

Venmore Community Care Centre 21/03/05

Venmore Community Care Centre 11/08/04

Venmore Community Care Centre 15/03/04

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: Venmore Community Care Centre Hartnup Street Anfield Liverpool L5 1UW     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: Jeanette Fielding     Date: 0 3 0 2 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 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: Venmore Community Care Centre Hartnup Street Anfield Liverpool L5 1UW 01512632888 01512610373 michelle.moss2@liverpool.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Liverpool City Council Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 25 Number of places (if applicable): Under 65 Over 65 25 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following category of service only: Care home only - Code 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 - Code OP The maximum number of service users who can be accommodated is: 25 Date of last inspection Brief description of the care home Venmore House care home is located in the Anfield area of Liverpool and is close to local shops and transport links. The home is a purpose built building split onto three floors and incorporates a large day centre, which residents can access. The home is registered to provide personal care to up to 25 residents. The home provides long term care to 10 older people, intermediate care to 10 people and early discharge from hospital following a stroke to 5 people. The three floors operate independently and have a separate kitchen, dining room, laundry and lounge on each floor. Fifteen bedrooms are provided with ensuite facilities. Care Homes for Older People Page 4 of 27 Brief description of the care home 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 unannounced inspection took place on 3rd February 2009 and a total of seven 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 evaulate the training that they had undertaken. Safety certificates were viewed to ensure that all equipment and facilites 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 Venmore. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 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. Detailed assessments are undertaken on all prospective service users to ensure that the home has full information regarding their needs and preferences to enable the home to meet those needs and preferences. Evidence: The home accommodates 10 service users for long term care, 10 service users for intermediate care and five service users on the early supportive discharge scheme from hospital for rehabilitation following a stroke. Service users accommodated for long term care are assessed by senior staff at the home to identify their health, care and social needs to evaluate whether these needs can be assessed by the home. The assessments take place in the service users own home or in the hospital as appropriate. The pre-admission assessments for recently admitted service users were inspected and were found to be detailed and informative. Care Homes for Older People Page 10 of 27 Evidence: Sufficient nformation is gathered to enable care plans to be prepared. Information is also recorded at the assessment of individual dietary needs and any preferences the service user may have that would enable them to enjoy the lifestyle that they prefer. Service users accommodated for intermediate care and under the supportive discharge scheme are assessed by hospital staff or social workers. Full information is given to the home who make the final decision regarding the appropriateness of the service user for rehabilitation. Staff undertake an assessment on these service users following their admission to the home to gather information regarding their needs and individual preferences. Assessments are also made by other health care professionals i.e. physiotherapists, speech and language therapists and occupational therapists, to ensure that the service users specific rehabilitation needs are identified. The home has reviewed and updated the service user guide and statement of purpose to reflect the changes that have taken place within the home. These documents are issued to all enquirers and additional copies are available from the home. 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 files are prepared to provide staff with full information about the health, care and social needs of all service users to ensure that they enjoy a good quality of life. Evidence: are files are prepared for all service users. A selection of files for service users accommodated across all services were inspected. All were found to be extremely detailed and informative and contained sufficient information to enable staff to provide the appropriate level of care required by the service users. Care files for service users accommodated for long term care are reviewed and updated each month, and more frequently if necessary. Service users also have a six monthly review and are invited to give their comments which are then included in their file. Care files for other service users also contain full information but are reviewed and updated more frequently as they spend only a short time, up to eight weeks, at the home. Their progress is continually monitored by the home and the health care Care Homes for Older People Page 12 of 27 Evidence: professionals and full information is recorded. Risk assessments are undertaken for all service users. Action plans are put in place to reduce or remove any potential risk to the service users. These include mobility, falls, moving and handling and nutrition. A plan is also prepared of how the individual service users would be evacuated from the home in the event of fire, based on the service users abilities and the location of their bedroom. A photograph of the service user is placed on their file, and on medication administration record sheets to assist with identification. Individual preferences i.e. time of going to bed and rising, name to be referred to by and food are recorded to assist with providing the level of support that the service user wishes. Records are held of all visits to, and by, doctors and other health care professionals and changes to the care to be provided is recorded. The home is also well supported by the Primary Care Services who visit the home as necessary. All changes are given verbally to staff at the handover at the beginning of each shift. Staff spoken to during the inspection confirmed that they were given every opportunity to read the care files to ensure that they were providing the right level of support. Independence is encourage, particularly for those service users who will be returning to their own home following their stay, and the files provide staff with the expected outcome for service users to enable them to live independently. Daily records are completed by the staff and provide evidence of the actual care afforded. Discussion took place with several service users and one visitor to the home. The service users, for all service provision, spoke extremely highly of the staff and of the care given to them. One service user said, I have to go back home in a couple of weeks. I have really enjoyed being here. I didnt know what to expect but the staff have given me information at every stage. If I have to go into a home to live, I would certainly come back here. One visitor spoke highly of the home and said The staff are wonderful. They are so caring and they do a really good job. The home is clean and homely. The home has a detailed policy and procedure for dealing with medications which has recently been reviewed. All staff who deal with medications have been given training and the certificates are displayed on the wall in the medication room. Medication Administration Record sheets (MARs) are accurately completed and were up to date. Medications are securely stored. Service users who are accommodated for short term care are encouraged to attend to their own medications following a risk assessment. All storage areas were clean and organised and arrangements are in place for Care Homes for Older People Page 13 of 27 Evidence: unwanted medications to be disposed of safely. Privacy and dignity are respected at all times. The inspector was introduced to all service users and an explanation for the visit given. Service users were asked individually if their bedroom could be seen prior to the tour of the building. It was evident that individual choices and preferences are respected at all times. 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: Service users have the opportunity to take part in a high number of social activities within the home. A programme of activities is prepared and service users can choose whether or not they participate. The home also provides a day care centre and those using the home can access this to enjoy an extensive range of activities and trips out. Chair based exercises and activities enable those with mobility problems to participate fully in the activities programme. Some service users who are accommodated for long term care are taken out during the day but those who are accommodated for rehabilitation are required to be in the home for the high level of physiotherapy and other services that are provided. Service users accommodated for rehabilitation have additional activities that include the development of kitchen skills to prepare them for returning home. The dining rooms within the home are fitted with sinks, refrigerator, dishwasher, cooker and kettle to provide facilities for those who wish to continue to maintain their domestic Care Homes for Older People Page 15 of 27 Evidence: skills and for encouraging rehabilitation and independence. The care files include information regarding the service users previous social activities and the programme of stimulation can be varied to ensure that all service users preferences can be incorporated. Visitors for long term service users are welcome at any time but for those service users whose accommodation is for rehabilitation, visiting times are limited to ensure that they are available for the therapy sessions. This system has worked well within the home and one relative spoken to said that family understood the restrictions on visiting and respected it as they were aware of the reasons why they were necessary. Service users can meet with their visitors in one of the communal areas or in the privacy of their own bedroom as they wished. Meals are taken in the dining room and provide a further opportunity for social stimulation. The dining rooms are extremely pleasant and the tables laid with cloths, napkins, place mats and table centres. The meals served at the time of the inspection looked and smelled appetising. Service users said that the meals were lovely. They confirmed that a choice of meal was always offered and that their likes and dislikes were known by the staff who made sure that the meal served was of their liking. Special diets can be provided on the advice of the GP, dietitian or on the request of the service user. A cooked breakfast is available, together with cereal and toast. A lighter lunch is provided with the main meal being served in the evening. Drinks and snacks are provided between meals and additional drinks and snacks are available overnight. Meals are prepared in the main kitchen. The kitchen was clean and organised and a good supply of fresh foods were stored. The menus provide evidence that a varied and balanced diet is offered. 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 to although all agreed that there were no issues that they had concerns about. Service users meetings are held regularly to provide a forum where issues can be raised and suggestions made regarding the home. The records show that comments made by service users are addressed and suggestions taken on board where appropriate. All staff have been given training in the Protection of Vulnerable Adults (POVA). The home has a robust policy regarding this and the staff are given training in the procedure to be followed. Staff spoken to said that they were aware of where all Care Homes for Older People Page 17 of 27 Evidence: information on the process was held and were able to demonstrate that they knew the different types of abuse and the action they would be expected to take if it were suspected. Accidents and incidents are recorded and the acting manager and staff have been actively involved in a falls prevention programme, with the occupational therapists, to enable the reason for falls to be identified and to put systems in place to prevent these where possible. 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 good standard to provide service users with a comfortable and homely environment in which to live. Evidence: Venmore is a purpose built care home which is owned and managed by Liverpool City Council. It provides accommodation and facilities on three floors. Fifteen of the bedrooms are provided with en-suite facilities and all other bedrooms have a wash basin. Bedrooms of service users for long term care are personalised to reflect the lifestyle of the service users with pictures, photographs and items of memorabilia. It is evident that staff have strived to provide a homely environment in all other bedrooms with pictures and ornaments. The home is generally well maintained although a small number of issues were identified as requiring attention. The carpet on the first floor corridor is showing signs of wear and consideration should be given to including the replacement of this in the business plan for the home. On the second floor, one bedroom carpet had been damaged by a previous service user who smoked in the room. This carpet should now be replaced. The lounge on the second floor would benefit from redecoration as some of the decor is faded. This detracts from the overall standard within the home. Care Homes for Older People Page 19 of 27 Evidence: One bed which is fitted with bed rails requires appropriate protection to be fitted to the rails. At present, duvets are placed on the rails to protect the service user. Dedicated bumpers should be used for all bed rails. The lounges provide comfortable armchairs, of various sizes, to meet the needs of the service users. Televisions are provided in lounges and these rooms provide service users with sufficient space to socialise. Service users are free to use the communal areas or their own bedrooms as they wish. The home provides a passenger lift which gives access to all areas of the home to those who have mobility difficulties or require the use of a wheelchair. Sufficient bathrooms and toilets are located around the home and aids are provided to assist service users following a risk assessment. The home provides facilities for staff which include lockers for personal use and a meeting room which is used for training purposes and staff meetings. The home was clean and fresh throughout and provides a pleasant environment for the service users. 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 excellent 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 staff team at the home has changed over the last twelve months. Staff from other homes owned by Liverpool City Council have relocated to the home following the closure of their previous place of work. The acting manager said that the staff had really gelled as a team and worked extremely well together. Some of the staff had previously provided care in an intermediate care unit and were able to contribute considerably when this level of care was developed in Venmore. The recruitment of staff follows Liverpool City Council policy and procedure and ensures that all staff are appropriately vetted prior to them commencing work at the home. All prospective staff are required to complete an application form prior to being called for interview. Two references are taken and checks are made through the Criminal Records and Protection of Vulnerable Adults registers to ensure that service users will be protected. Staff files inspected showed that all checks had been made on staff. All new staff are required to complete an intensive induction programme and training Care Homes for Older People Page 21 of 27 Evidence: continues throughout their employment with the Council. The staff records show that training has continued to be given and courses recently completed include POVA, food hygiene, manual handling, medications, personalisation and first aid. Specific training on Early Supported Discharge from hospital and Intermediate Care has been planned. Additional training is given in house from the health care professionals who are involved with the home. All staff, with the exception of two new staff, hold NVQ qualifications. Some of the staff files require to be updated to include all information on training. Staff spoken to during the inspection said that they had enjoyed all the training that had been given and were eager to further develop their knowledge and understanding. Staff were enthusiastic about the home, their role, and the care that is given to the service users. One member of staff said Its good to see the improvements in those who are here for rehabilitation. Another member of staff said that the training has helped develop the service and to understand the need for service users to maintain as much independence to help them when they go home. Supervision is now given to staff on a regular basis to enable training needs to be identified and to provide a forum for support in a confidential manner. The staff rota shows that the home provides staff in sufficient numbers to meet the needs of the service users. The acting manager stated that additional staff are provided when the dependency of the service users is high. 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. The acting manager is well supported by staff and senior management to ensure that service users are protected and provided with a quality lifestyle within a safe environment. Evidence: There has been no registered manager in post for a period of two years and an application to register a manager must be submitted to CSCI. The acting manager has run the home extremely well. She is supported by a well trained staff team who work well together to ensure that the needs of the service users are met. She has coped well with the changes within the home and has collaborated with other health care professionals to develop the new service. The acting manager is available for staff, service users and relatives. Staff spoke Care Homes for Older People Page 23 of 27 Evidence: highly of the acting manager and said that she was supportive and open to new ideas. One member of staff said She listens to you and looks at new ideas. She is prepared to try new ways of working to see how effective they are and is willing to do anything for the service users to make them comfortable and happy. The manager is supported by senior managers from Liverpool City Council who visit at least once each month. Service users are encouraged to complete comments cards when they leave the home and a high number of letters and cards of appreciation were seen. Policies and procedures are held in the office on the ground floor of the home to give the staff full access. These are reviewed and updated on a regular basis. The home holds small amounts of money for service users at relatives request. This is to pay for hairdressing, chiropody, newspapers and toiletries. Detailed accounts are held together with receipts for purchases made on service users behalf, and these are audited regularly. Tests on fire detection equipment are undertaken on a regular basis and are duly recorded. Equipment used within the home is checked by appropriate agencies and certification to confirm safety are held. Records are held of tests made on the premises and on portable electrical equipment are held. Health and safety issues are addressed as soon as they are identified to ensure that staff, service users and visitors to the home are protected. 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 31 8 The registered person must 27/03/2009 ensure that an application to register a manager for the home is submitted to CSCI To ensure that the home is managed by a suitable and competent person 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 19 Consideration should be given to replacing the carpets in one bedroom, where it has become damaged, and on the first floor corridor due to it becoming worn. 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. 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