Care Home: Arborough House Limited

What the care home does well Peoples needs are known before they move to Arborough, so they can be as certain as possible that the service will be suitable for them. Arborough provides a clean, comfortable and safe environment to live in. Residents and their relatives are confident concerns or complaints will be taken seriously. Staff are well trained and there are good systems to check them before they work in the home. This helps to keep people safe and ensure staff can meet their needs. There are various ways the service obtain the views of residents and people with an interest in how the service is run. We received the following comments in surveys, "They look after my relative very well, they are very caring, she is very happy. They give me advice when needed. Good food. One to one help. My relative is always dressed clean and tidy. They do not push people to do something they don`t want to do. The staff are friendly and understanding". What has improved since the last inspection? This is the first Key Inspection since the service was registered in August 2009. What the care home could do better: Residents would like more activities, one resident stated in their survey " I would like to go out more, and could if more staff were available". Medication must be signed for at the point of administration. The process for identifying maintenance work needs reviewing as several important safety issues had not been noticed. People surveyed stated that increasing staffing levels would improve their experiences of living/working at Arborough. The manager needs to submit her application to register with us to show she is the right person to manage the service. The manager should make sure the improvements are carefully planned. This will help to ensure they happen. Key inspection report Care homes for older people Name: Address: Arborough House Limited 7 Yarborough Road Southsea Hants PO5 3DZ     The quality rating for this care home is:   two star good 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: Tracey Horne     Date: 0 1 0 2 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Arborough House Limited 7 Yarborough Road Southsea Hants PO5 3DZ 02392821181 02392755058 sallyann@caringforyou.uk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Arborough House Limited Name of registered manager (if applicable) Mrs Catherine Elizabeth Green Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 17. The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the folowing gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Old age, not falling within any other category (OP) Date of last inspection 17 17 0 Over 65 0 0 17 Care Homes for Older People Page 4 of 27 Brief description of the care home Arborough House Limited was registered in August 2009 to provide personal support and accommodation for seventeen older people, who may have dementia or mental disorder. The property is situated in Southsea, Postsmouth, and comprises of a three story detached house. 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: The purpose of the inspection was to assess how well the service is doing in meeting the key National Minimum Standards (NMS) and Regulations. The findings of this report are based on several different sources of evidence. These included: We considered information received about the service since the service was registered, 27 August 2009. We looked at what the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. We sent out ten resident, eight staff, ten relative and ten health and social care professional surveys. We received responses from eight residents (three had been supported to complete the Care Homes for Older People Page 6 of 27 survey by staff/relative), seven staff, one relative and two health and social care professionals. A visit to the service by a Regulatory Inspector. This took place on the 1 February 2010 between 09:30 and 16:30. We looked at documentation relating to three residents and three staff. We spoke with the registered manager, three staff members and one person who was visiting their relative. We also spent time in communal areas observing interactions between staff and residents. We spent time looking at records such as pre admission assessments, care plans, medication records, staff recruitment and training files and records of complaints and compliments. 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. 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 Care Homes for Older People Page 8 of 27 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 are given accurate information about the service and their needs are known before they move in. This helps them make a choice about whether the service will be suitable for them. People can be as sure as possible that the service will be able to meet their needs. The service provides intermediate care when it has capacity Evidence: The AQAA states that two residents have been admitted recently. Ten people live at the home. A new brochure has been produced and each person has a welcome pack in their rooms. New residents have a trial period to ensure the service is best for them. All residents surveyed agreed they received enough information about the home before moving in which enabled them to decide if it was the right place for them. The manager confirmed that fourteen residents currently live at Arborough, since we received the AQAA, a total of four residents have been admitted. We looked at the Care Homes for Older People Page 11 of 27 Evidence: assessment records of three residents who had been admitted recently. They all showed that comprehensive assessments had been completed prior to admission by the manager, although one record did not include the date of the assessment. This was rectified immediately by the manager. The individuals relatives or representatives were involved in the process to gather as much information about the person as possible, such as individuals preferred routines, religion/spirituality, interests and dietary requirements. The assessments also identified any potential risks, such as a history of falls, and what steps would need to be taken to minimize them on admission, such as specialist equipment or the need for two staff to provide support when transferring. We spoke with one relative who confirmed that they felt that the home meets the needs of the residents, not just their relative, as they have observed during their visits, which are almost every day. Seven staff responded to our survey. All ticked always to being given up to date information about peoples needs. One relative stated they usually receive enough information about the service to help them make a decision. One health and social care professional agreed the assessment arrangements usually ensure that accurate information is gathered to provide the right service for people. The manager confirmed the service would only provide intermediate care if there was accommodation, equipment and staff available to meet the short term needs of an individual. 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. Residents who are able are involved in the development and review of their care plans. Records need to show that residents personal and health care needs are being met. The homes processes for storing and handling medication protect residents. However medication must be signed for at the point of administration. Residents privacy and dignity is respected. Evidence: The AQAA states that residents access their doctor, nurse, chiropodist, optician and hairdresser at Arborough. Care plans are reviewed monthly with individuals involvement. Staff are trained in all residents care needs. A new medication system has been introduced. Eight residents responded to our survey, five agreed that they always, three usually received care, support and medical support as they need. One relative agreed the service meets their relatives needs and usually responds to the different needs of individuals. One relative strongly agreed the service meets the needs of their relative. We looked at the care plan records of six residents, they included information about Care Homes for Older People Page 13 of 27 Evidence: their personal hygiene, mobility, medication, pressure area care, weight and nutritional needs. Each plan included risk assessments that had been regularly reviewed. Staff said this ensures any risks are identified and measures are put into place, such as using special equipment and moving and handling aids. We spoke with six members of staff who confirmed they got the information they needed from the care plan and from the daily handover and daily records. They agreed that the way in which they are informed about the people they support works well, and were very confident they have the support, experience and knowledge to meet the different needs of people who live at the service. Daily records showed that residents had access to health care services such as Doctor, District nurse, chiropodists and dentists who visit the service regularly to see anyone with minor health issues. One relative confirmed residents can see the doctor whenever they wished. One health and social care professional agreed peoples social and health care needs are monitored, reviewed and met by the service, and advice is sought and acted upon to improve peoples well being. They also agreed that individuals privacy and dignity is usually maintained. All medication is administered by staff who have received additional training in medication administration. Medication records are regularly reviewed by the manager to ensure they are completed correctly. We looked at some medication administration records (MAR) sheets, all but one had been completed correctly. The MAR sheet for one resident showed that one of their morning dosage of medication had not been signed for. Staff confirmed that the resident had been administered the medication, but they had forgotten to sign to confirm that. This was brought to the attention of the manager as medication has to be signed for at the point of administration. At the time of this inspection no resident manages their own medication. We saw many interactions between staff and residents. All of which were appropriate and valuing of the resident. Care was given in a discreet way and the assistance we saw at lunch time was given in an unobtrusive manner. Staff had an awareness of individuality and ensured that residents were treated individually and given time to make their own choices such as what drink they wanted to what they wanted to wear to where they wanted to go after lunch. We could see privacy screens were being used in shared rooms. We could see that staff always knocked on residents bedroom doors prior to entry and spoke in a respectful manner to residents. 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 living at the service would benefit from the opportunity to take part in more meaningful activities. Residents are able to exercise choice and control over their life, and benefit from a varied and healthy diet. Evidence: The AQAA states that the home employ an activities coordinator. Four residents agreed that the home always arrange activities, two usually and two sometimes. One resident stated in their survey I would like to go out more, and could if more staff were available. During our visit, residents were sat in the lounge. The television was on for those who wanted to watch it. Staff interacted with residents when they were in the lounge/dining room, by making brief conversation, offering magazines to read. Staff said that they wished one more staff was on duty, this would allow them to spend time with residents and engage in more meaningful activities. Staff said that residents rarely accessed the local community due to lack of staffing and transport. One resident stated that they would like to go out occasionally but that only those who had visiting friends and relatives willing and able to take them out had that opportunity. This was discussed with the manager who said would look into increasing staffing levels. Care Homes for Older People Page 15 of 27 Evidence: One relative who responded to our survey agreed to being kept up to date with important issues effecting the person living at Arborough, and agreed the service usually support their relative to live life as they choose. Residents and staff said that visitors are welcome in the service at any reasonable time. This was supported by entries in the visitors book held in the entrance hall, and a relative confirmed they are made to feel welcome whenever they visit. The lounge area had recently been altered to allow for a dining area, there was adequate space for all residents to eat their meals together, although some residents chose to eat their meals in the lounge. Staff were seen to be assisting those who required it, both to get to the table and to eat their meals. There was ample food available. Staff stated that menus are planned on a rolling monthly program and that residents are not involved in choosing menu options. However, it was stated that the staff knew what the residents liked and disliked and that these would be accommodated, and residents were asked their choice between two main meals for the following day. Seven residents agreed they always liked the meals, one usually. We could see that there were sufficient quantities of fresh fruit and vegetables in the kitchen and an appropriate range of dried and tinned foods in storage. The meal time was not rushed and there appeared to be enough staff on duty to assist and encourage where necessary, but staff needed to leave the dining room to answer call bells. 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. A robust complaints procedure ensures that people can be confident their complaints will be taken seriously and that appropriate action will be taken. Policies and procedures, together with the training provided for staff, ensures that residents are protected against the risk of abuse. Evidence: The AQAA states that two complaints have been received. Both were responded to within twenty eight days, as per the policy, both were upheld. All people who responded to our surveys agreed to knowing what to do if someone has concerns about the home. All residents agreed the staff listen to and act upon what they say. We looked at the complaints record, which showed details of the two complaints recorded in the AQAA. They had been dealt with satisfactorily. The complaints record was easy to follow and included all appropriate details from what the complaint was about, the investigation, to the outcome. All of the staff we spoke to agreed to knowing what to do if someone has concerns about the home. The AQAA states that no safeguarding adult referrals or investigations have been made. All necessary recruitment checks and training take place to ensure residents welfare and safety. The manager confirmed Arborough has a policy and procedure in relation to the protection of vulnerable adults. Training records showed that staff receive training in recognising and responding to suspected abuse. This was confirmed by staff spoken Care Homes for Older People Page 17 of 27 Evidence: with, who demonstrated knowledge of the correct procedures to follow. All of the staff we spoke to agree the service ensured their CRB and references were carried out before they started work, which protects vulnerable people. 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. A safe, clean, suitably furnished home is provided for residents, which meets their needs. Improvements are needed to ensure residents live a service that is suitably maintained. Evidence: We looked around the premises and found them to be clean and tidy, no adverse odors were present. But there were some areas that required immediate maintenance attention. Several window restrictors were broken, and one radiator cover was coming away from the wall in one bedroom. The hot water cylinder was housed in a cupboard on the top floor, but this was not locked. The manager confirmed in writing shortly after our visit that these issues had been addressed. However, these issues had not been identified prior to our visit, something that needs improving. The service employs a person to maintain the building and garden. Four of the bedrooms are shared rooms. We could see portable screens were available. Staff confirmed they are used to maintain residents privacy and dignity. The manager confirmed there are enough bathing facilities. All residents agreed the home is always clean and fresh. Staff told us they had received training in moving and handling and equipment such as hoists had been serviced. Corridors were clear from possible hazards. The manager confirmed that fire safety tests and training takes place regularly, and the fire system is serviced regularly. We could see staff working to good infection control guidelines as Care Homes for Older People Page 19 of 27 Evidence: they were using gloves and aprons when delivering personal care and serving food. The laundry has industrial washing and drying machines and dedicated laundry staff 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. Residents feel that a sufficient number and skill mix of staff are on duty to meet their individual and group needs. However more staff would ensure time is spent with residents pursuing meaningful activities. Recruitment practices ensure residents safety. Evidence: The AQAA states that there are sufficient number of qualified staff on duty to meet individual and group needs. Twelve care staff, one senior and one cook are employed. We received information in October 2009 regarding concerns about low staffing levels. We wrote to provider to investigate, the appointed manager responded. As stated earlier in this report, the manager is looking into increasing staffing hours to cover the busy times. Six residents stated that staff are always and two usually available when they need them. We spoke to three staff, all said that having more staff on duty would enable more time to be spent with residents. The manager is aware of this issue and needs to ensure there are appropriate number of staff to meet residents needs. All staff surveyed agreed they have been given enough training that is relevant to their role and helps them to understand individuals needs and keeps them up to date with new ways of working. One relative stated the staff usually have the right support, experience and knowledge to meeting the different needs of people. The AQAA states that 80 of staff have achieved NVQs in Care (National Vocational Qualification). This means that they have an increased skill and knowledge base which Care Homes for Older People Page 21 of 27 Evidence: may mean they are able to deliver an increased quality of care. All of the staff we spoke to agreed they have been given training that is relevant to their role and helps them to understand individuals needs and keeps them up to date with new ways of working. The following comments were made we have lots of training which is good as it keeps us up to date with working practices. We talked to one relative about the staff team, they said the staff are very helpful, kind and caring. We looked at three files of the most recently recruited staff. We could see the necessary checks had been completed such as two references, identification and Criminal Records Bureau (CRB). Two staff said the recruitment process and induction was thorough and they received training and support throughout. The manager confirmed the induction program meets with Skills For Care common induction standards. We looked at their training records and could see that staff had received training in areas such as basic food hygiene, nutrition, infection control, moving and handling, safeguarding adults, fire safety and understanding dementia. The manager said two staff are qualified to provide moving and handling training to other staff. Staff said they are supported to gain their National Vocational Qualification (NVQ) in Care, this means that they have an increased skill and knowledge base which may mean they are able to deliver an increased quality of care. 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 manager has experience of running the service, but is not registered with us to do so. The health, safety and welfare of residents and staff are promoted and protected. Systems are in place to monitor the quality of the service and to ensure residents needs and wishes are taken into consideration. Evidence: The current manager was appointed in June 2009 but has not yet applied to register with us. We have written to the provider about this, as it is not acceptable for a person to manage a service for which they are not registered to do so. The following comment was received from a relative in our survey Staff and management are very approachable. The manager said the organisation recently sent out surveys to residents, relatives and staff but the findings have not been published. The manager confirmed that residents expenses are paid for by the home and an invoice is sent to the residents relative or representative. Records of all transactions Care Homes for Older People Page 23 of 27 Evidence: are kept. We looked at the records for two residents and found them to be correct. A maintenance coordinator ensures all equipment and utilities are regularly serviced. Weekly tests were completed for fire alarms and fire doors. Fire drills are carried out at least monthly. This means that residents are living in a safe environment. Each month a representative of the organization visits the home under Regulation 26. The purpose of this visit is to talk to the manager, staff and residents, tour the environment, look at records and produce a report which shows how well care is being provided, or if any improvements are needed. But the safety issues mentioned earlier in this report were not identified during this process. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 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. 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