Care Home: Ashgrove Care Home.

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What the care home does well People who intend to use this home are holistically assessed prior to admission and this is then used as a basis to develop a more detailed care plan. These are evaluated regularly. Peoples views are sought so they are part of the planning process of their care needs and care plans reflect current needs. A varied programme of social activities ensures that peoples social, cultural and religious needs are being met. These events take place both inside the home and outside so people are not isolated from the wider community. As part of the quality assurance process peoples views are sought not only at the care plan stage but through regular surveys, meetings and through the complaints process. This ensures the home is being run for their benefit. A maintenance programme ensures the home is adapted to suit peoples needs and tastes and is a safe place in which to live and work. A robust recruitment process is in place to ensure staff are safe to work with people and are then supervised and trained to do their jobs. The quality assurance prgramme ensures regular audits are in place to maintain the building and ensure safe practices are in place for staff to follow so people are free from risk and harm. What has improved since the last inspection? No requirements outstanding. What the care home could do better: No requirements issued on this occasion. Key inspection report Care homes for older people Name: Address: Ashgrove Care Home. Ashgrove Care Home Whitehall Farm North Sea Lane Humberston South Humberside DN35 0PS     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: Theresa Bryson     Date: 2 2 0 4 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 25 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 25 Information about the care home Name of care home: Address: Ashgrove Care Home. Ashgrove Care Home Whitehall Farm North Sea Lane Humberston South Humberside DN35 0PS 01472210770 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Minster Care Management Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is: 45 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: Dementia- Code DE; Old Age, not falling within any other categories- Code OP Date of last inspection Brief description of the care home Ashgrove Care home is registered to take people with symptoms of old age and dementia. it is set in a residential area of Cleethorpes, which is a sea-side resort and near the fishing town of Grimsby. The building has a period house and a modern single storey buidling, where the Care Homes for Older People Page 4 of 25 Over 65 0 45 45 0 Brief description of the care home majority of rooms are placed There is ample communal sitting rooms, toilets and bathrooms and other circulation space. All garden areas are accessible for wheelchair users and comprise of paved walkways, sitting areas and enclosed garden areas. The home will accept people who are funded by the Local Authority, Primary Care Trust and privately funded individuals. The Company Statement of Purpose and Service Users Guide is on display in the main entrance and is given to each prospective client. Care Homes for Older People Page 5 of 25 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 inspection took place over one day in April 2010. Prior to this we sent out a number of surveys to people who use the service, relatives, staff and health and social care professionals. A small number were returned. We also checked the service history CQC keeps on each Registered Service to see what they had told us they were doing. The management team sent us their Annual Quality Assurance Assessment (AQAA) prior to our visit which told us what they had been doing and what they intended to do in the future. It also gave us a lot of other statistical data. During the visit we were able to speak to four people living in the home, two relatives and five staff. We also looked at a number of records and documents and toured the home and grounds. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. Care Homes for Older People Page 6 of 25 in future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 25 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 order line 0870 240 7535. Care Homes for Older People Page 8 of 25 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 25 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 assessed prior to admission to ensure the home can cope with their needs and this is then used as a basis to develop a fuller care plan. Evidence: Since the last inspection of this home it has been purchased by a larger organisation, Minster Care. Whilst new service user guides are being printed the old ones are being used, with inserts about the new Company. These are on display in the main reception area and given to each new prospective client. The home has also altered its category of Registration and now no longer has nursing beds but has added the category of dementia to the older peoples category. The home is open to admissions and will take people funded by the Local Authority, Primary Care Trust and privately funded individuals. Contract arrangements are developed locally but with a watching brief by head office staff. Prior to admission the manager ensures that each person has been assessed using an holistic assessment tool and this is then used as a basis for a fuller care plan to be Care Homes for Older People Page 10 of 25 Evidence: developed. The documentation we saw showed this had been thoroughly completed. People told us that they were comforted by how much staff knew about them prior to admission and that they had been asked what they would like to bring into the home of their personal belongings. People are encouraged to come for trial visits for the day or an overnight stay. Staff have recommenced some service specific training which has included, according to the certificates seen, dignity, nutrition, care planning and infection control. Dementia training has been booked, but we were informed by staff they can draw on the experiences of other homes within the Company who specialise in this category of Registration. The home does not provide intermediate care and therefore Standard 6 is not applicable. Care Homes for Older People Page 11 of 25 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. Peoples care plans reflect their current needs and these are evaluated regularly to ensure people are free from harm and risk. Evidence: Prior to the site visit we sent our a number of surveys to people using the service, relatives, staff and health and social care professionals. A small number were returned. Positive comments were made about the attitude of staff, saying very kind and considerate and feel like its a proper home for me. We also spoke to some health and social care professionals prior to our visit who told us they had seen some improvements over the last six months in the way care was delivered to individuals and felt staff moral had improved. During the site visit we spoke to four people who live in the home and two relatives. They told us it was a fabulous place, I dont want to go home and I mainly need help at night but staff come immediately I press my bell. They also made positive comments about the cleanliness of the environment and that they feel they are kept up to date with any new ideas in the home. We tracked three care plans which have improved since our last visit. The new Care Homes for Older People Page 12 of 25 Evidence: Company is putting in their own versions which they were in the progress of instructing staff to do during our visit, but the older versions were being up dated and were a more comprehensive tool. The main care plans showed good continuity in record keeping and appeared to record events accurately. For example where someone had an elimination problem the core care plan identified specific problems and a fuller risk assessment was also included of a continence assessment and bowel movement recording. Details were recorded when this was passed to a local NHS continence advisor for advice. Where a commode was in use a specific risk assessment had been developed to ensure the person was safe. This has ensured this person is being monitored regularly to help their well being. Accident recording and accuracy had improved. We saw clear evidence of when a person had fallen it was recorded on an accident form and the daily record notes. In this case the falls risk assessment had been reviewed by staff to ensure extra safety measures had been put in place. As the person had a visit to hospital the management team had sent us a Regulation 37 notice so we could make a judgment as to whether the correct action had been taken. The management team keep monthly statistics to ensure they can see any patterns developing in a specific individuals care needs or what, if any, triggers there may be environmentally or with certain staff on duty to help protect that person from harm. There was detailed information written down for us to see and staff, when spoken to were aware this occurs and how they can contribute to any system changes. There was written evidence to show that care plans are now being evaluated regularly and if significant incidents occur they let us know through sending us Regulation 37 notices. These are sent also if some one dies so we can make a judgment as to whether care was appropriately administered. We also saw in the care plans a separate section to record someones wishes for their death. This ensures there are no last minute problems at the final moment of a persons life and staff are aware of what to do. We sampled some medication record sheets to look at and found the entries to be accurate. We observed part of a drug administration round and found staff were using safe practices. The records held for temperature control and monitoring the use of controlled drugs was up to date and legible. Staff were clearer about lines of responsibility in administering medication and people appeared to be receiving their medication as prescribed. During the day we observed staff assisting people who live in the home with a number of tasks which they did respecting their dignity and gave encouragement where needed. Care Homes for Older People Page 13 of 25 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. A varied programme of events ensures peoples social, religious and cultural needs are being met. Evidence: In the care plans kept on each individual is a section for hobbies and social interaction. This had been completed, in care plans we tracked, by the key worker. We were informed by staff that they then tell the Activities Coordinator the likes and dislikes of each individual so that person can then plan appropriate social activities for groups of people or on a one to one basis. We also looked at the records kept on specific activities and these recorded a varied programme of events which had taken place. The details included what the event was, who had attended and their response (if a group activity, such as only listened did not contribute). There was more detailed evidence on this occasion of what efforts had been made to ensure links were made with the local community. Staff appeared to have taken into consideration the expectations of people more closely. For example ensuring that specific religious observances were adhered to with help from the local religious leaders. And exploring more contacts with such as the dementia awareness and local activities groups. This ensures that peoples social, religious and cultural needs and expectations are being met. Care Homes for Older People Page 14 of 25 Evidence: There was clearer written evidence in the care plans of when plans had been reviewed and who had taken part in that review. People living in the home and relatives told us they felt they could contribute at any time to those plans and were frequently asked how they felt about living at Ashgrove by their key workers. We made a brief tour of the kitchen as the local Environmental Health Officer had made a visit only a few months previously and awarded the home 3-star status for its Standards of hygiene. The highest award being 5-stars. We could see that food was being prepared in a clean and safe environment and that the 4-week cycle of menus appeared to give a balanced diet for people. People told us food is better than what it was and get too much to eat really. Relatives and other visitors told us they are offered refreshments when they visit which some told us was a nice touch. Care Homes for Older People Page 15 of 25 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 can make concerns known, realising they will be dealt with promptly and in confidence. Evidence: Since the new owners of Ashgrove had taken over the home there had been one safe guarding referral made to North East Lincs safe guarding team. This had proved not to be substantiated. The senior management currently in the home and the safe gurading team have ensured that they keep us informed of any concerns, so we can make a judgment as to whether the correct course of action has been taken. New Company policies are now in place and staff have been encouraged to ensure they read these. Staff were able to tell us they had seen no policy changes but there was no written information on which staff had read them. The home had recorded one complaint they had dealt with internally since our last visit and details were seen of how they had dealt with this and the letter which the complent had recieved. People told us they had every confidence in the manager in dealing with any concerns and staff spoken to felt this would be dealt with in confidence. There were no people living in the home who had the need for an outside advocacy service to be used but staff had been liasing with the local Deprivation of Liberty Coordinator to ensure staff had received training ,which we saw recorded, should the need arise. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People should be able to live in a safe and secure environment suited to their needs. Evidence: As part of the site visit we toured the building and looked at all areas of the home. Some minor changes had been such as making a quiet sitting room off the main reception area and the making of an equipment storage area. Some floor repairs had also been completed to the carpet in one of the main corridors. We were informed that a new maintenance plan was in preparation. Areas which need the most attention were the toilet floors as these areas look very worn and need new flooring and also painting to ensure they are comfortable areas for people to use. The new owners have put the category of dementia on their list Registered categories but we could not see any different environmental changes which had been completed to ensure those with memory loss were safe. Some people living at the home currently and some relatives raised concerns to us that if those with severe memory loss were to wander freely in the home, whether they and others would be safe from people intruding on their personal space. At the time of our site visit there were no people present whose memory impairment was causing any concerns to staff to be able to control. The Company should be more proactive in this and ensure that the environment is adapted to suit all the needs of people living in the home and that each person is safe and free from harm. In touring the home it was clean and tidy, which people living there remarked upon. Care Homes for Older People Page 17 of 25 Evidence: Saying I couldnt do better my self and the bedlinen comes back well ironed. No none expressed any concerns about their personal living space and there was ample evidence that people had been able to personalize them to their taste and needs. Where specialist equipment was in use such as bed rails and special mattresses we saw risk assessments in care plans showing the need and risks this imposed for each individual. The staff records showed staff had recently under taken up date training in controlling cross infection which has given them the skills to be able to identify risks and prevent people from being harmed. Care Homes for Older People Page 18 of 25 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. A robust recruitment process is in place to ensure staff are suitable for working with this client group and steps are taken to ensure they are trained to do their jobs. Evidence: During the course of the site visit we were able to speak to five members of staff and we also received five staff surveys back which had been sent prior to our visit. Staff made positive comments about the new ownership of the home and stated they had been kept informed of new processes being put in place. They had also much appreciated the training sessions which had been offered to them, saying it has really made me think about what I do and no staff member is excluded. They also stated that they feel they cannot always do justice to the care plans as there is little time to keep them updated and busiest time is the morning. People living in the home did not tell us their needs were not being met and the staffing matrix showed how the numbers of staff on duty had been calculated from the dependency levels of each person living in the home. The senior management team should keep a track of this and ensure there are sufficient staff on duty at all times to meet peoples needs. We tracked three staff personal files and there was sufficient evidence to support that adequate checks had been made prior to the commencement of peoples employment to ensure they were safe to work with people in the home. A new training matrix was in place which showed where staff had received up date training in all mandatory topics plus some other topics suited to their needs and to Care Homes for Older People Page 19 of 25 Evidence: ensure they had the skills to deal with the problems of people living there. We saw copies of certificates when we randomly looked at staff personal files.Of the twentyseven staff, nine had completed their NVQ training, which is lower than the 50 required as a minimum standard. There have been changes in staff employed which has resulted in this difference. We also saw letters which had been received detailing training which had been booked such as dementia awareness. This ensures that staff are keeping them selves up to date and are able to respond to the needs of people in the home with the latest knowledge at their finger tips. Care Homes for Older People Page 20 of 25 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. Peoples views are sought to ensure the home is being run for their benefit. Evidence: Since the last inspection there have been marked improvements in some areas of the management of this home. For example there is better and more accurate record keeping, care and attention is given and recorded of the views of people living in Ashgrove and environmentally the home is tidier and there are less hazards to over come when entering rooms and using communal areas. The local Registered Manager is now supported by a head office staff for the new Company and can make, if required daily telephone contact with experts within the Company structure. To help with the transition period a member of Minster Care Team visits weekly to help with the introduction of new Company policies in the home. Staff told us they feel supported by this and feel they are kept in touch with events as they unfold. The new Company has a quality assurance system in place and details of this were only now becoming effective in the home but covered the regular assessing of peoples needs and documented evidence of when their views have been sought, which could Care Homes for Older People Page 21 of 25 Evidence: impact on the business. We also looked at previous auditing processes and saw regular recording of peoples views being sought through the survey process and attendance at meetings. Most room fee account problems are dealt with by the Company head office and we saw this reflected in the policy manual to guide staff on how to deal with financial matters within the home. We also tracked three peoples personal allowance money which appeared to reflect accurately what money had been used for and the money was correct when counted. The recoding in the residents fund records had improved and showed clear entries of how money had been collected and what social events it had been used for. This ensures there is no fraudulent use of funds when accurate records are kept with receipts. A new policy and procedure manual was in place and showed it had been reviewed in February 2010. Records for maintaining the building and ensuring all equipment was safe to use were seen to be in place and that the building was being maintained by the Company and they were ensuring it was a safe place to live and work. To ensure staff look after people they are supervised in their work and the records reflected that regular sessions had taken place. These were a balance between discussion periods and observational supervision. The sessions included discussion on peoples needs who live in the home, their supporters, other staff, the staff members well being and training undertaken as well as future needs and action. This ensures people have suitably qualified staff to look after them. A number of people who sent surveys back to use and who we spoke to told us that they like living here and consider it home from home. When looking around the home people looked happy and well cared for and were suitably attired to suit their needs and tastes. Care Homes for Older People Page 22 of 25 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 23 of 25 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 1 19 The environment should be adapted to ensure it meets the needs of all people living in the home, especially where this affects the safety of those with dementia. The management team should ensure that there are sufficient staff on duty at all times to meet the needs of people living in the home. Staff should be encouraged to complete their NVQ training to level 2 or above to help enhance their role when looking after people. 2 27 3 28 Care Homes for Older People Page 24 of 25 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. © 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. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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