Care Home: Biffins

Similar services:

• Claremont House
• Oak Ridge
• Sun Court Nursing Home
• Ashville House
• Bilney Hall
• Hill Barn
• Mabbs Hall Nursing Home
• Henrietta House

What the care home does well The staff team and manager are friendly, experienced, well trained and professional. The residents looked well cared for and all commented that they were happy living at Biffins. Documentation and recorded information looked at by us was informative and well written. Staff knowledge of individual residents was good and the health safety and welfare of all people is monitored and maintained so that they are protected against harm or abuse. The general environment is a happy relaxed one and residents told us that they have formed good friendships with other people that live there. Families and friends are encouraged to visit and many events such as Christmas parties, get togethers and barbecues are arranged so that all people who live, work or visit the home can get to know each other in a relaxed environment. What has improved since the last inspection? All requirements from the last inspection have been achieved. The manager carries out a good quality assurance process and the outcomes from people`s views go toward improving the service. What the care home could do better: The provider should provide an outside area to the back garden that is easily accessible for all residents so that they can use the garden freely and have the choice to do so. Additionally many parts of the communal areas of the home are worn and in need of attention, so that it continues to provide a pleasant environment for all people. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Biffins 18 Thorpedene Gardens Shoeburyness Essex SS3 9JB     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: Sarah Hannington     Date: 3 1 0 7 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Biffins 18 Thorpedene Gardens Shoeburyness Essex SS3 9JB 01702292120 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : faizaljoomun@yahoo.co.uk Mr Mohammed Faizal Joomun,Mrs Bibi Sehnaz Bano Joomun care home 14 Number of places (if applicable): Under 65 Over 65 14 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is 14 The registered person may provide the following categories 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 Date of last inspection Brief description of the care home Biffins is a care home for older people over 65 years of age and can accommodate 14 people. It is situated in a residential area of Shoeburyness with easy access to shops and other amenities. There are good bus and train links to the area. The home has accommodation on two floors and there is a passenger lift to enable access to both floors. There are 10 single bedrooms and 2 twin bedrooms, although only 1 resident is occupying each of the twin bedrooms. The home has a large lounge/dining area and a large garden. All prospective residents are provided with a Statement of Purpose and Service User Guide that supplies them with up to date information on the home. Fees Care Homes for Older People Page 4 of 27 Brief description of the care home range from #362.46 to #445.00 and there are additional charges for hairdressing, chiropodist, newspapers and private telephone and Sky TV. 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 unannounced site visit took six hours to complete and was carried out as part of the annual inspection programme for this service. This visit was conducted with assistance from manager/provider. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. We looked at all the information that we had received, or asked for, or what the service has told us about things that had happened in the service since the last inspection. Four staff, one relative and four residents were spoken with during the site inspection. Prior to this site visit, CQC (Care Quality Commission) sent out surveys to all interested parties and 7 were returned to us(all by residents). Additionally the manager was sent an (AQAA) Annual Quality Assurance Assessment form by us. This is a self assessment Care Homes for Older People Page 6 of 27 required by law that asked how well the service is meeting the needs of the people who live at Biffins Care Home. All information obtained was triangulated and reviewed against the commissions key lines for regulatory activity. This helps us to use the information to make judgments about the outcomes for the people who use this service in a consistent and fair way. 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.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 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. A clear and comprehensive assessment process assures people that their needs could be met prior to moving in their home. Evidence: The manager told us in the Annual Quality Assurance Assessment that there is a statement of purpose and residents guide. (These documents provide information about the home to help people decide if they would be happy there). We saw that statement of purpose and residents guide gave information about the staff structure, their qualifications, the complaint process, support offered by staff, the accommodation, the local area and any health services that maybe needed. When we visited the home we looked at the way in which seven peoples needs had been assessed. We saw that the assessment covered details of the persons health needs as well as the support the person as required to maintain physical, mental and Care Homes for Older People Page 10 of 27 Evidence: emotional well being. In all documentation each persons communication needs, their likes and dislikes was recorded to help determine that the home would be able to meet their individual needs. The manager told us that a copy of the social services or local authority needs assessment is also obtained (these were present in all 7 residents files looked at) and that people are invited to visit the home before they move in. One relative told us that they had visited twice and received the service user guide and had read the CQC (then CSCI) report before deciding if the home was appropriate for their relative and two of the residents told us that they came to visit the home before moving in. 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. Peoples care plans describe their identified needs and helps to make sure the care provided is delivered in the way they choose. Evidence: The manager told us in the Annual Quality Assurance Assessment that each person had a care plan, looking within all 7 residents files it showed us this was the case. All 7 of the Care Plans seen were reviewed every month or more often where this was appropriate. The recording of reviews by staff were much improved since the last inspection and included a short summary of what had changed and why. Yearly reviews showed us that the residents, their families, social workers and community nurses or GPs were part of this process. The manager told us that emphasis was put on enabling residents to make decisions and choices about their health care and lives in general. We saw that all residents were supported in attending routine appointments for health care monitoring and that had access to medical, dental and optician services when needed. It was recorded that residents enjoyed good health and observation showed us that all residents looked well cared for. Care Homes for Older People Page 12 of 27 Evidence: Risks to residents health and safety were well managed while allowing residents to participate in activities such as accessing the community. Where the level of risk to a person was assessed as high and there was the likelihood that the person may injure themselves (such as risks associated with mobility or risks associated with health care needs) then staff imposed some limitations on access to these items or areas and supervised residents as needed. Where this was necessary then it was recorded clearly. When we visited the home we saw that the administration records were maintained in accordance with agreed procedures and the royal pharmaceutical legislation. At the time of the inspection none of the residents living in the home were capable of safely keeping and administering their medicines, therefore staff administered all medication. We looked at medicine administration records and these were completed accurately to show that residents received the medicines, which were prescribed for them and that they were securely held. We saw that all staff training was up to date. All controlled drugs have a specialised locked cabinet and controlled drugs book. There have been no incidents reported around medication issues or practice would suggest that medication is kept to a strict protocol and is maintained consistently to a good standard. Care Homes for Older People Page 13 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 using the service can be confident that their identified needs will be met appropriately and that they will be able to live the lifestyle they choose. Evidence: When we visited the home we saw in documentation provided that residents were involved in making choices such as new activities introduced, having regular contact with family or friends and a choice of community activities such as using local shops, using cafes, walking to the sea front or around the local area with staff and that this was recorded. Speaking with one relative and four of the residents they told us that the home holds a number of barbecues during the summer and that they get to meet each other (relatives and all staff) and that this is a fun occasion and felt it was very beneficial. One relative who we spoke with also said that it gave them confidence to know that other relatives experience of the home, staff and care was good and the same as their perception of the service. Observation on the day of the site inspection, showed us that a large percentage lot of the residents chose to sit within the lounge area and chatted, and laughed with each other. Some people chose to watch the television, a couple of people were reading Care Homes for Older People Page 14 of 27 Evidence: magazines and newspapers and one person was knitting. Staff were also playing cards with a group of residents. One person who had poor eye sight had a machine from the RNIB to play audio newspapers and books. A couple of people chose to spend time in their rooms listening to the radio or spending time as they wished. Whilst on inspection a mobile library service visited and people had a choice of reading material to choose from. Since the last inspection an activities coordinator has been employed. This member of staff carries out group and 1-1 activities with all of the residents. An activities folder showed us what activities were being carried out and found that they matched the interests of residents that were recorded within their files. The activities coordinator works a few hours each day. Apart from the organised activities, all staff encourage residents to be active or occupied and this was seen through out the day. The home allocates different staff each day to cook the meals during the week and weekends. The information for all staff showed us that they all held the relevant qualifications needed for this role such as their food hygiene. All kitchen equipment and regular checks were good and in place such as the checking of temperatures of the fridges and freezers. There was a four week menu that showed us that the likes of residents and their specific dietary needs, (that were recorded in their information) were reflected in the meals provided and that they had a varied and good quality of diet. The lunch time meal seen and was of good quality, home cooked and presented nicely. Liquidized meals for some people were prepared nicely and separated into meat and vegetables etc, so that smell, texture and quality were retained. Staff that were supporting people to eat meals did this in a sensitive and respectful way. All residents had a nutritional risk assessment held within their files and this was reviewed regularly on a monthly basis. The manager works closely with the local dietician which ensures that all people at Biffins are monitored regularly and dietary requirements maintained to a good level. Four residents spoken with and seven surveys returned told us that, the meals were of good quality, to their liking and that people had plenty of choice. One relative told us that, the food always smells and looks good. Care Homes for Older People Page 15 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. There are systems in place to ensure that peoples views are listened to and acted upon and that support residents from abuse. Evidence: Each of the four people living in the home told us that they knew who to speak with if they were unhappy or needed to make a complaint. Some residents identified staff who they would report to. Three members of staff told us that they were aware of the homes policy for dealing with complaints and safeguarding people from harm. When we visited the home we looked at the policies and procedures. We saw that there was detailed information available for residents to assist them in understanding how to complain if they were unhappy. There was also detailed information made available to staff once they commenced work at the home, which described their roles and responsibilities in reporting bad practice. This included a whistle blowing policy. This helped to assure staff that they would be protected from harassment should they need to raise concerns. We looked at how staff were recruited to work in the home and saw that all of the checks such as employment references, Criminal Records Bureau disclosures and PoVA First checks were obtained before a person started work at the home. This helped to ensure that only people who were suitable were employed. We saw that all staff had undertaken training in recognising and reporting abuse or bad practices. There had been no complaints or concerns raised about the home since the last inspection. Care Homes for Older People Page 16 of 27 Evidence: During the inspection we spoke with four of the residents and seven surveys returned to us told us that they felt staff treated them well. We saw that staff treated residents with respect and that residents were very comfortable and open in the company of staff. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and safe environment. Evidence: The manager told us that residents had all of the equipment that they needed and that bedrooms reflected each persons individual personality through their choice of furniture, decor and personal belongings. They told us that there had been improvements to the environment with the redecoration and refurbishment of some areas of the house. Each of the 7 residents who completed surveys told us that the home is always fresh and clean. When we visited the home we were invited by some residents to view their bedrooms. We saw that these rooms were bright, clean and reflected each persons individual taste. All residents we spoke with told us that they were happy with their home. The manager told us that in each bedroom were a nurse call point which was in easy reach for each person to use, these were also provided in all toilets, bathrooms, lounges and the dining room. This was seen by us when a tour of the building was undertaken. We saw that checks were carried out regularly to ensure that equipment was in good working order, such as, hoists used, kitchen equipment, call systems, the lift, fire doors, toilets, walking aids, commodes and wheelchairs. These checks were carried out on a three monthly basis by the manager and ensured that safety was Care Homes for Older People Page 18 of 27 Evidence: maintained for all residents. We saw that there were procedures in place and that staff had training to promote and to reduce the risk of infection. During the tour of the building many of the communal areas were seen to be in need of re carpeting, repainting and redecoration. Additionally access to the back garden could be improved upon. The issue at present is that all residents cannot access this area independent of staff. This is because once in the garden it presents a number of trip hazards. Therefore for this area to be fit for the use of all residents and the manager needs to address this. However the garden itself (apart from this issue) was maintained well, pleasant and provided plenty of space for people. One resident informed us that they often did some gardening and enjoyed this use of their time. Speaking with the manager he told us that a maintenance plan is underway and would be addressing these issues raised by us at this inspection. Since the last inspection the manager has redecorated the front of the building and front garden which looks pleasant and smart when arriving at the home. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are offered positive relationships by well-supported and caring staff and are protected by staff recruitment, induction and training. Evidence: Residents who completed surveys said that staff listen to them and act on what they say. When we visited the home we saw by observation that, staff interact well with residents, were motivated, competent and listened to people. One relative commented that she thought the staff ratios were always good and that the staff were permanent, well trained (staff certificates held in foyer of home) and that they kept in contact with her either about concerning things or things her relative was doing.( sitting in garden enjoying the good weather or carrying out an activity). The manager told us that all staff had been at the home for some years, although since the last inspection three new staff had been employed. He told us that all staff had a detailed job description in relation to their jobs, that they had an induction to the home when they started work and that they received both mandatory and specialist training to best support residents. Staff told us that checks such as Criminal Records Bureau disclosures had been obtained before they commenced their employment. Staff also told us that they received training, which was relevant to their roles, helped them understand the needs of residents and kept them up to date with Care Homes for Older People Page 20 of 27 Evidence: new way of working. When we visited the home we looked at staffing levels (which are good) and how staff were recruited, trained and supported to meet the needs of residents. We looked at the recruitment files for eight members of staff. We saw that before they commenced work that satisfactory employment references, Criminal Records Bureau disclosures and PoVA First checks had been obtained and a full ten year employment history was checked for both people. Staff told us, that their induction covered everything that they needed to know about the job. In addition we saw that staff had detailed job descriptions and information about their roles and the conduct expected of them. We saw that staff were supported well by the management team by means of regular supervisions and staff meetings, however yearly appraisals still need to be implemented. There was an ongoing programme for staff training and development. Staff undertook training in a wide range of topics including communication, assessing risks, dementia, diabetes and safe handling of medicines. Staff were also trained to recognise and report abuse or poor practices and they had specific training in understanding the needs of the people they supported. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management strategies of the home were stable which ensures the health, safety and welfare of all residents. Evidence: The registered manager (who is also the registered provider) has achieved much from the last key inspection and holds a wealth of experience and knowledge of the current resident group and this goes towards securing the health, safety and welfare of all people. It also provides consistency of care and supports the staff team to maintain the quality of care given to people. He is NVQ 4 qualified and holds the Registered Manager Award. Recently he has completed the, train the trainer course and is now qualified to train all staff under his care. (although he still uses a combination of the local borough training and an accredited outside trainer) We looked at the arrangements for ensuring that the home was maintained safely. We saw that regular checks were carried out on equipment such as hot water and heating Care Homes for Older People Page 22 of 27 Evidence: systems, fire alarms and fire fighting equipment, gas and electrical installations and equipment. All equipment was well maintained and repaired as required. The deputy manager is the official trained Fire Marshall and speaking with her showed us that she knew her role well, worked well with the fire officer (who has recently visited) and had competent fire risk assessments in place and trained the staff in evacuation procedures well. Residents finances are all looked after by their relatives. Monies that do come into the home from relatives for the residents use, are looked after, recorded and accounted for well and protects all people from financial abuse. We looked at how the views of residents, their families and other people who were important to them were obtained and acted upon. Residents meetings are regularly held and relatives who visited the home told us that staff were available to speak with them to gain their views or raise any concerns. We saw that questionnaires were sent to residents and other people each year to ask them for their views about the home, staff support and the findings from these were analyzed and action plans were in place. Additionally we saw that the manager carries out regularly monthly checks of the premises, speaks to staff, residents, professionals and relatives to monitor the quality of care provided. (regulations 26 visits) This alongside the AQAA forms part of the annual quality review of the home. All this information then forms the following years annual development plan for the home. This ensures that peoples views are in the forefront of improving the service and that good outcomes from the quality assurance process for all residents are achieved. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 The manager needs to ensure that the physical layout is suitable for the purpose of all residents and meets their needs. This is because the garden is not accessible for all residents to use independently. At present due to the design there is a high risk of trip hazards when using the garden, these need to be removed. 31/03/2010 2 19 23 The manager needs to ensure that the is kept in good repair and is kept in good decorative order. The home communal areas and some personal rooms need to be updated, repainted and re-decorated to residents choice. 31/03/2010 Recommendations These recommendations are taken from the best practice described in the National Care Homes for Older People Page 25 of 27 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 36 The manager needs to implement yearly appraisals for all staff. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!