Care Home: Bradbury House

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What the care home does well Before agreeing admission the home carefully considers the needs assessment for each person and its capacity to meet their diverse needs. Prospective people to use the service and their families are encouraged to visit the home and spend sometime. The home ensures that people`s personal and health care needs are met in a manner that protects and promotes their privacy and dignity. People using the service and staff were confident that the home was providing an excellent standard of care. The home provides an activity centre to ensure that people using the service are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The home is clean, safe comfortable and fitted with the appropriate aids and adaptation to promote independence. People said that `the home provides a safe and caring environment tailored to their individual needs and wishes.` The home ensures that staff are provided with the appropriate training to meet people using the service diverse needs. People said that `the staff were loving and caring.` The home is managed by a stable and experienced management team and there are systems in place to ensure that the home is run in the best interests of people using the service to promote their safety. What has improved since the last inspection? The activity programme has been reviewed to ensure that people have a range of meaningul activities to participate in. Internal and external maintenance work to the premises has been carried out to ensure that it is safe and comfortable for people to live in. The training programme has been reviewed to ensure that the staff team is provided with the appropriate training to do their jobs competently. What the care home could do better: The manager and staff continue to offer a high standard of care to people living in the home and are aware of the areas that need improving. Consideration must be made for the home`s medication policy to be reviewed. This is to ensure that it reflects some staff members have delegated responsibility from the district nurse to prepare and draw up insulin medication. The home must review its recruitment practice to ensure when employing staff that have previously worked with vulnerable people a reference from the previous employer is obtained. Key inspection report Care homes for older people Name: Address: Bradbury House Windsor End Beaconsfield Bucks HP9 2JW     The quality rating for this care home is:   three star excellent 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: Joan Browne     Date: 3 1 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Bradbury House Windsor End Beaconsfield Bucks HP9 2JW 01494671780 01494672533 wendy.s@bradburyhouse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Abbeyfield Society Limited care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 41 The registered person may provide the following category/ies of service only: Care home only (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 (OP) Date of last inspection Brief description of the care home Bradbury House is a purpose built residential home registered to provide care for up to forty-one elderly people. It is situated in a pleasant residential area of the old town of Beaconsfield, close to local shops, market place and the Church. There are transport links to the local towns such as High Wycombe and Amersham. The home provides comfortable single bedroom accommodation and spacious social areas. There are accessible attractive and well-maintained gardens. Car parking is Care Homes for Older People Page 4 of 25 Over 65 41 0 Brief description of the care home available to the front of the home. The local Abbeyfield Beaconsfield Society is responsible for the Management of the home and provides a House Committee. People using the service are registered with local General Practitioner (GP) surgeries and have access to local National Health Services through GP referral. 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was carried out on the 31 July 2009 and covered all of the key National Minimum Standards for older people. The inspection lasted for approximately seven hours commencing at 11:30 am and concluding at 18:30 pm. The last key inspection on this service was completed on 9 August 2007. Prior to the inspection a detailed self assessment questionnaire known as the annual quality assurance assessment (AQAA) was sent to the manager for completion and surveys were sent to a selection of people living at the home, relatives, staff and visiting professionals. The AQAA was returned by the due date and contained detailed information demonstrating how the home had listened to people using the service and their relatives and recognising the areas that it still needs to improve in and how it was planning to do this. Eleven people using the service, one relative, eight staff members and two health and care professionals completed surveys and their replies have helped to form judgements about the service.The deputy manager, a senior team leader, people using the service, Care Homes for Older People Page 6 of 25 staff and a relative were also involved in the inspection process and their responses and views of the home have been incorporated into the report. Further information was gained by observing staffs practice, examination of care plan documentation, staffs records, health and safety records and a tour of the premises. Feedback was given to the deputy manager and senior team leader on the inspection findings. There were no requirements and recommendations made on this visit. We (the Commission) would like to thank all the people using the service and staff who made the visit so productive and pleasant on the day. 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. Prospective peoples needs are assessed prior to them moving into the home so that the individual and the home can be certain that all identified needs would be met and the placement is appropriate. Evidence: The AQAA informed that all prospective people to use the service have a preadmission assessment, which is carried out by experienced staff members with skill and sensitivity. Four care plan documentation was examined and we found that a comprehensive needs assessment was carried out before individuals were admitted to the home. Prospective people to use the service are encouraged to spend time in the home to meet staff and other people using the service. Individuals are encouraged to participate in a meal or have a cup of coffee or tea. Information is gathered from a range of sources including other professionals and with the individuals agreement relatives interests are taken into account. A person recently admitted to the home said that they were given time to accept the permanent placement and that they Care Homes for Older People Page 10 of 25 Evidence: visited the home several times before moving in. People who respond to the Commissions survey said that they had received enough information about the home to help them decide if it was the right place to move into. 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. The home ensures that people using the service receive effective personal and healthcare support using an individualised approach which is base on the rights of dignity, equality, fairness, autonomy and respect. Evidence: Care plans were clear detailing how individuals identified needs goals and aspirations would be met in a personalised manner. Risk assessments seen identified potential and actual risks detailing how these risks would be managed. Wherever possible people using the service or their relative signed the care plan to indicate their involvement and agreement with the care that they were receiving. Staff involved in the monthly review of the care plans also signed and dated them. Discussions on the day of the visit with people using the service indicated that they were involved in the review of the care plan as and when needs changed. The AQAA informed that people using the service have the opportunity to choose their own general practitioner (GP) from two surgeries in the local area and have access to national health service (NHS) facilities via the GP. We were told that some individuals were capable to make their own medical appointments and arrangements would be Care Homes for Older People Page 12 of 25 Evidence: made for those who are unable to. The home has a good relationship with health care professionals such as the district nurse, tissue viability nurse and continence nurse. If required aids and equipment to promote continence would be provided. Two health care professionals who responded to the Commissions survey said that the home always ensures that peoples health care needs were properly monitored, reviewed and met. In discussion with staff members they were extremely proud of the high standard of care they were providing to people using the service. People who responded to the Commissions survey said that they always receive the medical support they need. The home uses a monitored dose medication system. No unexplained gaps were noted on the medication administration record (MAR) sheets examined. The records for the receipt and disposal of medication were clear and accurate. A random selection of controlled drug medication was checked and found to be correct. A list of staffs names and signatures identified as capable to administer medication was kept in the medication folder. Photographs of individuals were in the medication record folder to minimize the risk of errors occurring during medication administration. We were told by staff that some people had been assessed as capable to self-medicate and the appropriate risk assessments were in place. We were told that two staff members were assessed by the district nurse and deemed competent to prepare and draw up the daily insulin dosage. We noted that the assessed persons were carrying out this procedure on their own. It was advised in the interest of safety that two staff members should be present to witness the preparation and drawing up of insulin. Staff were not administering the insulin because the individuals were assessed as capable to self-administer. However, they were signing the MAR sheet which made it look like they were administering the insulin. It is advised that the MAR sheet should clearly reflect that staff were signing for witnessing the self-administration of the insulin. The home should also review its medication policy to ensure that it reflects that the district nurse has delegated responsibility to specific members of staff to be involved in the preparation and drawing up of insulin. Staff spoken to confirmed that they had been provided with training in health care matters such as, safe handling and administration of medication, Parkinsons disease, dementia, bereavement and diabetes. We observed staff treating people in a friendly and respectful manner. Individuals spoken to and those who responded to the Commissions survey said that the personal care they receive was excellent and they were well cared for. They said that the staff team was very supportive and caring. Individuals attire was clean and tidy with attention to detail. Staff were observed knocking on bedroom doors and waiting for a reply before entering. The AQAA informed that the home provides a very high standard of care to people who are terminally ill or dying. Individuals wishes and arrangements after death are discussed sensitively and recorded. The GP is consulted and involved with end of life Care Homes for Older People Page 13 of 25 Evidence: care plans and family members are supported by the homes staff. Peoples religious and cultural needs are respected. Care Homes for Older People Page 14 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that people using the service are involved in meaningful daytime activities which meet their choice, interests and diverse needs. Individuals are able to maintian contact with their family and friends. Meals provided were of a high standard and served in pleasing surroundings. Evidence: The homes daily routine is flexible and fitted around peopes diverse needs and preferences. The AQAA informed that individuals are encouraged to lead a lifestyle of their own choice, partaking in activities as and when they wish to both in the home and within the community. The service has its own activity centre which means that people have a choice of activities to participate in daily. Individuals living in the community are welcome to use the centre, which means that links with the local community are maintained. The AQAA informed that the activity programme has increased from two sessions per day to an average of four or five activities running concurrently throughout the day. Sessions include music and movement, armchair gardening, indoor skittles, crafts, word games, reminiscence, skittles, knitting, baking and art classes. Some people spoken to said that they enjoy the internet facility as they were able to surf the net and send and receive e-mails to friends and family. Some individuals said that they enjoyed writing blogs on facebook. Various guests are Care Homes for Older People Page 15 of 25 Evidence: invited to provide entertainment which include entertainers to farm animals in the garden. Staff are actively encouraged to participate and some have been keen to discuss their cultural differences and provide the opportunity for people to experience tasting different types of food. People who responded to the Commissions survey said that the home always arrange activities that they can take part in. The following additional comments were noted: Bradbury house has a wonderful activity centre but I feel there should be more activities at the weekend. The home does not have any restrictions on visiting. Relatives and friends are encouraged to visit and play an active part in peoples lives. A visitor spoken to said that staff always made her feel welcome and facilities were available for visitors to make their own refreshments. The staff encourage people using the service to exercise personal autonomy and choice and to handle their own financial affairs for as long as they wish to and have the capacity to do so. Individuals are encouraged to bring personal possessions and furniture to personalise their rooms. The following comments were noted from a respondent to the Commissions survey: the home allows me to keep and use a great many of my possessions, furniture, furnishings ornaments etc. The menu seen was varied to ensure that peoples likes and dislikes were catered for. Three meals were provided daily and hot and cold drinks and snacks are available at all times and offered regularly. Fresh fruits were displayed in the dining area which means that people were able to help themselves to a piece of fruit if they wished. The AQAA informed that peoples views on meals were actively sought and the chef was happy to meet with individuals to discuss the menu. Individuals were able to have their meals in their bedrooms or the dining area. Lunch was observed and this seemed to be a relaxed and social occasion. Meals served looked attractive to stimulate appetite. Lunch was sampled and it was tasty. Staff were observed providing assistance to those who needed help in a discrete and sensitive manner. People who responded to the Commissions survey said that they always or usually liked the meals. One respondent said that they would like the food to be much hotter. Care Homes for Older People Page 16 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints and safeguarding policy in place which should ensure that people would be confident that their complaints would be investigated and they would be protected from any potential risk of harm or abuse. Evidence: The home has a complaints procedure which is accessible to people using the service, staff and relatives. The AQAA informed that all complaints made and the actions taken in response to them are fully recorded and the home learns from complaints in order to improve the service. Within the last twelve months the home had received six complaints and evidence seen indicated that they were appropriately investigated. People who responded to the Commissions survey said that they knew how to make a complaint and were confident if they had to raise a complaint it would be taken seriously and acted upon. The training records seen reflected that all staff had received training in the safeguarding of vulnerable adults which is updated regularly. Staff spoken to were aware of how to respond in the event of an alert. The AQAA informed that staff are trained and understand the implications of the mental capacity act and fully respect the human rights of people using the service.The home has not had any safeguarding referrals or investigations within the last twelve months. Care Homes for Older People Page 17 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people using the service to live in a safe well-maintained and comfortable environment, which encourages independence and protects their privacy and dignity. Evidence: The home is purpose built and provides a homely, safe, clean and comfortable environment for people to live in. There is a programme of routine maintenance and renewal of the fabric and decoration of the premises in place.The grounds were safe, tidy, attractive and accessible to people using the service. All the rooms were single occupancy with en suite facilities and personalised with small items of furniture, family pictures and mementos to reflect the characters of individuals. Bathrooms have been fitted with aids and adaptation to promote independence and meet the needs of individuals with physical disabilities. All areas of the home were clean, hygienic and free from offensive odours. The laundry room has an effective ozone washing facility to minimize the risk of cross infection.The hot water temperature records indicated that temperatures were regularly checked and within the appropriate temperature range. People who responded to the Commissions survey said that the home was always fresh and clean. The following additional comments were noted:the cleanliness of the home is good. The home is very well designed and situated. 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. The home ensures that staff are trained to carry out the aims of the home and meet the changing needs of people using the service. Evidence: The rota demonstrated that the number and grade of staff on duty to provide care to people was adequate to meet their assessed needs. 90 of the care staff have acquired the national vocational qualification (NVQ) in direct care at level 2. A number of staff had acquired the level 3 and 4 qualification in direct care and the registered managers award. The staff team is multicultural offering a diversity of experience, skills and knowledge. There is a stable staff team and staff spoken to said that they enjoyed working at the home and felt valued. Team spirit and morale were high. The following comments were noted from staff members:The home is very well run. We try to ensure residents are happy and well cared for. The recruitment files of three recently recruited staff members were examined. It was found that they contained the required documents to verify that Pova first checks and criminal record bureau clearances had been obtained. However, in one particular file it was noted that a reference was not obtained from the individuals recent employer. Since 26 July 2004 the regulations require that where applicable a reference relating to the persons last period of employment of not less that three months duration which involved work with vulnerable adults must be obtained. Care Homes for Older People Page 19 of 25 Evidence: Mandatory training and specialist training for all staff was up to date. The home is part of the Buckinghamshire cluster group. A senior team leader is responsible for arranging training within the cluster. The AQAA informed that training provided is focused on improving good outcomes for people using the service. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the experience to run the home and works to continuously improve services and provide an increased quality of life for the people using the service. Systems are in place to ensure the health, safety and welfare of people using the service and staff are protected and promoted Evidence: The registered managers is a registered nurse and has completed the registered managers award. She has fourteen years management experience in the care home setting and is supported by a deputy manager, care manager, three senior team leaders, and a group of care and ancillary staff and an executive committee. The AQAA informs that the manager promotes an open and transparent approach and communicates a clear sense of direction. In discussion with people using the service and staff it was felt that the home was being effectively managed and run in the best interests of people using the service. Regular meetings with staff and people using the service are held. The views of people who use the service, relatives, staff and other stakeholders are listened to and action Care Homes for Older People Page 21 of 25 Evidence: taken in response to findings. Reports written by a representative following monthly visits to the home were available for examination. The AQAA contained excellent information that was fully supported by appropriate evidence. The management team shows a high level of self-awareness and recognises the areas that the home still needs to improve in and how it intends to do this. Policies and procedures were in place and are reviewed on a regular basis. Procedures for dealing with peoples money and valuables were being appropriately maintained in line with the homes policies. A sample of records relating to health and safety were examined and found to be up to date and well maintained. 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 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. 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 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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