Care Home: Coalville Nursing & Residential Home

Similar services:

• Applegarth
• Byars Care Home
• St Marys Nursing Home
• Bramble Lodge
• Parkmanor Residential Home
• Thornham Grove
• Hunter`s Lodge
• London Road Neurological and Specialist Care Unit

What the care home does well The home provides staff to look after the residents who are recruited thoroughly and receive comprehensive training. The staff look after the residents in a caring and considerate way. The home provides a safe,comfortable and homely environment for the residents to live in. The residents are given choice in their meals that are presented well. The residents` views are taken into consideration and put into place to make sure that their choices are met. The residents receive activities that suit their needs and take into consideration their previous interests. Visitors to the home are made very welcome and families are communicated with about changes to the resident. What has improved since the last inspection? There were no requirements made at the last inspection on 10th April 2006. The home has taken note of the recommendations made and the care plans now show evidence that the residents and/or their families are involved in planning them. The hot water temperatures are now being tested regularly. The home has put a new `wet room` in place so that the residents may shower more easily. What the care home could do better: The home could make sure that all the staff undertaking medicine administration are aware that they should sign the records, of how the medicines for residents out of the home are given and that all ointments should be marked with the day that they are opened. That all of the residents have their activities expectations met. Provide better storage facilities for hoists and wheelchairs to make sure that the staff and the residents can easily access the bathroom. Staff should be given the opportunity to complete a National Vocational Award to achieve the recommended numbers for the home. The senior manager for the home has written to us since the inspection to tell us that all these issues have been or will be addressed. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Coalville Nursing & Residential Home Albert Road Coalville Leicestershire LE67 3AA     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: Anthea Richards     Date: 0 3 0 4 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: Coalville Nursing & Residential Home Albert Road Coalville Leicestershire LE67 3AA 01530817441 01530817441 jo.dilley@rushcliffecare.co.uk 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) : Rushcliffe Care Limited care home 40 Number of places (if applicable): Under 65 Over 65 20 40 40 2 dementia old age, not falling within any other category physical disability sensory impairment Additional conditions: 20 0 10 2 No one falling within category PD may be admitted into the home where there are 10 persons of category PD already accommodated within the home No one falling within the categories DE and DE(E) may be admitted to the home where there are 20 persons in total of these categories/combined categories are already accommodated within the home. No one falling within the categories SI or SI(E) may be admitted to the home where there are 2 persons in total of these categories/combined categories are already accommodated within the home. No one under the age of 55 may be admitted into the Home. No person in categories OP, PD, PD(E), & DE DE(E) may be admitted into Coalville Nursing & Residential Home where there are 40 persons in total of these categories/combined categories already accommodated in the home. Date of last inspection Care Homes for Older People Page 4 of 27 Brief description of the care home Coalville Nursing and Residential Home, first registered in 1995 and part of Rushcliffe Care Limited, is a purpose built home registered for 40 residents over 65 years of age. They may also provide for a limited number of older residents with physical disability, sensory impairment and/or those who require terminal care. The home is managed and staffed by Registered Nurses, care staff and ancillary staff. The home may now also admit up to and including twenty residents within the category of dementia DE(E). The home is bright and clean with a high standard of decor throughout, with two spacious lounge/dining rooms, and adequate assisted bathing and toilet facilities. All rooms have en-suite facilities. It is situated on two floors with a 13-person passenger lift servicing the first floor. There is a safe, well-planted and attractive garden and all areas of the home are accessible to residents who use wheelchairs. Food is prepared on site, with a choice of menu, and special dietary requirements are catered for. Situated in North West Leicestershire it is within easy reach of Coalville town centre and the towns of Ashby de la Zouch and Loughborough. The local bus route is within a few minutes walk of the home and there is ample car parking for visitors. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection of a care home for older people, which ended with an unannounced visit to the service. Before the visit we [throughout the report the use of we indicates the Care Quality Commission], spent five hours reviewing information received by the Care Quality Commission [CQC] since the last annual service review on the 10th April 2008. The visit took place on the 3rd April 2009 and lasted six hours. During the visit we checked all the key standards as identified in the National Minimum Standards. Care Homes for Older People Page 6 of 27 This was achieved through a method called case tracking. Case tracking means that we looked at the care provided to three of the residents. To achieve this we spoke with the staff supporting their care and looked at the records relating to their health and welfare. We spoke with the residents and visiting families. With their permission the residents bedrooms were looked at. We also checked how the home was run and organised. This included looking at staff records, training and how the staff are organised. We looked at health and safety records, menus, minutes of meetings and the quality audit. The policy for handling complaints and how the home dealt with them was looked at. We looked at how prospective residents and their families are given information about the services the home can offer and whether they are suitable for them. During the visit we spoke with the manager, the residents, the staff and families visiting the home. We also spoke to a doctor visiting the home. We looked at the Annual Quality Assurance Assessment (AQAA) that the home had sent to us when we asked for it. Surveys sent to us from the residents the families and the staff were looked at. 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. The residents needs are always assessed before moving into the home and they have good information to help them make the right choice about the home. Evidence: The surveys received from the residents families and the families spoken with, told us that they had received a Statement of purpose and a service user guide. The residents spoken with confirmed that they had had a visit from someone from the home and had the information that they needed to make a decision. The Statement of Purpose and Service Users Guide gives people the information that they need to know about to help them make a decision about the home. All of the residents case tracked had thorough, completed pre admission assessments in their care plans. These had been completed by the manager or a senior member of staff. Care Homes for Older People Page 10 of 27 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. The staff meet all the individual care needs of the residents, with privacy, dignity and respect. Evidence: The case tracked records were found to contain good individual evidence of the care being given to the residents and reflected the care that they needed. There was evidence that the residents and/or their relatives had been involved in planning the care. We spoke with many residents and families who all told us that they received the care that they needed and that they were happy that they received it. The care plans contained all the required information, but this was not always easy to find, as they were at the back of the file and each need was not individually identified. The care staff were seen to be treating the residents with dignity, respect and consideration when talking to them and giving them care. They were seen to be knocking on the residents bedroom doors before they went into them. Care Homes for Older People Page 12 of 27 Evidence: A comment received: We are looked after well There are records of the involvement of G.P.s, chiropodist, optician, where needed in the care plans, showing that thorough health care is being provided for the residents. We spoke with a Doctor who was visiting. He was very happy that the residents were well cared for and that the staff referred them to him as soon as they needed his care. There was evidence that the care plans are regularly reviewed and the resident and the family spoken with confirmed that they had been involved and were aware of the care to be given and that they were happy with it. The daily record of care was up to date making sure that the residents receive the right care and the staff know what has happened to them during the day or night. There are records of the residents nutritional needs and weight, which makes sure that they are eating well and are not losing or gaining large amounts of weight. There were records of the dietician and speech and language therapists being involved when the resident had swallowing difficulties or were being fed by a tube. The staff spoken with were aware of the care needs of the residents. The residents, the families spoken with and the surveys told us that they were happy that all care needs were being met. There were risk assessments in place to cover all the identified risks for the residents and how the staff should manage those risks. This makes sure that the residents and the staff are protected from any risks that have been identified, without restricting their activities. Medication records for the case tracked residents were in order. Medicines are given by the trained nursing staff who have regular updating and training in medicines. We saw that the medicines were administered individually and the residents were seen to be taking them. Medicines are supplied in a monitored dosage system where each tablet is in a separate pop out card, which is a safe method of administration, helping to make sure that the resident is always given the right medicines. The staff spoken with were knowledgeable about the medicines and where to obtain information. They were also aware of the requirements for the receipt, storage and disposal of medicines. Care Homes for Older People Page 13 of 27 Evidence: A tube of ointment that was being used did not have the date when it was opened on it, which could lead to it being used after the expiry date. The manager carries out a monthly written audit of the medicines and the medicine sheets to make sure that they are correct. There were two occasions seen on the medication records looked at where the staff signatures had been missed. One of these was when a resident had gone out to visit their family, which indicated that they had missed their medicine. This was not the case, but the member of staff spoken with was unsure about whether medication was sent out with them. It was later confirmed that the residents were always given their medicines to take out and these were signed and checked appropriately. The senior manager has confirmed to us since the inspection that all the staff are now aware of the correct procedure to follow. The controlled [dangerous] drugs and records were checked and found to be in order. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides some activities that the residents enjoy and take part in and meets their spiritual and nutritional needs. Evidence: The home employs an activities organiser who, with the staff, provides activities in all parts of the home. She regularly documents the activities that the residents have taken part in into an activities file. The care plans describe the residents past life and their interests so that the home can help them continue those interests if they wish to. Activities include craft work, newspapers, nails, hairdressing, card games, board games, relaxation classes and outside entertainment such as singers. Staff in the dementia unit were seen sitting and talking to the residents and playing cards. Residents on this unit appeared happy with the activities and the family told us that they were happy with the amount of activities and that the residents joined those that they wished to. Residents on the ground floor in the older persons area joined in the relaxation group in the afternoon, but most told us that there was not a lot to do. Trips out of the home Care Homes for Older People Page 15 of 27 Evidence: such as pub lunches or visits to the local supermarket take place, but we were told that they were not happening as frequently as previously. Visitors are welcomed into the home at any time and are invited to attend social functions and the regular resident/family meetings. On the day of the visit we saw many visitors to the home and saw the welcome that they were given. The menus seen gave choices of meals and the cook and the staff were aware of individual needs and choices. Soft diets were presented well with all the different items separate. The residents had the cutlery and plate guards they needed to eat their meal and the staff were seen to be sitting with the residents to help them with their meals. The many visitors to the home, particularly on the dementia unit were seen to be helping the residents with their meal. The manager told us that the staff were able to cope with helping the residents even if there were no visitors helping. The chef told us that menus were planned with the residents and that each home had individual menus. She also told us that she received regular good quality deliveries of food, but did have the flexibility to buy individual items locally. Religious needs are catered for by the residents having a regular service in the home or by visits from a local minister. The hairdresser visits every fortnight and there is a dedicated hairdressing room, which is also used for doing the residents nails. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good systems in place to support and protect residents and staff are aware of the processes. Evidence: There is a complaints policy in place which gives the details of how to complain and who to complain to in the home if they needed to. The policy could be made available in a large print and other languages if it was needed, which makes that as many people as possible could read it. The complaints form was clear and easily followed. The home has received four complaints since the last annual service review on 10th April 2008. These have now been resolved, which was confirmed by the manager and the correspondence seen. The residents, the families spoken with and the surveys told us that they were aware of how to make a complaint and were happy that it would be dealt with properly. The staff were aware of how to deal with a complaint and were happy that they would be dealt with correctly. The staff spoken with were able to describe how they would deal with an allegation of Care Homes for Older People Page 17 of 27 Evidence: abuse, knew the areas where abuse could happen and could describe the process that they would go through if they suspected any abuse. They confirmed that they had had training in safeguarding adults and whistle blowing and the manager and the records seen supported this. They were confident that the management would handle any issues correctly. We looked at the accident book, which had been completed correctly. These practices make sure that the residents are safe from any abuse and that any concerns are handled properly. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents and staff are well protected by the policies and procedures in the home that provides a safe and pleasant environment to live in. Evidence: Coalville Nursing and Residential Home is a purpose built home close to the town of Coalville. The home has a large lounge/ dining room on each of the two floors that were both bright, well decorated and suitably furnished. All the bathrooms seen were clean and well equipped. One of the lesser used bathrooms has been converted into a wet room which makes it easier for the residents to shower in. One of the bathrooms was being used for the storage of hoists and wheelchairs, causing the staff to have to move all the items to be moved before they could use the room. There were bedrooms on the first and second floors that could be reached by the stairs or the lift. The bedrooms of the case tracked residents that were seen, with their Care Homes for Older People Page 19 of 27 Evidence: permission, were clean, bright, well decorated and personalised. The residents spoken with told us that they were pleased with their rooms and that they were kept clean and decorated. I can have my own things in my room. There was evidence of equipment in the home to help the residents, such as wheelchairs, special mattresses and hoists. The kitchen has had a recent Environmental Health Officer inspection and was given a satisfactory rating. The garden is enclosed and provides sitting areas, the home has plans to make part of the garden into a sensory area. It is easily accessible for the residents. Fire alarm testing, drills and instruction were found to be up to date, this was confirmed by the records seen, the staff spoken with and the manager. Hot water temperature records were found to be up to date and within recommended levels. The residents and the families spoken with were happy with the cleanliness of the home, and told us that the staff worked hard to keep it clean. There are staff employed to complete the cleaning in the home and they have had training in health and safety. The cleaning products are stored in a locked cupboard, which we saw. This was confirmed by the staff spoken with, the records seen and by the manager. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are protected by the recruitment and training practices in the home. Evidence: Rushcliffe Care Limited, Epinal Way Care Centre undertakes the recruitment process centrally and the staff files are inspected when visiting the Epinal Way Care Centre. However they have put a sheet confirming that references, a Protection of Vulnerable Adults check and a Criminal Records Bureau check and number have been received. These were in place for the three staff records that we looked at. The staff spoken with told us that they could not start work until they had all the paperwork in place. The staff spoken with confirmed that they had received recent training in moving and handling, dementia, safeguarding of vulnerable adults and first aid. This was confirmed by the records seen and the manager. The manager holds a training matrix showing when courses would be held and which staff needed to attend. The residents, the families spoken with and the surveys received all felt that the staff were well trained to do their job and that there were usually enough staff to look after them. Care Homes for Older People Page 21 of 27 Evidence: We saw the induction programme, the basic one takes three days to complete and includes fire, health and safety, moving and handling and infection control. The staff then complete a more detailed one over six weeks. Only 25 of the care staff hold a National Vocational Qualification [NVQ] at level 2 or above. The National Standards guidance is that 60 of staff should have achieved this award. The National Vocational Qualification is a qualification for care staff to make sure that they receive training in the needs of the resident group whom they are caring for. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents views are taken into account and their safety is protected by the practices in a home that is run in their best interests. Evidence: There is an acting manager in post who is a Registered Mental Health Nurse and has had 9 years experience working with Rushcliffe Care. She is shortly due to have an interview with the Care Quality Commission (CQC) for her registration as the Registered Manager. There are regular meetings held for the residents and for their families, to discuss activities and menus in addition as to how the home is meeting their needs. These were confirmed by the resident, their family, the surveys received and by the minutes that we saw. There is an annual quality questionnaire sent to the residents and their families and Care Homes for Older People Page 23 of 27 Evidence: the questionnaires that we saw on the visit confirmed this. The families and the residents told us that they had completed the questionnaire. We received positive comments from the residents and the families at the visit and in the surveys returned to us, amongst which were that the staff were very supportive of them and their relative. I feel as well looked after as my Mum The residents accounts were seen and found to be in order and had two signatures on each entry. This makes sure that the resident and the member of staff handling the money are protected. We saw that receipts were obtained for purchases. There was evidence from the staff spoken with and from the records seen with that they are having regular, formal supervision with their line manager. Formal supervision of the staff gives them and their line manager the opportunity to discuss work and training issues and needs. There are regular staff meetings held, confirmed by records held and by the staff spoken with. The manager completes a regular audit of any accidents that have happened in the home to make sure that if at all possible they could be avoided. The areas of health and safety such as hot water temperatures and fire alarm testing were found to be in order. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 9 9 That all ointments are labelled with the date of opening. That all the staff are aware of the procedure for the administration of medicines when a resident is out of the home. That the medication administration records are always completed correctly. That the home makes sure that all of the residents have their activity needs addressed. That alternative storage facilities are found for hoists and wheelchairs, to make sure that staff and residents can access bathrooms without hindrance. 3 4 5 9 12 22 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!