Care Home: Crescent House

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What the care home does well The atmosphere in the home was comfortable, homely and relaxed and staff were seen to be kind and caring towards people living in the home. Residents spoken with said that staff are very good and so were the meals. People moving into the home are able to bring in their personal possessions to personalise their bedrooms and the home has a well maintained garden to the rear of the property and limited parking at the front. There is an open-house policy, which welcomes visitors at all reasonable times and complaints are handled well ensuring that residents feel listen to and their views acted upon. What has improved since the last inspection? A great deal of work has been carried out to meet the shortfalls identified at the last inspection. Pre admission documents have been expanded to include information as to how needs will be met and all residents have a plan of care. Risk assessments now include direction to staff in reducing the risks and improvements have been made to the recording of medication. A number of improvements have been made to the environment including the provision of accessible call bells, providing raised flower beds, a new bath and hoist, water deliver temperatures and the use of door wedges. A number of bedrooms have been redecorated and refurbished with new carpets, beds and furnishings provided. The quality monitoring systems has been extended to include regular meetings for staff and residents and the Registered Provider now make monthly visits and the reports available for inspection. All aspects of the care planning system has been improved as has the overall management processes. A cook has been employed to enable the manager and staff to have more time with residents. What the care home could do better: Shortfalls were identified in respect of the use of correction fluid on staff rotas and recruitment documents, ensuring all volunteers who have access to residents have criminal record bureau checks. Additional work needs to continue to ensure all parts of the home are well maintained and that information in care plans is consistent. In order to ensure staff are aware of changes in legislation and to meet residents needs, all staff need to be trained in dementia care and it is recommended that they are also trained in the Mental Capacity Act and the Deprivation of Liberty Safeguards. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Crescent House 108 The Drive Hove East Sussex BN3 6GP     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: Gwyneth Bryant     Date: 0 5 0 5 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 25 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 25 Information about the care home Name of care home: Address: Crescent House 108 The Drive Hove East Sussex BN3 6GP 01273732291 01273732393 markandtree@hotmail.com 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) : The London & Brighton Convalescent Home care home 17 Number of places (if applicable): Under 65 Over 65 17 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 17. The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the 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 The home has been owned for over a hundred years by the London and Brighton convalescent Home, a charity. The home is a detached Edwardian property located half a mile from Hove. Main line train services are within walking distance and the home is near to bus routes into Hove and Brighton. The home is registered to provide care for up to seventeen older people. The home is on three levels, ground, first and second floor, with a chair lift providing access to first floor. Service users accommodation is situated on the ground and first floor with the second floor used as a storage area. All bedrooms are for single occupancy with six Care Homes for Older People Page 4 of 25 Brief description of the care home having en-suite facilities. There is a shared dining room, lounge and conservatory. The home has a rear garden with the front garden gravelled to provide off road parking. The homes literature states that its mission is to assist its residents in maintaining a highest quality of life, as well as quality of care. And assures its residents individual care with respect to their privacy, dignity safety and security. The fees are from £391 to £450 per week. These fees include all services and facilities apart from hairdressing, chiropody and newspapers, any taxis required and dry cleaning of clothes, these extras are itemised separately with appropriate receipts. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term service user to describe those living in care home settings. For the purpose of this report, those living at Crescent House are referred to as residents. This was an unannounced inspection and took place in just under six hours. The purpose of the inspection was to check compliance with key standards and other standards. There were seventeen people in residence on the day of which one was in hospital. Three residents were spoken with in addition to discussions with the Registered Manager, the deputy manager and the cook. The last key inspection was carried out on 19 May 2008. A number of documents and records were viewed; including personnel files, medication Care Homes for Older People Page 6 of 25 charts and care plans and a tour of the premises was also carried out. Prior to the site visit we asked the Registered Providers to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. This was completed well and provided when we asked for it and the information included in this report as necessary. 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 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People moving into the home benefit from an admission process that ensures their individual needs and wishes are assessed and identified as being able to be met prior to moving into the home. Evidence: As part of the care planning process all people now moving into Crescent House have an assessment of their needs which is used as a basis for their individual plans of care. The admission assessments for three individuals were viewed and it was evident that care needs had been identified prior to all three people coming to live at the home. The Deputy Manager confirmed that residents are now provided with an up to date copy of the Statement of Purpose and Service Users Guide with summaries placed in residents bedrooms. Care Homes for Older People Page 10 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. People benefit from a good care planning system and the safe handling of medication. Evidence: Overall the care planning process is good with clear direction to staff in meeting needs. The care plan format is in two parts, with one part being a summary of preferred daily routines and the main plan which includes much more details of care needs. Four care plans were viewed and it is clear that they have been developed from the information in the pre-admission assessments. The plans were satisfactory in that they included clear information on the care needs of people living in the home and the necessary action to be taken to meet those needs. Most parts of the plans were based on a scoring system that is used to assess the dependency of the individual and it was good to see that the scores were supplemented with details of what staff need to do to meet care needs. Not all parts of the main care plan were consistent with the information on the daily routines sheet and this needs to be addressed to ensure all staff are directed in providing good quality and consistent care. As the home is relatively small with a good staff team, some information is shared verbally as staff Care Homes for Older People Page 11 of 25 Evidence: know residents well. While it is good to note that staff work as a team and exchange information this system relies on good memory and teamwork, therefore there is a danger that information may not be passed on. Some residents need their food and fluid intake recorded and while this is done, the records lack details to demonstrate that fluid is given hourly and how much food is consumed. These additional details would prompt staff to offer between meal snacks to ensure a good nutritional intake is maintained. People living in the home are encouraged to remain independent within a riskassessed framework. Risk assessments had been carried out and they clearly identified the hazards and included sufficient detail for the management of risks. Again the care plans use a scoring system to assess risks but additional comments ensure staff know what action to take to reduce risk. There are policies and procedures on respecting service users dignity and privacy and all residents are offered keys to their bedrooms and staff were seen to knock on doors before entering. Throughout the site visit staff were seen to treat individuals with care and respect and it was evident that comfortable working relationships had been developed. All of the residents spoken with praised the staff for their care and kindness. Care plans included information on meeting healthcare needs and visits from District Nurses and GPs. Medication Administration Records were viewed and there were a some shortfalls in that some signatures were scribbled out and there were some code letters and signatures overwritten. However, most errors occurred on one day so the senior carer agreed to address the matter with the individual member of staff therefore no requirement has been made. The controlled drugs register also showed some dates that had been overwritten and this needs to be addressed. The time the controlled drug was given was not always recorded but where it was recorded it showed that medication was administered at a time convenient to the resident which demonstrates that residents are treated as individuals. Some residents are able to self medicate and appropriate risk assessments are carried out to ensure they are able to do so safely. It was good to note there were records to show when staff should offer residents medication that is prescribed to be taken as required. The information on medication records needs to be consistent with the information in care plans and this was discussed with the deputy manager and the senior who agreed to address this. Care Homes for Older People Page 12 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home have the opportunity to experience a lifestyle that matches their expectations, choice and preferences in respect of leisure activities and meals Evidence: There is a varied daily programme of activities for each afternoon and care plans included information on encouraging residents to participate. Comments from residents spoken with said they joined in if they felt like it and others saying they prefer their own activities or that they prefer to remain in their rooms. This indicates that individual wishes are respected although residents are encouraged to join in group activities. A range of activities are provided including manicures,arts/crafts, foot pamper,board games, films, bingo, reminiscence, visits to a local club and jewellery making. Menus are varied and the meal on the day consisted of meat, potatoes and two vegetables. The meal was attractively presented and those residents spoken with all agreed that the food was good and there was plenty of choice and one person said that cook is always happy to make something that is not on the menu if residents request it. There was evidence that residents are given a choice as one person was seen to have a jacket potato with prawns and salad. Discussion with the cook found Care Homes for Older People Page 13 of 25 Evidence: that she has already compiled a list of residents likes and dislikes and has begun to make home made soups which are very popular. The cook joined staff on the nutrition training so is aware of how to ensure residents maintain a good nutritional intake. One person mentioned the birthday party they had earlier in the year and how much they enjoyed it. On the day staff were preparing for another residents birthday party and it was clear that staff go to a lot of trouble to ensure individuals enjoy their day. Residents spoken with indicated that their visitors are made welcome and that they go out with them to the town. Throughout the site visit staff were seen to treat residents with care and respect which indicates that comfortable relationships have been developed. Residents spoken with all said that the staff were wonderful and very kind. Care Homes for Older People Page 14 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints procedure with evidence that those living in the home feel that their views are listened to and acted upon. People living in the home are further protected by satisfactory adult protection systems. Evidence: The AQAA demonstrated that the home has policies and procedures on both complaints and safeguarding adults. The complaints log was viewed and showed that no complaints had been received in the home since the last inspection and none have been received by the Commission. Discussion with the deputy manager found that of the twelve staff all had received some training in Safeguarding Adults as for new staff this is covered in the induction programme. There is a staff training programme that ensures all staff have full training in Safeguarding Adults that is regularly updated. It is recommended that all staff be trained in both the Mental Capacity Act and Deprivation of Liberty Safeguards to ensure they remain up to date with current legislation and are aware of what action to take should the issue arise. Care Homes for Older People Page 15 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of decor and maintenance within the home is good, providing people living in the home a safe, homely and comfortable environment. Evidence: A tour of the premises was carried out and a random selection of rooms inspected and it was evident that a great deal of work had been carried out since the last inspection to improve all aspects of the environment. The front of the home provides parking space but the mature shrubs have been removed and spring flowers planted in the raised beds. This has resulted in more light in the downstairs rooms and generally the front of the home is more attractive. Similarly work was in progress to improve the rear gardens to provide seating areas near the conservatory and a herb bed had been planted. As the plants are in raised beds, residents who enjoy gardening will now be able to continue with their hobby. Individuals bedrooms are well maintained, clean and pleasingly decorated and it was evident that people are able to bring in their own possessions in order to personalise their bedrooms. All en-suite facilities and the communal bathrooms were clean and tidy. A new bath and hoist has been fitted in the first floor bathroom, therefore those residents on the first floor no longer have to walk through communal areas to bathe. One of the downstairs baths needed a thorough clean but the Manager explained that Care Homes for Older People Page 16 of 25 Evidence: it is not suitable for current residents and is due to be replaced when funds allow. The maintenance log was viewed and this showed that all minor repairs are logged and ticked off when completed. All people living in the home are offered a key to their room within a risk assessed framework. Several rooms have been redecorated and refurbished since the last inspection and new chairs, carpets and beds purchased. These rooms were viewed and found to be very attractive and pleasant. The entire call bell system has been install and bells are now accessible in all rooms. Water delivery temperatures are now within the acceptable range so do not pose a risk of scalding to residents. The laundry was viewed and was seen to be clean and tidy and staff observed to be working in ways that reduce the risk of cross infection. There were ample supplies of gloves, aprons and antiseptic handwash in all communal bathrooms and toilets. Care Homes for Older People Page 17 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. There are sufficient staff with appropriate skills to meet the needs of those people living in the home and recruitment practice is robust. Improvements need to be made to ensure all volunteers have the required checks. Evidence: The staff rota showed that there are two carers on each day time shift and two night staff. Senior staff and the manager also have an on-call rota for night time. Recruitment records for the last three people to be employed were viewed and all had provided the required documentation prior to starting work. All had two written references, Protection of Vulnerable Adults and Criminal Records Bureau checks. One person did not have a reference from their last employer and the deputy manager explained that their previous employer did not respond to the request for a reference so one was sought from their student placement. These recruitment practices ensure that people living in Crescent House are not at risk. A cook has been employed since the last inspection which gives the manager and senior staff more time to spend with residents. The AQAA showed that of the 12 care staff, seven have already achieved National Vocational Qualification at level 2 and the Deputy Manager has begun work on this qualification at level 3. On the day of the site visit the Deputy Manager confirmed that two other care staff have just started the Vocational Qualification 2 course and another senior carer has started work on Vocational Qualification at level 3. Therefore Care Homes for Older People Page 18 of 25 Evidence: the home exceeds the required 50 of staff with these qualification. The home is working towards a more person centred way of working and on the day it was noted that staff spent more time with residents and less on tasks although the Deputy Manager still maintains responsibility for care plans and related documents. Discussion with the Manager found that volunteers do shopping for residents and these people need to have Criminal Records Bureau checks as do the hairdresser and chiropodist as all have unsupervised access to residents. Correction fluid was used on staff rotas and recruitment documents and this needs to cease. All new staff now have an induction programme that meets the Skills for Care guidance. All staff have mandatory training in manual handling, fire safety and Safeguarding adults in addition to first aid, nutrition, infection control and food hygiene. It is recommended that all staff have up to date training in dementia care to ensure they have the knowledge to meet the needs of those residents who have become confused. Comments from residents included: * the carers are kind in every way and put themselves out to help you. * They cheer you up if you are feeling down. * Cant fault them. * Nothing is too much trouble. * The staff are lovely and I am very happy here. Care Homes for Older People Page 19 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is well managed and all aspects of the welfare, safety and health of people living in the home are protected and promoted. Evidence: The Registered Manager has completed the required training of the National Vocational Qualification in care at level 4 which ensures she has the skills and knowledge to effectively manage all parts of the service. Now that a full time cook has been employed the Registered Manager has more time to manage the home as she now only cooks at weekends. Lines of management responsibility are now clearer with senior carers having specified roles such as medication and care plans, which enables the Registered Manager to have oversight of the service as a whole. The Head of Care holds some monies on behalf of some people living in the home and all transactions are recorded and receipts obtained as necessary to ensure no one is at risk of financial abuse. There are quality monitoring systems in place with regular residents and staff Care Homes for Older People Page 20 of 25 Evidence: meetings being carried out. The minutes of these meetings were viewed and it was evident that both staff and residents are encouraged to have a say in how the home is run. Residents spoken with indicated they would be happy to approach any of the managers or staff if they had any concerns which demonstrates the management approach is open. One person said that its better now that the manager is available as she is not always in the kitchen nowadays. The Registered Provider now makes monthly visits to the home and the subsequent reports were available for inspection. These reports were viewed and demonstrated that the providers are able to regularly evaluate the service and make improvements where necessary. The home does not handle residents money at all and if items are purchased the cost is added to the monthly invoice and receipts provided. Although correction fluid is no longer used on care planning documents it had been used on other records including staff rotas and staff files and this needs to cease as it is important that any changes made to documents are clear. The AQAA showed that regular checks are made on all electrical and gas appliances and systems In addition checks are carried out on call bells, water delivery temperatures and emergency fire systems. All staff have been trained in fire safety and a fire safety risk assessment has been carried out for all parts of the premises. These systems ensure the safety of people living in the home in the event of fire. Accident records were viewed and found to be accurate and maintained in line with the Health and Safety Executive guidance. Care Homes for Older People Page 21 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 22 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 1 7 15 That care plans are consistent with information in the daily routines sheets and medication charts. To ensure staff have access to accurate and consistent information. 05/07/2009 2 8 15 That food and fluid intake records are more detailed. To ensure a good nutritional intake is maintained. 05/07/2009 3 37 17 That the use of correction fluid on documents relating to the running of the home ceases. To ensure all records are clear. 05/06/2009 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 23 of 25 1 18 That all staff be trained in the Mental Capacity Act and Deprivation of Liberty Safeguards. Care Homes for Older People Page 24 of 25 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 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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