Care Home: Five Acres Nursing Home

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What the care home does well Potential service users receive a thorough needs assessment to ensure the home can meet the care needs of the service users. Care plans have been produced for all people who use the service, and these inform the care staff what they must do to meet the needs of the individual. One comment received in in a survey, under the section "what the home does well" was " provide good care and make sure peoples needs are met". There is a motivated and established staff team that consists of nursing and care staff who respond to service users in a respectful and appropriate manner. Comments received in surveys about the staffing in the home include, "staff are very kind and always helpful" and "the staff are lovely. I know my relative is in safe hands". The home provides a pleasant and comfortable environment in which people can live. Individuals are encouraged to personalise their own rooms with their own furniture and personal belongings. Communication between people who use the service and staff was observed to be positive and open. The provision of meals and mealtimes are of a good standard. Lunch was observed and staff provided discreet support to people who needed extra help. Comments received in surveys include,"the food is lovely, and we have lovely cakes" and "the food is very good and there are two hot meals a day". There is detailed evidence in care plans of nutritional screening and weights are recorded on a monthly basis. There is a robust recruitment procedure in place that ensures service users are protected from harm. There is a good range of policies and procedures, providing staff with relevant information about all aspects of care and the home/organisation. Health and Safety procedures are thorough and records are well maintained. The evidence seen and comments received indicate that this service meets the diverse needs e.g. religious, racial, cultural, disability of individuals within the limits of its Statement of Purpose. What has improved since the last inspection? The home now sends a letter to people before they are admitted to the home, confirming that their needs can be met at the home. All assessments are now signed by the person completing the initial assessement. On going improvements to the home ensure a safe and homely environment. What the care home could do better: The home should continue to provide a good quality service to people who use this service and continue with the on-going improvements to the environment. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Five Acres Nursing Home Five Acres Simpson Village Milton Keynes Bucks MK6 3AD     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: Barbara Mulligan     Date: 0 7 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 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 28 Information about the care home Name of care home: Address: Five Acres Nursing Home Five Acres Simpson Village Milton Keynes Bucks MK6 3AD 01908690292 01908696244 onlyvid@talktalk.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Five Acres Nursing Home Ltd The registered provider is responsible for running the service Name of registered manager (if applicable): Name of registered manager (if applicable) Terri Walker Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 32 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Five Acres is a privately owned care home offering personal and nursing care for thirtyfour older people over the age of sixty. Five Acres is an older building set in pleasant Care Homes for Older People Page 4 of 28 22 0 Over 65 0 22 care home 32 Brief description of the care home grounds in Simpson. There is a combination of single and shared rooms, although most of the shared rooms are currently used as single rooms. The upper floor is accessed via a passenger lift. There are dining and lounge areas. The village of Simpson is situated on the outskirts of Milton Keynes, with public transport links into the city centre. There is a registered manager, supported by a team of qualified nurses and carers and the experienced proprietors. Fees as at April 2006 range from £545- £670. Additional charges are made for hairdressing, chiropody, personal transportation and days out. Care Homes for Older People Page 5 of 28 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 unannounced key inspection was conducted over the course of a day and covered all the key National Minimum Standards for older people. Prior to the visit, a detailed self-assessment questionnaire was sent to the registered manager for completion. This was returned to the Commission by the day it was due and was fully completed, giving us the information we needed. Information received by the Commission since the last inspection was also taken into account. The inspector was Barbara Mulligan. Nineteen surveys were sent to the home and seven of these were returned to the Commission. The inspection consisted of discussion with the management of the home, discussion with care staff, opportunities to meet with people who use the service, examination of some of the homes required records such as care plans, risk assessments and staff files, the medication systems and accompanying records, staff rosters, observation of Care Homes for Older People Page 6 of 28 practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. As a result of the inspection the home has not received any statutory requirements. Feedback on the inspection findings and areas needing improvement was given to the management of the home at the end of the inspection. The management of the home, the staff and service users are thanked for their cooperation and hospitality during this unannounced visit. 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. Care Homes for Older People Page 8 of 28 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 9 of 28 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 10 of 28 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. Service users needs are assessed prior to admission ensuring that staff are prepared for admission and have a clear understanding of the service users requirements. Evidence: Four completed needs assessments were examined, including people newly admitted to the home. An experienced nurse carries out a full assessment of need before the individual is admitted to the home. In each file there is information from other professionals so that all the needs are known, and a judgment can be made that the home will be able to meet the needs of all those admitted. Each file had a completed needs assessment and shows that all areas and conditions of people using the service were assessed prior to offering them a place in the home. Each assessment contains further information about the persons family and friends, likes, dislikes and preferences. During the previous inspection it was identified that Care Homes for Older People Page 11 of 28 Evidence: needs assessments were not signed by the person completing the assessment and this was recommended. Assessments seen show that this is now being completed. At the previous inspection a requirement was issued for the home to send a letter to the individual before admission confirming that their needs can be met at the home. It is pleasing to see that this has been complied with. The assessment demonstrates that prospective service users, family members or representatives are included in the assessment process if this is appropriate. One survey informed us that they had been able to bring their relative to visit the home and the staff had been very welcoming and answered all their questions. The home does not provide intermediate care, so this standard is not applicable. Care Homes for Older People Page 12 of 28 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 meets the health, personal and social care needs of the residents, by developing care plans and responding to their changing needs, as appropriate. Evidence: Four care plans were examined during this inspection, including people newly admitted to the home. These provide adequate information about the person using the service and how staff are to meet their identified needs. Care Plans are pre-printed and the areas which are not applicable to the individual are crossed out. These are not individual to each person and are not person centred. Many entries in the care plans lack detail, for example, for oral care the care plans states, offer facilities for cleaning teeth and for bathing ensure X is offered a bath/shower on a regular basis and needs assistance with showering. These are vague statements and do not fully detail the actions to be taken by staff. Care plans should contain specific details for staff to follow to ensure the assessed needs of people using this service can be met. One comment received in a survey, under the section what the home does well was provide good care and make sure peoples needs are met. Care Homes for Older People Page 13 of 28 Evidence: The staff spoken to are knowledgeable about service users care needs and preferences. There is evidence that care plans are reviewed monthly and updated when appropriate. Daily notes are detailed and informative and record the personal care received and activities that the individual has undertaken through out the day. Visual observations of people using this service showed that people were smartly dressed including jewelery, make up and nail varnish, people were seen to be wearing the aids needed, for example hearing aids and clean glasses. Risk assessments are in place covering areas such as falls, moving and handling, nutritional assessments and wound assessment. These are up to date, signed and dated by the person completing the assessment. Service users are registered with four local GP practices. Tissue viability assessments are in place for service users and these were seen to be reviewed on a monthly basis and pressure relieving equipment was seen in place for individuals who need it. The registered manager said a domiciliary optical service visits the home and service users receive an annual eye test. Referrals for a hearing test go through the service users G.P. Chiropody services visit the home every three months and dental services visit the home annually or as needs arise. Records of health screening was noted in multi disciplinary notes and feedback received in the surveys was positive about how people access medical treatment and healthcare services. One person who was being nursed in bed said, I am feeling poorly but the staff are marvelous, they are very kind and Im very well looked after. The procedures for the administration of medicines were examined during this inspection. At this visit we looked at the medication administration record (MAR) charts, medication supplies and care plans for the four people whose care was being looked at as part of this inspection, and at the remaining MAR charts for people using this service. The home was not using any controlled drugs at the time of the visit. However there are facilities for the storage of controlled medication and there is a controlled drugs register in place. Qualified nurses administer all medicines and at the time of this visit there were no people using this service who were able to administer their own medicines. Medication administration records (MAR) show no omissions.There is guidance in place for as needed homely remedies. However the home should also provide guidelines for prescribed as needed medicines. The home should implement a system that ensures service users plans include guidelines for the administration of all when required/when needed medicines. These guidelines should include when the medicine is to be given and when it is not and include a strategy for Care Homes for Older People Page 14 of 28 Evidence: when variable doses can be given. Care Homes for Older People Page 15 of 28 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. There is a range of activities available to residents who are encouraged and supported to remain in contact with their families and friends and to use local community facilities, ensuring people do not become socially isolated. The presentation and standard of food is good and meets the nutritional needs of people who use the service. Evidence: The routines in the home are flexible and care plans show that people have a choice as to when they get up and when they go to bed. People can have meals in their rooms if they wish. Relatives and friends are welcome at any time and this was confirmed in the surveys returned to the Commission. The home employs an activities organiser and there is a range of activities organised in the home, which is displayed in many areas of the home. The range of activities include quizzes, films, exercises groups and beauty therapy. There is a relatives forum and they provide a weekly bingo session. A regular church service is held in the home and other church denominations visit the home. Care Homes for Older People Page 16 of 28 Evidence: Service users are able to receive visitors in the privacy of their own rooms and are able to choose whom they see and do not see. Family and friends are invited to participate in some of the social event organised. On the day of the visit one person was visiting their relative and providing them with support with their lunch time meal. A comment made in a returned survey was, the staff are very welcoming and I can visit at any time of the day. An invitation to bring in personal items of furniture and other belongings is included in the service users guide and this was evident during a tour of the premises. Service users are offered three meals a day. The inspector had the opportunity to observe residents having lunch, including those that need extra support with feeding. Lunch is taken in a dining area which was laid with attractive tablecloths and napkins, and a small arrangement of flowers. The meal was relaxed, unrushed and well organised. People were well supported by staff and the food was attractively presented, including liquidised meals. People who responded to the survey and spoken to on the day all responded positively about the food provided in the home. Comments made include,the food is lovely, and we have lovely cakes and the food is very good and there are two hot meals a day. There is detailed evidence in care plans of nutritional screening and weights are recorded on a monthly basis. Care Homes for Older People Page 17 of 28 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 is able to effectively manage complaints and safeguard service users ensuring service users are listened to and kept safe from harm and abuse. Evidence: The home has a complaints procedure which illustrates timescales and how complaints are dealt with. We discussed with the registered manager how complaints are managed by the home and the manager said she welcomes any complaints or concerns and actively encourages residents and relatives to raise any issues they have at the earliest opportunity. The Annual Quality Assurance Assessment (AQAA) tells us that the home has not received any complaints since the last inspection. A summary of the complaints procedure is included in the Statement of Purpose and Service Users Guide. People who responded to the surveys all said they knew how to make a complaint and who to complain to. Procedures are in place for safeguarding vulnerable adults (SOVA) and staff have access to a whistle blowing policy. The home has a copy of the local authority SOVA policy. Training records demonstrate that staff have completed Safeguarding training and this is regularly updated. The Annual Quality Assurance Assessment tells us that there has been one safe guarding referral in the previous twelve months. One the day of the visit the registered manager said there has been a further five safe guarding referrals. These have been appropriately referred to the local authority, which is the Care Homes for Older People Page 18 of 28 Evidence: lead agency in these matters. Training records demonstrate that staff have undertaken training in adult protection and this is updated regularly. Care Homes for Older People Page 19 of 28 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 the environment within the home is good, providing people who use the service with an attractive and homely place to live. Evidence: Five Acres is an older building set in pleasant grounds in the village of Simpson. The home is on two levels and is suitable for its stated purpose and on-going improvements have been made to the home over the last twelve months. The upper floor is accessible via a passenger lift. The ground floor is comprised of the entrance hall, a number of seating and dining areas, a conservatory, kitchen, laundry, bathrooms, toilets and some sleeping accommodation. The lounges are comfortably furnished and spacious and on the whole these are in good decorative order. Efforts have been made to make these areas look homely, with many personal touches such as pictures, side lamps, books, plants and ornaments. Bedrooms vary in size and are comfortably furnished, clean, tidy and have been personalised. There is a combination of single and shared rooms, although most of the shared rooms are currently used as single rooms. Care Homes for Older People Page 20 of 28 Evidence: There are accessible toilets available for service users throughout the home and several are close to the lounges and dining area. Bathrooms and toilet areas have the appropriate aids and adaptations to meet the needs of individuals and to promote independence. Laundry facilities are sited so that soiled articles, clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten and do not intrude on service users. The laundry floor finishes are impermeable and these and the wall finishes are readily cleanable.The home has an infection control policy and the inspector observed this. Staff training records show that staff have received infection control training and this is updated regularly. Care Homes for Older People Page 21 of 28 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 staffing numbers and skill mix is satisfactory and staff training is sufficient and up to date to ensure that people who use the service benefit from staff who are competent to do their job. Recruitment procedures are undertaken to ensure staff have the right skills and competencies to support the people who live there. Evidence: The homes staff rota demonstrates that there are adequate numbers and skill mix of staff on on duty at all times. The home presently employs nine Registered General Nurses and there is a nurse on duty at all times. The manager confirmed that there were additional staff on duty at busy times of the day. The manager is supernumerary on the roster, allowing for flexibility during peak and holiday periods. The care team are also supported by full time housekeeping laundry and catering teams. Comments received in surveys about the staffing in the home include, staff are very kind and always helpful and the staff are lovely. I know my relative is in safe hands. The home continues to support care staff on NVQ training and at the time of this inspection there were seventeen care staff employed by the staff and fourteen have achieved a national vocational qualification in care. Some of the catering and domestic staff have undertaken training to achieve national vocational qualifications. The recruitment files for four staff were examined, including those people new to the Care Homes for Older People Page 22 of 28 Evidence: service. These contain all the necessary documentation required. Staff files are kept in lockable filing cabinets in the managers office. All staff complete an induction programme that covers the common induction standards for social care and this was seen in the four files examined. During the initial induction to the home staff are extra to the numbers on the staff rota and work alongside more experienced staff. Training records show that staff are up to date with their mandatory training which includes moving and handling, fire training, basic food hygiene, infection control, safeguarding and first aid. There is specialist training available for staff, and an example of this is communication and confidentiality, PEG feeding, dementia care and continence training. There is specialist training available for staff, and an example of this is nutritional care, oral health, managing challenging behavior and dementia care. Care Homes for Older People Page 23 of 28 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 home is well managed by a stable experienced management team and service users are protected by safe working practices ensuring the health and safety of people using the service. Evidence: The registered manager is Terri Walker and is experienced and skilled at managing the home. The registered manager has completed the Registered Managers Award. Further training undertaken by the manager in the previous twelve months includes, Dementia Care, Mental Capacity Act and Stage 2 Safeguarding Vulnerable People. The organisation & home has a clear and accountable management structure and the manager is supported by the organisation. The inspector noted good teamwork in progress and all the staff spoken to had a good working knowledge of the individual residents and their care needs. The organisations management system includes a quality assurance system which Care Homes for Older People Page 24 of 28 Evidence: includes monthly audits and service satisfaction questionnaires which are sent out on an annual basis. Once these have been returned an action plan is drawn up to address any improvements needed. Regular residents forums are held and a senior manager from the organization undertakes regular monitoring visits. Reports of these visits are kept at the home and are open to scrutiny. Service users are encouraged to look after their own financial affairs where at all possible. If this is not practicable then families will undertake this role. There are secure facilities available for the safe-keeping of money and valuables and record and receipts are kept of possessions left for safe keeping. There is a comprehensive health and safety policy in place and health and safety training is completed and up to date for staff. Records were seen for fire safety. These cover the homes fire procedures, practice fire drills, fire prevention, fire alarm testing and emergency lighting testing. Testing of the homes fire alarm system is undertaken on a weekly basis and evidence was seen of this. There is a fire based risk assessment that is reviewed annually. Service reports are in place for PAT testing, gas appliances and electrical installation. Care Homes for Older People Page 25 of 28 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 26 of 28 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 27 of 28 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 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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