Care Home: Garsewednack Residential Home

What the care home does well The physical environment of the home is pleasant, comfortable and well maintained. People using the service were all complementary about their care, the food, and the staff that support them. Records are maintained to a good standard. We are very pleased with the on going improvement of this service, and the commitment of the registered persons are showing to bring this improvement about since 2007. What has improved since the last inspection? There has been significant improvement to this service since 2007. Since the last inspection care planning and record keeping has improved, there is improvement to the operation of the medication system, there has been improvement regarding recruitment checks on staff and staff training, and there have been improvements to the management arrangements of the home. What the care home could do better: One statutory requirement has been set regarding continuing to improve training provision, although this has continued to improve since we last inspected this service. We have given some advice, in the text, to help the registered persons to continue to bring about improvement in other areas but this service is now considered to be well managed and have positive outcomes for the people living there. Key inspection report Care homes for older people Name: Address: Garsewednack Residential Home 132 Albany Road Redruth Cornwall TR15 2HZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ian. Wright     Date: 0 3 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Garsewednack Residential Home 132 Albany Road Redruth Cornwall TR15 2HZ 01209215798 01209215798 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Nicola Carla Brazier,Mr Neil Edward Brazier,Mrs Anne Brazier Name of registered manager (if applicable) Miss Alison Smith Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 21. The registered person may provide the following category of service: Care home only Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Dementia aged 65 years or over on admission (Code DE(E)) maximum of 4 places Mental disorder aged 65 years or over on admission - (Code MD(E)) - maximum of 4 places Date of last inspection 2 5 1 1 2 0 0 8 0 0 0 Over 65 4 4 21 Care Homes for Older People Page 4 of 24 Brief description of the care home Garsewednack provides personal care for twenty-one older people. Four people living in the home may have dementia, and four other people who use the service may have other mental health needs. The home also provides day care for some people. The registered providers are Mrs Anne Brazier, and Mr Neil and Mrs Nicola Brazier. Mr N and Mrs N Brazier also own another residential care home in Newquay. The registered manager Ms Alison Smith supervises care and the staff team on a day-to-day basis. The accommodation is on two floors. There is a staircase and stair lift, which allows access to the first floor. There are 19 single bedrooms and 2 shared bedrooms. A minority of bedrooms have en suite facilities. There are sufficient shared toilet and bathroom facilities. There are two lounges, a dining room and garden area accessible to people living in the home. A copy of the inspection report is available in the hallway. It is suggested a copy is requested from management if required. Alternatively a copy is available free of charge from the CQC website, or via our customer services team, details of which are on the back page of this report. Current fees are available from the registered persons. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. Care Homes for Older People Page 5 of 24 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: Two inspectors completed this unannounced inspection in one day. The methodology used for this inspection was: *To case track people who use the service. This included, where possible, meeting and discussing with the people concerned their experiences and inspecting their records. *Discussing with staff members their experiences working in the home. *Discussion with other people who use the service and their representatives. *Observing care practices. *Discussing care practices with management. *Inspecting records and the care environment. Other evidence gathered since the previous inspection such as notifications received from the home (e.g. regarding any incidents which occurred) were used to help form the judgements made in the report.) Care Homes for Older People Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 24 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 8 of 24 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. Information provided to people who use the service (e.g. regarding services offered) is satisfactory. For example all people who use the service receive a statement of terms and conditions of residency or contract when they move in. This ensures people are aware of their rights and responsibilities. Pre assessment procedures are satisfactory and should help to ensure the registered provider checks they can meet the persons needs before admission is arranged. Evidence: The registered provider has a satisfactory assessment procedure. We inspected files for four people, some of whom had moved to the home since the last inspection. Records were satisfactory although pre admission assessments should be dated when completed, rather than dated on the day of admission. Notes from the actual assessment meeting, and contacts prior to admission, should be maintained on file. We were able to inspect contracts / statements of terms and conditions of residency for two people using the service, and information seems satisfactory. Care Homes for Older People Page 9 of 24 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. Health and personal care needs of people living in the Home appear to be satisfactorily promoted and met, which should give people the assurance that they will be well looked after at this home. Evidence: A care plan was contained in the files for the people we case tracked. These contain satisfactory information and there is evidence care plans are reviewed. The manager and senior carer were encouraged to include social/life histories of people to enable them to provide even more individualised care and support. Care plans are accessible to staff. Risk assessments including a moving and handling assessment were also contained on each file. People who use the service, who we spoke to, were positive about the care they received. People who use the service said they were satisfied with the health care support they receive. This includes visits from GPs, district nurses, chiropodists, dentists and opticians. Records regarding these medical interventions are satisfactory and we were able to track when someone last saw the appropriate medical professional. One Care Homes for Older People Page 10 of 24 Evidence: external professional who answered our postal survey was complementary about support offered by the staff particularly as some people with complex needs had been placed at the service, and had made good progress since they had moved into Garsewednack. The registered provider has a policy regarding medication. We inspected the medication system. Storage of medication was satisfactory, although a controlled drugs cabinet does need to be purchased should this type of medication be kept at the home. Stock levels of medication are satisfactory. Records kept regarding receipt and administration of medicines are also satisfactory. Staff records demonstrated the majority of staff on duty, on the day of the inspection, had received training regarding the handling and administration of medication. We spoke to several people who use the service who were complimentary about the care they received, one comment made was it is like home from home here. People said they felt their privacy and dignity was respected by staff. Postal survey responses from people using the service, staff and external professional were all generally positive about the care and support provided. Care was deemed individualised, caring and supportive. Many of the respondents made a point of saying that staff and management were very caring and saw the welfare of the people living in the home as their top priority. This came over as the main theme in the responses we received. We raised a concern, at the last inspection, regarding one person who was in a shared room but wanted a single room. We received a further concern about this matter in a written survey prior to this inspection. Staff and a social worker have been involved in this matter. The person concerned is very specific about the bedroom they want. It has been agreed that the person will be offered this room should it become vacant. The person has been offered other bedrooms but does not appear to want these. We have been assured management will continue to offer alternative accommodation, including the room they want should it become available. Care Homes for Older People Page 11 of 24 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. Routines, food and opportunities meet the needs of the people living in the home Evidence: People using the service, who the inspector spoke to, said they could get up and go to bed when they wished, and said routines in the home are relaxed. People, who we spoke to, said they could spend their time in their bedrooms or in one of the lounges as they wished. Some activities are available to people living in the home. For example there are sessions from different musical entertainers. Staff also organise other activities and these are displayed on a notice board. Some people are happy to organise their own time either reading, doing puzzles, watching TV or listening to music. Some people receive regular visitors, and some people go out with relatives. In the postal survey we received some comments from some respondents suggesting it would be an improvement if staff had more time to spend with people for example more one to one time, or opportunities for people to have trips out every two or three months. Care Homes for Older People Page 12 of 24 Evidence: People are positive about the food provided. This appears to be to a good standard. There is not a choice of main meal but people said it is always nice. There is a choice of evening tea, and people appear to have hot and cold drinks / snacks available to them. Suitable records of food eaten are kept. On the day of the inspection most people went to the dining room for their meal, staff were seen giving assistance, where required, in a suitable and discreet manner. Care Homes for Older People Page 13 of 24 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 registered provider has satisfactory complaints and adult safeguarding procedures. These should help ensure any complaints, concerns and allegations are investigated appropriately should they occur. Evidence: A copy of the complaints procedure was inspected and this appeared to be satisfactory. One complaint has been received by the registered provider and also the commission. Issues regarding the user concerned were referred to Cornwall Council by the registered persons, under the homes safeguarding procedure. The matter is being resolved and the commission has been consulted and kept informed appropriately by the registered manager. The registered provider has a satisfactory Adult Safeguarding procedure. Some staff have received training regarding adult safeguarding, and other staff will be trained as opportunities become available either internally or from Cornwall Council. Care Homes for Older People Page 14 of 24 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. Garsewednack provides a pleasant environment for the people living there. Evidence: The building was inspected. There is suitable shared space, for example, two lounges and a dining room. Communal rooms seem pleasant and homely. Toilet and bathroom facilities are suitable in size and facilities provided. Soap dispensers and paper towels were available in bathrooms and toilets. These facilities were clean on the day of the inspection. Locks are fitted to the majority of toilet and bathroom doors, although these still need to be fitted to the doors of at least two bathrooms. The registered manager said the registered provider would complete this shortly. Bedrooms are decorated and furnished according to individual tastes. People who use the service said they were able to bring their own furnishings and belongings with them when they moved in. Call bells appear to be accessible to people who use the service. Part of the call bell system is currently being replaced. The majority of bedrooms do not have a working lock on the door. However, the registered provider has said people are asked if they want a lock on their bedroom door when they move in and this is recorded on the persons file. It should be the default position of the home that there is a lock on each bedroom door, and people are issued a key if appropriate. However some people do have a lock on their doors after they have requested it. Care Homes for Older People Page 15 of 24 Evidence: The home was clean, warm and light enough on the day of the inspection. The kitchen also was clean. Laundry facilities are satisfactory. Gloves and aprons are provided to staff to assist with cleaning and personal care. Alcohol gel is available to staff, visitors and people who use the service. The outside of the building and the gardens are well maintained. The registered provider has completed a radon test. Although radon levels were high, the registered provider has taken suitable remedial action to resolve the problem. Care Homes for Older People Page 16 of 24 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. Staffing levels appear satisfactory to meet the needs of people currently accommodated at the home. Recruitment checks are generally satisfactory. Training is also generally satisfactory although some improvement regarding the delivery of training is required. These measures ensure people using the service are supported by a satisfactory number of staff who are appropriately vetted and trained to meet their needs. Evidence: On the day of the inspection there were three care staff on duty from 0800 to 13:00, two of which remained on duty until 15:00. There are then two staff on duty from 15:00-22:00, and one member of staff on duty from 15:00 until 19:00. There are two waking night staff on duty from 2200-0800. Additional ancillary staff such as cooks and cleaners are employed. This seems satisfactory. Personnel records were inspected for eight staff (i.e.staff on duty during the 24 hour period on the day of the inspection). Records kept regarding recruitment checks are satisfactory. Staff employed since the last inspection had two references, a Protection of Vulnerable Adults First check (POVA First) , a Criminal Records Bureau check (CRB) and a completed application form. However there should be more detailed application form for example giving more detail regarding employment history, and more detail to ascertain medical fitness. A copy of information confirming the persons Care Homes for Older People Page 17 of 24 Evidence: identity (e.g. birth certificate or driving license) should be kept on file, as required by the regulations. In regard to training, the following is required by law: * Regular fire training in accordance with the requirements of the fire authority. * There must always be at least one first aider on duty (at appointed person level). *All staff must have manual handling training and regular updates of this (e.g. annually) * All staff must have basic training in infection control. * Staff who handle food receive food hygiene training. * All staff must have an induction and there needs to be a record of this. * At this home people should have training regarding dementia awareness The registered manager keeps a record of training which has been delivered. We were given a copy of this. This record, and records on individual personnel files are generally good. Induction training also appears satisfactory. There appears to be satisfactory access for staff to obtain a National Vocational Qualification in care. There are some gaps in the delivery of training. For example on the morning and afternoon of the inspection their was limited evidence that care staff had received first aid training to appointed person level (although some of the staff had received internal training via a distance learning course). However both the senior carer and the registered manager had an appointed persons first aid certificate. It is strongly advisable that at least one of the carers has this training in case the senior or manager have to go out e.g. to a meeting or carry out an assessment etc. The registered persons training programme in regard to manual handling, infection control, food hygiene and dementia is completed internally, using materials supplied by a company providing distance learning. Completion of training and the issuing of certificates is completed internally. It is advisable that test papers are sent off to the company for validation, and the certificate is issued by the training provider. This entails a small cost. It is also essential that training materials are reviewed and as necessary renewed regularly so they reflect current practice. Similarly those providing mentoring / training of candidates need to maintain their own knowledge and skills if such internal training is to remain valid and effective. Care Homes for Older People Page 18 of 24 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 registered persons have suitable skills, knowledge and experience to manage the service. Quality assurance measures are satisfactory, although the current policy needs some revision. The monies of people living in the home are managed appropriately and suitable records are kept. Health and safety standards are satisfactory. These measures all demonstrate that people who use the service can be assured that the home is managed to a good standard. Evidence: The registered providers have owned the home for several years. They appear to have suitable skills, experience and knowledge to manage the home. The manager has been registered with the Care Quality Commission since the last inspection. In our postal survey many respondents said had a positive view of management, and management did their best to meet the needs of the people living in the home. The registered provider has a quality management policy. However this appears to be a purchased off the shelf type policy, and does not necessarily reflect the practices in Care Homes for Older People Page 19 of 24 Evidence: place. The registered provider should re write the policy to reflect actual quality assurance practices. Quality assurance practices are very good. The building is maintained to a high standard-so suitable checks and on going plans must be in place to maintain the building to a good standard. Surveys have been carried out regarding the views of people who use the service and their representatives. The results, although not collated or used to help form a development plan, are all positive. Suitable systems are in place to check medication, personnel records, staff training and health and safety standards. The registered provider maintains a monthly checklist to help maintain current standards. The practice in place appears to work well. The registered provider has ensured some resident meetings and staff meetings have occurred. These are good for ascertaining peoples views, ensuring people feel supported and involving them in the process of bringing about continuous improvement. However, it would beneficial to have these more frequently than is currently the case. The registered providers look after some monies on behalf of people who use the service. The system in place is operating to a satisfactory standard. No valuables are currently held on behalf of people who use the service. The provider was asked to check with their insurers the upper limit of money that can be kept on behalf of a resident The registered provider has a health and safety policy. Testing of fire extinguishers, call points, emergency lighting appears satisfactory. There is evidence that staff have received fire prevention awareness training. Health and safety risk assessments are completed. Portable electrical appliances have been tested by the registered provider. The electrical hardwire circuit has been tested and has been deemed, according to the registered manager, as satisfactory. This has only been completed recently and the registered persons are awaiting the certificate. We were informed any remedial work to the circuit has been completed. It is advisable to send a copy of the certificate to the commission. There appears to be a suitable risk assessment and system regarding the prevention of legionella. Manual handling equipment appears to be tested appropriately. The stairlift has been serviced. Suitable records are maintained regarding the testing of the temperature of bathwater. The registered providers risk assessment regarding this matter states thermostatic valves are fitted to hot water outlets on the baths. Care Homes for Older People Page 20 of 24 Evidence: The heating system has been tested, and there is a current gas certificate. The radiator in the entrance hallway was not covered and had a lot of flaking paint on it. The manager said that the radiator is not used so does not require a cover. In view of the flaking paint the provider was asked to remove the radiator to reduce the risk of injury to people who may rub up against it. An up to date certificate of insurance is displayed. Care Homes for Older People Page 21 of 24 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 24 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 30 18 The registered provider must complete training planned for all staff. For example first aid training at appointed persons level. This will help to ensure people who use the service are supported by suitably trained and skilled staff. 01/03/2010 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 3 7 9 38 Include social / life histories for each person using the service as part of their care plans. The home should have a controlled drugs cabinet, in line with guidance issued by the Royal Pharmaceutical Society. Remove the radiator in the front hallway if this is no longer in use or otherwise make arrangements to reduce any risk of injury. Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 24 - 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!