Care Home: Hookstead Resource Centre

What the care home does well Service users benefit from having an appropriate Contract (Terms and Conditions of Stay) in place, which is signed and agreed by all parties involved. The health needs of service users are well met with evidence of good multi disciplinary working taking place. Staff provide personal support to service users in such a way that promotes and protects service users privacy and dignity. Service users benefit from an activities calendar that is stimulating and arranged according to their choice. Service users experience mealtimes that are unhurried, whilst all meals are home cooked with an alternative option being available for each mealtime. Service users can be assured that there is an efficient complaints procedure in place and that the homes processes and staff training should protect service users in the event of an allegation of abuse. The location and layout of the home are suitable for its stated purpose. All areas of the home are accessible to service users. Service users experience the benefits of a staff team that have the necessary skills and experience to the meet their needs. Staff training is on going and is appropriate to the level of needs of current service users. The management and administration of the home is good, with evidence of consideration being given to service users and/or relatives opinion at all times. What has improved since the last inspection? Staff have ready access to pre admission assessments prior to a new service user being admitted to the home. What the care home could do better: In order to ensure that service users needs can be met, care plans and risk assessments for those who reside at the home for longer then a month period, must be reviewed on a monthly basis and any significant changes recorded. Staff recruitment files must be maintained in an appropriate manner, recruitment checks undertaken must be kept file. By maintaining appropriate checks, service users will be further safeguarded against harm. It is recommended good practice that the staff duty rota is updated to include staff job designations and that all transactions from Safe Custody Accounts are signed for by two persons. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hookstead Resource Centre Goldsmith Avenue Crowborough East Sussex TN6 1RH     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: Rebecca Shewan     Date: 2 0 0 1 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 26 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Hookstead Resource Centre Goldsmith Avenue Crowborough East Sussex TN6 1RH 01892667855 01892655862 margot.hand@eastsussex.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): East Sussex County Council Name of registered manager (if applicable) Mrs Margot Carole Hand Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 22. The registered person may provide the following category/ies of service only: Care home only 1 (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) Dementia (DE) Mental Disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Hookstead is run by East Sussex County Council (ESCC), and is a purpose built property on three floors; set in its own grounds located a short distance from the centre of Crowborough. Service user accommodation comprises of twenty-two single bedrooms situated on the first and second floor in four self-contained units (suites), each with a lounge and dining area. All the suites provide respite care or short term Care Homes for Older People Page 4 of 26 care home 22 Over 65 0 0 22 22 Brief description of the care home care of up to six months for service users with a mental disorder or dementia type illness. There is a five-day, day care service on site, which service users can access when there is a vacancy. Level access is facilitated in the home by the provision of a passenger lift between all floors. There is a very attractive garden at the rear of the home. Fees charged for respite and short-term care provided are in accordance with ESCC policy and procedures and at the time of the inspection the charges are £102.90 to £545.00 a week. The level of fees charged will depend on the outcome of a financial assessment. Additional charges are made for hairdressing, toiletries, dry cleaning and chiropody. Care Homes for Older People Page 5 of 26 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 inspection took place during the morning and afternoon of the 20th January 2009. The Annual Quality assurance assessment (AQAA), incident reports and previous inspection reports, held by the Commission for Social Care Inspection, were read before the inspection. The inspection of the home took six and a quarter hours. Records such as care plans, staff files and medication records were also viewed. Eighteen service users were accommodated at the home at the time of the inspection. A tour of the whole home was undertaken and the appointed Manager, two Carers and three residents were spoken with. The CSCI also conducted Service User and Staff surveys. Of which three Staff surveys were received. The responses from the surveys received, were positive in many of the areas relating to the home and the care Care Homes for Older People Page 6 of 26 provided. Areas of concern have been highlighted in the body of the report. 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 26 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 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 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has good processes in place for assessing potential new service users. Service users are protected by the completion of a contract/terms and conditions. Evidence: The home is able to demonstrate that it has the capacity and authority to meet the assessed needs (including specialist needs) of service users. Pre- admission assessments are conducted in various manners dependent on the type of admission i.e. respite care or functional. For respite admissions a telephone referral is made to the duty office. Respite admissions can be: hospital referrals, convalescence or carer relief. Functional care is offered to service users who require crisis management, in particular those with a mental health illness. The Appointed Manager reported that any potential new service users needs that could not be met by the home, would be declined from admittance. Copies of care management assessments, from the placing authority, are also obtained for all admissions. Documented records are maintained of Care Homes for Older People Page 11 of 26 Evidence: all correspondence with the placing authority. Records inspected showed that preadmission assessments are carried out on all new and potential service users. Discussions with the Appointed Manager confirmed that pre admission assessment issues have been raised with placing authorities and assessment teams, it has been noted that on occasion the pre assessment data is not reflective of the service users actual needs. Thereby allowing service users whose needs cannot be met in their entirety, enter the home. This was also highlighted in the staff surveys received. The Appointed Manager stated that the issues had been fed back to the assessment teams and that the Senior Management of ESCC are aware and are taking actions to address this issue. Service user contracts (Terms and Conditions of Stay) are in place. Those viewed were noted to be signed and dated by the service user and/or their representative. The contracts viewed were found to contain all elements listed under the National Minimum Standards. Intermediate care is not provided by this service. Care Homes for Older People Page 12 of 26 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. Service users are offered a good provision of health care and personal support by the home. Care plans ensure that service users needs and limitations are well documented. Improvements are required to ensure that service user care plans are reviewed appropriately. All care is administered in way that protects service users privacy and dignity. Medication procedures ensure that all necessary precautions are taken to ensure errors do not occur and that medications are stored and administered safely. Evidence: Care plans were sampled and it was evidenced that they were comprehensive, detailed in content and covered all aspects of service users needs. Care plans are written to allow the assessor to gain a good overview of individuals medical, nursing, mental health, social and personal care needs. Daily care records were also viewed and these were found to be written in accordance with service users care needs. Suitable risk assessments for Falls prevention, moving and Handling and Health and safety issues were noted to be in place. There is a need however for care plans and risk Care Homes for Older People Page 13 of 26 Evidence: assessments to be reviewed on a monthly basis. From the care plans sampled it was evidenced that service users whose stay is over a month period, do not have their care plan reviewed. Risk assessments also require reviewing as part of this process. Therefore a Requirement has been made. Service users from out of area are registered on a temporary basis with a GP from a local surgery. Service users from the local area are encouraged to maintain their own GP, where able. For Dental and Opticians services, the home utilises the services of either the local surgeries, hospital facilities or service users are encouraged to attend their own. District Nurses attend the home as needed. Audiology is accessed via the hospital or GP as and when required. A Chiropodist attends the home as and when required. The home has good procedures in place for the monitoring and recording of all drugs administered, disposed of and those entering and leaving the home. Medication administration records were viewed and these were found to be maintained appropriately. Each service user bedroom has a wall mounted locking medication cupboard. There is a staff signatory list in place. It was evidenced from the records viewed that ESCC PMI (Personal Medication Instruction) were in place for all service users, these detail service users medication on admission. Staff training records viewed confirmed that staff receive appropriate training and refresher training in medication matters. Staff were observed providing personal support to service users in such a way that promoted and protected service users privacy and dignity. Care Homes for Older People Page 14 of 26 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. Service users are offered a variety of activities to choose from. The home provides a wide range of social, cultural and recreational facilities. A wide range of choice is available at mealtimes, including specialist diets. Service users choice and wishes are respected in all activities. Evidence: Care staff co-ordinate activities and all activities are service user lead. Activities held include: quizzes, jigsaws, Pat dog, bingo, birthdays/seasonal festivities, annual BBQ (in association with Alzheimers Society), inflatable tin pin bowling, Knitting Club, Friday Choir and cream teas. Service users attend activities at a level of their choosing, though they are actively encouraged to participate to promote socialisation. Service users are encouraged to attend the local shops/town. A hairdresser attends the home once a week. Service users religious wishes are observed and arrangements are in place for service users to attend a non denominational church service, which is held once a month. Private one to one church services are provided to service users via Forest Fold. Denominational visiting religious services can also be arranged upon request. Care Homes for Older People Page 15 of 26 Evidence: Discussions with the Appointed Manager highlighted that although the current service users had similar religious beliefs, the home would welcome any potential new resident who has special cultural/religious/spiritual beliefs and would make provision to accommodate their needs. The management of the home believes in promoting an equal and diverse culture among staff and service users. Service users are encouraged to attend local community events, where able. Contact with family and friends is positively encouraged with visitors being able to attend the home at any time and in accordance with the service users wishes. Service users are treated with respect and there is a good rapport between staff of the home and service users. Service users reported that the home assists them to maintain their independence with their daily living and daily routines. The homes menus are devised on a four week rolling programme. All meals are home cooked with an alternative option available for each mealtime. Mealtimes can be varied upon request and service users guests are also welcome to have meals at the home. Meals can be taken in the service users bedroom or in the communal dining room. Medical, therapeutic or religious diets are provided as needed. Drinks and snacks are available at all times. The meal served during the inspection was ample in quantity and attractively presented. The lunchtime meal was observed to be unhurried. Care Homes for Older People Page 16 of 26 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. Service users benefit from a robust and efficient complaints procedure, whilst the homes procedures, processes and staff training should protect service users in the event of an allegation of abuse. Evidence: The home has an established complaints procedure in place. Records are maintained of all complaints received. Neither the home or the CSCI have received any complaints within the past twelve months. Criminal Record Bureau (CRB) checks have been carried out on all existing staff. Both CRB and Protection of Vulnerable Adult (POVA) checks are carried out on all new staff. The home has a copy of the ESCC Whistle Blowing policy. Staff have attended training in the Protection of Vulnerable adults within the last twelve months. This was evident from the staff files were viewed. There have been two Safeguarding Alerts raised by the home in the last twelve months. One has been actioned and one is currently being investigated. Care Homes for Older People Page 17 of 26 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 home provides accommodation for service users that is well maintained, hygienic and odour free, whilst infection control procedures are adhered to at all times. Evidence: The location and layout of the home are suitable for its stated purpose. The home is well maintained and all areas of the home, including the garden, are accessible to service users. The home has an ongoing plan of refurbishment in place. The home has an infection control policy in place and staff are trained in infection control procedures, staff training records viewed confirmed this. Staff were observed adhering to infection control procedures. It was evidenced that a clinical waste contract is in place. The home was clean and odour free throughout. There is a daily cleaning schedule in place. Staff spoken with stated that often there is one cleaner on duty, which takes care staff away from care duties as they are cleaning rooms in preparation for new admissions. This information was conveyed to the Appointed Manager at the time of the inspection. Care Homes for Older People Page 18 of 26 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 health needs of service users are well met by a staff team that have the necessary skills and experience to the meet the needs of current residents. There are improvements required to ensure that service users are safeguarded by having good maintenance of staff recruitment files in place. Staff training meets the National Minimum Standards and ensures that staff receive training that is both current and appropriate to the needs of service users. Evidence: A competent staff team, sufficient in number, meets the residents needs. There is a staff rota in place, which details staff hours of working, though job designations are not clearly recorded. Therefore a Recommendation has been made. The home is staffed on the basis of five Carers in the morning, five Carers in the afternoon and two waking Carers overnight. Discussions with the Appointed Manager highlighted that care staffing levels would be increase, both day and night, if service users needs increased or if the number of service users accommodated increased. There are two Domestics on duty daily (one for laundry and one for cleaning). The kitchen has a cook on a daily basis. The home has a permanent staff team of the Appointed Manager, three Senior Care Officers, eighteen Carer Officers, one Cook, one Assistant Cook and 1 Kitchen Care Homes for Older People Page 19 of 26 Evidence: Assistant, two Domestics (Cleaning and laundry) and one Handy person. Additionally the home has two long term placement contracted Agency staff (Carers) at present. Eleven Care Officers are National Vocational Qualification (NVQ) level 2, in Care, trained. One Senior Care Officer is NVQ level 3 trained. There are three qualified A1 Assessors. A further two Care staff are undertaking the NVQ level training and two are undertaking the NVQ level 3. Additionally, there is one Administrator NVQ level 2 trained in administration and one Kitchen Assistant who has an NVQ level 2 in Food and Catering. The home has an Equal Opportunities policy in place and is an equal opportunities employer. Staff recruitment files were viewed and it was evidenced that these files did not contain all items required under the Care Homes Regulations 2001. Copies of application forms, references, proof of identity and photographs were not evidenced. Therefore a Requirement has been made. Staff induction training is conducted in line with Common Induction Standards guidance. Mandatory training consists of Infection Control, medication, Moving and Handling, Protection of Vulnerable Adults, Health and Safety, Induction, basic food hygiene and Fire Safety. Additional training is conducted in NVQs, two day Dementia training, Gentle Exercise, Nutrition, Mood Food, Risk Assessment Awareness and general Building Safety. Care Homes for Older People Page 20 of 26 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. Service users experience the benefits of a home that is well managed and administrated. Consideration is given to service users choice and opinion in all aspects of provisions provided. The health, safety and welfare of service users and staff is protected at all times. Evidence: The Appointed Manager of the home is currently in the process of applying to become the Registered Manager. She is undertaking the NVQ level 4 in Leadership and Management course and has worked for ESCC for 18 years. Mrs Hand is also an NVQ A1 Assessor, Train the Trainer qualified in Moving and Handling, has a Certificate in Dementia Care and is a registered Risk Assessor. Both staff and service users spoken with stated that Mrs Hand is always approachable, open to suggestions and is willing to listen. There is a formal Quality Assurance process in place. Service user forums are held six Care Homes for Older People Page 21 of 26 Evidence: weekly, the minutes of which were viewed. Service users are requested to provide feedback to ESCC following discharge, these forms are sent back to ESCC directly and the results of which are made available to the home. Regulation 26 visits are conducted, Regulation 26 visit reports viewed confirmed this. Monthly audits are also conducted in First Aid, Fire Safety, staff recruitment and resignation, accidents and falls monitoring. The home does not take any responsibility for many of the residents finances and most residents have family, friends or representatives who protect their financial affairs. Personal allowance accounts (known as Safe Custody Accounts) are maintained for those service users, who require assistance with maintaining monies whilst residing at the home. The accounts were audited and nil discrepancies were noted. It was discussed with the Appointed Manager that to further safeguard service users and staff, that all deposits and debits from accounts should be signed for by two persons. Therefore a Recommendation has been made. Staff spoken with and records viewed confirmed that staff receive two monthly supervision sessions with the Registered Manager. Staff also receive annual appraisals. The homes AQAA was viewed and it was evident that fire drills, fire alarm testing and fire equipment checks, health & safety checks and water checks are carried out. During the tour of the premises it was observed that unnamed bath products were in the shower and bathroom areas. The Appointed Manager was advised of the risks associated with this and all products had been removed prior to the conclusion of inspection. No other health and safety issues were noted. The EHO and Fire Safety Officer visited the home in 2008, the recommendations made at the time of these visits have been actioned. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 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 reviewed 20/02/2009 on a monthly basis. Service users needs should be reviewed on a monthly basis to ensure that staff are aware of any change of need or the service users current limitations. 2 29 19 That staff recruitment files contain all items required under this Regulation and the associated schedules. In that staff files held locally do not contain all necessary recruitment data. Service users will be further safeguarded by having appropriate recruitment checks in place. 20/03/2009 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 24 of 26 1 2 27 38 That the duty rota is updated to include staff members job designation. That two persons sign for all transactions in service users Safe Custody Accounts. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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