Care Home: Hunters Lodge Care Home

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What the care home does well The individual assessments of need and care plans are of a good standard. Detailed guidance is recorded for staff to follow, which includes reference to individual preferences. Daily preferred routines are recorded, such as preferred times for getting up and what the person likes to eat for breakfast. Residents and/or their representaives have opportunities to involve themselves in the assessment and care planning. The home uses specialised equipment for stimulating residents` memory. Residents have a choice of food at each meal time. Staff were obesrved to interact well with residents when providing support. Training in equality and diversity is provided for staff. The views of residents are sought and are posted on a notice board with corresponding action being taken by the home to address any suggestions for improvement. Residents` representatives state that the service always acts when any issues or concerns are raised. What has improved since the last inspection? The residents` admission documentation has been developed. Nutritional care plans have been completed by a new catering manager. Ongoing staff training is provided. Improvements have been made to the environment including the redecoration of some bedrooms, refurbsihment of the lift and recarpetting. The home has developed a management team by appointing staff with specific responsibilities, such as human resources. What the care home could do better: Controlled medication must be stored in the controlled drug cupboard. The staff duty roster needs to include the hours worked by the management team. Key inspection report Care homes for older people Name: Address: Hunters Lodge Care Home 39 Kiln Road Fareham Hants PO16 7UQ     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 Craig     Date: 0 7 0 4 2 0 1 0 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 27 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Hunters Lodge Care Home 39 Kiln Road Fareham Hants PO16 7UQ 01329285257 01329315005 hunters.lodge@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hunters Lodge Care Homes Limited Name of registered manager (if applicable) Mrs Bridget Hardman Type of registration: Number of places registered: care home 30 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: 30. The registered person may provide the following category/ies of service only: Care home only (PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental Disorder (MD) Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Hunters Lodge Care Homes Ltd. became registered providers of Hunters Lodge Care Home on 24 November 2009. Care Homes for Older People Page 4 of 27 Over 65 0 0 30 30 30 0 Brief description of the care home The building has gardens and grounds with parking spaces. Communal areas consist of several lounge areas including a conservatory. There is ramped access for those with mobility needs. A passenger lift, with space to accommodate a wheelchair, serves each of the 3 floors. All bedrooms are single with the exception of 3 double rooms. Each bedroom, except 1, has an en suite bathroom or toilet. Care staff are provided 24 hours a day and there is a team of ancilliary staff providing catering, cleaning and maintenance. Activities are arranged for the residents on a regular basis. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection consisted of a site visit of approximately 6 hours. During this time records, documents and polices and procedures were looked at. This included the care records for 5 residents. 3 staff were spoken to during the visit as well as 2 members of the management team, the registered manager and the responsible individual. The views of residents and their representaives were sought by interviews with 3 residents and 1 residents representaive. Staff were observed working with the residents. Surveys were sent to residents and staff to ask their views on the service provided. At the time of the inspection only 1 survey had been returned. Care services are required to complete an Annual Quality Assurance Assessment Care Homes for Older People Page 6 of 27 (AQAA). This was completed by the home and returned to the Commission. Information contained in the AQAA has been used for this report. Care Homes for Older People Page 7 of 27 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 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are able to make an informed choice about whether or not to move into the home. A thorough needs assessment helps ensure that the service accommodates only those whose needs it can meet. Evidence: The service has documents which are provided to those who are considering moving into the home. This includes a Statement of Purpose and a Residents Information Pack. These give details of the homes aims and objectives, the accommodation facilities, the service provided, staff details and the complaints procedure. A checklist is completed when a resident is admitted to the home; this includes reference to the Statement of Purpose being offered or given to the person. A copy of the Statement of Purpose is available in the hall and a copy of the Residents Information Pack is in each bedroom. Care Homes for Older People Page 10 of 27 Evidence: Residents and/or their relatives can look around the home before making a decsion about moving in. This was confirmed from the homes management, the AQAA, observation of relatives looking round the home and from residents themselves. The home completes an enquiry form when a referral for possible admission takes place. An assessment is carried out by staff from the home to determine if the persons needs can be met by the home. Copies of these assessments were seen for 5 people. Where applicable, the home also obtains copies of referring social services care managers assessments and /or hospital discharge letters. Copies of these were seen with residents records. The pre admission assessment of care needs is comprehensive and includes the following: physical health and well being, personal care needs, mobility/transfers and dexterity, dietary needs, continence, communication and senses, oral health, foot care, social interests, religious/cultural interests, cognitive health and mental capacity, emotional and mental health, personal safety and risk issues, living in a care environment, medication and ethnicity. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are of a good standard. Residents health and personal care needs are met. The residents are treated with dignity and their privacy promoted. Evidence: Care records were looked at for 5 people. These include a photograph of the resident and details of the name the person prefers to be called by. Personal details such as the persons next of kin, General Practitioner, date of birth and other information are recorded on a front sheet. Care plans are comprehensive and cover the following needs: medical history, family history, social needs, finances, religious/cultural needs, mental health, communication, personal care, dressing, haircare, foot care, oral health, continence, eating/drinking mobility and night care needs. The care plans make detailed reference to individuals care needs including personal preferences so that staff have clear Care Homes for Older People Page 12 of 27 Evidence: guidance to follow. For instance, this included details of the persons daily routine such as preferred drinks and fruit for his/her room, and preferred routines for getting up and breakfast. Care plans include reference to how mental health needs are to be addressed. Care plans are signed and dated by the person completing them and the resident and/or their relative has an opportunity to sign to acknowledge the content of the plan. There is a Care Plan Worksheet where staff record updates in care needs. Care plans are reviewed and updated on a regular basis. Care staff described how they refer to care plans and how they record daily occurrences. Assessments are completed to minimise risks of injury from possible falls, the development of pressure areas, social isolation and other identified risk areas. Records are kept to monitor any injuries. Daily running records are maintained for each person. These are signed and dated by the person completing them. A nutritional assessment is carried out and recorded for each person. Individual residents weight is monitored and recorded. Records are maintained of contact with health and social care professionals. These show liaison with residents General Practitioners and community nursing staff. Records show that chiropody services are arranged for residents. The AQAA states that the home has made arrangements for a dental surgeon to attend to residents. The homes management also stated that arranagements are being made for eye sight and dental treatment via a specialist company. Residents say that they are are looked after and that the staff treat them with kindness and respect. The homes medication procedures were looked at. Records show that staff record a signature each time medication is administered to a resident. Stocks of medication show that medication is administered as prescribed. It was noted that medication that has to be stored in a controlled drug cupboard was being stored in a lockable container inside the medication trolley rather than the controlled drug cupboard. Records were maintained in a controlled drugs register of controlled medication. Care Homes for Older People Page 13 of 27 Evidence: There was 1 discrepancy regarding the stock of a medication. This was immediately addressed by the member of staff responsible for dealing with the homes medication. Guidelines are recorded where medication is administered on an occasional basis. It was noted that for 1 medication administered on an occasional basis that the guidance needed to be more specific, which the home agreed to address. Staff receive training in medication procedures and records show that this includes a series of observational assessments of individual staff competency. Privacy screens are provided in shared bedrooms. Bedrooms doors are fitted with locks so that residents can have privacy. Residents are offered a key to their bedroom door so that they can lock it when they go out. At the time of the inspection several residents had made use of this facility. Staff were observed to treat residents with dignity and respect explaining to residents how they were being helped when giving assistance. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a range of activities and stimulation. Residents are able to exercise choice in how they spend their time. Nutritious food is provided with a choice of meals. Evidence: The home employs an activities co ordinator for facilitating and arranging activities for the residents. There is an activities programme displayed on a notice board and a record is kept of activities, including which residents take part. The activities include arts and crafts, bingo, cooking, exercise to music, parties, karaoke and entertainment from visiting professional musicians and singers. The record of activities for the month of March 2010 showed 14 different events, which residents took part in. Photograph displays of parties are displayed on notice boards as well as purposely designed memory boards for stimulating recollection of events, famous people and places. Care Homes for Older People Page 15 of 27 Evidence: There are trips out to shops and for walks. Residents are able to grow plants in the garden and there are plans to create a raised flower bed for residents to use. Residents say that activities are provided and a residents representative described the various activities he/she has observed taking place. Religious needs are catered for including visits to the home by local priests as well as trips out to church services. Hairdressing services are provided and residents can have a foot spa and manicure. Residents confirmed that they are able to spend their time as they wish, including times for getting up and going to bed. The days menu plan was displayed in the dining room. A member of staff was observed asking residents what they would like to eat for the forthcoming early evening meal and the main midday meal for the following day. A choice of meals was offered and this was recorded for use by the homes cook. Residents described the food as good. Residents are able to choose what time and place they have breakfast as well as the type of food. Cooked breakfasts are available. This was confirmed from residents records and from residents spoken to. Drinks were available in the dining area and residents were seen having tea or coffee with biscuits in the afternoon. The midday meal time was observed. Staff were seen to help those who needed help with eating. This was done in a courteous manner with staff interacting with each person. The meal looked appetising. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service listens and acts on issues raised by residents. Steps are taken to protect residents from possible harm. Evidence: The homes complaints procedure is contained in the Statement of Purpose. The AQAA states that the complaints procedure is given to each resident or to their representative at the time of admission. Residents and a residents representaive state that they are able to raise any concerns informally. The homes management are said to be approachable and to always act on any issues that are raised. A notice in the hall displayed feedback received from residents about how the service could be improved and action that the home is taking to address these suggestions. This included reference to a greater availability of fresh fruit and soup as well as more quizzes. There have not been any complaints made to the servicve since it was registered on 24 November 2009. Staff receive training in how to deal with any suspected abuse. This was confirmed from training records and from staff themselves. The training is provided by the local authority and the home has a copy of the local authority safeguarding vulnerable Care Homes for Older People Page 17 of 27 Evidence: adults proceure. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and well maintained with good facilities for the people who live there. Evidence: The communal areas and a sample of bedrooms were seen. All bedrooms are single with the exception of 3 doubles. Privacy screens are provided in shared rooms. Each bedroom, except 1, has an en suite toilet or bathroom. Bedrooms were found to be clean with decor and furnishings intact. There was evidence of residents brining their own belongings to the home. Lockable storage is provided in bedrooms for residents to secure valuables. Each bedroom has a call point so that residents can alert staff that they need assistance. A resident said that he/she likes his/her bedroom and that the environment is homely. Bathroom facilities consist of 2 bathrooms each with a specialist bath plus a shower room. There are plans to update the shower room to a walk in shower room. In addition to the en suite toilet facilities there are communal toilets. There is ramped access to the garden to aid access to this area for the residents. The garden has tables and chairs on a patio. A passenger lift serves each floor. Door Care Homes for Older People Page 19 of 27 Evidence: widths are of 800mm allowing wheelchair access. Grab rails are installed in key areas where residents may need help. Communal areas consist of 3 sitting areas plus dining areas. The home has a conservatory which overlooks the garden. Air conditioning is provided in the conservatory and in other communal areas. Other facilities include a loop system for those with hearing needs. A computer with internet telephone facilities is available in the lounge. The home was found to be clean and there was an absence of any odours. There is a laundry area and designated staff for laundry and cleaning. Staff receive training in infection control. Feedback from residents and their representatives state that the home is clean. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient numbers of well trained staff are provided to meet residents needs. Staff recruitment procedures help ensure residents are protected. Evidence: The homes staffing levels were looked at. This was done by discussion with the homes management, observations on the day of the visit, feedback from staff and residents, plus the staff duty roster. The home aims to provide the following staff: 8am to 2pm 5 care staff, 2pm to 8pm 4 care staff, 8pm to 10pm 3 staff and 2 waking night staff. The staff rota and observation showed that these hours were being provided. In addition to these staff hours are the hours worked by the registered manager, the deputy manager, a senior carer and the training co ordinator. These hours were not recorded on the staff duty roster. The homes management said that these hours were recorded until recently and agreed to resume recording the working hours of all staff on a duty roster. Staff, residents and residents representatives said that there are sufficient staff to meet the needs of the people who live there. Residents said that staff respond when they ask for help. Care Homes for Older People Page 21 of 27 Evidence: The home also employs the following staff: 2 kitchen staff 7 days a week, 102 hours of cleaning staff a week and 42 hours of laundry staff plus a gardener/maintenance person. Staff were described by residents as being kind and friendly. One person said, The staff are you friends. A residents representative said that the staff are good and treat the residents well. Training records were looked at for 5 staff. These show that an induction is carried out to prepare new staff for the job. This includes staff being provided with a Staff Handbook and a record to show that fire safety in the home, daily routines and the organisation of the service have been explained. Staff confirmed that they received an induction which helped prepare them for the job. 17 of the 28 staff have National Vocational Qualification (NVQ) level 2 or 3 in care. A further 3 staff are studying NVQ level 2. The AQAA states staff who do not complete the NVQ training complete the Skills for Care Common Induction Standards in social care over 12 weeks. Records show that staff also receive training in medication procedures, dementia, equality and diversity, moving and handling, fire safety, adult protection and first aid. The home uses a local authority for training updates. The homes management provide individual supervision of staff as well as appraisals. Management staff who carry out this task have been trained in supervision and staff appraisal. Records of supervision are maintained and staff confirm that they receive regular supervision. Recruitment procedures were looked at for 4 staff who have started work at the home in the recent past. Records show that each person completes an application form and that 2 written references are obtained including 1 from the most recent previous employer. Records of job interviews with staff were seen. Criminal record bureau (CRB) and Independent Safeguarding Authority (ISA) checks are obtained before staff start work. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the best interests of the people who live there. Evidence: The registered manager is a qualified nurse and has National Vocational Qualification level 4 in and the Registered Managers Award (RMA). She has also completed training, which qualifies her to train staff in specific subjects such as manual handling. There is a management team who share responsibilities for the training and supervision of staff as well as the daily management of the home. The home uses surveys to ask residents their views about the service. Details of these are displayed on a notice board with corresponding action that the home will be taking to address the residents suggestions. Audits of the medication procedures are carried out. Care Homes for Older People Page 23 of 27 Evidence: The home has a business and financial plan for the year ahead. Ongoing improvements are made to the environment and any outstanding maintenance work is recorded in a log book for rectifying. Residents meetings used to take place but were stopped due to low attendance. The home intends to reintroduce them to aid communication with the residents. At the time of the visit the home did not look after any residents monies or valuables. The AQAA confirms that the homes appliances and equipment are tested and serviced by suitably qualified persons. Staff receive training in food hygiene, first aid, moving and handling and fire safety. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 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 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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