Care Home: Maria Residential Home (EMI) Ltd

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What the care home does well All prospective users of the service can be confident that their health, social and personal care needs are fully assessed prior to them being offered a place at the home; this is to ensure that both parties are confident that their individual needs can be met appropriately. Staff provide personal care and support to service users in such a way that promotes and protects service users privacy and dignity. The meals provided are freshly cooked on the premises offering variety and choice to meet people`s individual needs and are provided in an unhurried manner, with assistance being given discreetly where required. The home has a complaints procedure to ensure that people using the service could raise a concern and be confident that it would be addressed. The home ensures that there are sufficient numbers of staff on duty at all times to meet the needs of the people using the service. The home ensures that people using the service are supported by staff that have been appropriately recruited and trained, which should protect them from any potential risk of harm or abuse. The home provides a relaxed friendly atmosphere, with a high standard of cleanliness throughout. What has improved since the last inspection? This is the first inspection since registration. What the care home could do better: When staff are using COSHH solutions they must ensure that they are stored securely after their use to ensure that people using the service be free from any potential risks to their health, safety and well being. Key inspection report Care homes for older people Name: Address: Maria Residential Home (EMI) Ltd Silver Birches Kendalls Close High Wycombe Buckinghamshire HP13 7NN     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: Jane Handscombe     Date: 0 8 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 26 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 26 Information about the care home Name of care home: Address: Maria Residential Home (EMI) Ltd Silver Birches Kendalls Close High Wycombe Buckinghamshire HP13 7NN 01494530042 01494530042 mariaresidentialhome@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Maria Residential Home (EMI) Ltd Name of registered manager (if applicable) Mr Zulfiqaz Ahmad Mr Ahmed Zvifiqa Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 8 The registered person may provide the following category 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 category: Dementia (DE) Date of last inspection Brief description of the care home Maria Residential Home (EMI) Ltd is registered to provide care and accommodation for up to eight service users who have a diagnosis of dementia. The premises are a bungalow with seven bedrooms, one of which is intended for shared use. The service is located close to the centre of High Wycombe in south Buckinghamshire and is accessible by public transport. 8 Over 65 0 Care Homes for Older People Page 4 of 26 Brief description of the care home Information regarding the service can be obtained from the home on request. The current fees range from £459 to £750 per week. 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 was an unannounced inspection, which took place over one day on the 8th April 2010. The purpose of the visit was to see how the service is meeting the National Minimum Standards. Prior to the inspection we required the service to complete an Annual Quality Assurance Assessment (AQAA), which enables them to evaluate the quality of their service and forward to ourselves when asked. This initially helps us to prioritise the order of the inspection and identify any areas that may require more attention during the inspection process. Results of this inspection report are derived from discussions with staff during the inspection, viewing service users records held within the service, viewing policies and procedures, staff personnel files, general observation throughout the visit, information provided to us in the completed AQAA, returned surveys which we sent to the service prior to our visit to distribute to service users and staff members and any other information that we have received about the service in order to gain an understanding of how the service meets the service users needs and how it impacts upon their lives. Care Homes for Older People Page 6 of 26 We looked at how well the service was meeting the key standards set by the government and have in this report made judgments about the standard of the service. Care Homes for Older People Page 7 of 26 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 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 9 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. All prospective users of the service can be confident that their health, social and personal care needs are assessed prior to them being offered a place at the home; this is to ensure that both parties are confident that their individual needs can be met appropriately. Evidence: Both prospective users of the service and those already receiving a service are provided with printed information about the home and the services that it offers, which can be produced in formats to meet peoples individual needs. Whilst viewing the service users guide, it was noted that the provider details detailed the responsible individual as the registered provider and not that of the registered provider. The registered provider informed us that this would be attended to and amended so that people are provided with correct up to date information about the service. Prior to being offered a place at the home, the home ensures to visit each prospective Care Homes for Older People Page 10 of 26 Evidence: service user to discuss and assess their individual needs in order that all parties can be confident that their needs can be met appropriately at the home. It was noted that where a referring agency had made a referral, there was no paperwork within the relevant files providing the home with the referring agencies assessment of need/care plan. We recommended that whilst the service themselves undertake a thorough assessment of prospective service users needs a care service order and copy of the referring agencies assessment be sought and held on individuals files. This care home does not offer an intermediate care service. Care Homes for Older People Page 11 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. Every user of the service has a care plan in which their care needs are identified and details the actions required to meet them. Personal support is offered in a way that promotes and protects service users privacy, dignity and independence Evidence: During this inspection we inspected two service users care plans in detail and found them to be comprehensive, individualised and informative. There was evidence contained within the service users files to highlight that the manager and staff have worked closely with service users and their family members to gain an insight into the service users life histories and to develop individual service users profiles which include details about their likes and dislikes, their past experiences, interests and hobbies, their preferred timings for waking and retiring all of which provide staff with important details of each individuals preferred ways of life. Each user of the service has a comprehensive care plan detailing their health, social and personal care needs and where appropriate addresses any identified risks. Care Homes for Older People Page 12 of 26 Evidence: Effective risk management plans are in place to reduce any identified risks and reviewed regularly to ensure the health safety and welfare of those using the service; these include nutritional risk assessments, moving and handling, pressure area care and falls. Monthly reviews of the care plans take place and where issues arise, separate documentation is held within the files with daily entries detailing the interventions being undertaken to address the issue. Important information held within the service users folders is cross referenced throughout, to alert staff and to ensure all aspects of their personal, social and health care needs are appropriately met. There is, generally, evidence in each file that the service user and/or their representative has been consulted with and understands and agrees to the contents of their care plan, although it was noted that one service users file did not contain such evidence. Upon speaking with the said service user we were informed that he/she had been consulted with during the care planning and assessment process and we were informed by the service that relevant evidence was sought within 24 hours of this visit, signed by the service user and placed within the service users file. Suitable arrangements are in place for meeting the health care needs of those using the service. Records of contact with health care professionals, including GPs, district nurses, chiropody services, optician and other health care services are maintained and also logged in the daily notes. There are good arrangements in place for the storage and administration of medicines in the home. Where users of the service have the ability to remain in control of their medication, they are enabled to do so within a risk management process. Care Homes for Older People Page 13 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. People living in the home are provided with a pleasant and relaxed environment. Service users are encouraged to maintain contact with friends, family and the local community. Meals are home-cooked, nutritious and nicely presented with an alternative being made available for those who require. Evidence: People using the service are provided with the opportunity to maximise their choice and control over the lifestyles they lead within the home. They are enabled to spend their day as they wish spending their time mixing with others in the communal areas of the home, joining in the daily activities provided in the home either on a one to one basis or in a group setting, or spending some quiet time in their rooms. The home encourages residents to maintain links with family, friends and the local community and support is given to maintain contact where required. Service users are able to receive visitors in private and choose who they do/do not see. Each user of the service has an activities profile in their file which is based upon their past and present interests, lifestyle and their communication and sensory abilities Care Homes for Older People Page 14 of 26 Evidence: which enables the service to provide activities suitable to their needs and preferences. There is a varied programme of daily activities provided for those who wish to partake, which are offered in both group sessions and on a one to one basis to suit the needs of those using the service. The activities provided include art and craft, ball games, music and dance, hand massage, flower arranging, reminiscence sessions, quizzes and foot spa sessions as well as watching the television. The home also provides users of the service with trips to the local shopping centres and coffee shops and have been working with relatives to plan and organise a local boat trip which is envisaged to take place during the summer. The home ensures that service users religious and spiritual needs are met, where required, through the local community, either by service users attending a place of worship or appropriate member of the religion being welcomed into the home. A record of activities that people have taken part in is logged within their files and in the daily reports. There is also a visiting hairdresser and chiropodist who visit the home regularly for those who require. People using the service are encouraged to maintain contact with their families, friends and their local community. Service users are able to receive visitors at the home and there are no restrictions imposed on visiting unless requested by the service user themselves. Service users are able to entertain them in their own bedrooms or in the communal areas of the home and meals can be provided for visitors who visit during mealtimes if required. People who use the service are provided with good quality food, which is freshly cooked on the premises and are offered a choice. Special diets are available to meet peoples health and cultural needs. The service always endeavors to take individual tastes into account and discusses their preferences with them periodically. Care Homes for Older People Page 15 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. People using the service and their relatives are encouraged to express their concerns, have access to an effective complaints procedure and are safeguarded from abuse. Where people have little capacity and/or are unable to get their voices heard, the home accesses an independent advocacy service to ensure that they work in their best interests. Evidence: The home tell us that it has not received any complaints during the period under review. They continue to let us know about things that have happened since the last inspection through their notification procedures. People using the service and/or their relatives tell us that they know how to make a complaint and are confident that any concerns that they may have would be dealt with appropriately. Where people have little capacity and/or are unable to get their voices heard, the home will access an independent advocacy service to ensure that they work in their best interests. The homes complaints procedure is set out in the service users guide and a copy of the procedure is also provided in each service users bedroom. There are policies and procedures in place to guide the manager and staff on how to respond to any suspicion of abuse, these are in line with the Buckinghamshire multi Care Homes for Older People Page 16 of 26 Evidence: agency policies and procedures. Training is provided to all members of staff to assist them in becoming aware of their own care practices, to recognise signs and symptoms of abuse and to emphasise each staff members responsibility to whistle blow on any poor practice or concerns that come to their attention. 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. People using the service are provided with a safe, well maintained, comfortable, homely, environment in which to live which is kept to a high standard of cleanliness and meets their needs appropriately Evidence: The home is registered to provide care for up to 8 service users, has seven bedrooms, one of which is designed for two sharing. Some rooms are provided with en suite facilities and one has a shower and toilet allowing space to manoeuvre a wheelchair and comfortable use of a hoist. There is a communal bathroom and toilet although one person can only use the facility at any time, which is provided with the necessary aids and adaptations to help those with mobility problems. Service users are provided with a communal lounge leading into a small dining area, adjacent to the kitchen with a large conservatory leading off this. The communal lounge is where the majority of service users choose to spend time during the day. It is equipped with a large screen TV to enable those with varying degrees of visual impairment to watch the television in comfort. The doors leading from the communal lounge are designed to provide easy access for wheelchair users. There is also a large, spacious conservatory which is air conditioned during the warmer months to ensure users of the service can use the room all year round. Whilst Care Homes for Older People Page 18 of 26 Evidence: the majority of people choose to take their meals in the communal lounge, the conservatory contains dining table offering people the choice. People using the service have access to a small garden area and are also able to relax on a sun terrace, which is accessed via the conservatory. Service users are always accompanied by a member of staff when using this area to ensure their health safety and welfare. All areas of the home are cleaned to a high standard, and the condition of the decor and furnishings is good. The communal rooms are comfortable and homely, and the service users individual rooms are personalised with their own possessions, and photographs. Whist touring the home, we found a hazardous substance being stored in the kitchen in an unlocked under sink cupboard; upon finding the substance the registered person removed it and immediately placed it in the appropriate locked cupboard used for such substances; a requirement has been made within this report to ensure such substances are stored securely after their use. Generally, all records were being kept appropriately although there had been a slippage in the recording of bath water temperatures, which we were assured would be brought up with staff and dealt with appropriately. Within 24 hours we received correspondence from the service who informed us that a staff meeting had been held the following day to address the poor recording and the storage of hazardous substances and minutes of the meeting were provided to the Commission. Care Homes for Older People Page 19 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 home is staffed in accordance with the needs of the service users and staff receive the appropriate training and support to meet their needs appropriately. Evidence: The staffing levels on the day of inspection were sufficient to meet the needs of those using the service. We inspected a sample of 2 staff members personnel files, both of which generally showed evidence of a thorough recruitment process, with references and required checks being taken up before employment. However, it was noted that the service do not ask for a full employment history on the application form, only that of their last employer. Upon highlighting the requirement that staff personnel files must contain a full employment history, the provider assured us that this would be dealt with appropriately. We received correspondence from the provider within 24 hours of the inspection informing us that all staff personnel files now contain their full employment histories, with any gaps explained and copies of these for the two staff members files we inspected were provided as evidence. Evidence viewed within staff personnel files informs us that members of staff undergo induction training, upon appointment to their posts, and are offered ongoing training, which equips them to meet the assessed needs of the residents within the home. Care Homes for Older People Page 20 of 26 Evidence: Likewise feedback gained from all eight staff members who completed questionnaires sent out prior to the inspection informs us that they were all provided with an induction programme and all tell us that the induction they were provided with covered everything very well. The home has a good programme of training in place for staff. The staff records viewed contained evidence of induction training, all relevant mandatory training and ongoing training that has been undertaken, to ensure that they have the skills and knowledge to undertake their roles competently. A training matrix is in use to enable the service to audit training requirements at a glance and book further training and updates when required. Information provided within those personnel files viewed and information on the training matrix evidenced that all staff mandatory training has recently been updated and places have been booked for staff to attend challenging behaviour and Mental Capacity Act and deprivation of liberty standards training, to further their knowledge and skills. The proportion of care staff who have attained National Vocational Qualification (NVQ) in Care at Level 2 or above is above the 50 recommended by the Commission; of the nine permanent care staff, five have attained the NVQ qualification. Staff are provided with supervision and support on a regular basis, which is documented within their personnel files, this was further confirmed from feedback from carers themselves via questionnaires in which all eight staff who responded told us that their manager gives them enough support and meets with them regularly to discuss how they are working. Care Homes for Older People Page 21 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. This is a well managed home, run in the best interests of those using the service. Safeguards are in place to protect their health, safety and welfare. Evidence: This is a small home run on a personal basis. The home promotes a strong caring ethos and both the proprietor and the manager are present alongside residents and staff for much of the day. This enables them to receive feedback on the quality of the service on a day to day basis and to deal with any problems at an early stage. The registered manager is experienced, knowledgeable, has the required qualifications and competency to manage the home. As part of the inspection process we discussed health and safety issues and saw appropriate maintenance records relating to maintaining a safe environment for service users. Regular safety checks are undertaken relating to fire safety and infectious diseases and regular servicing and maintenance of equipment, all of which Care Homes for Older People Page 22 of 26 Evidence: were seen to be documented appropriately. The home engages regularly with users of the service, family members and other stake holders to gain feedback on the service it provides; this is undertaken on both an informal and formal basis through feedback and suggestion forms, noting any comments or concerns when undertaking residents care reviews, resident meetings and an annual questionnaire. The service users finances are safeguarded in that the staff do not deal with peoples financial affairs, this is dealt with by the family or Social Services Money Management. The home deals with a number of diverse care needs and always ensures to offer a personalised service to meet the individual needs and preferences of their service users. There is a commitment to ensure that all users of the service, however diverse their needs may be, receive a person-centred package of care which meets their needs appropriately and in a safe manner Care Homes for Older People Page 23 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 24 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 38 13 Hazardous substances must be stored securely at all times to ensure the health, safety and welfare of those using the service. Regulation 13 (4)(a) of the Care Home Regulations 2001 requires that the registered person shall ensure that; (a) all parts of the home to which service users have access are as far as is reasonably practicable free from hazards to their safety. 30/04/2010 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 Care Homes for Older People Page 25 of 26 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 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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