Care Home: Nunthorpe Hall

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What the care home does well In a recent evaluation carried out by Middlesbrough Council in September 2009, involving extensive use of surveys of people who use the service, their representatives and staff, an overall satisfaction rate of 89.7% was achieved, with 93% for the building. These are high scores, indicating considerable satisfaction with the standard of service provided. Typical comments included: "Martin the manager is a gentleman." "Nothing ever seems to be too much trouble. I can find no fault in the quality and attitude of the staff, they are extremely caring and professional." "The manager is good and very approachable." These findings were reflected in the comments received from people who use the service and staff during the inspection, including: "I`m quite happy here." "The staff are very good and helpful." "The staff treat me well." "I am a diabetic and the District Nurse visits me here twice a day to help me with my insulin injections." People said that they enjoyed living at Nunthorpe Hall and got on very well with the staff and management. They felt their individuality was understood and respected. They felt well cared for and supported by people who had their welfare at heart. They described a family type of living, but where their rights to self-determination, independence and personal choice were respected. People were very satisfied with the quality of the meals. They had a high regard for the exceptional quality and spaciousness of the building and its grounds. The majority of staff have achieved National Vocational Qualifications in Care and all of the staff who administer medicines have completed accredited training in the Safe Handling of Medicines or its equivalent. The majority of staff have completed all mandatory training following their inductions, although are due for refresher training commencing in December 2009. What has improved since the last inspection? The service has maintained its strong commitment to achieving positive outcomes for the people who live at Nunthorpe Hall, either long or short term, and their representatives. It has been supported in this aim by its Administrators (Baker Tilly) during a period of financial uncertainty. It is anticipated that the service will come out of administration in the near future, due to the progress it has made with its finances. What the care home could do better: The temperature of the room in which the medicines are stored should be monitored to ensure that it does not exceed 25 degrees centigrade. An alternative storage facility should be considered if the temperature cannot be maintained below 25 degrees centigade. The views of people who use the service should be reflected in further development of social and recreational activities where possible, so that all interests are addressed. The home should update its complaints procedure with the name, address and telephone number of the Care Quality Commission. Staff refresher training in mandatory subjects should recommence promptly to ensure staff skills and knowledge remain current and any new staff have ready access to foundation training. The home must have a registered manager. Key inspection report Care homes for older people Name: Address: Nunthorpe Hall Nunthorpe Hall Nunthorpe Village Middlesbrough TS7 0NP     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: Stephen Ellis     Date: 2 9 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Nunthorpe Hall Nunthorpe Hall Nunthorpe Village Middlesbrough TS7 0NP 01642316611 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Nessfield Homes Limited care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Nunthorpe Hall is a former manor house, which dates from the seventeenth century. It provides personal care for up to 21 older people. All bedrooms have ensuite toilet facilities. The home is set in extensive grounds that include lawns, flower beds, mature woodland gardens and a secluded pond. The home has been refurbished to provide spacious communal areas including lounges, a games room and a library. Decoration and fittings were found to be of a high standard and have been selected to complement the style of the building. At the time of inspection, the fees charged by the home were £480 per week. 0 Over 65 21 Care Homes for Older People Page 4 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was carried out on 29th October 2009 and took place over 5 hours. It included discussions with the manager and 3 members of staff, plus discussions with 5 people who use the service and the spokesperson for the administrator, Baker Tilly. Three plans of care were examined along with 3 staff files, plus samples of other documents required to be kept. There was a tour of the building during which most rooms and facilities were observed. The medicine storage and administration arrangements were examined, including the sampling of a number of records of medicines administered, plus discussions with the manager and staff. A meal was taken with people who use the service. Reference was also made to a public report by Middlesbrough Council concerning its evaluation of social care quality at Nunthorpe Hall in September 2009. The last key inspection of this service was carried out on 1st November 2007, with an annual service review in November 2008. The provider, Nessfield Homes Ltd, has been in administration for nearly 2 years, but anticipates coming out of administration early in 2010. Care Homes for Older People Page 5 of 25 Care Homes for Older People Page 6 of 25 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 Care Homes for Older People Page 7 of 25 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 25 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 25 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. People who use the service are able to make an informed choice about the suitability of Nunthorpe Hall, based on the information provided by the home and an assessment of their personal needs and requirements. Evidence: People who use the service said that they believed their needs and wishes were well known and understood by staff at the home. They felt that their individuality was respected. They said that the home was able to meet their needs, based on a personal and individual assessment. Care plans showed that full assessments of need underpinned the individual plans of care. Staff and manager confirmed that no one was admitted to Nunthorpe Hall without a careful assessment of needs having been completed, to ensure that the service was suitable to the individual needs and requirements of the person to be admitted. This view was reinforced by the evidence of surveys completed for Middlesbrough Council in September 2009 by people who use the service, their representatives and staff, when an overall satisfaction score of Care Homes for Older People Page 10 of 25 Evidence: 89.7 was recorded. Intermediate care is not provided. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: People who use the service and their representatives were positive and complimentary in their comments in a survey carried out by Middlesbrough Council in September 2009. An 89.7 satisfaction rate was scored overall for the service experienced at Nunthorpe Hall. On the day of the inspection, typical comments received included: Im quite happy here. The staff are very good and helpful. The staff treat me well. I am a diabetic and the District Nurse visits me here twice a day to help me with my insulin injections. Plans of care were sufficiently detailed to give clear guidance to staff about how best to support people who use the service with regard to their health and personal care needs. Staff members confirmed that they had good knowledge of peoples health and personal care needs. People are able to choose their GP within geographical constraints and an independent chiropody service visits regularly for those people who wish to use that service. Both staff members and people who use the service said that they got on very well, with respect for peoples Care Homes for Older People Page 12 of 25 Evidence: privacy and dignity being evident. People said that their individuality was respected and affirmed by all members of the staff team. The arrangements for medication were found to be good, although the temperature of the room in which the medicines are stored appeared to be high and will need to be monitored. The manager and all staff who administer medicines have completed accredited safe handling of medicines training. Further accredited training is planned with the University of Teesside in the near future. Records of administration of medicines were found to be well maintained. The manager reported a good working relationship with the supplying pharmacy. Care Homes for Older People Page 13 of 25 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 who use the service are able to make choices about their lifestyle, and are supported to develop their life skills. Social, educational, cultural and recreational activities meet individuals expectations. Evidence: People who use the service engage in a variety of activities and events organised or facilitated by Nunthorpe Hall. They said they were able to exercise choice in their daily lives. For example, one person liked to use his computer in his bedroom and another person liked to garden. Cards and dominoes were organised several times per week, with the lead being taken by one service user who had a strong interest in both activities. A visiting library called every few weeks and large print books were available. A hairdresser visits regularly and there is a hairdressing room available. Visitors were always made welcome and the staff and manager described their relationships with the people who used the service and their relatives as being like that found in a family. Birthdays were always celebrated with a special cake and birthday tea. Seasonal events such as Halloween were observed, with staff taking the lead. The home receives visiting clergy and peoples religious needs are addressed. Although the majority of people who use the service were satified with the arrangements for social and recreational activities, there were a minority who had said Care Homes for Older People Page 14 of 25 Evidence: in a recent survey that they would like more. The home should see if it could develop its programme further. It was noted that the manager and staff try to facilitate transport for people who would like to get out more, often with assistance from relatives. The menus were well appreciated. People said there was a good choice and the quality of the meals was good. There was much evidence of peoples preferences being met and high levels of satisfaction with the catering. The meal taken by the inspector with residents was very enjoyable, being appetising and nutritious. Peoples special dietary needs and preferences were acknowledged. A four week menu is followed and the kitchen has received a 4 star award for food hygiene from the local environmental health authority. Care Homes for Older People Page 15 of 25 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 who use the service are able to express their concerns and have access to a robust, effective complaints procedure. They are protected from abuse. Evidence: People who use the service said that they were confident about approaching staff with any concern or complaint. They knew they would be listened to and taken seriously. They knew that the manager would do his best to resolve any complaint or concern. They had access to a complaints procedure plus telephone contact details for Middlesbrough Council, displayed prominently on a notice board. Staff said that they had undergone enhanced Criminal Record Bureau (CRB) checks (or equivalent) when they were being recruited. Many staff have been at Nunthorpe Hall for a long period of time. One new member of staff confirmed that she had had an enhanced CRB check prior to starting, plus 2 references were taken up. She had undergone a comprehensive induction. Staff members were aware of safeguarding issues and procedures. They would not hesitate to share concerns with the manager or Middlesbrough Council if they suspected someone was at risk of abuse or neglect. However, the homes complaints procedure needs to be updated with the name, address and telephone number of the Care Quality Commission. Care Homes for Older People Page 16 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: The premises are quite unique and impressive, being an exceptionally spacious building dating from the 1700s, standing in its own, well maintained and attractive grounds. The accommodation was found to be warm, clean and welcoming, with good access around the building internally. Communal rooms were exceedingly spacious, well furnished and attractively decorated, creating a welcoming but practical environment, in keeping with the needs of people who use the service and with the period and character of Nunthorpe Hall. Bedrooms were all spacious, with en suite facilities, comprising 15 singles and 3 doubles. At the time of the inspection, no one was sharing a bedroom. These rooms were personalised by their occupants and appeared to be well equipped, with excellent views from many bedrooms across the extensive grounds and surrounding countryside. People who use the service expressed pleasure and pride in their environment, saying the premises were clean, well maintained and comfortable. The administrator for Nunthorpe Hall said that equipment and facilities within the home were subject to regular servicing and maintenance, in line with maintenance schedules, as confirmed in a sample of maintence records that were examined. The kitchen has been awarded 4 stars out of a maximum possible of 5 Care Homes for Older People Page 17 of 25 Evidence: for food hygiene, by the local environmental health authority. The Laundry area was well equipped and fully functional. Paper towels and liquid soap were present in communal bath rooms and toilet areas, to help minimize the risk of cross infection. In September 2009, Middlesbrough Council awarded Nunthorpe Hall a Quality Rating of 93 for its premises, in terms of the satisfaction expressed by service users, their representatives and staff about the building. This is an exceptionally high rating, indicative of excellent quality. Care Homes for Older People Page 18 of 25 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. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. Evidence: There are good staffing levels throughout the day and night, with typically 2 members of care staff on duty from 8 am, plus a domestic, plus Cook, plus manager. From 3 pm there are 2 members of care staff on duty until 9 pm. From 9 pm to 8 am there are 2 awake members of care staff on duty. This is for 14 people currently using the service. There are 12 permanent care staff and 5 ancillary staff. Over 70 of care staff have achieved National Vocational Qualifications (NVQ) in Care at level 2 or above. Further NVQ training and assessment opportunities are being arranged for the near future, so that all staff can obtain relevant qualifications for their work, including NVQ levels 3 and 4 where appropriate. The majority of staff have been long-serving at Nunthorpe Hall and have completed all mandatory training in essential skills and knowledge. They do need to refresh those competencies and the manager has arranged for a rolling staff training programme to recommence from December 2009. Staff members said they were keen for this to happen, as training has been very limited over the past 2 years. Two new staff have been recently appointed, and comments received confirmed that good recruitment procedures had been followed, as evidenced in 3 staff files that were examined. Care Homes for Older People Page 19 of 25 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 management and administration of the home is based on openness and respect, with effective quality assurance systems devised and implemented by a competent but unregistered manager. Evidence: The manager, Martin Hodgkinson, is not currently registered as manager of Nunthorpe Hall, although he has been in the past and is also a Director of Nessfield Homes Ltd, which is the registered provider of the service, currently in administration. The administrator is Baker Tilly and their spokesperson told the inspector that they are pleased with how the home has been operated and managed over the past year, with regular checks supplied by them. Indeed, the administrator anticipates that there is a good chance that the home will come out of administration in the early part of 2010. People who use the service, their representatives and staff expressed confidence in the management of the home, in recent surveys carried out by Middlesbrough Council (September 2009). They described the manager as being approachable and helpful. Typical comments included: Martin the manager is a gentleman. Nothing ever Care Homes for Older People Page 20 of 25 Evidence: seems to be too much trouble. I can find no fault in the quality and attitude of the staff, they are extremely caring and professional. The manager is good and very approachable. A family atmosphere was evident and service users and staff said that there was good communication between people living and working at Nunthorpe Hall and with the relatives of people who use the service. The manager and staff invite feedback on the quality of service provided and would try to improve quality and choice where possible. The manager is present in the home most days and is actively involved in providing leadership and guidance, in partnership with an experienced staff team. For example, he takes a lead on medicine management and assessment of needs of people who are thinking of admission, either for temporary or long-term care. The home has been run as a family business for at least 16 years, and members of the managers family have been involved in delivering services to people who are resdent at Nunthorpe Hall during that time. This has helped to create a distinctive character to the quality of the home and its quality assurance systems, that depend to a large extent on good inter-personal communication and efforts to achieve high levels of satisfaction for service users and their families. The results of Middlesbrough Councils recent evaluation of the quality of the service (September 2009), as reflected in surveys carried out with people who use the service, their representatives and staff, were very positive, with an overall quality rating of 89.7 and 4 stars out of a maximum of 5 for its social care quality. Most people who use the service look after their own personal monies, often with assistance from their families. However, the home does help some people to keep their personal monies safe, usually small amounts for hairdressing, chiropody and other small items of personal expenditure, such as toiletries. All such monies is accounted for and regularly audited. Each item of income and expenditure on these accounts is recorded, with 2 signatures and receipts wherever practicable. Management and staff make sure that the home is safe by carrying out regular servicing and maintenance of equipment and reviews of working practices. For example, fire training and fire drills are routinely carried out. Health and safety issues are regularly discussed within the staff group, including staff meetings which are recorded. The administrator has been monitoring the homes performance in this area, as part of its ongoing supervision whilst the home is in administration, and has been satisfied with the standard achieved. Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 25 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 31 8 The home must have a registered manager. It is a legal requirement for the person managing the home on a day by day basis to be registered as manager. 19/05/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 The temperature of the room in which the medicines are stored should be monitored to ensure that it does not exceed 25 degrees centigrade. An alternative storage facility should be considered if the temperature cannot be maintained below 25 degrees centigade. The views of people who use the service should be reflected in further development of social and recreational activities where possible, so that all interests are addressed. The home should update its complaints procedure with the name, address and telephone number of the Care Quality Commission. Staff refresher training in mandatory subjects should recommence promptly to ensure staff skills and knowledge remain current and any new staff have ready access to Page 23 of 25 2 12 3 16 4 30 Care Homes for Older People 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 foundation training. Care Homes for Older People Page 24 of 25 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 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!