Latest Inspection
This is the latest available inspection report for this service, carried out on 11th June 2010. CQC found this care home to be providing an Good service.
The inspector made no statutory requirements on the home as a result of this inspection
and there were no outstanding actions from the previous inspection report.
For extracts, read the latest CQC inspection for St Helena's Residential Care Home.
What the care home does well The home provides service users with a high standard of care and support from a well trained and competent staff team. The environment is bright, welcoming and homely and all areas are clean and fresh. What has improved since the last inspection? All aspects of care provision have improved since the last key inspection of the service. A new manager has been appointed and has improved the quality of the records within the home. Care plans are detailed and informative and all documentation is regularly audited and reviewed. A programme of redecoration, refurbishment and improvements to the premises have ensure that service users are provided with a brighter and safer home in which to live. Quality audits of the premises have identified areas for improvement and the records held show that these have been implemented. Staff training has increased and all staff now well trained and have their competencies assessed to ensure that they work effectively. What the care home could do better: The planned programme of redecoration, refurbishment and improvements should continue to further enhance the home. Key inspection report
Care homes for older people
Name: Address: St Helenas Residential Care Home 6 Roby Road Huyton Liverpool Merseyside L36 4HE 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: Jeanette Fielding
Date: 1 1 0 6 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 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) © 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 25 Information about the care home
Name of care home: Address: St Helenas Residential Care Home 6 Roby Road Huyton Liverpool Merseyside L36 4HE Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) St. Helenas Residential Homes Ltd Type of registration: Number of places registered: care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service uses who can be accommodated is: 33 The registered person may provide the following category of service only. Care home only - Code PC. To service users of the following gender: Either Whose primary care needs on admission to the care home are withing the following categories: Old age not falling within any other category- Code OP Physical Disability - Code PD Date of last inspection Brief description of the care home St Helenas is a residential care home which is registered to provide personal care and support for up to 33 older people and older people who have a physical disability. It is situated in Huyton and is close to all amenities and transport routes including the M62 Care Homes for Older People
Page 4 of 25 Over 65 33 33 0 0 Brief description of the care home motorway. The home is laid out on two floors and all areas can be accessed by the passenger lift or the stair lift. The ground floor comprises a lounge, dining room and conservatory as well as some bedrooms. The laundry, kitchen and office are also located on the ground floor. The first floor provides bedrooms and a small lounge. Bathing and toilet facilities are located throughout the home. Fees range between 375.34 and 456.75 pounds per week. Care Homes for Older People Page 5 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 is the first key inspection since the home was re-registered under the new Directorship. The home has been registered for many years and no changes have been made to the staff team as a result of the changes in registration. This unannounced key inspection was undertaken in one day over a period of eight hours. As part of the inspection process, all areas of the home were viewed including some of the service users bedrooms. Assessments and care plans were inspected together with staff records and certification to ensure that health and safety legislation was complied with. Observation of the interaction between staff and people who live at the home provided further evidence of the actual care given. The care files of four residents were case tracked to evaluate their care. Discussions took place with the Responsible Individual, Manager, staff and service users. The Manager completed an annual Quality Assurance Assessment form to give additional information regarding the home. Surveys were sent to service users and staff and the comments in these are Care Homes for Older People
Page 6 of 25 incorporated in this report. Care Homes for Older People Page 7 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 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. Prospective service users are provided with full information about the services and facilities provided by the home to enable them to make an informed decision regarding their care provider. Evidence: The Statement of Purpose and Service User Guide have been reviewed and updated to a high standard. These documents provide current and prospective service users, their relatives and other stakeholders with full information regarding the facilities and services provided by the home. These documents are provided to all enquirers and are readily available from the home on request. Copies are displayed in the foyer of the home together with a copy of the most recent inspection report. All prospective service users are fully assessed prior to their admission to the home to ensure that all needs are identified to enable the home to confirm that those needs can be met. The assessments are undertaken by the manager or by one of the senior
Care Homes for Older People Page 10 of 25 Evidence: staff who has been given training in service user assessments. The assessment of the most recently admitted service user was seen and was found to be comprehensive and informative. Details are recorded regarding health and social needs together with preferences in respect of daily routines. Dietary needs are identified together with details of any necessary aids or equipment that would be necessary to assist and protect the service user. The service users health history is also identified at the assessment. 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 system for the administration of medications is good with clear and comprehensive arrangements in place to ensure that service users medication needs are met. Evidence: All care files have been reviewed and rewritten since the appointment of a new manager. A selection of care files were viewed to evaluate the level of care and support required by service users and to see evidence that the service users needs were being met. The home uses a Standex system of recording information and individual files are held for each service user. The files viewed showed that all needs had been clearly recorded and care plans put in place to inform staff of the care required, together with information on how the service user wishes to have this care. Independence is promoted and the care files identify how this is to be addressed. Information is recorded in the care plans regarding personal care, mobility, hearing and sight, dietary needs, sleeping, anxiety, social needs and includes information recorded by staff on a daily basis. Each service user is allocated a key worker and reports by the key workers are also included. Risks are clearly identified and risk
Care Homes for Older People Page 12 of 25 Evidence: management plans are put in place to remove or reduce any potential risks on an individual basis, dependent on the service users abilities. Service users spoken to confirmed that they were aware of the information recorded about them and sign to indicate that they have read them or have had the files read to them. The care plans clearly show that the service users personal preferences are taken into consideration. Aids and equipment required by the service users are identified and all staff have been trained in the use of these. All care plans are reviewed and updated on a monthly basis and whenever the needs of the service users change to ensure that staff have full and up to date information. The care files are audited by the manager who completes a record of the audit. These showed that quality of the reporting in the care files has improved over the last few months. Medications are administered to service users by the senior staff who have undertaken considerable training and their competency to administer medications has been assessed. All medications were seen to be stored securely and all storage areas were clean and organised. The medication administration record sheets were clear, accurate and up to date. The home has a comprehensive policy and procedure for the administration of medications and these were observed to have been followed. Service users who wish to administer their own medications may do so following an assessment of their ability. Copies of the risk assessments are held on the service users files together with information for staff on how to support the service users to do this. A separate medication care file is held which provides additional information regarding service users medication needs. Regular audits of medications by the manager shows that the number of discrepancies in the recording of medications administered to service users has dropped dramatically, with no concerns highlighted at the last audit. Separate records are held in service users bedrooms regarding the creams and lotions that care staff are required to apply. Detailed information regarding the frequency of application and the areas to where the creams and lotions are to be applied is held. Care staff sign to indicate when the creams and lotions have been applied. Staff were observed to administer medications to service users in a safe, professional and dignified manner. 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. A comprehensive and indivualised programme of activities are arranged to provide service users with entertainment and social stimulation. Evidence: The home employs an activities co-ordinator for 25 hours each week. These hours are over 5 or 6 days and at times to suit the activities that service users have chosen. A planned programme of activities is displayed and each service user is involved in the preparation of their individual plans. A detailed record of daily activities that have taken place is held and included photographs of games in the lounge, special events and trips out. Activities include singing, bingo, baking and gardening. A barbecue was arranged for the day following the visit to celebrate three service users birthdays and an entertainer had been booked for the event. Service users meetings are held on a regular basis and provides a forum for them to make comment or suggestions. A newsletter is produced every two weeks, or more frequently as needed, to keep service users, and visitors to the home, informed about ongoing changes, birthdays and planned activities. A copy of this is provided to each service user and is also displayed on the notice board. Photographs of recent activities are also displayed in the home. A daily newspaper is provided by the home and some service users purchase their own newspaper on a daily basis. A minister visits the home each week
Care Homes for Older People Page 14 of 25 Evidence: to provide services for groups or individuals as they wish. The minister also visits on a monthly basis and plays his guitar for service users. Service users spoken to said that they enjoyed the activities, particularly the entertainer that came into the home. Meals are served in the dining room, the lounge or the service users own bedroom as they wish. Breakfast is taken whenever the service user requests between 7.45 am and 11 am. A cooked breakfast is available and a selection of cereals are available. The main meal is served in the evening and a choice of meals is offered for both lunch and dinner. The menus show that a varied and balanced diet is offered. The dining room is bright and pleasant and tables are attractively laid. The manager said that she is looking to provide a board in the dining room where the meals of the day can be displayed. Service users choose their meals from a selection, but can sometimes forget what they ordered and so the board will act as a reminder of the meals offered. In the mornings, the home employs a hostess who works with service users in the dining room. The hostess serves breakfast and drinks but does not prepare the meal or attend to personal care. This enables the care staff to attend to personal care at this busy time. Meals are served individually by the chef who is aware of individual preferences and dietary needs. The meal served at the time of the visit looked and smelled appetising. Service users spoken to said that the meals in the home were really good and confirmed that they could choose an alternative meal if they did not want any of the meals on the menu. The kitchen was clean and organised and a good supply of fresh fruit and vegetables were available. 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. Good safeguarding procedures help to ensure that service users remain safe in St Helenas. Evidence: The home has a robust complaints procedure which is detailed in the Statement of Purpose and Service User Guide and is also displayed in the home. Service users spoken to said that they would feel comfortable in speaking to the manager if they had any concerns. A low number of complaints have been received by the home in the last twelve months and the records held in the home are comprehensive. All complaints are acknowledged in writing and the records show that a full investigation is undertaken. Information is recorded about the action taken and complainants are responded to with the outcome of the investigation. Records are well maintained. All staff have been trained in the Protection of Vulnerable Adults and this is reinforced at supervision and at staff meetings. Staff spoken to were able to demonstrate that they were aware of the different types of abuse and of the action they should take in the event of abuse being suspected. The home has a whistleblowing policy and all staff are fully aware that they can speak with the Manager or Director if they have any concerns. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Investment in the home has resulted in a bright, pleasant and homely environment for service users to live. Evidence: St Helenas is laid out on two floors. The ground floor comprises a lounge, conservatory, dining room and bedrooms. Bedrooms and an additional seating area are provided on the first floor. A passenger lift and a stair lift both provide access to the first floor. Some bedrooms on the first floor require a small number of steps to be negotiated and so only service users who are fully mobile are accommodated in this area. The home consists of an original building which has been extended to provide additional facilities. The conservatory is bright and provides additional seating areas and also provides access to the garden. Lounges are homely and bright and service users can choose where they spend their day. A programme of redecoration and refurbishment is currently taking place, and whilst all bedrooms are bright and welcoming, the rooms which have now been completed are decorated and furnished to a very high standard. New bedroom furniture is being provided when rooms are redecorated and of a high quality. Service users are encouraged to personalise their bedrooms and those seen clearly reflected the lifestyle of the occupants. Some service users have chosen to provide small items of furniture and all bedrooms contained pictures, photographs and items of memorabilia. Care Homes for Older People Page 17 of 25 Evidence: Service users may have satellite television and telephones installed in their own bedroom but remain responsible for all costs associated with these. Plans are in place to replace the nurse call system as the current system. The Managing Director said that the new system should be in place within the next 3 to 4 months as the new system had been identified and discussion had taken place with the system provider. Since the last key inspection of this service, a new roof has been fitted and the windows replaced. Plans are also in place to adapt a room which is not currently available for service users, for an activities and hairdressing facility. No timescale for the changes to this room have yet been set. The home also provides a kitchenette where visitors to the home can make refreshments. Staff will provide visitors with drinks but some relatives like to make their own and provides a more homely facility. A tuck shop trolley is provided where service users and staff can purchase sweets and drinks. All areas of the home are clean, bright and fresh and provide service user with a pleasant and homely place in which to live. Improvements have recently taken place within the garden to provide raised beds. Service users have established a gardening club and have chosen the items that they wish to grow. Arrangements have been made for a gardener to visit the home to speak with the service users and to offer advice and information regarding the plants and vegetables which would be of benefit. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by a well trained, effective staff team who have gone through a thorough recruitment process to ensure that their needs are met and they are safe at all times. Evidence: The home employs a full staff team and the turnover of staff is low thereby providing service users with a consistent level of care and support. The staffing rota shows that the ratio of staff on duty at any one time is based on the individual needs of service users to provide a more personalised approach to care. Day staff commence work at 7 am and work in conjunction with the night staff until 8 am. For the remainder of the day, 3 or 4 staff are on duty, with 2 staff at night. The manager is available during the day and her hours are supernumerary to the care staff. Care staff spoken to confirmed that if they made a request for additional staff hours, due to the needs of an individual service user, this would be provided. Staff also confirmed that there were sufficient staff on duty at all times to enable them to provide for the needs of the service users and that they did not feel overworked or pressured. A key worker system is in place and each service user is aware of their own key worker. Specific responsibilities are given to the key workers and each completes their own weekly report on the service users that they are responsible for. This system has
Care Homes for Older People Page 19 of 25 Evidence: proven to be successful although staff said that they are more than happy to do tasks for each others service users and that they work extremely well together as a team. Staff all said that they enjoyed their work and looked forward to coming into work each day. Considerable training has been given to staff in the last twelve months. A training matrix is displayed in the office together with information about forthcoming training events. Evidence of staff training is held on the staff files. The home has a robust recruitment procedure. All prospective staff are required to complete an application form prior to being called for interview. Two references and taken and checks are made through the criminal records and protection of vulnerable adults bureaux. Qualifications are verified and certificates are required to be provided. All new staff are required to follow a comprehensive induction training programme and competencies are assessed. NVQ training is promoted within the home and a high number of staff have achieved this. The files for four members of staff were seen and all were found to be well maintained, up to date and to contain all information as required. One service user said Everything here is perfect, including the staff. Care Homes for Older People Page 20 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. St Helenas is well managed and is run in the best interests of the people who live there. Evidence: Since the last key inspection, a new manager has been appointed. Mrs Colette Corfield is qualified, competent and extremely experienced in the management of care services for older people. Since her appointment, many changes have been made, particularly in the documentation held in the home. She has redesigned and rewritten care plans to ensure that the specific and individual needs of service users are recorded to ensure that staff are fully aware of the care and support to be given. All other documentation was found to be of a high standard and accessible to staff as appropriate. Staff spoke extremely highly of the manager and said that she was firm but fair and was extremely supportive. An application to register the manager with CQC has been submitted. All staff receive regular supervision and annual appraisals. Staff meetings are held on
Care Homes for Older People Page 21 of 25 Evidence: a regular basis and staff spoken to said that they felt comfortable in raising issues at the meetings in the knowledge that their comments would be given due consideration. Polices and procedures have been reviewed and updated and copies of these are readily accessible to the staff. Quality assurance questionnaires have been issued to all service users and their relatives and the outcomes of the survey have now been included in the Statement of Purpose and Service User Guide. The results show that those who responded to the survey were happy with the care. One area which resulted from the surveys, where some service users commented that they had not signed their care plans, has been addressed. The Managing Director is involved in the day to day running of the home but leaves all matters relating to the care of the service users to the Manager. It was evident that the Manager and Managing Director work well as a team for the benefit of the service users. Health and safety issues are addressed as soon as they are identified and the responsibility for reporting repairs is with all staff. Regular fire drills are held and checks are made on the fire detection equipment as required and are duly recorded. Safety certificates for the premises and the equipment are held and all were found to be in place and up to date. Care Homes for Older People Page 22 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 23 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 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. © 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. 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!