Care Home: The Chimneys

Similar services:

• Byars Care Home
• St Marys Nursing Home
• Bramble Lodge
• Parkmanor Residential Home
• Thornham Grove
• Hunter`s Lodge
• London Road Neurological and Specialist Care Unit
• Carlton Care Home

What the care home does well People live in a comfortable home which offers a welcoming and homely atmosphere. People told us that they would not change anything at the home as the manager and staff went out of their way to make everything suit their needs. Their comments indicated that they were supported in an inclusive manner, which respected their rights and choices, while offering them independence. Staff demonstrated a very good knowledge of the people they supported which helped them to provide a personalised service. They also have access to a varied training programme facilitated by a supportive management team. What has improved since the last inspection? No requirements were made following the last key inspection. However the content of the AQAA and observations on the day showed that improvements to the environment had been made including 2 new en-suite facilities. What the care home could do better: Care records need to be kept up to date so that they reflect the care and support people need, as well as how issues identified during the assessment process have been addressed, monitored and where applicable resolved. Other areas highlighted below would benefit from some attention. Additional information should be added to the Statement of Purpose and Service Users Guide so that people have access to detailed information about what it is like to live at the home. This should include information about staff qualifications and training, as well as daily staffing arrangements. The information collated about peoples social hobbies and social needs should be developed into individualised care plans that tell staff how they need to support people so that they can continue to follow their interests. People should sign their care plans as this will help to demonstrate that they have been involved in the planning of their care and agree with it. Staff should complete a daily record about how people have spent their day, as well as their general well being and any changes in their condition. This will provide a historical record of any issues that arise, how they were addressed and the outcomes. Staff should receive regular supervision sessions and an annual appraisal. This will help to ensure they are provided with adequate support and guidance. Key inspection report Care homes for older people Name: Address: The Chimneys 1 Station Road Alford Lincolnshire LN13 9HY     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: Dawn Podmore     Date: 1 6 1 2 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 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 27 Information about the care home Name of care home: Address: The Chimneys 1 Station Road Alford Lincolnshire LN13 9HY 01507462789 01507462789 hugh-jacklin@supanet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Victoria Taylor,Mr Philip Taylor,Mrs Annette Jacklin,Mr Hugh Jacklin care home 11 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The Home is registered to provide personal care for service users of both sexes whose primary needs fall within the following categories:- Old age, not falling within any other category (OP) (11) Date of last inspection Brief description of the care home The Chimneys Care Home is situated close to the centre of the market town of Alford. People have easy access to the towns amenities which are within walking distance of the home. The property is on a recognised public transport route. The building is a detached two-storey property that is sited in a predominantly residential part of the town. There is a paved area at the front of the building and a garden to the rear, with car parking spaces for two cars. Roadside parking is also available. 0 Over 65 11 Care Homes for Older People Page 4 of 27 Brief description of the care home Accommodation is provided on two floors with access to the first floor by a stair lift. There is a lounge and a lounge-cum-dining room on the ground floor. The home is registered to accommodate 11 older people in 9 single and 1 double room. It is a family owned business, which aims to provide a high standard of personal care for people over 65. At the time of the inspection the manager confirmed that the weekly fees ranged from £360 to £440, depending on peoples assessed needs. Additional charges are made for things like hairdressing and chiropody. Information about these costs as well as the day-to-day operation of the home, including a copy of the last inspection report is available at the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was unannounced and took any previous information held by C.Q.C about the home into account. Throughout this report the terms we and us refers to the care Quality Commission (CQC). Before the the visit the provider had returned an Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans for improvement over the next twelve months. We also sent out surveys to residents and staff, 10 of which were returned in time to be included in this report. We have carried out an Annual Service Reviews each year since the last key inspection took place on 7/12/06 to assess how the home was operating. The main method of inspection used was called case tracking. This involved selecting a proportion of residents and tracking the care they received through the checking of records, discussions with them and the staff who care for them, and observation of Care Homes for Older People Page 6 of 27 care practices. A partial tour of the home was also conducted, which included looking at some bedrooms, communal areas and bathing and toilet facilities. Documentation was sampled and the care records of the three people being tracked were examined. We spoke with four residents and 2 visitors and 3 members of staff. They shared their views about how the home operated on a day to day basis and the care and facilities provided. The owner/manager, Victoria Taylor, was present throughout the visit. The outcomes of the visit were discussed with her during and at the end of the inspection. On the day of the visit 9 people were living at the home. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 27 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 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A comprehensive admissions procedure helps to make sure that the home can meet the needs of the people who come to live there. Evidence: The home provides people with various information to help them decide if it is the right place for them to live, this includes a Statement of Purpose and a Service Users Guide. Although both documents contained basic information about how the home intends to operate they lacked some details, this included staff qualifications and training arrangements. A review of all information available prior to the visit to the home and the content of peoples care records, showed that the home does not admit residents without a comprehensive assessment of their needs being completed. The AQAA also says that people are encouraged to visit the home before making any Care Homes for Older People Page 11 of 27 Evidence: decisions and trial stays can be arranged. People confirmed that an assessment of their needs had taken place and that they had received sufficient information about the home to help them decide if it could meet their needs. The manager said that although people come to the home for short stay placements the home does not provide intermediate care. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are empowered to make choices about their lives and supported to lead their lives as they prefer. A knowledgeable staff team provide person centred care and support, but some care records are inadequate. Evidence: The care records we looked at contained good information about what care and support people needed and their individual preferences and abilities. This included individual profiles about their past history, both social and medical, and their hobbies and interests. Some details in the assessment records had not been fully incorporated into the planned care. For example one plan told staff that they needed to support one person to check their blood sugar levels, but it did not say how often this happened or the signs and symptoms they should look for should the levels be high or low. However the staff we spoke to knew exactly when this procedure should take place and demonstrated a very good knowledge of the people they supported. Assessments for potential risk areas, such as manual handling and falls had been carried out. This information had then been used to formulate care plans to guide staff Care Homes for Older People Page 13 of 27 Evidence: as to how to minimise these risks. A record of what care had been provided was being maintained but this was not completed daily and entries did not outline how people had spent their day or any events that day. In the majority of cases the entries contained only the care plan number, although some more detailed entries were seen. The manager said that the numbers indicated which parts of the planned care had been carried out. Not everyone had signed their care plans to acknowledge that they agreed with the planned care. However the people we spoke to confirmed that they had been asked about their care requirements and that staff delivered care and support to suit their needs. Care plans also indicated that the manager had considered peoples mental capacity and included this in the care planning process. This is new legislation that is aimed at protecting peoples rights and choices. Staff training in this subject had also been facilitated. Records and peoples comments indicated that residents had access to outside health professionals such as doctors and district nurses. Peoples health was being monitored, however records did not always reflect this in sufficient detail. We observed staff speaking to people with respect and in discussion with staff they had a good understanding of how to maintain residents privacy and dignity. One staff member told us, we aim to give the best care we can. The people we spoke with, as well as the people who returned surveys to us, said that they were happy with the level of care and support provided. One person said that the care and attention provided was very good. Another person told us, the staff answer my bell promptly and anything you want they get for you, plus they have time to sit and chat. The home has satisfactory policies and procedures concerning the receipt, storage, administration and disposal of medications. At the last pharmacy inspection the report highlighted several areas that could be improved. These included recording medications coming into and out of the home more comprehensively and staff signing over the drug keys at the end of each shift. The manager confirmed that she had already addressed some of these issues and others were currently being actioned. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to a variety of social stimulation that meets their needs and they are enabled to maintain and develop links in the local community. People receive a nutritious and varied diet that is based on individual preferences and health requirements. Evidence: The home does not employ an activities coordinator, but stimulation is facilitated by the manager and care staff. Forthcoming activities were displayed on the notice board and people told us that these met their needs. Various activities take place on a regular basis. These included bi-monthly physical motivation sessions, quizzes, slide shows, sing a longs, word games and film sessions. Disability Lincs outings and talks had also taken place which included a trip to a Manor House to watch a concert. On the day of the visit it was the Christmas party and a carol concert was also to take place. Although peoples hobbies and interests were well documented in the care plan files no specific social care plans had been produced. These would help staff to be aware of their role in supporting people to maintain their social interests. However people said that staff knew what they liked to do and supported them appropriately. Care Homes for Older People Page 15 of 27 Evidence: The home arranges for outside entertainers to visit and people said that they were assisted to access the local community. They told us that they were encouraged to be as independent as possible and some said that they regularly went out on their own or with relatives. People told us that they were happy with the activities that took place and said that they could choose not to join in if they preferred not to. They said that relatives could visit at anytime and that they were always made very welcome by the staff. One person said, I help by feeding the fish in the garden, setting the tables and sometimes I go out to Skegness to help with the homes shopping. Another person commented. my sister visits every day and the staff are very good with her. Due to the dining room being prepared for the Christmas party, lunch was served to people in their rooms. People told us that they enjoyed the meals very much. Their comments included: I enjoy the food, I am eating well now, it was a problem before I came here and lots of choice, I like rice so I have that sometimes when other people have vegetables. A member of staff said, the home caters for individuals, for example if someone wants something different to eat it is bought in for them. At the last visit by the Environmental Health Officer the kitchen was awarded a 3 star rating for the cleanliness and organisation of the kitchen, the highest rating being 5 Star. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected by clear policies and procedures for handling complaints and allegations of abuse. Evidence: The home has a complaints procedure, this is displayed in the home and included in the Service User Guide, this is given to people when they come to live at the home. The AQAA said that no areas of concern had been raised, but a system was in place should any complaints be made. People said that they knew how to make a complaint and would be comfortable highlighting any issues. However they told us that they had no complaints. The home has procedures concerning the protection of vulnerable adults. Staff demonstrated a satisfactory knowledge of what to do if they suspected abuse could be occurring. They also confirmed that they had received training in this subject. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well maintained, comfortable and homely environment, which offers a good standard of decor and furnishing. Evidence: We took a partial tour of the home looking at the bedrooms of the people being case tracked, communal areas and bathing facilities. The general atmosphere of the home was very welcoming and homely. Bedrooms had been personalised by the resident or their relatives with photographs, mementos and small items of furniture. Improvements to the home since the last visit included completion of the refurbishment programme. This included redecoration of the home, some new carpets being fitted, the addition of a shower room and 2 bedrooms being provided with ensuite facilities. People told us that they were happy with their rooms. They commented, I spend most of my time in my room, which is lovely and they are just finishing off my en-suite, it will be lovely to have my own facilities. The garden was well maintained and seating was available. People told us that in the summer they enjoyed sitting outside watching the world go by. Care Homes for Older People Page 18 of 27 Evidence: Separate housekeeping staff are employed to maintain the cleanliness of the home. On the day we visited it was clean and tidy throughout with no unpleasant odours. Everyone told us that the standard of cleanliness was always high and so the home was always fresh and clean. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A robust recruitment procedure and varied training programme helps to make sure that people are supported by staff who are suitable for the job and appropriately trained. Evidence: Records and observations on the day showed that there was sufficient staff on duty to meet peoples needs. People spoken with, and those who returned surveys, raised no concerns about the staff and felt that there were enough staff available to meet their needs. One person told us, they always have time to sit and talk to us. Staff also said that they felt that the current staffing levels were satisfactory. One person said, there is more than enough staff available, we have time for the extra little things and chats. We saw people being supported in a calm and relaxed manner. We checked the files of 2 staff and these showed that their recruitment had been carried out correctly with essential checks, such as written references and C.R.B. (Criminal Records Bureau) checks, being undertaken. Records and staff comments demonstrated that new staff received a satisfactory induction to the home. The home has a training programme which includes essential subjects such as manual handling, protection of vulnerable adults from abuse, fire safety, administration of Care Homes for Older People Page 20 of 27 Evidence: medications and infection control. Some staff had also received dementia awareness training and the manager said that more was planned. The manager encourages staff to complete an N.V.Q (National Vocational Qualification) in care. Information provided showed that out of 7 care staff 6 have attained an N.V.Q. award. Residents and relatives told us that they were very happy with the way staff supported people. Their comments included, the staff are very good, I cant fault anything, the staff are wonderful and I cant fault them. Staff said that they felt well trained and supported and they demonstrated a very good knowledge of the people they were caring for. One person said, there is a stable staff team and good training. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Supportive leadership and guidance is provided to staff which helps to ensure that care is delivered in a consistent manner. There are systems in place to ensure that the health and welfare of residents and staff are protected. Evidence: People said that they felt that the home was well run and that the manager was very helpful and supportive. They praised the support provided and said that the manager and staff were approachable. When asked what the home did well one person told us, everything. Another said that there was nothing they could improve and that everything and everyone are so nice and helpful. When we asked what could be improved at the home no-one identified any areas that could be done better. Staff were enthusiastic about their work and said that it was a nice place to work. They commented, it is a homely environment that is clean and safe, nothing is too much for the management , they are approachable and supportive and it is the best home I have ever worked in. Care Homes for Older People Page 22 of 27 Evidence: The staff said that they felt supported in their work, however records and staff comments failed to demonstrate that they were receiving regular supervision sessions and an annual appraisal. The manager said that she was aware that this was an area that needed addressing. The home has a quality assurance system so that they can gain the views of the people who use the service. The AQAA said that this included surveys and meetings. Surveys had been sent out to residents and the results analysed to provide an action plan to address any ideas or issues they had raised. The ones we samples showed that people were very happy with the service being provided. People or their families handle residents financial affairs so the home does not currently hold any monies for people in safe keeping. There are health and safety polices and procedures to guide and instruct staff. There is also a programme in place to service and maintain equipment in the home on a regular basis to make sure that it is safe and working correctly. Information provided in the AQAA demonstrated that regular checks on equipment, such as fire equipment and hoists, had taken place as scheduled. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care records must be kept up to date so that they reflect the care and support people need, as well as how issues identified during the assessment process have been addressed, monitored and where applicable resolved. This will help to make sure that staff have access to current information which will help them to support people appropriately. 22/02/2010 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 1 The Statement of Purpose and Service Users Guide should provide people with detailed information about living at the home. This should include information about staff qualifications and training, as well as daily staffing arrangements. Care Homes for Older People Page 25 of 27 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 2 7 Staff should complete a daily record about how people have spent their day, as well as their general well being and any changes in their condition. This will provide a historical record of any issues that arise, how they were addressed and the outcomes. The information collated about peoples social hobbies and social needs should be developed into individualised care plans that tell staff how they need to support people so that they can continue to follow their interests. Staff should receive regular supervision sessions and annual appraisals, which are planned and recorded. This willl help to make sure that they receive the right level of support to in carry out their job. 3 12 4 36 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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!