Care Home: Thornham Grove

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What the care home does well The home provides staff to look after the residents who are recruited thoroughly and receive comprehensive training. The staff are committed to the care of the residents and are very aware of the individual needs. The home provides a safe, comfortable and homely environment for the residents to live in. The residents have good choices in their meals that are presented well. The residents` views are taken into consideration and put into place to make sure that their choices are met. The residents receive activities that suit their needs and take into consideration their previous interests. Visitors to the home are made very welcome and families are communicated with about changes to the resident. What has improved since the last inspection? There were no requirements or recommendations made at the last inspection on 4th July 2006. What the care home could do better: Care plans should identify all of the residents identified care needs. Risks to the resident should be identified and risk assessments put in place to protect them. The staff should make sure that they are aware of the category of medicines received into the home. The manager should make sure that the staff are fully aware of how the fire system operates. Key inspection report Care homes for older people Name: Address: Thornham Grove 137 Chapel Street Ibstock Leicestershire LE67 6HG     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: Anthea Richards     Date: 0 3 0 7 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: Thornham Grove 137 Chapel Street Ibstock Leicestershire LE67 6HG 01530262573 01530262573 Sandra.Porter@rushcliffecare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Rushcliffe Care Limited care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability sensory impairment Additional conditions: No one falling within category DE(E) may be admitted to the home where there are 15 persons of category DE(E) already accommodated in the home. No one falling within category LD(E) may be admitted to the home where there are 4 persons of category LD(E) already accommodated in the home. No one falling within category MD(E) may be admitted to the home where there are 3 persons of category MD(E) already accommodated in the home. No one falling within category PD(E) may be admitted to the home where there are 4 persons of category PD(E) already accommodated in the home. No one falling within category SI(E) may be admitted to the home where there are 4 Care Homes for Older People Page 4 of 27 0 0 0 0 0 0 Over 65 15 4 3 34 4 4 persons of category SI(E) already accommodated in the home. No person in categories OP, DE(E), LD(E), PD(E), SI(E) & MD(E) may be admitted into Thornham Grove where there are 34 persons in total of these categories/combined categories already accommodated in the home. The service users admitted to the home who fall within the above categories, between the age of 55-65 years, and were resident in Thornham Grove at the date of registration may continue to reside there. Date of last inspection Brief description of the care home Thornham Grove is a residential care home for thirty-four older persons of both sexes. It is a modern, purpose built home comprising of four interlinked zones - Redlands, Rose Villa, Park View and Elbow Row. The home provides care for older persons with mental disorder, physical disability and sensory impairment. It also offers a small number of places for elderly people with a learning disability and some respite placements The home is bright and clean with a high standard of decor throughout and provides a safe and caring environment for all of the residents. One double bedroom has an en-suite facility and there are adequate toilet and assisted bathing facilities throughout the building. Each area has its own sitting/dining area with a smaal conservatory attached. They also all have a satellite kitchen. There is a bar where residents are able to obtain a drink in the evening. There is a safe, attractive courtyard garden in the centre of the property and well-kept gardens to the front. It is situated in the centre of Ibstock, close to all the usual amenities such as, shops, post office etc. and is easily accessible by public transport or car. There is sufficient parking for visitors. The Statement of Purpose, Service Users Guide & Inpection Report are available on request. The Statement of Purpose and Service Users Guide are provided for all new residents. At the time of the site visit the Senior Manager stated that weekly fees were: £341.00 to £450.00 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 was a key inspection of a care home for older people, which ended with an unannounced visit to the service. Before the visit we [throughout the report the use of we indicates the Care Quality Commission], spent five hours reviewing information received by the Care Quality Commission [CQC] since the last annual service review on the 10th November 2008. The visit took place on the 3rd July 2009 and lasted eight hours. During the visit we checked all the key standards as identified in the National Minimum Standards. This was achieved through a method called case tracking. Case tracking means that we looked at the care provided to three of the residents. Care Homes for Older People Page 6 of 27 To achieve this we spoke with the staff supporting their care and looked at the records relating to their health and welfare. We spoke with the residents and visiting families. With their permission the residents bedrooms were looked at. We also checked how the home was run and organised. This included looking at staff records, training and how the staff are organised. We looked at health and safety records, menus, minutes of meetings and the quality audit. The policy for handling complaints and how the home dealt with them was looked at. We looked at how prospective residents and their families are given information about the services the home can offer and whether they are suitable for them. During the visit we spoke with the senior manager, the residents, the staff and families visiting the home. We also spoke to a doctor and nurse visiting 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. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents needs are always assessed before moving into the home and they have good information to help them make the right choice about the home. Evidence: The residents and the families spoken with, told us that they had received a Statement of Purpose and a service user guide. The residents spoken with confirmed that they had had a visit from someone from the home and had the information that they needed to make a decision. The Statement of Purpose and Service Users Guide gives people the information that they need to know about to help them make a decision about the home. All of the residents case tracked had thorough, completed pre admission assessments in their care plans. These had been completed by the manager or a senior member of staff. Care Homes for Older People Page 10 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. Despite the lack of some documentation, the staff are aware of the residents needs and they give good, individual care, with privacy, dignity and respect. Evidence: The case tracked records were found to contain individual evidence of the care being given to the residents and reflected the care that they needed. We spoke with many residents and families who all told us that they received the care that they needed and that they were happy that they received it. The care plans contained some of the required information, but complete records of the residents needs and how they should be met were not always present. The staff spoken with and seen with the residents, were very aware of each individuals needs and were carrying out appropriate care despite it not being documented. There was evidence that the care plans are regularly reviewed but there was no evidence that the residents and the families that they had been involved. When we Care Homes for Older People Page 11 of 27 Evidence: spoke with them they were happy that the care being given was the right care. The care staff were seen to be treating the residents individually with dignity, respect and consideration when talking to them and giving them care. Comments received included: The care here is very good and I feel at home They look after me and care for my needs There are records of the involvement of G.P.s, chiropodist, optician, where needed in the care plans, showing that thorough health care is being provided for the residents. We spoke with a G.P. and a district nurse who were visiting. They both told us that they were very happy with the care that was given, that the residents were referred to them appropriately, in plenty of time and not unnecessarily. They told us that instructions were carried out well and that there was good communication with the home. The daily record of care was up to date making sure that the residents receive the right care and the staff know what has happened to them during the day or night. There are records of the residents nutritional needs and weight, which makes sure that they are eating well and are not losing or gaining large amounts of weight. There were risk assessments in place to cover some of the identified risks for the residents and how the staff should manage those risks. All the risks for the residents should be identified to make sure that the residents and the staff are protected from any risks that have been identified, without restricting their activities. There were Getting to know you forms in the records that told of the residents past lives, what they were interested in and what they would like to be called. Medication records for the case tracked residents were in order. Medicines are given by the well trained senior care staff who have a very thorough medicine training and regular updating and supervised medicine rounds. We saw that the medicines were administered individually and the residents were seen to be taking them. Medicines are supplied in a monitored dosage system where each tablet is in a separate pop out card, which is a safe method of administration, helping to make sure that the Care Homes for Older People Page 12 of 27 Evidence: resident is always given the right medicines. The staff spoken with were knowledgeable about the medicines and where to obtain information. They were also aware of the requirements for the receipt, storage and disposal of medicines. All of the residents have a self medicating drug assessment to identify people who are able to look after their own medicines and those who are not. There were no residents responsible for their own medicines at the time of the visit. The manager carries out a regular written audit of the medicines and the medicine sheets to make sure that they are correct. There were no controlled [dangerous] drugs being kept by the home at the visit but the staff were aware of the storage and the records to be kept. The home were using a patch for pain relief for a resident that is not a high risk controlled drug(CD) but that it would be good practice to monitor. The senior manager immediately put this in the CD cupboard and recorded it in the drug register. Care Homes for Older People Page 13 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. The home provides activities for the residents to enjoy and take part in and meets their spiritual and nutritional needs. Evidence: The home is trying to recruit an activities organiser who, with the staff, could provide the activities in the home. The care plans describe the residents past life and their interests so that the home can help them continue those interests if they wish to. Activities include craft work, newspapers, nails, hairdressing, card games, board games, discussions and outside entertainment such as singers. The home regularly holds car boot sales in the grounds of the home and the residents told us about the summer fair that they were preparing for the day after the visit. Comments received on the day of the visit and from the surveys from the residents and their visitors told us that they were happy with the amount and variety of activities. Care Homes for Older People Page 14 of 27 Evidence: Visitors are welcomed into the home at any time and are invited to attend social functions and the regular resident/family meetings. I am able to do what I want to do and can go out, go to bed and get up when I want to The menus seen gave choices of meals and the cook and the staff were aware of individual needs and choices. We spent time with the residents during their lunch, which was well presented and they told us that they were enjoying. The staff were seen to be sitting with the residents to help them with their meals and talking with them. The chef told us that menus were planned with the residents and that each home had individual menus. She also told us that she received regular good quality deliveries of food. Residents told us that they enjoyed the meals but that they would like more choice at tea time. Religious needs are catered for by the residents having a monthly service in the home or by visits from a local minister. The hairdresser visits every week and there is a dedicated hairdressing room. Care Homes for Older People Page 15 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. There are good systems in place to support and protect residents and staff are aware of the processes. Evidence: There is a complaints policy in place which gives the details of how to complain and who to complain to in the home if they needed to. The policy could be made available in a large print and other languages if it was needed, which makes that as many people as possible could read it. The complaints form was clear and easily followed. The home and the the Care Quality Commission have received one complaint since the last annual service review on 10th November 2008. Whilst this had been resolved and there were letters to support this, a formal complaints form had not been completed. The senior manager completed this during our visit. The residents, the families spoken with and the surveys told us that they were aware of how to make a complaint and were happy that it would be dealt with properly. The staff were aware of how to deal with a complaint and were happy that they would be dealt with correctly. The staff spoken with were able to describe how they would deal with an allegation of Care Homes for Older People Page 16 of 27 Evidence: abuse, knew the areas where abuse could happen and could describe the process that they would go through if they suspected any abuse. They confirmed that they had had training in safeguarding adults and whistle blowing and the manager and the records seen supported this. They were confident that the management would handle any issues correctly. 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. The residents and staff are well protected by the policies and procedures in the home that provides a safe and very pleasant environment to live in. Evidence: Thornham Grove is a single storey, purpose care home close to the small town of Ibstock in Leicestershire. The home is divided into four units each of which has a lounge/dining room with a small conservatory. There is a satellite kitchen in each lounge area which is used for making breakfast and drinks. There is a lounge provided for those residents who smoke. All the bathrooms seen were clean and well equipped, one did contain some toileteries that could be a hazard to confused residents, but these were removed before the end of the visit. The bedrooms of the case tracked residents that were seen, with their permission, were clean, bright, well decorated and personalised. The residents spoken with told us that they were pleased with their rooms and that they were kept clean and decorated. Care Homes for Older People Page 18 of 27 Evidence: I can have my own things in my room. There was evidence of equipment in the home to help the residents, such as wheelchairs, special mattresses and hoists. The kitchen has had a recent Environmental Health Officer inspection and was given three stars and a good rating. There are pretty gardens that have seating areas and are easily accessible for the residents to use. Fire alarm testing, drills and instruction were found to be up to date, this was confirmed by the records seen, the staff spoken with and the manager. Hot water temperature records were found to be up to date and within recommended levels. The residents and the families spoken with were happy with the cleanliness of the home, and told us that the staff worked hard to keep it clean. There are staff employed to complete the cleaning in the home and they have had training in health and safety. The cleaning products are stored in a locked cupboard, which we saw. This was confirmed by the staff spoken with, the records seen and by the manager. 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. The residents are protected by the recruitment and excellent training practices in the home. Evidence: We looked at three staff file s and all of them contained the documents that are required. These include two written references, a Protection of Vulnerable Adults check and a Criminal Records Bureau check. The staff spoken with confirmed that they had received recent training in moving and handling, challenging behaviour, safeguarding of vulnerable adults, first aid, medicine training and care planning. This was confirmed by the records seen and the manager. The manager holds a training matrix showing when courses would be held and which staff needed to attend. We looked at the medicine training completed by all the staff who are involved in working with the medicines. It was comprehensive and contained excellent information for the staff. The residents, the families spoken with all felt that the staff were well trained to do their job and that there were usually enough staff to look after them. Care Homes for Older People Page 20 of 27 Evidence: We saw the induction programme, the basic one takes three days to complete and includes fire, health and safety, moving and handling and infection control. The staff then complete a more detailed one over six weeks. 50 of the care staff hold a National Vocational Qualification [NVQ] at level 2 or above or are completing the award. The National Vocational Qualification is a qualification for care staff to make sure that they receive training in the needs of the resident group whom they are caring for. 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. The residents views are taken into account and their safety is protected by the practices in a home that is run in their best interests. Evidence: The manager has worked for Rushcliffe Care for many years and has achieved her Registered Managers Award. She was not available at the time of the visit and we were accompanied by the senior manager. There are regular meetings held for the residents and for their families, to discuss activities and menus in addition as to how the home is meeting their needs. These were confirmed by the residents and their families and by the minutes that we saw. There is an annual quality questionnaire sent to the residents and their families and the questionnaires that we saw on the visit confirmed this. The families and the residents told us that they had completed the questionnaire. We received very positive comments from the residents and the families at the visit, Care Homes for Older People Page 22 of 27 Evidence: amongst which were that the staff and the manager were very supportive of them and their relative. The residents accounts were seen and found to be in order and had two signatures on each entry. This makes sure that the resident and the member of staff handling the money are protected. We saw that receipts were obtained for purchases. There was evidence from the staff spoken with and from the records seen with that they are having regular, formal supervision with their line manager. Formal supervision of the staff gives them and their line manager the opportunity to discuss work and training issues and needs. There are regular staff meetings held, confirmed by records held and by the staff spoken with. The manager completes a regular audit of any accidents that have happened in the home to make sure that if at all possible they could be avoided. The areas of health and safety such as hot water temperatures and fire alarm testing were found to be in order. The fire alarms sounded during our visit and there were some concerns about finding the sensor that had been activated and how to silence the alarms. the handyman attended and managed to resolve this. We were assured that if this had happened when the handyman was unavailable that the fire brigade would have been called. 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 (1) The Registered Manager must make sure that all identified needs have a careplan in place. To make sure that resident receives all the required care. 30/08/2009 2 38 23 4(e) The manager must make sure that all staff respond to the fire alarms and that the persons in charge are aware of how to identify the fire sensor and to use the fire panel. To make sure that the residents have competent staff to protect them. 30/07/2009 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 8 That all risks to the residents are identified and risk Page 25 of 27 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 assessments put in place. 2 3 10 15 That all medications received into the home are checked to make sure that they are not scheduled or controlled drugs. Consideration should be given to providing a more varied choice of food at tea-time. 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. 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