Care Home: Thorp House Nursing Home

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What the care home does well The home reviewed and updated their statement of purpose and the service user`s guide to show the changes since the change of ownership. These new documents clearly explained what could be expected if new residents chose this home. The manager explained the admission procedure. The documents related to admission were in residents` folders and confirmed that the assessment was appropriate. Residents folders contained very detailed documents, care plans, risk assessments, various charts, records and other relevant individual documents for each resident. All residents spoken to confirmed that their needs were met, that they were respected and treated with dignity. The activity coordinator`s hours have been increased and more staff were employed since the change of ownership and services for residents were improved. The home was in the process of employing 5 more part time staff, allowing flexibility in planning shifts and much better cover of peak hours, such as meal times. Neither the home, nor we, the regulators, had received any complaints apart from one concern that the home had dealt with sucessfully. There were no safeguarding issues or allegations that needed investigating or referring to Adult Protection team. New staff were recruited through appropriate checks to ensure protection of residents. Their induction included practical aspects of work done under the supervision of the allocated mentor-a more experienced member of staff. New owners also emphasised training and offered training relevant to residents` conditions. Work on improvements in the environment had started, but this area of provision still needed to be much improved to meet the standards. What has improved since the last inspection? Since the new organisation took over the business many changes were introduced. For the purpose of registration, the home had got a new manager, increased staffing level and environmental changes that were appropriately prioritised. An example was: obtaining 9 hospital beds first, replacing older TV units with new ones and connecting them to digital TV programmes, while plans were in place for completely changing "bungalows" to improve respect for residents privacy, to redecorate many areas of the home and re-furnish most communal places. Progress was significant since the change of ownership and plans for further improvements were acknowledged. What the care home could do better: The manager explained her intention to review and improve records kept for residents. She was planning to reduce repetitions in residents` files, to introduce a summary of care plans that would help staff learn quickly about basic needs for each individual. The main changes were planned in the environment and would ensure respect for privacy for residents and improve all communal areas in the home. Although some of the environmental factors were below minimum standards, the company needed time to improve all of these and some required changes were presented as recommendations, rather than as requirements. Key inspection report Care homes for older people Name: Address: Thorp House Nursing Home Thorp House Nursing Home Church Road Griston Tetford Norfolk IP25 6QA     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: Dragan Cvejic     Date: 1 6 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 26 Information about the care home Name of care home: Address: Thorp House Nursing Home Thorp House Nursing Home Church Road Griston Tetford Norfolk IP25 6QA 01953881786 01953884048 mandy.masters@kingsleyhealthcare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Althea HealthCare Ltd Name of registered manager (if applicable) Mrs Samantha Beck Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service: Care Home with Nursing - Code N To service users of the following gender - Both Whose primary care needs on admission to the home are within the following categories Older people, not falling within any other category - Code OP 30 Dementia - Code DE(E) 10 The maximum number of service users who can be accommodated is: 40 Date of last inspection Brief description of the care home Thorp House is a 40 bedded care home with nursing, situated in the village of Griston which is approximately 4 miles from the market town of Watton. The home provides nursing care for elderly people, and people who have varying degrees of dementia. The accommodation is on the ground, including bungalow wing with six flats and first floor Care Homes for Older People Page 4 of 26 Over 65 10 30 0 0 Brief description of the care home in the main building. There is a large enclosed garden and some residents rooms have direct access to this area. There are 6 places available in accommodation described as flats in a bungalow wing where residents have their own sitting area and kitchenette with a separate bedroom and en suite bathroom. This area is currently under refurbishment. There is a car park at the front of the home. The fees charged for the service are presented in the homes information pack. Extras are hairdressing, chiropody, papers and toiletries. The home has been re-registered this year as a result of the change of ownership. New owners are introducing many changes to the environment and are improving physical conditions of the home. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The home has recently changed ownership and was re-registered with us, the regulators. The new owners, Kingsley Healthcare, started investing heavily and improving many areas of life in the home, such as environment, staffing, ethos and quality assurance. Since their registration, about 6 months ago the home was going through changes. This inspection showed the improvements already made and confirmed the plans for futher significant changes. We were given new revised statement of purpose and new service users guide. During the site visit, we checked 3 staff files, 2 new staff applications, three residents folders with care plans, risk assessments and other relevant information about residents and care for them. We spoke to the manager, to two staff members, to 8 Care Homes for Older People Page 6 of 26 residents and to one of the directors that visited the home on the day. We witnessed contracted workers coming to replace the doors. We also checked the medication procedure, including the storage, records and administering process. We checked activities where 8 residents took part. The manager showed us the home and explained the plans for the further improvements. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 26 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 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. With new updated information about the service, new prospective residents could now make an informed choice and be sure that after a detailed inital assessment their needs would be met if admitted. Evidence: The manager produced and gave us a revised statement of purpose and service users guide. These documents explained in detail what new residents could expect. The admission process included assessments carried out by the manager and the nurse. They obtained the social services documentation for each individual referred. They contacted the current report for the referred individual from their GP and spoke to existing carers or members of family. In three checked files this documentation was detailed and appropriate to create a plan of care. Residents spoken to confirmed that their needs were met. One of them answered the question of carers reaction when residents call them: They come straight away when Care Homes for Older People Page 11 of 26 Evidence: we need them, we dont need to wait. Another resident added: I would reccommend this place to other people. It is lovely. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensured that residents healthcare needs were addressed appropriately and that external professional support was sought as soon as practicable. Good and safe medication process also protected residents. However, the environment did not offer appropriate privacy. Evidence: Three residents files were checked. They were detailed, updated and contained many entries related to each other to the point that some were repeated. The manager explained her plans to review this system, to reduce administration by avoiding repetitive notes and ensure that this time was spent with residents. Current care plans were drawn up form the initial assessment. One of the initial assessments stated: would like assistance with cutting nails. The care plan stated: to see chiropodist every 6 weeks. Records in daily notes showed that she was seen a chiropodist 3 times in the past 3 times in the past 4 months. Activities that a resident took part in were recorded on the activity records and matched a duplicated entry on daily records. A list of personal clothing brought in the home at admission was made, but it was not updated when some items were disposed of. The manager was looking into Care Homes for Older People Page 13 of 26 Evidence: how to make these records up to date and relevant at the present time. One of the care plans was signed by the resident, while the other two had signatures of their relatives. Evaluation of care plans was recorded in each section of plan with dates that showed regular reviews. Four residents stated that the home does call a GP when there was a need, despite the fact that they had nurses working in. This also showed a good practice to call appropriate external professionals and record their visits. Medication was checked regarding the storage, records, administration and staff knowledge of it. A senior carer-nurse-showed us and competently explained the procedure. She was also observed giving the medication to a user under distress who was not well. The GP was already called in and the senior staff explained to the resident that they were waiting for a GP. Although staff showed full respect for residents privacy and dignity, the environment, especially in the bungalow area, with huge windows that faced the main corridor did not provided sufficient privacy. Some windows had blinds, none had a net or light curtains and a number of doors were with glass panels. The workmen came on the day of the inspection to replace some doors. The manager explained the plan for a complete refurbishment of this area. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offered increased level of activities for residents since the change of ownership. Residents aspirations were taken into account regarding the daily life and their routine. Evidence: Daily routine was set at the pace to allow residents to take part in stimulating activities. Eigth residents were in the dining room doing various things with the activity coordinator. her hours had recently been increased to expand the choice for the activities. The home also kept records in individual files of the activities taht residents took part in. However, there was no pressure on them to join others who were taking part. A resident brought in an old organ and kept it in her room. Another resident was seen watching his TV in his room in bungalow. Any prolonged conversation with a resident was also recorded in daily records allowing the hoem to analyse how much attention was given to individuals. The activity coordinator told us: There is a new activity programme. We also got a new bedding for all residents. Two new, big digital TVs had been purchased. We have also arranged putting pictures on the wals making the communal areas more homely. Residents now can bring in their own things not only in their bedrooms but to the Care Homes for Older People Page 15 of 26 Evidence: communal areas too. A resident stated: I did not want my big wall unit in my bedroom. I wanted it in my hallway, showing how much she felt at home when she stressed MY HALLWAY. Yesterday we had a massage session for 3 residents and several others came afterwards to have their nails painted. Residents were consulted and chose the colour for the hallway and carpets. Decorators were invited to visit several times prior to starting their work to meet residents as visitors, make them more comfortable and cause the least disruption when the painting takes place. Local Brownies were also invited to visit the home for various occassiont. The home was getting ready for the Halloween party where the staff and residents were going to wear approrpiate Halloween clothes. When staffing level was increased, since the change of ownership, the staff had more time to spend with residents. Extra staff at peak time also reduced the rush and institutionalised approach. residents reminded an activity coordinator of the recent activity they enjoyed very much: blackburry picking. Food is quite good. they provide altentaive meal if we dont like something, said a resident, and three others confirmed saying: Oh yes, yes. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff were trained and knew how to deal with issues regarding protection, including appropriate reporting procedure. This ensured good protection for residents. Evidence: Complaint procedure was displayed arround the home, on a board in the hall, but also in the staff room, showing and reminding everyone that complaints would be listened to and acted upon. There was one complaint launched in October that was resolved satisfactorily. There were no allegations or referrals to the Protection of Vulnerable Adults (POVA) register. The home had a policy of not dealing with residents money. So, when residents were supposed to pay for hairdressing or similar, the home would pay and then invoice the holders of residents finances, relatives or social services. Most staff had already completed the training on Deprivation of Liberty and ensured better protection of residents. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the new owners addressed environmental changes necessary to improve conditions for residents, there was a long way to go to meet minimum standards. Evidence: The layout of the home naturally divided the home into two main areas: a main bulding and 6 adjacent bungalows. The main building provided many smaller areas where residents could enjoy quiet time, or see their visitors. However, some of these were in the process of being updated, refurbished and some walls were being altered to provide expected standards. Renewal of carpets in the hallway and corridors were approved, carpets were ordered as residents chose the colour, but at the time of the site visit, too dark, somewhat institutionalised and partly worn furnishing did not meet the basic standards. One of the toilets and bathroom was out of use at the starting point of refurbishemnt. This smaller wing did not have another toilet, so residents could only use commodes. the manager was aware and stated that only residents whose needs indicated the use of commodes would be accommodated in that area. One of the directors visited the home on the same day with workmen to discuss connection to the main sewage system. Workmen had also come to change some of the doors woth glassed pannels that did not offer privacy to residents. Most doors did not have locks at all,so it was not possible for residents to hold their keys if they wanted. Only one resident held a key Care Homes for Older People Page 18 of 26 Evidence: at the time of the site visit. There were 9 new hospital beds that had already been brought in, as they were more appropriate for residents needs. Some new pictures were in the office waiting redecoration before they were hung up. Some bedrooms in the bungalow wing had blinds on the windows facing the main corridor, but none had net curtains or similar lighter curtains for privacy. New furniture and a new roof on the conservatory made it much more pleasant, but the ramps for wheelchairs were still to be installed both in the conservatory and on the main door. The home had a big aviary where there were about 40 peacocks. Gradually a number of peacocks were donated to various localities, reducing the number of birds to a reasonable level. One of these birds greeted us at the front door on our arrival and moved away after 7 minutes, allowing easy access to the home. Many of the en-suite facilities were planned for refurbishment. One was seen in an unused bedroom and did not look nice at all, the flooring was stained, not fitted properly and if it was used, would present serious risk to residents. Some radiators were covered, but some were not. The manager and staff ensured that areas used by residents currently were safe, but there was a long way to go to ensure that all areas were comfortable, appropriate and safe for residents. As the company, the manager and the staff were already addressng all environmental issues, only one reqirement was made in this report. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Increasing the staffing level benefitted both residents and the staff team in working with respect for residents dignity. Well organised training also ensured good protection of residents. Evidence: The staff rota was checked. It showed sufficient number of carers per shift. The manager reported that extra staff were engaged to cover peak hours, such as meal times that further improved services for residents. Five new staff were recently recruited to work part time and fill in these extra shifts. Senior staff member described the day to day operation of the home: Both staff and residents feel happy about the home. We have a lot opportunitities for training. We, as nurses get all training necessary to maintain being on the NMC register (Nursing and Midwifery Council). Atmosphere in the home is very good, positive. We have regular supervision and support. I supervise junior carers and sessions are held regularly. Recruitment process was carried out according to the companys policy, but was organised and held locally, allowing the homes management team to choose the best workers. All checks were also done locally. the manager stated that each new job applicant was taken to a tour around the home, thus meeting staff and residents prior to interview. The manager consulted staff and residents before making the final decision of accepting a new worker. Once started, all new employees went through a structured induction programme and Care Homes for Older People Page 20 of 26 Evidence: were supported by mentors, who were experienced carers. Induction included practical work, so that both candidates and their supervisors were clear of their ability. Training that staff were undertaking included: dementia, first aid, fire, Infection control, health and Safety, Holistic care and POVA or SOVA. Recently Deprivation of Libert trainging was added to the list of training for staff. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Well managed, the home offered good care, support and protection to residents and created pleasant working conditions for carers and other supporting staff. Evidence: The manager had more than 10 years experience. She was in the process of registering with us, the regulators. She was enthusiastic and commited, created a positive and inclusive atmosphere and lead the staff team successfully. Quality assurance review process was conducted once a year and all relevant people were surveyed, residents, their relatives, staff and external professionals visiting the home. The home created an action plan based on the findings. The feedback to people that contributed was organised in different ways: the findings were published and displayed in the home, staff were informed and further consulted on staff meetings, residents and relatives were informed mainly on a one-to-one basis. The service did not deal with residents money, but the staff were trained in Deprivation of Liberty, so that residents rights could be protected. As stated in staff section, supervision was appropriately cascaded and carried out Care Homes for Older People Page 22 of 26 Evidence: regularly. The manager would supervise all new workers the first time and after that the appropriate senior staff member took over the cascaded supervision plan. Staff spoken to stated that they felt supported. During the site visit a staff member approached the manager and asked for a chat regarding issues related to work and this demonstrated that the manager was open to discussion and support outside of the planned supervision programme and outside of the cascaded supervision responsibility. Safety and welfare of residents were implemented as much as the environment allowed. The laundry and kitchen were made safe after the takeover took place. However, refurbishments that still needed to be done affected some radiators which stayed uncovered. The manager stated that the bedrooms in that area were not in use whilst being refurbished. Also the number of communal toilets and bathrooms varied depending on which one was refurbished. The manager, staff and the company put all possible plans in place to protect residents temporarily while the work was on-going. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 The home must be bright, 21/12/2009 comfortable, safe, accessible, equipped and offer a decent accommodation to residents. This would ensure that their privacy and autonomy could be respected. 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 10 The home should arrange the procedures relative to the environment shortfalls, so that residents privacy and dignity were respected. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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