Care Home: Vi & John Rubens House

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What the care home does well All the staff are very aware that Vi and John Rubens House is the home of the residents and try to make this as pleasant as possible. There is a relaxed and friendly atmosphere on all units and residents appeared unhurried and are given sufficient time and support in their everyday lives. All staff work as a team for the benefit of residents and in such a large home the manager and staff are to be commended for this. The home provides an excellent service to members of the Jewish community which is responsive to the needs of residents. The manager is very experienced and sets high standards for the home. She works with a strong staff team who are committed to the continuous improvement of the service. There was a very good response from surveys and all commented positively about the quality of care being provided in the home. Comments included: "I have no concerns, this home is outstanding". "My family are very happy with the way I am looked after and the excellent care that I receive". A relative commented: "No home is perfect, but Vi and John Rubens comes very near the mark". Equality and diversity, and anti-discriminatory practice are given a high profile and the organisation is committed to promoting equality of opportunity for all. Good staff interaction was observed with all residents and this resulted in a high level of motivation for people living in the home. The service has a strong commitment to enabling residents to develop or maintain their skills including social, emotional and communication skills. People living at the home are encouraged to maintain important personal and family relationships. What has improved since the last inspection? There have been significant improvements to the environment on the dementia care unit, especially to the large lounge/ dining area. This has helped to reduce noise levels and has created quiet areas which can be enjoyed by people living with dementia and their relatives. There is also improved signage and this was seen to be enabling people to find their way around with minimal assistance. Several shower facilities have been installed in response to residents preferences. All the requirements from the last inspection have been met. What the care home could do better: It is strongly recommended that where a resident has an allergy to either medication or food; it is recorded more prominently and highlighted on the front sheet of the residents file and on the Medication Administration Record (MAR) chart. Also the medication records on the dementia unit should have an identifying photograph. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Vi & John Rubens House 39 Clarence Avenue Gants Hill Ilford Essex IG2 6JH     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Gwen Lording     Date: 0 3 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Vi & John Rubens House 39 Clarence Avenue Gants Hill Ilford Essex IG2 6JH 02085186599 02085546402 morourke@jcare.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Mary O`Rourke Type of registration: Number of places registered: Jewish Care care home 121 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Vi and John Rubens House is owned and operated by Jewish Care Ltd. it is a care home registered to provide accommodation with personal care and nursing for up to 121 residents, of whom 16 have dementia type illnesses. All residents are over 65 years and of the Jewish faith. The home is purpose built and situated in a residential area of Gants Hill in the London Borough of Redbridge. The home is well served by public transport and close to shops and other amenities. The majority of the bedrooms are single and have en-suite facilities, some with showers. The home has a passenger lift to all floors. On the day of the inspection the range of fees for the home was between four hundred and ninety two pounds and eight hundred and sixty three pounds per week. This range is dependant on whether the person requires residential or nursing Care Homes for Older People Page 4 of 27 Over 65 16 105 0 0 Brief description of the care home care. A copy of the Statement of Purpose and Service User Guide is made available to both the resident and the family. There is a copy of the guide in each bedroom, and at the main reception area. A copy of the most recent inspection report is available on request. 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: three star excellent 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 an unannounced inspection, which took place over five hours. The inspection was undertaken by two inspectors, namely the lead inspector, Gwen Lording and Sandra Parnell-Hopkinson. The registered manager was not on duty on the day of the visit however, the deputy manager and head of care for the dementia unit were available throughout the visit to aid the inspection process. We had a phone discussion with the registered manager the following day. This was a key inspection in the inspection programme for 2008/2009. Discussions took place with the deputy manager, head of care for the dementia unit, kitchen, laundry and domestic staff. We spoke to a number of residents and visiting relatives; and where possible residents were asked to give their views on the service Care Homes for Older People Page 6 of 27 and their experience of living in the home. Nursing and care staff were asked about the care that residents receive and were also observed carrying out their duties. A tour of the premises, including laundry and main kitchen was undertaken. The files of several residents on each unit were case tracked, together with examination of other staff and home records. This included medication administration, staff training and recruitment procedures and files, maintenance records and complaints. Information was also taken from an Annual Quality Assurance Assessment (AQAA); which was completed and returned to us prior to the inspection. This is a self assessment process, which all providers are required to complete once a year. Additional information relevant to this inspection was also obtained from Regulation 26 monitoring reports and Regulation 37, notification of events. Surveys were sent out prior to the inspection for completion by staff, residents where possible and relatives, and there was a very good response. We have been told previously that the majority of people living in the home prefer to be called residents. This is reflected accordingly in this report. We would like to thank the residents, relatives and staff for their input during the inspection and to those individuals who completed and returned surveys. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 27 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.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. Comprehensive pre-admission assessments are undertaken for all residents. This means that staff have the detailed information to determine whether or not the home can meet a prospective residents needs. The home does not offer intermediate care. Evidence: From the evidence seen we are satisfied that all new residents receive a comprehensive needs assesment prior to admission which is undertaken by staff with skill and sensitivity. The service ensures that a summary of any assessment undertaken by a local authority or Primary Care Trust is received prior to admisssion to the home. Prospective residents and their families have the opportunity to visit the home prior to Care Homes for Older People Page 11 of 27 Evidence: admission, talk to staff and residents and assess the homes facilities. Wherever possible prospective residents are invited for a guest day and we saw evidence of this when looking at files. We spoke to a relative who told us that she visited the home before her mother moved in. 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. Residents health, social support and personal care needs are set out in individual care plans and provide staff with the information they need to satisfactorily identify and meet residents needs. There are clear medication policies and procedures to follow, so as to ensure that residents are safeguarded with regard to their medication. All residents could be assured that at the time of their death, staff would treat them and their family with care, sensitivity and respect. Evidence: Care plans viewed were comprehensive and covered health, social and personal care needs. Generally care plans were being reviewed on a regular basis and updated accordingly. Where necessary residents were being seen by a GP, and other healthcare professionals such as psycho-geriatrician, district nurse, tissue viability nurse, diabetic nurse specialist; optical, dental and chiropody services. Several people had pressure Care Homes for Older People Page 13 of 27 Evidence: wounds, some of which were hospital acquired. The documentation/ health records relating to wound management were good, and advice and input had been sought from the district nurse or tissue viability nurse where necessary. It was evident from the care plans seen and through discussion with residents and staff that their health care needs were being met and understood on a daily basis. In discussions with staff they were very knowledgeable about the health and social care needs of the people living with dementia. There was a very positive level of interaction between staff and residents, and staff demonstrated a good understanding of the individual communication needs of each resident. From observations and discussions with staff, residents and relatives, it was evident that the privacy and dignity of residents was respected. Discussions with staff and the review of medication records show that staff are following policies and procedures, so as to ensure that residents are safeguarded with regard to medication. However, the following good practice recommendations have been made: Where a resident had an allergic reaction to either medication or food this was recorded on the Medication Administration Record (MAR) and in the care plan. It is strongly recommended that where such an allergy has been identified; it is recorded more prominently and highlighted on the front sheet of the residents file and on the MAR chart. On the medication records maintained on the dementia unit there were no identifying photographs of each resident. Both these issues were addressed with the respective heads of unit and steps were being taken to action these as a matter of urgency. From discussions with staff and from letters/ cards received by the home, it was evident that residents are assured that at the time of their death, both they and their families would be treated with care, sensitivity and respect. We are satisfied that all residents spiritual needs, rites and functions are observed, and that relatives are also given support and understanding at this time. One family had written: We would like to thank all of the carers on the 2nd floor for the wonderful way you looked after my sister. Her year at the home for her was so happy which made us able to cope with her illness and death so much better. Another relative wrote: I had a parent who was never very nice to staff but who at at the end of her life was cared for with dignity, compassion and great cleanliness. Would you please convey our thanks to Mary and her team for all they do on an everyday basis, under difficult circumstances to all those in their care. 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. The lifestyle within the home matches the expectations and preferences of people living in the home. The attitude and practice of the service and that of the staff working in the home, promote opportunities for residents to remain independent, exercise choice and express their wishes and needs. The home is able to meet the cultural and religious needs of people from the Jewish faith. Evidence: The service has a strong commitment to enabling residents to develop or maintain their skills including social, emotional, communication and independent living skills. People living in the home are encouraged and enabled to maintain important personal and family relationships. The routines of daily living are flexible to suit the differing needs and preferences of all people living in the home. Throughout the visit we observed staff allowing time for residents to express their wishes and supporting individuals to make choices in their everyday lives. Residents are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. People are given the opportunity to participate in community activities such as shopping and theatre trips and the home uses transport from within the organisation. Care Homes for Older People Page 15 of 27 Evidence: There is always a choice of meals and these are balanced and nutritious. Care staff are sensitive to the needs of all residents, and especially to those residents who have difficulty in eating and drinking. Assistance is given in an appropriate and sensitive way, and at a pace dictated by the individual resident. A kosher kitchen is maintained and Jewish Care employ a peripatetic Jewish chef who visits the home to advise on all food issues. Generally residents commented positively on the quality and choice of meals. However, some residents commented: Choice is sometimes limited. Its not appetising, although it looks quite nice on the plate. The manager is aware of individual views. There is an ongoing focus on menu planning and meal provision with the active involvement of people living in the home. As this home is exclusively for people of the Jewish faith, all of the relevant festivals and high holy days in the Jewish calendar are celebrated. Residents are supported and enabled to participate in Shabbat services and there is a synagogue on the first floor of the home. One resident told us: Vi and John maintain the Jewish tradition and way of life. 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. The organisation and staff team make every effort to sort out any problems or concerns. Residents and their relatives can be confident that their complaints and concerns will be listened to, taken seriously and acted upon. All staff working in the home have received training in safeguarding vulnerable adults to ensure that there is a proper response to any suspicion or allegation of abuse. Evidence: The home has a written policy and procedure for dealing with complaints, and staff spoken to were aware of the complaint procedure and how to deal with complaints or concerns made to them. Complaints are taken seriously at this service and are dealt with promptly and effectively. A copy of the complaints procedure is prominently displayed throughout the home and is accessible and available to both residents and their relatives/ friends. One relative told us: Staff like to sort out problems quickly before they become bigger issues. Residents also have access to external agencies and professionals through advocacy and leaflets are on display within the reception area of the home and other public areas. The service has robust procedures for responding to suspicions or evidence of abuse or neglect, and all such allegations are followed up promptly and action taken is clearly recorded. In discussions with staff members they were able to demonstrate a good Care Homes for Older People Page 17 of 27 Evidence: understanding of the homes policy and procedures on safeguarding, including whistle blowing and challenging bad practice at work. A member of staff told us: I would not hesitate to report any concerns around the care of a resident, afterall it is our responsibility to make sure they are well looked after and cared for. All staff have undertaken training in safeguarding vulnerable adults and this is included in induction training for all newly recruited staff. Care Homes for Older People Page 18 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 overall atmosphere in the home is very welcoming and provides a physical environment that is appropriate to the specific needs and lifestyle of the people who live there. Evidence: The standard of the decor, furnishings and fittings are generally being maintained to a good standard. The home is clean and tidy and odour control is good. Bedrooms are well maintained and residents and their familes are encouraged to personalise their rooms. There are aids and equipment at various points around the home which are capable of meeting the needs of all residents. There are a number of shared communal areas and quiet areas where residents can meet their relatives/ friends or alternatively meet privately in their bedrooms. There is an ongoing refurbishment and redecoration programme. Improvements made since the last inspection include new call alarm system, redecoration of corridors and communal areas with new carpets and furniture, and several shower facilities installed in response to residents expressed preferences. Significant improvements were noted to the dementia unit, especially to the large lounge/ dining area. This large area has now been divided into smaller areas by the use of wooden screening, and this has Care Homes for Older People Page 19 of 27 Evidence: helped reduce noise levels and has created quiet areas which can be enjoyed by people living with dementia and their relatives/ friends. There was appropriate signage and this was seen to be enabling some people to find their way around the unit with minimal assistance. The home has a good infection control policy and staff work to this policy in order to reduce any risk of infection. Care Homes for Older People Page 20 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. Staffing levels are satisfactory and there are sufficient staff on duty to meet the individual assessed needs of the residents. Residents benefit from a committed staff team who have the skills and training to meet their needs. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. Evidence: The staffing levels and skill mix of the staff teams are in line with meeting the diverse and changing needs of the residents. Staff are effectively deployed so as to ensure that residents choosing, or needing to remain in their bedrooms are cared for appropriately. Staff interact and communicate well with all residents and this includes nursing, care, ancillary and administrative staff. All staff are clear about their individual roles and responsibilities and demonstrate a strong commitment to provide good quality care to all people living in the home. There is a very stable team of staff with very little turnover, and this does mean that residents at Vi and John Rubens House do get consistent care from staff they know well. One relative told us: I am very satisfied with the care my father receives. Residents we spoke to were also very positive about the care being provided to them. We were told: No home is perfect, but Vi and John Rubens comes very near the mark. A relative commented: As a Care Homes for Older People Page 21 of 27 Evidence: family we are very happy with the way my mother is looked after and the excellent care that she receives. All staff receive training that is relevant to meeting the individual assessed needs of residents in a person centred way. Some training is accessed from external providers whilst other training is delivered by the organisation. All staff receive training in essential areas during the induction period and refresher training in these areas at the required times. Though the service is provided exclusively to members of the Jewish community, the home and Jewish Care as an organisation, employs a workforce from diverse cultures, religions and backgrounds. As part of the induction programme all staff learn about Jewish culture and way of life. The manager and some key staff have undertaken training in the Mental Capacity Act 2005, and its implications on the delivery of care to vulnerable people. We were told that that this training is scheduled to be delivered to all staff through a programme of in house training. The organisation is able to demonstrate that they operate a proactive recruitment and selection process in accordance with the requirements of legislation, equal opportunities and anti-discriminatory practice. Care Homes for Older People Page 22 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager of the home is a well qualified and experienced person. She is ably supported by a deputy manager, heads of units and strong staff teams and residents benefit as the home is run in their best interests. Monitoring visits and quality audits are undertaken regularly to monitor, report and improve on the quality of the service being provided to people living in the home. Evidence: All staff spoke very positively about how well supported they felt by the manager, deputy manager and heads of units. There are very clear lines of accountability and well established systems for effective communication. Staff said that they felt valued and there was a good sense of team working across all units. Staff told us: We work as a team for the benefit of all our residents. Another told us: It is a big home but there is always someone to talk to if we have any concerns or problems. The manager Mrs ORourke is very resident focused, has strong and supportive teams, and works in Care Homes for Older People Page 23 of 27 Evidence: partnership with the families of residents and professionals involved in their care. She has a clear understanding of what further improvements are needed and the key areas, which need development. The Annual Quality Assurance Assessment (AQAA) contains comprehensive information that was fully supported by evidence seen during the inspection. It tells us how the service has improved by listening to the views of people living in the home. It clearly identifies the plans for improvement over the next year. The home has worked continuously to improve the service and provide an increased quality of life for people living there. Residents are supported to manage their own finances where possible or by their relatives/ representatives. The home has responsibility for the personal allowances of several residents. There is a computerised financial system in place which is managed by the homes administrator. There is a comprehensive range of policies and procedures which are regularly reviewed and updated in line with changing legislation and good practice guidance. There are clear written records of all safety checks and accidents/ incidents, and all such records were found to be maintained in good order. The organisation monitors the quality of the service being provided in the home through monthly Regulation 26 monitoring visits with reports that are comprehensive and identify areas for action. There is also a very good quality assurance system and quality audits are undertaken on an annual basis and a written report is produced. Care Homes for Older People Page 24 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 25 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 It is strongly recommended that where a resident has an allergy to either food or medication; it is recorded prominently and highlighted on the front sheet of the residents file and on the Medication Administration Record (MAR) chart. It is strongly recommended that the medication records on the dementia unit have an identifying photograph. 2 9 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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