Care Home: White Waves

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What the care home does well People who live here say it`s a nice place to live and they are happy. The new staff spoken to said they liked their job What has improved since the last inspection? We did not find any significant improvements at this inspection. What the care home could do better: Improvements need to made to the running of the home. We have made requirements for the home to improve their recruitment practises and their knowledge and understanding of safeguarding adults protocols. Key inspection report Care homes for older people Name: Address: White Waves 17-19 Seal Road Selsey Chichester West Sussex PO20 0HW     The quality rating for this care home is:   one star adequate 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: Liz Palmer     Date: 1 3 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 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 25 Information about the care home Name of care home: Address: White Waves 17-19 Seal Road Selsey Chichester West Sussex PO20 0HW 01243602379 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: whitewaves@fsmail.net Platinex Limited care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 19 The registered person may provide the following category of service only; Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home White Waves is a privately owned care home registered to provide accommodation and personal care for up to nineteen elderly (over 65 years) persons. The registered provider is Platinex Limited for whom Mr Satchell is the responsible individual. Mrs J M Satchell is the registered manager. White Waves is a detached two-story building situated in a residential road in the village of Selsey. It is a short distance from local shops and the seafront. Care Homes for Older People Page 4 of 25 Over 65 19 0 1 2 1 1 2 0 0 8 Brief description of the care home Accommodation is arranged in thirteen single and three double rooms. A lounge and dining area provide communal space on the ground floor. There is a passenger lift, which serves all rooms with the exception of three, which are on a mezzanine level. The homes weekly fees currently range from £410 to £750. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate 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 inspection included a site visit to the home by two inspectors, over a period of six hours, from 9.25am to 3.25pm. During this time three staff were spoken to and the registered manager was present. Four service users were met and spoken to others were observed during the inspection. Care plans, medication records, policies and staff records were sampled. Other information used to make judgements about the standard of care in the home included the homes Annual Quality Assurance Assessment (AQAA) that they completed and returned to us. We also looked at the last inspection report and other information received by us since the last inspection including notifications of any events in the home. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are assessed to ensure that only those whose needs can be met are admitted to the home. Evidence: We looked at one assessment of a service user who moved into the home in April this year. They had been assessed by the deputy manager the day before they moved in. The assessment included details such as the persons general practitioner (GP), next of kin and the arrangements to take place in the event of their death. A brief clinical history was included and details of their preferred routine, personal care needs and social interests. Care Homes for Older People Page 9 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have their personal care needs met in a way that respects their views and upholds their right to privacy. There are some inconsistencies in how peoples health care needs are met and care plans are not always kept up to date and accurate. Evidence: We looked at three care plans and found that two of them contained enough detail for staff to be able to meet their care needs. For example, personal preferences on getting up and going to bed were recorded. Information on personal care needs were detailed. A lack of detail in one care plan could lead to inconsistency in the care provided. For example, one care plan states needs help with washing; there are no details of when or how often this needs to be done. We also found that on the same persons care plan changes had not been recorded when their care had changed. The old care plan was on the file and this could have led to confusion. We also noted that a record of fluid input and output was in place for this person. There was no action plan in place to advise staff what to do if input was low. Their care plan also stated monitor bowel movements. There was a chart for this but there was no guidance for Care Homes for Older People Page 10 of 25 Evidence: staff on when to report or intervene. On the daily records we looked at we saw information relating to another service user. This could compromise their privacy as well cause confusion to staff delivering care. Other information in care plans included communication needs, social interests, food preferences, allergies and other health details. We also saw that preferences and arrangements for the event of their death were recorded, except in one case where it was recorded that it had not been discussed yet. Residents told us that they could request to see a GP if they needed one, records of this were seen as well as records of community nurses visits, optician appointments and chiropody visits. We found one occasion where a district nurse visit had not been recorded and another where a persons daily records said on the Saturday they needed to see the GP on Monday. Records showed that a GP visited on the Wednesday and prescribed antibiotics. No explanation for the delay in calling out the GP was recorded. Risk assessments were seen to be in place for mobility, falls, skin condition and nutrition. Care plans and risk assessments were seen to be signed as reviewed each month by the deputy manager. There was no evidence of service users or their relatives being involved in the process. We looked at the storage and records relating to medication. We found that medication is stored in a locked cupboard within a small lockable room. The home uses a blister pack system which they take out on a trolley when administering to residents. There are facilities in place to store medication that needs to be kept in the fridge and controlled drugs which need to be stored in a particular way. We looked at the records of medication administered over the last two weeks. We found that where creams were prescribed they were not being signed as administered. We also found that three residents were prescribed a medication to be given when required and records showed they had received this every night for the last two weeks. We also found two boxes of eyes drops. There was no date recorded, for when the one in current use had been opened, the box stated discard 4 weeks after opening. In the controlled drugs cabinet we found a green bottle with the letters DIAZ on it. There was no prescription label on it. Mrs Satchell explained this belonged to a resident on respite and their relative had insisted it be kept. The practice of ensuring the safery of all medications was not evidenced by this example. Care Homes for Older People Page 11 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People say there are enough activities in the home and they are happy with the arrangements. People told us they are satisfied with the food provided. Evidence: At the last inspection we found the outcomes in this area to be good. In their AQAA they told us that they have a varied activities programme which is displayed around the home for service users attention. It also states that people are asked during the pre-admission assessment about their leisure activities which can be included in their plan of care. During this inspection we did not look in depth at this area. However, we did observe people joining in a crossword with one of the care staff. The staff member said this was not the planned activity of the day but had been the choice of service users. Two of the people living in the home told us they enjoyed the regular knitting circle and were very proud of the blankets they had produced to raise money for charity. People were observed enjoying the sunshine in the well kept garden and the front of the home. Service users moved freely around the home and they confirmed to us that they can choose how to spend their time and may spend time alone in their rooms if they wish. Peoples hobbies and interests were recorded in their care plans including details of daily papers which staff get for them. Staff told us they thought people had enough to do and that they had enough time to spend on a one to one Care Homes for Older People Page 12 of 25 Evidence: basis with service users either chatting, reading their paper or giving a manicure. Visitors are welcome in the home and service users told us they are offered drinks and can stay for meals if they wish. Concerns were raised with the Commission about the food stocks in the home and a lack of a cook in the home. We looked at the stocks of food and found the freezer was full and some fresh produce was also available. We met the new cook who had been in post for two weeks. The lunch on the day was a frozen pie with vegetables. The cook said she intended to start cooking home made food once she has settled in. A list of food eaten each day is kept and those people who have special diets written into their care plan were known to the cook. People spoken to said they enjoyed the food and had enough to eat. Care Homes for Older People Page 13 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are able to air their concerns and can expect to have complaints listened to and acted upon. People are not protected by the homes procedure for reporting suspicions of abuse. Evidence: In their AQAA the home tells us that they have an open and friendly approach to communication with clients, visitors and health care professionals. They display their complaints procedure within their Statement of Purpose and Service Users Guide. They tell us that concerns or complaints raised are taken seriously, are investigated and any outcomes are communicated to the complainant in writing. All complaints are responded to within 28 days, if an outcome has not been reached in that timescale, the complainant would be informed of the delay. We looked at the log of complaints kept by the home and found details of two complaints reported to the home by social services about the staffing levels in the home. Both had been responded to, one was not upheld, the other did not have an outcome recorded. Three people living in the home were asked about complaining and all said they could talk to the manager or any of the staff, they said the home was open to ideas and responded to their comments. One gave an example of a recent request that had been acted upon to their satisfaction. At the last inspection we found that a previous requirement made by us regarding Care Homes for Older People Page 14 of 25 Evidence: training staff in safeguarding adult procedures had been met. During this inspection we spoke to two new staff who said they had received training in this area in their previous employment. Both were aware of their responsibilities about reporting suspicions or disclosures. One member of staff had not heard of whistle blowing and was not aware whether or not the home had a policy on this. During the inspection we found an incident record regarding an unexplained bruise sustained by a resident of the home. This had not been reported to us under Regulation 37 nor had it been reported to social services under their safeguarding adults procedures. The manager told us she did not have any evidence to report it. This shows a lack of understanding about the procedures and potentially puts people living in the home at risk. The manager told us she had informed the persons social worker whilst they were visiting on October 12 2009. The incident was recorded on September 25 2009. An alert was made by us to social services as a result of our findings. Care Homes for Older People Page 15 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from a comfortable and clean environment. Evidence: In their AQAA the home tells us that there is an ongoing maintenance and refurbishment program. In the last twelve months they have replaced the garden furniture and refurbished two of the ground floor bedrooms. During the inspection we saw the lounge and dining area, two of the toilets, the kitchen and two bedrooms. All areas seen were clean and suitably furnished. People living in the home said it was always kept clean. We noticed during the inspection that the hot water tap in the downstairs toilet was not working; as it is used by residents suitable hand washing facilities are vital to maintain hygiene in the home. The manager has informed us that since the inspection she has had this fixed. Care Homes for Older People Page 16 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are not protected by the arrangements for recruiting and training staff. Evidence: The home is registered for 19 people, there are currently ten permanent residents. Staff told us that there are usually two care staff plus Mrs Satchell, on duty. Rotas looked at confirmed this. Staff said that they have enough time to give personal care to residents including those who need two carers to assist them. Staff said that not everyone gets up at the same time so they can stagger the care without rushing. At the last inspection we found staff to be working excessive hours. Since then a large proportion of staff have left and the home have relied heavily on staff from an agency. No records were available in the home to provide proof of identity of these staff. The manager said they came wearing a uniform and an identity badge. An investigation was recently undertaken by social services into an allegation of staff shortages in the home. The investigations found the allegations to be unsubstantiated. The home is currently in the process of filling the vacant posts and has recently appointed four new staff. There were five staff on duty during the inspection this includes the manager and a Care Homes for Older People Page 17 of 25 Evidence: management consultant. Two of the staff had been employed in the last two weeks. Another member of staff told us she was starting work permanently in three weeks time, currently she is employed by an agency. All had done care work before and received training relevant to their roles. One was employed by White Waves as a cook and she had completed the West Sussex County Council Essential Food Hygiene Workbook. The two care staff told us they had undertaken a skills for care induction programme. We looked at the records of this for one of the staff and found they had only completed the parts relevant to White Waves, we were told this was because she had completed it at her previous employment. The other person, currently an agency member of staff had no record of an induction on their file. We looked at the training records for two care staff and found that one had up to date certificates for Moving and Handling, Food Hygiene, Infection Control, COSHH Awareness and Communication. The cook had undertaken Food Hygiene. In their AQAA the home tells us all newly employed staff are subject to a robust recruitment procedure to include a completion of an application form, interview, two written references, one of which must be the last employer, and a satisfactory POVA (Protection of Vulnerable Adults check). We looked at the recruitment files for three staff. We found the home had not followed their own procedures in the case of two staff who had only one written reference on their file. In the case of the most recent appointment the one written reference on file was signed by a member of White Waves staff, in her other capacity as a trainer. We were told that a verbal reference had been taken up with their previous employer, however, no record of this was kept. As a result of this we wrote to the responsible individual for the home, making a requirement for them to do an urgent risk assessment on how they were protecting people who live in the home in the absence of two written references for two of their staff. The manager has since informed us she is in receipt of the second reference for both her employees. Care Homes for Older People Page 18 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Inconsistencies in the running of the home may put people at risk. In particular with regard to recruitment procedures and safeguarding adults protocols. Evidence: Since the last inspection concerns have been raised to us about staffing levels and the running of the home, including from other professionals visiting the home, who expressed concern about Mrs Satchells attitude towards them. During the morning of the inspection Mrs Satchell was supported by a management consultant she has employed. This person has signed themself as the deputy manager on documentation we saw. We have written to the responsible individual for the home and asked for clarification on this. In the afternoon when this person had left there were several bits of information Mrs Satchell could not give us because she had delegated this responsibility to them. We have received some Regulation 37 notifications from the home regarding deaths to Care Homes for Older People Page 19 of 25 Evidence: residents, however, the home did not inform us of the incident involving unexplained bruising to a resident. We have made a requirement for this. Residents and staff spoken to on the day said they got on well with Mrs Satchell and found her approachable and supportive. Residents said she was open to suggestion and helpful. With regard to quality assurance, they home tells us in their AQAA that they have monthly Regulation 26 visits from the responsible individual and additional visits in his capacity as a proprietor. They also tell us that opinions and views are sought through questionnaires. These are audited and a report printed. These reports along with letters of appreciation are on display in a folder in the dining room. They were not looked at during this inspection, however we sampled the monthly monitoring visits (Regulation 26) records and noted they are undertaken regularly and a written record is supplied to the home. In their AQAA the home tells us that any monies managed for our clients is easily audited. Records are accurately kept. We sampled the records held for three people who have cash looked after for them by the home. Receipts and running totals of monies were seen to be kept. Each persons money was stored separately and securely. Two of the balances that we checked were accurate and a third was found to have more cash held than recorded. Although no money was missing it is important that all financial records are accurate and up to date. Fire records were looked at and found to be up to date. Regular safety checks are carried out and the emergency lighting and fire alarm service certificates were seen. Two members of staff told us they had received fire training, however one did not know what the fire evacuation procedure was. We informed Mrs Satchell of this at the time of the inspection. We also saw that water temperatures are checked and recorded. Care Homes for Older People Page 20 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be kept up to date when a persons needs change and must contain enough detail for staff to provide care consistently. To ensure peoples changing needs are met. 02/11/2009 2 9 13 The registered person must 02/11/2009 ensure that where an as required medication is given regularly this should be reviewed by a medical practitioner, at the request of the home. To protect the people who use the service from harm. 3 18 13 The registered person must ensure that all suspicions are reported according to safeguarding adults protocols. To protect people from abuse. 02/11/2009 Care Homes for Older People Page 22 of 25 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 4 29 19 The registered person must ensure that no new staff are employed without all the documents listed in Schedule 2 being on file. To ensure that people using the service are protected by the homes recruitment procedure. 21/11/2009 5 29 19 The registered person must do an urgent risk assessment to show how you are protecting people who use the service during the time staff are working without the full recruitment procedure being followed. To ensure that people using the service are protected by the homes recruitment procedure. 22/10/2009 6 37 37 The registered person must 02/11/2009 ensure that the Commission is notified in writing of any event described in regulation 37 of the Care standards Act. To protect people living in the home. 7 38 18 The registered person must ensure that all staff are trained and competent to carry out the homes fire evacuation policy. 02/11/2009 Care Homes for Older People Page 23 of 25 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 To protect people against the risk of fire. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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