Inspection on 05/10/09 for Great North Road 68

This is the latest available inspection report for this service, carried out on 5th October 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

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Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Great North Road 68 Great North Road 68 East Finchley London N2 0NL     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: Nurcan Culleton     Date: 0 5 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 Adults (18-65 years) 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 Adults (18-65 years) 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 Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Great North Road 68 Great North Road 68 East Finchley London N2 0NL 02083406035 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: HAIL (Haringey Association for Independent Living Limited) care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 The Registered Person may provide the following category/ies of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disabilities ? Code LD Date of last inspection Brief description of the care home 68 Great North Road is a large detached residential care home providing accommodation, board and personal care and support for up to five service users with a learning or physical disability. The home is owned and maintained by the London and Quadrant Housing Trust; The care service is operated by Haringey Association for Independent Living (H.A.I.L). The home is situated on a busy road close to East Finchley tube station and a short walk from local shops. The home has a vehicle, which is accessible to the five service users. The building offers spacious, bright and homely accommodation, which is arranged over three floors. The ground floor includes a lounge, a large kitchen/diner providing access to a large garden at the back of the Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 5 Brief description of the care home house. There is an overhead hoist in the lounge and in one of the ground floor bedrooms. The two ground floor bedrooms have a shared en-suite. Three further bedrooms and bathroom with assisted bath are located on the first floor with office accommodation on the second floor. The stated aim of the home as set out in the statement of purpose is to provide service users with a secure, relaxed and homely environment in which their care, well-being and comfort is of the prime importance. HAILs fees at the time of this inspection for Great North Road were 1,319.03 to £1,732.09 depending on the level of support. This fee included rent which is 108.10 per week per person. Care Homes for Adults (18-65 years) 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection lasted one day and the lead inspector was assisted by a second healthcare assessor. We interviewed the manager, one support worker, spoke with individuals using the service and examined documents and records in the home. These included three files of people living in the home and three staff files. Additionally we examined health and safety and medication practises and went on a tour of the premises. Care Homes for Adults (18-65 years) Page 6 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. 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 Adults (18-65 years) Page 7 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Prospective individuals to the home can be assured that their needs will be assessed prior to their admission to the home to ensure the home is a suitable placement for their needs. Evidence: We were unable to examine initial assessments during this inspection as the manager informed us they had all been archived. However these have been seen at previous inspections and thought to be satisfactory. There have been no new admissions since the last inspection. The homes admission policies and procedures are based on good practice and include prospective residents would have introductory visits to the home. Care Homes for Adults (18-65 years) Page 9 of 26 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 in the home have their needs identified in detailed care plans that are regularly reviewed and updated. Individuals are supported to take responsible risks. Evidence: We looked at the care plans in the files of three individuals living in the home. The evidenced that people in the home received support to suit their individual support needs and were encouraged to take responsible risks. They were regularly reviewed and updated. Whilst each file contained individualised care plans the manager acknowledged that at present these have been slightly clinical and for this reason, the manager showed us an example of work in progress to improve the format of care plans for all individuals in the home. The care plans will be more personalised better integrating individual risks and health plans into one central file that will be easier to review and update as necessary. They will contain pictures and photographs and will be in a simpler, clearer easier to read format for both the residents and staff. Individuals will contribute to the development of their plans, working with staff to identify their preferences in all aspects of their care and daily living. Some of the plans Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: are at a more developmental stage than others. The plans are detailed and comprehensive. The manager informed that she had sought general advice from the Communication Team in Haringey to help her work in more person centred way at the home and receive training from both the previous and current provider that has helped in the development of these plans. Care Homes for Adults (18-65 years) Page 11 of 26 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. Individuals in the home have access to local services and day time social activities. However a reduction in staffing has affected the social and leisure opportunities available to people in the home, preventing their ability to make lifestyle choices that promote their independence. Evidence: At the time of inspection only one individual was using full-time day care. Another goes to a centre part-time, one individual chooses not to attend a centre and staff are trying to find something suitable for another individual. This has proved difficult given that any centre would need to be able to have appropriate facilities for their individual needs and to have wheelchair access. Currently individuals have received transport to and from their day centres and do not need escorting. We discussed at length however the impact and possible further impact on the lifestyle Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: and choices available to individuals in the home as since the new provider, Haringey Association for Independent Living (H.A.i.L) has taken over there have been staff reductions in the service. There are now two staff members on duty during the day and three staff members to five service users at busy periods. The service users needing support have variable medium to high level support needs. The manager explained how this has impacted on service provision particularly in there now being a need to plan activities more in advance due to having less staff on duty and therefore the loss for individuals of being able to undertake activities more spontaneously. The manager admitted to a drop off in social activities such as outings or pub lunches if other individuals need staff support to be taken to the doctors or to other health appointments. Their choice of what activities they take and when they wish to engage in them are affected by the numbers of staff available to them at that time. We expressed concern at this new development and the effect of staffing issues restricting the choices available to individuals and the potential long-term detrimental impact on the wellbeing of those individuals. We advised that if there is evidence that inadequate staffing arrangements prevent these persons to be supported to live independent lifestyles and to make independent choices, as required by regulation and National Minimum Standards, this could also reduce the overall quality rating of the service. Available records and verbal accounts evidenced that individuals in the home continue to maintain close relationships with people who are significant to them. Care Homes for Adults (18-65 years) Page 13 of 26 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Individuals living in the home can be assured that their health care needs will be met. Appropriate medication administration and recording procedures are in place. Evidence: Records related to medical appointments and medical reports evidenced that the service has good contact with a range of health professionals to ensure that the health and wellbeing of individuals are attended to and reviewed. The manager informed how the GP of one individual diagnosed with diabetes was satisfied that the home was managing their condition well with diet alone. Speech and language therapists had produced menu guidelines to assist with this. Medication practices were examined and evidenced that satisfactory medication and recording procedures were in place. We were satisfied that individuals are consulted for their end of life wishes and that these currently included in their care plans or are being incorporated into their new plans. Care Homes for Adults (18-65 years) Page 14 of 26 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. Complaints are taken seriously and appropriately dealt with. Individuals in the home are protected by policies, procedures and practices in order to protect them from harm. Evidence: There is an appropriate complaints policy and procedure available in pictorial form. The complaints log was viewed and two complaints had been received and appropriately responded to by the home. There have been no significant incidents other than a scabies scare which the manager reported to the Health Protection Agency which confirmed that the home was not the source of the scabies infection. Appropriate procedures are in place to deal with the management of finances of individuals. The manager is the appointee for three individuals. The home has an appropriate policy and procedure for the protection of vulnerable adults from abuse. The London borough of Haringeys policy is also available. Staff have received POVA training and also been on courses in how to respond appropriately to people who present challenging behaviours. Care Homes for Adults (18-65 years) Page 15 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 environment is safe and suitable for the needs of people living in the home, though there are areas where improvements could be made to maintain the homely environment throughout. Evidence: At the time of inspection the home was clean and tidy throughout. Rooms were generally well decorated. Overhead hoists are in place for two ground floor bedrooms and the lounge. Rooms were personalised with photographs, pictures and other personal possessions. The rear garden is a pleasant area, which is enjoyed by people living at the home. No safety hazards were apparent during the visit. We discussed with the manager two points for improvement regarding the environment. In the bathroom shared by two individuals on the ground floor we observed that plastic gloves and other items related to the personal care needs of one individual were openly displayed on the shelves in the room creating a clinical appearance. We suggested that they could be stored in a cabinet instead of the open shelves in order to maintain a homely environment and to preserve the privacy and dignity of the individuals sharing the bathroom. We also observed that a large residents noticeboard in the ground floor hallway Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: covered with letters and notices. The manager stated that this contained a variety of information for the residents however they did not appear to be accessible to the individuals in the home and detracted from the hallway having a more homely appearance creating an institutional feel instead. We suggested and recommended that the information could be made available to individuals in alternative and more accessible ways and that the noticeboard could be replaced with a picture or other attractive adornment on the wall. We considered that the appearance of the hallways were plain generally and could benefit from more pictures or adornments overall. Care Homes for Adults (18-65 years) Page 17 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Staff are trained and supported to carry out their activities, however their supervision needs to be consistent and formalised. Individuals have less choices available to them about their activities due to a reduction in staffing levels. Evidence: The Project Manager described how there has been an impact on staffing levels following the change of provider and how there may in future be one manager covering two residential homes. Prior to the change of provider there were three to four support workers on duty which was ideal. Now they are down to three staff on duty at busy periods only. There is a minimum of two staff on per day and two staff night working. The Project Manager stated that this has resulted in reduced opportunity to provide social and leisure day care activity, the spontaneity has gone. An example given was that one of the service users wanted to go to the pub but this could not happen as the staff had to prioritise another service users medical appointment. Changes in the hours and role of the deputy manager has also put more administrative responsibilities on the Project manager presenting further challenges. Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: The only administrative task now covered by the assistant manager is the medication system. The Project Manager clearly expressed some concerns about the change in her role, with her increasing management responsibilities. We informed the manager of our concern about the staffing and management changes and the impact that could already be seen on service provision to the individuals in the home. We also advised that should there be evidence of further impact on the ability of individuals to make choices about the way they wish to live their lives due to the lack of available staffing, this could also impact on the quality of service and therefore reduce its quality rating. The manager informed that four staff have the NVQ 2 and 3 qualifications and one person has been put forward for the NVQ 3 course. Three staff personnel files were examined. One contained all elements of the Schedule 2 documents required during staff recruitment. The other two files did not keep either copies of identification, references or application forms or a record that they had been and were deemed to be satisfactory. When questioned the manager stated that all these would be held by the central by human resources department. The CRBs were held on the files. Whilst we acknowledged that there was a central personnel department which held personnel files, we advised that personnel records were also required by regulation to be maintained in the home for the purpose of inspection at all times. We looked at staff training records. We found that one staff member had not received manual handling training since 2006 and were told their refresher had been booked in November 2009. The manager told us that she informs the training manager, one of the service directors, of staff who need refresher training. However priortity is given to staff who do not have any training. Courses attended may be internal and external however according to the manager, finding suitable courses does sometimes take time as the organisation is keen to seek out quality training. We were told that HAIL, the provider organisation refresh all mandatory courses every three years. Whilst this may be legally acceptable, the manager would need to be satisfied that staff are sufficiently competent in the areas covered by their training, for example manual handling and there are no changes in manual handling practises where staff may require further training. Supervision records examined showed that formal supervision did occur however Care Homes for Adults (18-65 years) Page 19 of 26 Evidence: these were infrequent and did not meet the standard of a minimum of six supervision sessions a year. The manager stated that she aimed to do supervision six weekly but found this difficult and that as she was on site she supervised people informally. Records showed that new staff members recieved adequate induction. We interviewed a support worker who was complimentary about the manager, informing that she was supportive and approachable, was someone that staff had confidence in and was is in touch with what was going on in the home. Care Homes for Adults (18-65 years) Page 20 of 26 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is effective management in the home, however the organisation needs to ensure that any changes in management roles and responsibilities do not affect the quality of service provision. Good health and safety practises are in place. People living in the home can be assured that their views about the service are sought. Evidence: The manager has an advanced City and Guilds management qualification in the care profession, an NVQ Level 4 and a Registered Managers award. The manager demonstrated her knowledge, experience and competence in her field and ability to manage the service effectively. However the overall management external to the management of the home need to take into account the pressures created on the manager by taking on additional management responsibilities. The organisation must ensure that any changes in management structures, roles and responsibilities do not negatively impact on the quality of service provision. The service has a system in place to gage the views of people using the service, both through ongoing key-working and also through surveys. We saw three satisfaction Care Homes for Adults (18-65 years) Page 21 of 26 Evidence: surveys expressing positive views, however as they were not dated it was not possible to know what period of time they related to. The monthly person in charge visits take place, however the manager informed that reports are not always produced following these visits. The health and safety folder contained all certificates required for examination such as gas and electrical safety. There is a monthly visual check of equipment and the organisation is contracted with a service to check hoists twice yearly. A contractor visits monthly to check and adjust the temperature for water appliances and test the tank for Legionella Disease. Fire drills and monthly fire alarm checks are in place and an external contractor is used to test multi-alarms. A valid employers liability insurance certificate was available. Care Homes for Adults (18-65 years) Page 22 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 Adults (18-65 years) Page 23 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 14 16 The service needs to ensure that the independence, freedom of movement and choice of activities available to individuals are not restricted due to insufficient staff numbers. Following consultation with people living in the home, the care home must enable service users to engage in a programme of activities of their choice. 12/02/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 24 We recommend a cabinet instead of open shelves in the shared bathroom to store items related to the personal care needs of individuals in order to maintain a homely environment and to preserve the privacy and dignity of the individuals sharing the bathroom. We recommend that residents information on the noticeboard in the ground floor hallway to be made Page 24 of 26 2 24 Care Homes for Adults (18-65 years) 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 available to them in alternative and more accessible ways and that the noticeboard is replaced with a picture or other attractive adornment on the wall. 3 33 The organisation needs to ensure that staff are sufficient in numbers to ensure that individuals are able to engage in activities of their choice rather than to be restricted to activites that are only available due to limited staff numbers. All staff to have regular, recorded supervision meetings at least six times a year with their senior/manager in addition to regular contact on a day to day practice. All service user satisfaction surveys to be dated. 4 36 5 39 Care Homes for Adults (18-65 years) 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 Adults (18-65 years) Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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