Inspection on 15/05/09 for Premier Care (Plymouth) Ltd [Bud House]

This is the latest available inspection report for this service, carried out on 15th May 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Premier Care (Plymouth) Ltd [Bud House] Bud House 257 Ham Drive Pennycross Plymouth Devon PL2 3NG 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: Stella Lindsay Date: 1 5 0 5 2 0 0 9 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. They reflect the things that people have said are important to them: 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 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 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 28 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Premier Care (Plymouth) Ltd [Bud House] Bud House 257 Ham Drive Pennycross Plymouth Devon PL2 3NG 01752510362 01752510362 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Premier Care (Plymouth) Ltd care home 2 Number of places (if applicable): Under 65 Over 65 2 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability - Code LD The maximum number of service users who can be accommodated is 2. Date of last inspection 2 1 0 5 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 28 A bit about the care home Premier Care (Plymouth) Ltd has been established to provide care homes for adults with a Learning Disability Bud House is situated in the Pennycross area of Plymouth, and has been specifically established to meet the individual needs of people who may have challenged other services. This may include people with autistic spectrum disorders, behavioural needs, or specialised patterns of living. The home provides accommodation for a maximum of two adults of both genders aged between 18-65 years. The property is semi-detached with parking at the front and a good -sized enclosed garden at the back. The first floor of the home has two large bedrooms, a toilet/bathroom and toilet/ shower room. These rooms are accessed via the staircase and would therefore not be suitable for people with severe mobility problems. Downstairs there is a kitchen, and each service user has their own lounge. There is an office, which is accessed through one of the lounges, but it also has an entrance from the garden. The laundry is in an out house. Bud House is situated close to many local amenities and a main bus route into Plymouth City Centre. Fees are 1600 - 1800 pounds per week, determined by care costs and non-care costs. Care Homes for Adults (18-65 years) Page 5 of 28 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 28 How we did our inspection: This is what the inspector did when they were at the care home We visited Bud House on Friday 15th May, and met the people who live there as well as the Manager and two other staff on duty. The Manager sent us lots of information about the home and how it is run. Two staff returned our surveys, giving their views on the service. What the care home does well Care Homes for Adults (18-65 years) Page 7 of 28 This service is run entirely for the people who live there. Everything is arranged to suit them. They are given choices in everything they do. What has got better from the last inspection The house has been changed around so that both the people who live at Bud House now have their own lounge as well as their own bedroom. Care Homes for Adults (18-65 years) Page 8 of 28 They can do what they want in their own lounge. What the care home could do better The Manager should have a system of checking that lets her know when something is unsafe. Care Homes for Adults (18-65 years) Page 9 of 28 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Stella Lindsay Care Quality Commission 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA 0117 930 7110 www.cqc.org.uk 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 set out 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 10 of 28 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 11 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home undertakes excellent pre-admission planning, to ensure that the service is offered appropriately, and that peoples needs can suitably be met. Clear information is available, and arrangements for visiting are made to suit individuals. Systems for assessment of need are comprehensive, and the home makes an individual response stating what can be offered. Evidence: Prospective service users and their representatives had been given copies of the homes Statement of Purpose and Service User Guide. We were given copies, and saw that they were clearly written, attractively presented, and had been updated to maintain accuracy. They included symbols and photos, to enhance understanding. The Manager told us she had also given out copies of the homes inspection report when admissions were being considered. We saw the records of one resident who had been admitted since the last key inspection. The Manager had been to visit them in their previous placement, meeting the prospective service user and staff who had been caring for them as well as their care manager. She told us that her practice is to contact other professionals who had knowledge of a client, and request an Occupational Therapy assessment. All this is to Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: ensure that she could be clear about what could be offered at Bud House, and to respond to the application with a costed plan for each individual. The home received feedback from a social worker saying, I am extremely impressed with the bespoke service you designed for my client. Visit the to the home were arranged to suit the person, to meet the other service user, and have opportunities to see what it would be like to live at Bud House. Staff were prepared for the person moving in with full information about their needs, in particular their ways of communication. Care Homes for Adults (18-65 years) Page 13 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The organisation actively promotes communication with the service users. Staff are actively committed in supporting individuals to lead purposeful and fulfilling lives, making their own informed decisions. Professional agencies are actively engaged to ensure multi-disciplinary advice and support is received. Evidence: We examined both service users care plans, and found they were detailed, and regularly updated. Staff in surveys and those who spoke to us during the visit said they are always given up to date and accurate information that they need to support the service users, and they have time enough to read the care plans and risk assessments. They had a good understanding of service users needs and said that the information about specific needs, guidelines and daily routines are clear and easily accessible. Advice had been taken from Speech and language therapists with regard to promoting communication with each of the service users, and staff had been trained in communication strategies including the use of signs, symbols and modeling appropriate behaviours. Family members and independent advocates had been involved in care planning, as well as health care professionals who had worked with Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: service users in the past in order that the care plans are fit for purpose. We saw that what was important to the service users and what they enjoy was included in their care plans, as well as health and personal care issues. Respectful language was used at all times. The management of distressed behaviours was included, with reference to behavioural guidelines, in order to avoid damage or injury to service users and others. An independent appointee was handling the finances of one service user, and this support was being actively sought for the other. Both had secure storage in their own rooms, but the Manager had been asked by one to keep some cash in the office, to avoid anxiety. Risk assessments were in place to ensure that staff knew how to safeguard service users while in recognised times of potential disturbance including bathing, being out in the community, and particular safety advice with respect to car journeys. In the AQAA the Manager said, the homes philosophy is to empower choice, not restrict through inappropriate risk assessment. Care Homes for Adults (18-65 years) Page 15 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The routines and activities at Bud House and activities in the community are individualised, person centred, and reflect the diverse needs of the service users. Evidence: The two service users had very different preferences, which are respected. One had regular activities every day. They showed us their Activity Planner that was kept in their room, with pictures representing activities attached by velcro. They were talking in an animated way about their visit to the Music Zone on the previous evening. Other activities included dancing, crafts, bingo, housework and visiting family. The other service user needed support, praise and encouragement to make any activity a positive experience. An activity evaluation sheet was completed every day, to help staff reflect on what this person might benefit from. Different holiday arrangements had been tried out, in order to suit the different people. Service users are provided with a key to their bedroom and the front door. In accordance with the person centred approach at Bud House, meal times and menu Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: planning is flexible. During this visit one service user lunched together in their room with a visitor. Staff checked again that this was what they wanted, and they agreed with enthusiasm. Nutritional needs had been assessed. Healthy eating was promoted, with plenty of fresh fruit and vegetables. Care Homes for Adults (18-65 years) Page 17 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The team are alert to service users personal and health care needs, and continue to investigate practices that work well for each person. There was evidence of good multi-disciplinary working taking place on a regular basis. Evidence: We examined care plans and health records. Care plans included instructions for staff on how to help service users help themselves, for example, praising teeth cleaning and enabling choice in clothing, and specific instructions on personal hygiene. One service user needed specialist attention for dentistry, and had gone to discuss treatment on the morning of this inspection. The other had received advice from a dietician, and had received eye treatment. We looked at the system for administering medication. The home has a policy which includes arrangements for people to self medicate, but current service users had not been assessed as capable of doing this. Most medications were in a monitored dosage system packaged by the pharmacist. We saw that medications that could not be packaged in this way had been dated when opened, and recorded properly. The pharmacist had checked the system in December 2008. The Manager told us that one service user has their medication reviewed by their GP every second month to ensure they are given the correct medication. Care Homes for Adults (18-65 years) Page 18 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Staff awareness and knowledge protects residents from potential harm. Management action had been taken to provide a safe environment for the service users. Evidence: The home has a complaints procedure that is produced in symbol format to help service users understand, and is provided to all staff, service users and other professionals including independent advocates and family members. No complaints had been received by the home or the Care Quality Commission. We saw that the Alerters Guide was available for staff to read, with information as to who should be contacted in the event of any allegation of abuse. Staff were aware that the service users care managers were to be contacted in the event of any concerns arising. In the transition period following admission of the second service user, there had been incidents of aggression between service users, the last being more than a year before this inspection. Staff had made observations as regards triggers to disturbed behaviour, and in meetings with the Challenging Behaviour Service considered how best to improve the situation. It was agreed that sharing a lounge was causing difficulties for them, and in discussion with both service users it was agreed that a separation would be tried, with each service user having a lounge of their own. We saw that service users were happy in their own lounges, and staff told us that disturbed behaviour was so much reduced that there was now no need for restraint. Staff had been given information about the Deprivation of Liberty safeguards, though these are not currently needed at Bud House. Care Homes for Adults (18-65 years) Page 19 of 28 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 house has been reorganised in order to meet the needs of the service users. It provides a comfortable and attractive homely environment for them. Evidence: Bud House is a spacious, semi-detached property situated in the Pennycross area of Plymouth. To the front of the house there is parking for two cars. There is a level garden which is mostly grassed, and a patio area with garden furniture, so that service users may enjoy the open air. The house is generally kept in good repair, with a handyman to deal with every-day repairs and improvements. Since the last inspection the house had been rearranged in order to meet the specific needs of the service users. It had been seen that sharing the lounge caused difficulties for them, as they had different views on music and other entertainment, and did not always enjoy each others company. In consultation with the service users, their representatives, and the staff team, the front room was made into a lounge for one service user, and the dining room into a lounge for the other. They could now choose whether they want company, and can enjoy their own interests and have their own visitors. This was seen to be working extremely well, and was seen as an improvement by everyone who spoke to us during this visit. The laundry was in a separate building at the back of the house. It was uncluttered, Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: and not obviously dirty, but the walls and floor were not smooth and easily cleanable, and therefore posed a potential source of contamination. The Manager undertook to deal with this during 2009. Care Homes for Adults (18-65 years) Page 21 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The service has staff available at all times to support the needs, activities and aspirations of people who live at Bud House in an individualised and person centred way. Staff are employed who have been found to meet the specific needs of the service users, and have the skills and ability to communicate well with them. Management provide training to meet the specific needs of people who use the service as well as maintaining the programme of mandatory training. Evidence: We observed staff engaging with people living in the home in a respectful yet confident manner. They told us that they were well supported in their roles. They were constantly aware of the service users well-being, and alert to any trigger signs for disturbance. Two staff returned surveys to us. They said they were well trained and that access to information was good. The Manager told us that all potential employees are introduced to service users, so that their style of interaction may be observed, and the residents reactions to them evaluated. We examined the files of two recently appointed staff, and found that all documents needed to avoid potential harm to service users, including references, Criminal Records Bureau checks and proof of identity, had been gathered. We saw probation reports on these files, and records of supervision sessions and appraisals for more established staff showing that their performance was monitored, feedback given, Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: and their training needs considered. Staff told us they were proud of the Person Centred nature of this service. Everything is organised for the service users, they told us - they are given choices at every opportunity. All Support staff are either qualified or working towards NVQ level 2 in Health and Social Care, or above. They are required to undertake mandatory training. Staff were attending Food Hygiene training at the time of this inspection. We saw certificates showing that training had been delivered in Safeguarding vulnerable adults, Moving and Handling, Total Communication, Control of infection, safe administration of Medication, and all staff had received first aid training. Each staff member had an individual training record. Training had also been provided with respect to service users specific needs. The Manager told us that external training obtained for the year ahead would include Challenging behaviour, Learning Disability Awareness, Person Centred Planning Training for all Key workers as a priority. Care Homes for Adults (18-65 years) Page 23 of 28 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 . The Manager is an imaginative and effective leader who consistently provides high quality services and an excellent role model for other employees. There are systems for maintaining safety in the home, but the monitoring system had not been robust enough to pick up certain problems. Evidence: The Registered Manager is Mrs Karen Davies. She is competent to carry out her role effectively. She is currently working towards the Registered Managers Award NVQ level 4 and has a clear job description to support implementation development of her role. She has an open door policy to all staff and service users are able to raise any concerns or complaints in relation to the organisation, standards of the environment or care practices. She has been teaching and assessing students at the Plymouth City College for NVQs including tutorials & monitoring and is consequently well versed in the award. The Responsible Person and Director for the Company, Tracey Underwood, has worked within the care sector since 1995, and has also been involved in managing a college based NVQ training department. This has involved training staff that work with the Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: elderly, physically disabled and people with a learning disability. She visits the home frequently and makes a monthly inspection on behalf of the company. We were shown reports from these visits, showing that she had met with people who live and work at the home, to hear about their progress and any concerns, had paid attention to matters of health and safety and identified policies that needed attention or up-dating. The home actively gathers feedback by way of questionnaires from people who are interested in the service. We saw that comments were entirely positive. One health professional had recorded that Bud House provides a model example of how a modern residential service should be run. There is a qualified First Aider on duty at all times, as the Registered Manager and Senior Support Worker have the four day qualification, and all other staff have the half day appointed person training. Two senior people in the company are qualified trainers for Moving and Handling, and therefore well placed to keep staff up-dated. In-house training had been provided in fire safety, using videos and questionnaires. In view of the safety concerned, it is advised to obtain professional training or to arrange for a staff member to be trained as Fire Warden, to guide the home in fire safety. One of the people who live in the home confirmed that they knew where to go if the alarms sound - and that they are very loud! The fire precaution system had been serviced professionally on 23/01/09. There was a monthly audit of safety in the home. However, this had recorded in the month prior to this inspection that all fire doors were working properly, but we found that the kitchen door was jammed open and would not shut in the event of the fire alarms sounding. The office door was also jammed open. The system to report faults should be reconsidered. The regular check of each room included window restrictors, to record whether safety was maintained. Gas and electrical installations had been professionally checked. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes  No  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 26 of 28 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 Description 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 Description 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 2 42 42 The system for auditing safety in the home should be able to identify problems as they occur. It would be good practice to have some professional input to Fire Safety training in the home. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone : or 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) 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. Care Homes for Adults (18-65 years) Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!