Inspection on 16/12/09 for The Orchard Care Home

This is the latest available inspection report for this service, carried out on 16th December 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.

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: The Orchard Care Home LTD. 10 Papplewick Lane Hucknall Nottingham Notts NG15 7TJ The quality rating for this care home is: three star excellent 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: Lynda Dyer Date: 1 6 1 2 2 0 0 9 This report is a review of the 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 stars – excellent • 2 stars – good • 1 star – adequate • 0 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. 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 Care Homes for Adults (18-65 years) Page 2 of 33 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 33 Information about the care home Name of care home: Address: The Orchard Care Home 10 Papplewick Lane Hucknall Nottingham Notts NG15 7TJ 0115 9527102 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): garrycallan@btinternet.com www.theorchardcarehome.com The Orchard Care Home Limited Name of registered manager (if applicable) Mrs Nicola Wardle Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 6 6 0 0 care home 6 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Learning Disability, not falling within any other category Code LD Mental Disorder, not falling within any other category Code MD The maximum number of service users who can be accommodated is 6 The registered person may provide the following category 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 Date of last inspection 2 4 0 3 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 33 A bit about the care home The Orchard is a care home and there are three people living there. The home is owned by Mr Garry Callan and it is run as a family business. The home is near to Hucknall. It is close to shops, pubs, the tramline and the train station. Everyone living in the home has their own bedroom. The home has had some more bedrooms built and may soon have Care Homes for Adults (18-65 years) Page 5 of 33 another three people moving in. There is a big garden with a wooden summer house which has games in for people to use. There is also an area to play outdoor games and a BBQ area. There is a family room for people to meet with their family and friends in private. It costs £1176 a week plus £10 per hour for one to one time to live in the Orchard Care Home. Care Homes for Adults (18-65 years) Page 6 of 33 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 7 of 33 How we did our inspection: This is what the inspector did when they were at the care home The manager and the owner were there when we visited and they were very helpful and friendly. We also asked the manager to fill out a form for us. We call this an Annual Quality Assurance Assessment (AQAA). We sent out a survey to people that live in the home, staff that work there and people that visit. 8 people filled in the surveys and sent them back to us. Care Homes for Adults (18-65 years) Page 8 of 33 We looked at the care plan of a person that lives in the home. We looked at records that were kept in the home, which included staff records and health and safety records. We spoke with one person living in the home and we also spoke with three staff that work in the home. All of this helped us to plan what we needed to look at when we inspected the home. Care Homes for Adults (18-65 years) Page 9 of 33 What the care home does well People living in the home have meetings and can have a say in how the home is run. Staff have lots of training so that they know how to care for people well. People have lots of things to do and are helped to go to work and to go on trips. Care Homes for Adults (18-65 years) Page 10 of 33 What has got better from the last inspection The home has a new family meeting room and a place for people living in the home to do their laundry. Medicine storage is better. Care plans are more organised and they are person centred. Care Homes for Adults (18-65 years) Page 11 of 33 What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 12 of 33 If you want to speak to the inspector please contact: Lynda Dyer Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 03000 616161 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 13 of 33 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 14 of 33 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. People’s needs are properly assessed before admission to ensure that peoples needs can be met in the home and placements are offered once it has been established that individual needs can be maintained. Evidence: The manager told us in the Annual Quality Assurance Assessment (AQAA) that Information is given to the service user in the form of a welcome pack which has information about the home, the staff team and an up to date statement of purpose. A full assessment is then completed in conjunction with members of the multi disciplinary team, the service user and their families. We received completed surveys from people who live in the home and they said that they were asked before they decided to move in to the home and said that they received enough information to decide if it was the right place for them. We viewed the care plan of one person living in the home and a full needs assessment was present. Page 15 of 33 Care Homes for Adults (18-65 years) Evidence: Before agreeing admission the service carefully considers the needs assessment for each individual prospective person and the capacity of the home to meet their needs. Care Homes for Adults (18-65 years) Page 16 of 33 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 living in the home are supported to make decisions and to take responsible risks to ensure they have control over their daily lives. Evidence: The manager told us in the Annual Quality Assurance Assessment (AQAA) that person centred plans are set up with each service user on admission to the Orchard. The person centred plan is then reviewed on a monthly basis or more often as necessary. Each service user has a key worker who assists the service user with the review. The care plan that was viewed had lots of information about the persons needs and how they lived their life. Daily records were filled in using lots of information about how the person chose to spend their time. Some of the records were in a format tailored especially for the individual it was intended for to enable them to read it. The care plan was clear and had a detailed new snapshot plan which gave staff an instant picture of what the person likes to do with their day and how much support staff should give to maintain the pathway they had chosen. The care plan also included information Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: about people’s health and any external professionals involved in their care. Records showed that the risk assessments and the care plans were being reviewed regularly with input from the person it was written for. Support plans include reference to the Mental Capacity Act 2005 and the effects it has upon peoples lives. This is to ensure that their rights and choices are protected. People living in the home have regular meetings and are able to have input into decisions made about the home. People’s choices around how they spend their time are being respected and we observed positive examples of this on the day of the inspection. A member of staff told us, I feel that The Orchard promotes the needs and preferences of all individuals and places the individual at the centre of everything. Another said, We meet service user’s needs and give them plenty of choice in order for them to live a happy and full life. Care Homes for Adults (18-65 years) Page 18 of 33 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. People living in the home are actively encouraged to develop and maintain social, emotional, educational and independent living skills. People are supported to make informed choices and maintain family and personal relationships. Evidence: The manager told us in the Annual Quality Assurance Assessment that service users participate in a range of activities within the local community, service users also attend day services and 1 service user works on a local farm as well as attending college based activities 2 days a week. Service users attend specialist swimming sessions and also a local club which enables service users to socialise with peers who share the same or similar disability. All service users are members of the local library and 1 service user attends a local Walk for health group. Service users also attend a church of their choice and church based activities. Activities are tailored to individual needs and preferences. Each month service users have a meeting in which they plan their activities both inside and outside of the Orchard. Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: Care plans and activity plans we viewed showed evidence of people living in the home being supported to be independent and involved in all areas of daily living in the home, including where appropriate, taking responsibility for shopping, planning meals, and meal preparation. They also showed evidence of people being supported to access external work based opportunities and being involved in activities, trips and attending clubs and social events in the community. The person that we case tracked had an active social life and their care plan contained evidence of their hopes and dreams for the future and how staff were supporting them to fulfill these goals. One relative told us, The home provides a varied and active social life for my relative. Another said, They provide a varied and healthy diet. One person living in the home told us, The home helps promote my independent living skills. Another said, They support me in my daily living skills and wherever else I need it. A member of staff told us, There are lots of activities for the service users. We saw evidence of people living in the home being supported to maintain close family links and by going to visit their relative and having their relative visit the home. People living in the home were observed having their choices around food and when and where to eat it respected and staff told us that the home was very flexible toward where people ate their meals. People living in the home are consulted about their choice of meals and have the opportunity to share in the preparation of the menu and the food. Care Homes for Adults (18-65 years) Page 20 of 33 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. People living in the home have their health care needs met and they receive personal support in the way that they prefer. Medication procedures are safe. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that all service users dignity is respected and service users are supported to be independent and take control of their own lives making choices and being informed of all risks along the way. Support and guidance is offered with personal hygiene and service users are registered with external health professionals and all services are accessed as necessary. When hospital appointments are made service users are supported to attend these. Service user’s health is monitored and any medication needed is only administered by appropriately trained individuals. We saw records of health care appointments and routine health and well person checks that had been arranged. Staff told us that people living in the home were able to choose who delivered their personal care and we spoke with a person living in the home and they confirmed this. We viewed the care plan of one person living in the home and it showed how they liked to Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: spend their days and how much support they needed with their care. They had also attended a health action planning training course with staff to show them how to manage their own health care needs with support from staff. We also saw evidence of a healthy lifestyle and diet being promoted by staff. One relative told us, The home generally offers an all round caring service to both the service users and their relatives. Another said, They make sure my relative has regular health checks at doctors, dentists etc. They always inform us of any health problems and keep us up to date with treatments and appointments needed. We looked at the homes medication procedures and found that the medication has been re-located to a new small medication area and we found that storage and administration of medicines is safe. Staff training files were viewed and staff are trained to administer medication safely. Care Homes for Adults (18-65 years) Page 22 of 33 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. People living in the home are safeguarded from abuse and people know how to make a complaint. Evidence: The manager told us in the Annual Quality Assurance Assessment that a copy of the complaints procedure is displayed prominently at the Orchard and that service users and their families are made aware of this. Service users are also asked at service user meetings if they have any complaints or concerns they wish to raise. They state they also have a complaints, comments or compliments book which staff, visitors or service users can fill in at anytime and that a copy of the complaints procedure is displayed prominently and Service users and their families are made aware of this. Service users are also asked at service user meetings if they have any complaints or concerns they wish to raise. The AQAA states that all staff have undertaken safeguarding training. The commission has not received any complaints about the service in the last 12 months and there has not been any complaints made to the home in the last 12 months. The home has a complaints procedure on display and they have produced a picture version of the complaints procedure and placed this in all of the bedrooms so that people living in the home are supported to make a complaint if they wish to. People living in the home told us that they knew who to speak to if they were not happy and staff told us that they knew what to do if people living in the home raised concerns Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: with them. The home has safeguarding referral policies that follow current local procedures and staff records show they have received training in safeguarding vulnerable people. The manager has made one safeguarding referral in the last twelve months and this was managed appropriately. One person living in the home told us, I feel safe here. Care Homes for Adults (18-65 years) Page 24 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, comfortable and homely environment. Evidence: The manager told us in the Annual Quality Assurance Assessment (AQAA) that the home is clean, comfortable and personalised by the service users living there and that all hygiene standards are met. Service users recently had input into the redecoration of the lounge and dining area. Service users are encouraged to personalise their bedrooms and add or take away furniture as they wish. Service users choose their own bedding and each service users bedroom is kept as they wish with staff support offered as necessary. Staff follow a cleaning rota which is monitored by the management team to ensure that there are no hygiene issues. The home provides a homely environment for people to live in. It is decorated and furnished to a high standard. On the day of the inspection the home was very clean and well maintained. Since the last inspection the home has had more improvements, including an extension to the lounge to introduce a private family meeting room and utility room for people living in the home and staff to use. The garden has been landscaped and provides areas for people to sit and relax, a section Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: for holding barbecues and an outdoor games area. In the garden there is a sensory/games summer house and this provides various activities for people to take part in. The home has extensive health and safety practices and procedures in place and these are monitored by an external health and safety company. The home has infection control systems in place to prevent the spread of infection and staff are trained to maintain the systems. Care Homes for Adults (18-65 years) Page 26 of 33 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 home operates a safe staff recruitment process and staff are trained effectively in supporting people living there. Evidence: The manager told us in the Annual Quality Assurance Assessment (AQAA) that all staff complete the skills for care common induction book as well as the Orchard induction. All staff have current criminal record checks and staff undertake all mandatory training and other training such as recognised qualifications. The rota ensures a good skill mix on each shift and staffing ratio is increased should a situation arise. We looked at the files of two staff working in the home and they were well organised and contained evidence that the required safety checks had been completed prior to employment commencing. The files also held training certificates which showed that the home recognises the importance of providing an induction to new starters and having a well trained workforce. People living in the home told us in surveys that staff always treated them well and listened and acted on what they said. Staff told us when we spoke with them and in the surveys they completed that they felt Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: they had the right amount of training offered to them and that the induction they received when they started working at the home covered everything they needed to know. One member of staff told us in a survey, There is lots of training and another said, All the staff care a lot about the service users Staff spoke with on the day of the inspection showed a good understanding of the needs of the people they support. The staff have all recently attended training on the Mental Capacity Act 2005 and the manager and provider are going to be attending on the Deprivation of Liberty Safeguards in the new year and this will be cascaded to all support staff. Care Homes for Adults (18-65 years) Page 28 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people living there. Evidence: The manager states in the Annual Quality assurance Assessment (AQAA) that the home is well run and everyone is valued as part of the team. The manager has the registered manager’s award and training is offered to all staff as well as the management team. A self monitoring document is done every 4-6 months and health and safety checks are done weekly. Service users are encouraged to give feedback about the running of the home. The Orchard de-registered with the Commission and then re-registered as they became a limited company. However, because they have shown us that they consistently provide excellent outcomes for people living in the home they are able to retain their three star, excellent rating. Surveys received back from members of staff told us that the manager regularly met with them to give them support and discuss how they are working. Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: One member of staff told us, The home is not only supportive to service user’s needs and preferences but are also supportive to all members of staff. I feel I am able to speak with the manager at any time if I need to. We viewed two staff files and these contained records that showed that regular formal supervision was taking place. The manager has been working at the home for three years and has a recognised qualification. The provider of the home also works within the home on a daily basis and assists the manager to oversee the running of the home. The provider works well with the manager and the team of staff and constantly strives to make more improvements to the home in order to give people living there high quality person centred care. The home has a quality assurance monitoring system which includes the views of people living in the home and staff supporting them. The provider has a commitment to health and safety with systems and training in place to support this. The fire systems within the home are very comprehensive, the systems continually maintained and staff are trained in fire precautions and evacuation. One relative told us. The manager at The orchard always goes the extra mile to help people in her charge. Care Homes for Adults (18-65 years) Page 30 of 33 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 31 of 33 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 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 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) 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 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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