Inspection on 05/02/10 for Thorndene

This is the latest available inspection report for this service, carried out on 5th February 2010.

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

Thorndene 10/05/05

Thorndene 04/01/05

Thorndene 07/09/04

Thorndene 08/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Thorndene Canterbury Road Swingfield Dover Kent CT15 7HZ     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: Kim Rogers     Date: 0 5 0 2 2 0 1 0 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 27 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 27 Information about the care home Name of care home: Address: Thorndene Canterbury Road Swingfield Dover Kent CT15 7HZ 01303892244 01303894553 thorndene@talk21.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Thorndene Ltd care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 22. The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Physical disability (PD). Date of last inspection Brief description of the care home Thorndene is a care home for up to twenty two people with a learning disability. It is situated in a rural position in village of Swingfield, near Hawkinge, Kent. Thorndene is a not-for-profit organisation. Its philosophy is to encourage each resident to maximise his or her potential within a safe and supportive environment. Respect and understanding for individual strengths and needs are seen as paramount. 22 22 Over 65 0 0 Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home The home offers spacious accommodation. It is a large country house, arranged in small homely groups, with a separate, smaller house in the grounds providing accomodation and support for five people. The annex is designed to promote increased independence. There are extensive and well-maintained grounds. The home is very well maintained. It is beautifully decorated and furnished. Local shops are close by both in the village and nearby Hawkinge. There is easy access by road and public transport to the larger towns of Dover, Canterbury and Folkestone. The registered manger, Mrs Pat Moore, ensures that there is a person-centred approach. There is a wide range of cultural, educational and recreational activities. The weekly fees range from about £495 to £818 per week. Additional charges are made for those residents who have a high level of dependency and require one to one support. For more information please contact the Provider. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home 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 was a key inspection of the service and included an unannounced site visit by one inspector. We went to the home on a Friday morning, 05/02/10, and spent about four hours talking to service users, the manager and staff and observing what was going on. We sampled records and had a look around the home. Some people showed us their bedrooms. There was a very relaxed atmosphere with people choosing how to spend their day. All of the key minimum standards were assessed. The previous key inspection was carried on 02/02/07. This inspection was very positive with no requirements for improvement made. We have carried out an Annual Service Review since the last inspection. This is how we monitor services. The home is rated as excellent and we found that the home continues to provide an excellent service. We looked at the Annual Quality Assurance Assessment or AQAA that the manager Care Homes for Adults (18-65 years) Page 6 of 27 completed. This is very well completed and gives detailed information about what the home does well, what could be better and how they intend to improve. We looked at other information we have received about the home including any concerns, complaints and notifications about incidents or accidents. Care Homes for Adults (18-65 years) Page 7 of 27 What the care home does well: What has improved since the last inspection? The AQAA shows that there are lots of plans to improve the service for people. Improvements to some bathrooms and shower rooms are planned to ensure the facilities continue to peoples needs as they get older. There are new laundry facilities, new pathways outside and a plan to build a three bedded house in the grounds some time in the future. Care Homes for Adults (18-65 years) Page 8 of 27 The range of activities on offer has been extended. Individual activities and hobbies are supported and they have introduced individual person centred activity planners. They plan to develop a residents charter with full involvement of everyone. As well as an activity coordinator there is an independent living skills instructor teaching people new skills and developing existing skills. There is also a new staff development officer who organises training for staff. 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 9 of 27 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 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, 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. Thorough assessments are carried out before a person moves in to make sure the home is right for them. People have information to help them decide about moving in and any move into the home is planned at the persons own pace. Evidence: Thorough detailed assessments are carried out before a person moves in. This is done to make sure that the staff have the skills needed to meet peoples needs and aspirations. Prospective service users are fully involved in this process. Moves into the home are planned at the persons pace. So trial stays and visits are offered with full involvement of the person and their family and friends. This means that people have the opportunity to get to know current residents and staff before they decide about moving in. To help people decide, there is information available in different formats. One person, who has moved in recently said the like their room and that they have made friends. They said they like living at Thorndene. Another service user said they Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: had enough information about the service before they moved in. Care Homes for Adults (18-65 years) Page 12 of 27 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. People have the support they need to lead the lives they want. People know that their needs including any risks will be supported. There are systems in place to support communication. Evidence: Each person has a service user plan that they have been involved in developing. This is called, My Plan. The plan sets out peoples needs and personal goals for the future. It shows what staff need to do to give the right support. There are records showing that people have had the support they need to achieve their goals. Plans are person centred in that the things people want out of life are identified, recorded and supported. People told us that staff give them the support they need. As part of the My Plan, any potential risks are identified and assessed. This means that staff have the information they need to reduce and where possible eliminate risks to people without restricting them. Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: Detail about how people prefer to communicate is recorded. We observed staff communicating effectively with people. The manager said that staff know people well so they can usually tell if someone is not happy about something. There are systems in place to support communication, for example the cook has some photographs of different meals so she can show people what is on the menu when they ask. The cook said they will consider putting the meal choices on display so people can see for themselves rather than having to ask. One person showed us their activity planner which is produced in a way that is meaningful to the person. Staff said, The home looks after the needs of everyone, residents and staff. Another staff said, In the home, people come first and Thorndene has an amazing positive attitude which is set to improve, fulfil and enhance every individuals life. Service users said that they have the support they need. Care Homes for Adults (18-65 years) Page 14 of 27 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. Peoples individual hobbies and interests are supported. There are a wide range of activities on offer at home and in the community. Relationships are maintained with family and friends. People enjoy a balanced healthy diet and are involved in planning and preparing meals. Evidence: People have support to take part in a wide range of activities when at home or out in the community. People showed us their activity plans which are produced in a user friendly way so people know what they are doing from day to day. Each person also has a person centred activity folder that has peoples individual interests, hobbies and aspirations recorded. There are clear plans in place for staff to follow to ensure that people get the support they need. There is also a comprehensive shift plan which shows staff what is expected of them while they on duty. This gives clear direction to staff and maximises staff deployment to increase opportunities for service users. Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: Some people go to college, day services and other community based activities. There are four vehicles for staff to use to help access activities and interests. There is an on site day centre which is run by the activity coordinator so there are lots of activities available when people are at home. People told us they lead busy lives. The manager said that staff are able to support individual interests and hobbies due to high staffing levels and funding from the provider company which is a not for profit organisation. People told us about their interests including discos, church and film clubs that they have support to attend. One person told us that they can choose how they spend their days, evenings and weekends. Individual holidays are supported. A person is employed as an independent living skills teacher to support people to develop and increase their skills. Everyone has support to be involved in the running of the home. People have a house day each week when they have support to take part in things like the household chores and the laundry. They have made adaptations to ensure this inclusion continues. For example there are plans to open up a bigger area of the kitchen to encourage more participation. People told us they like cooking and everyone is involved in planning the menu, doing the food shopping and cooking. Special diets are catered for and people have the support they need to maintain a healthy weight. Most of the residents have known each other for a long time. People told us they have friends at Thorndene. There are close links with family and friends with regular events held so that everyone gets together. Trips to stay with family and friends are supported by staff. One person told us about their birthday celebrations when they had a big party. People have support to keep in touch with family and friends by phone, letter and e mail. The manager said, it is very important to us that people have contact with their family so we arrange transport for them. One staff told us, There are plenty of activities off site and a well run interactive positive day centre on site. Another staff said, Thorndene has an amazing positive attitude which is set to improve, fulfil and enhance each and every individuals lives. Another staff said, As a member of staff it has always been a pleasure to work with residents, their families and my colleagues. Care Homes for Adults (18-65 years) Page 16 of 27 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. People know that their personal and health needs will be met by competent and knowledgeable staff. Medication practice is safe protecting service users. Evidence: The support people need with their personal care is recorded so that staff know how people prefer to be supported. Service users are able to have a say about who supports them. People were dressed in clean and ironed clothes and everyone has their own style. Most of the bedrooms have en suite facilities and others have bathrooms close by. The manager said there are plans to improve some bathrooms so that peoples changing needs are supported as they get older. We observed people being supported by staff discreetly and respectfully. The manager and staff have good knowledge of peoples health needs and work closely with health professionals to ensure that people remain well and healthy. The deputy manager said they have a very good relationship with the local GP practice, she said they are brilliant and the practice nurses are very good. Staff have training in areas related to peoples health needs including epilepsy. Health needs are assessed and recorded using recognised tools like the OK health check and My health booklet. This Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: means that staff have the information they need to understand and support the wide ranging health needs that people have. We looked at some aspects of medication practice with the named person who has responsibility for medication. Medication is centralised with one person having time set aside to ensure that medication practice is safe. There are regular checks and audits to ensure practice remains safe. Storage is tidy and secure with systems in place to keep the keys to the medication secure. Records are in order with no gaps or mistakes. Staff said that if people want to they can take control of their medication with the right support. This would follow a process of assessment and skills development. Staff have training and in house assessments before they can administer medication. Care Homes for Adults (18-65 years) Page 18 of 27 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. There is a user friendly complaints procedure. People are protected from harm and abuse and know who to talk to if they have a problem. Evidence: There is a complaints procedure. This is produced in a user friendly format so that more people can use it. Staff have training in how to communicate with service users so they can find out if there is something wrong. Staff also know service users well so they can tell if there is a problem. Staff meet with service users individually on a monthly basis giving opportunity for people to raise any concerns. Neither the home nor the Commission have received a complaint since the last inspection. A service user told us that if they were not happy about something they would talk to their key worker or to the manager and they would sort it out for them. There is a safeguarding policy and procedure that shows how they protect people from harm and abuse. Staff have training so they know how to recognise and respond to possible abuse. There are systems in place to protect peoples money. Care Homes for Adults (18-65 years) Page 19 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, 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. The home is clean and well maintained and continues to suit peoples needs. Evidence: The manager and deputy manager showed us around parts of the home. Some service users showed us their rooms. People said they are happy with their rooms. Although the home is registered for 22, people live in smaller groups. Five people live in a detached house in the grounds and in the main house there is natural divide between two groups of people. This means that people have the opportunity to socialise and be together and they also have the opportunity to spend time with less people or be on their own. There are plenty of communal spaces where people can relax. These areas are homely with photographs of residents on outings and holidays. There is access to the garden which has seating and a patio area and has new pathways. All parts of the home are clean and smell fresh with good quality furniture and fittings that meet peoples needs. Most of the bedrooms have en suite facilities or have a bathroom and toilet close by. Bedrooms are all individual as they are all personalised. Since the last inspection the laundry has been improved. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, 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. There are enough trained and competent staff to meet peoples needs and support their goals. Recruitment checks are robust protecting service users. Evidence: Staffing at the home is organised around peoples needs. There is a very clear and comprehensive shift plan used so staff can see who they will be supporting and what they will be doing. This means that the staff time is maximised for the benefit of service users. There is also a clear record on the shift plan of what one to one support is provided and how this is used. The deputy manager said, staff like the shift plan, they can see what they are doing and we get the skill mix of staff right. They have introduced a minimum staffing level to ensure that there are always enough staff to meet peoples needs. There is a staff development officer who organises training for staff. Mandatory training including first aid and fire awareness is provided for all staff as well as training related to peoples needs including Autism and epilepsy. There is a sound induction with a focus on learning disabilities for new staff that gives them some underpinning knowledge of peoples needs. Staff have the opportunity to attend regular staff meetings and one to one meetings with a line manager. This means that staff have the opportunity for some support, coaching and mentoring. There are handovers Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: between shifts so staff know what has been happening. Most of the staff have worked at the home for several years and know service users well. Staff spoke to us with knowledge and understanding of peoples needs. We observed respectful and positive interactions between staff and service users. Recruitment checks are carried out before anyone starts work at the home. This ensures that people are safe to work with vulnerable adults. The manager said they have older and younger staff so they have a good balance and range of skills available. Staff said, Thorndene has always encouraged staff training and development. We received four surveys back from staff. They all said they have the training and support they need. Care Homes for Adults (18-65 years) Page 22 of 27 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 very well managed and is managed in service users best interests. People know that their health and safety is protected. Evidence: The same manager is in post as at the last inspection. The manager has been at the home for fifteen years and has the qualifications and experience necessary. This means that the manager knows the service and the service users well. The manager spoke to us in detail and with understanding about peoples needs. The manager is registered with us so she has passed our fit person process. Staff and service users said the manager is a good manager. Staff said the manager has plans to improve the service. The manager completed the AQAA, Annual Quality Assurance Assessment. This is very well completed with lots of detail. The AQAA shows that issues relating to equality and diversity are understood and supported. The manager has lots of ideas about improving the service and has identified barriers to improvement in the AQAA. The manager has creative ideas about overcoming these barriers ensuring the home continues to improve. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: There are systems in place to check the quality of the service and monitor practice. Service users views are sought and changes made based on their views. People have the opportunity to have one to one meetings with their key worker and meetings together so they can talk about how things are and staff know if they then need to make any changes. Families and friends are involved in giving feedback and airing their views about the service. Changes have been made based on peoples views including the installation of satellite television for three people, the purchase of a Wii games system and basketball hoops. The AQAA shows that the required health and safety checks are carried out on the building and equipment. Staff have training in areas related to health and safety including first aid, food safety and fire awareness. There is a staff development officer who plans and books courses so that everyone is always up to date. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 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 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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