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Inspection on 12/03/09 for 149 Ash Street

Also see our care home review for 149 Ash Street for more information

This inspection was carried out on 12th March 2009.

CSCI found this care home to be providing an Adequate 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 149 Ash Street Ash Near Aldershot Surrey GU12 6LT     The quality rating for this care home is:   one star adequate 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: Kenneth Dunn     Date: 1 2 0 3 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. 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. 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. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI 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 29 Information about the care home Name of care home: Address: 149 Ash Street Ash Near Aldershot Surrey GU12 6LT 01252330529 Telephone number: Fax number: Email address: Provider web address: jill.woolley@new-dimensions.org.uk www.new-support.org.uk Name of registered provider(s): Type of registration: Number of places registered: Dimension (NSO) Ltd care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 5. 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). Date of last inspection Brief description of the care home The home is registered with the Commission for Social Care Inspection to provide accommodation and care to five service users with a learning disability. The home is located in a residential area close to public amenities and other facilities. Accommodation is on two floors accessed by stairs and comprises of an office, two lounges, dining room, breakfast area, bathrooms, toilets, laundry facilities and five single bedrooms. Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 5 Brief description of the care home The home has a garden which is secure and accessible with private parking available. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home 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: The Commission has, since the 1st of April 2006, developed the way it undertakes its inspection of care services. The inspection of this Care Home for Younger People was an unannounced Key Inspection. Regulation Inspectors Mr Kenneth Dunn undertook the site visit. The inspector looked at how well the service is doing in respect to the National Minimum Standards for Care Home for Younger Adults. The site visit took into account detailed information provided by the registered provider and the manager, and any information that Commission for Social Care Inspection has received about the service since the last inspection. Documents sampled during the inspection included the home policies and procedures and certificates from professional organizations or contractors. Care Homes for Adults (18-65 years) Page 6 of 29 The service has submitted the Annual Quality Assurance Assessment prior to the inspection, some details of which have been added to the report. In addition the CSCI has received information about the service in the form of staff surveys and comments made on behalf of one resident by their next of kin. The inspector would like to thank the registered provider and manager for their time, assistance and hospitality during this inspection. The fee for this service are 1,196.00 to 1,214.00 pounds sterling per week. The quality rating for this service is one star. This means the people who use this service experience an adequate quality outcomes. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 29 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 29 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 29 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. The residents and provided with a wide range of information, which meets their needs. The assessment process is robust and well developed. Evidence: A review of the statement of purpose and service users guide was undertaken as part of this site visit. The review demonstrated that there is a range of detailed information available to the residents to allow them or their representatives to make an informed decision on whether the service is able to meet their specific needs. The service has not admitted any new residents since the previous inspection visit by the CSCI (14/03/2007). The most recent person to move into the home was over 5 years ago and a full assessment was completed before this individual was offered a place at 149 Ash Street. A review of the admissions policy indicated that a full assessment of needs would be carried out on any potential future residents prior to them being offered a place at 149 Ash Street. Care Homes for Adults (18-65 years) Page 11 of 29 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. The residents are provided with an individual care plan, which records their individual needs and goals. They are supported to make decisions about their lives with appropriate assistance. Individuals are supported by staff. Evidence: The home has developed a series of detailed care and health action plans. The plans are reviewed regularly. A member of staff stated that the residents are supported where ever possible to participate in the reviewing process of their own care plans. A random review of two care plans provided evidence that the reviews are undertaken within the time frames given. Individual needs and personal goals of residents were recorded and these have been developed using the residents previous likes and dislikes. The service also consults with families and other stake holders/professionals. The random sample of the residents files provided evidence that they are supported by the staff team to make Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: appropriate decisions about their lives. A member of staff stated that the support offered is to promote some form of individual independence no matter how small. However the random review highlighted the lack of systems in place at the home for the retention of information within the care files of individuals. The files reviewed contained all the relevant information required to successfully care for the individual but there was no format and information was haphazardly stored and retained within the files. The net result is very cumbersome and difficult files to use and to extract information from. The home has developed a series of multiple risk assessments to enable the residents participate in as active and as independent a lifestyle as possible. Care Homes for Adults (18-65 years) Page 13 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are able to exercise choice in their daily lives. Staff assist the residents to maintain and develop bonds with family and friends, and take part in social, cultural, religious and recreational activities. The meals provide are healthy, balanced and highly individual. Evidence: The lifestyle expectations of the residents of 149 Ash Street are good. The staff working in conjunction with individuals living at the home have developed a series of individualized activities, that are age, peer and culturally appropriate for the residents. A review of individual activity plans provided evidence of appropriate and engaging activities being offered to the residents for example art, drama, swimming and day centers. The residents have a very flexible system in place for meals, they are supported by Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: staff to ensure that the meals offered are healthy and balance. At the time of this site visit only one resident had spacial dietary requirements, the manager of the service stated that this is maintained by staff monitoring the individuals meals and by using a spacial diet. Care Homes for Adults (18-65 years) Page 15 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has consistent recording and documentation to evidence that the people who use the service, health care, wellbeing and welfare are supported. The homes medication procedures are robust and should ensure the safety of the people living in the home. Evidence: The care plans demonstrated that the personal support needs were well documented and had been agreed with the resident, families and health care professionals. A member of staff stated that the time for getting up and going to bed in the home is flexible. On the day of the site visit two residents were having an at home day and took advantage to sleep in and got up when they wanted to. However when the inspector gained access to the home one resident was clearly visible from the front door lying in bed with the bedroom door wide open possibly compromising the persons dignity. A review of individual care plan indicated that all residents are registered with a local general practitioner (GP). Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: It was documented that the people who use the service have access to dentists, chiropodists and opticians. A member of staff stated that because of the length of time the residents have been living at 149 Ash Street there is a good rapport in the home and that good observation of the residents helps in the quick identification of the changing needs of the individuals, this enables us to request specialist in-put for their assessments. The homes Medication administration practices were examined. Protocols were in place for the residents receiving As required medication. All medication is stored in a locked cupboard and there is documentation to indicate that the medication is reviewed and audited regularly. However during the site visit a medication audit was undertaken it was apparent that the records did not accurately reflect the quantities of medication stored by the home. The audit highlighted a large amount of controlled medications (56 Lorazepam) was being held by the home but they were not recorded in the controlled drugs book or the MAR sheets. This was discussed with the homes manager and a requirement was made at the time of the site visit. Care Homes for Adults (18-65 years) Page 17 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service should benefit from a robust set of policies and procedures designed to protect and safeguard them from abuse. Evidence: The complaint procedure had been produced in a pictorial format. Records sampled provided evidence that two complaints have been made since the last inspection, both complaints had been made by people living around the home. The manager of the home stated that both complaints had been effectively handled using the home policies and procedures and were completed to the satisfaction of the parties involved. The Commission for Social Care Inspection had been informed of these issue in the form of regulation 37 notifications. There is a clearly written safeguarding adults procedure and a copy of the local authority safeguarding adults from abuse policy was available. The contact details for the local authority Social Care Team was also displayed. One safeguarding meeting had been held in respect to an incident at the home which required a review of policies and procedures and the introduction of specific guidance for supporting one resident. The AQAA provide evidence that all members of staff have undertaken safeguarding training, this was reaffirmed on the day of the site visit by a member of staff. This was also corroborated during the by a random review of staff training records. Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: On the day of the site visit the CSCI inspector was able to gain access to the property without being challenged, as the main front and porch doors were unlocked and the member of staff on duty was not on the ground floor. The situation was further compounded by the service displaying a full and detailed plan of the building with the names of individuals and the locations of there bedrooms clearly visible. The inspector could also see one resident still in bed as all the doors were left open. The manager stated that there had been a mix up with keys and the member of staff on duty was left with a set that did not had the correct chubb key for the front door. The manager stated that as a result the member of staff on duty could not lock the front door. In light of this a requirement was issued to review the security of the home and to introduce protocols for the safe storage and handling of keys. Care Homes for Adults (18-65 years) Page 19 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The layout of the home should enable the people who use the service to live in a safe environment. The home could benefit from intensive cleaning and more emphasis on environmental hygiene. Evidence: A full tour of the building was undertaken as part of the site visit. The home is a large converted older property, which has been adapted in an effort to meet the needs of the people who live there. The home has a series of communal areas breakfast area, dining/sitting room, an open area and one small sitting room which is used solely by one resident. In all areas the decor, furnishings and cleanliness was only adequate. The walls in the small sitting room were heavily stained with food and other marks and the furniture was old stained and inappropriate for the person using the room. The furnishings throughout the communal rooms was of an assortment of mismatched and inappropriate items. The dining set had tree different styles of chairs the table was scratched and marked, the two couches and the easy chair in this area were mismatched and on the day of the site visit appeared to be in a poor state of repair. The carpets throughout the home were heavily stained and in areas of high use they had blistered and lifted from Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: the floor. The bathrooms were cold and institutional. The kitchen and the appliances had a film of grease over worktops, drawer fronts, doors and appliances. One bedroom entered during the site visit had a very strong mal odours. The home in general would benefit from a deep clean and a reappraisal of the furnishings and fittings throughout. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff group appeared skilled and in sufficient numbers to provide 24-hour care within the home. The systems for recruitment and training are designed to be robust and should protect the people who use the service. Staff file do not comply with current legislation. Evidence: The completed AQAA stated that all staff currently working at the home have undertaken a full induction program. The inspector was provided with copies of duty rotas, which indicated that adequate staffing levels are maintained in the service. The service had at the time of the site visit two full time and one part time vacancies. The manager of the home stated that wherever possible the home would fill the vacant shift with known agency workers to maintain a good level of continuity and consistency. The organization has a robust set of recruitment policies and procedures. The policies require potential staff members producing all the relevant documents as detailed in Schedule 2 of The Care Homes Regulations 2001 are requested prior to starting in the service. A requirement was made in the previous inspection report 14/03/2007 to Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: ensure that all the required information regarding persons employed be kept on file. A random review of four staff files highlighted that there is still gaps in the files including references, employment and education histories, application forms and photographs. Therefore the requirement made on the 14 of March 2007 remains unmet. The AQAA states that all staff has had a criminal record bureau (CRB) check and Protection of Vulnerable Adult (POVA) check prior to starting work in the home. Care Homes for Adults (18-65 years) Page 23 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service should benefit from home that is well run. There are procedures in place to self-monitor the services being offered. The health, safety and welfare of individual within the home are promoted and there are appropriate risk assessments in place. Evidence: At the time of the CSCI visit the home did not have a registered manager. The organization had appointed a manager, who stated that he has made an application to the CSCI to be registered as the manager pf 149 Ash Street. A member of staff stated that the manager provides management stability, leadership and direction to the staff team. Further evidence reviewed during the site visit confirmed the home had a management structure with clear lines of communication and accountability and during discussions a member of staff stated the manager is making changes for the better. The service has not conducted a quality assurance questionnaires since the previous Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: inspection report (14/03/2007). The main source of feed back used by the home is verbal feedback and home meetings. The views of other stakeholders and family members of the residents have not been solicited to gage the effectiveness of the service. The minutes provided evidence that the residents views are considered during these meetings. Further evidence indicated the provider carried out regular Regulation 26 (monitoring visits). The regulation 26 reports were available for inspection during this site visit. The reports highlighted some areas of good practices and areas for improvement. The home had a policy on health and safety and staff stated that they have received training in health and safety, fire safety, basic food hygiene and first aid. However on the day of the site visit the safety of the residents could have been compromised by the ineffective security measures in place, which allowed the inspector to walk into the home without being challenged. In addition the availability of a detailed plan of the building with individual bedrooms highlighted could also pose a potential risk the the residents. The manager was able to explain what had happened on the morning of the site visit in respect of the doors not being locked and felt that by adding an additional snib lock this potential risk would be minimized. In respect of the detailed plan the manager stated that it would be made anonymous and placed in the correct fire safety folder with immediate effect. The AQAA stated that the home has a current gas safety certificate and service inspection reports for fire equipment, small portable appliances and emergency lighting. The home had information about health and safety displayed in the home and a policy on COSHH (Control of Substances Hazardous to Health) to promote safety. However the COSHH store in the laundry was left unlocked and was only secured after it was discussed with member of staff. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes R 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 1 34 7,9,19 Schedule 2 The registered person must 01/05/2007 ensure that the home has all the required information regarding persons employed including a recent photograph to safeguard the welfare of service users. Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 The registered provider must ensure that regular medications audits are completed and all medication coming into the home must be fully documented and stored in the correct location. To ensure that the people who use the service are safeguarded from poor medication recording and storage. 09/04/2009 2 23 37 The registered provider 10/04/2009 must review the security of the home, ensuring the correct protocols are in place for the safe storage and handling of keys. To ensure that the residents are safeguarded from abuse or harm. 3 24 16 The registered provider must ensure that item for the use of the residents of 09/04/2009 Care Homes for Adults (18-65 years) Page 27 of 29 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 149 Ash Street are fit for purpose and meet their individual and collective needs. To met the health safety and comfort of the residents. 4 30 23 The registered provider 09/04/2009 must ensure that the home is kept clean and hygienic at all times. To met the health and safety needs of the residents. 5 39 24 The registered provider 30/04/2009 must ensure that an annual quality assurance open to all stakeholders undertaken by the service. To ensure that the quality of service is effectively meeting the needs of the residents and other stakeholders. 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 6 It is recommended that the registered provider reviews the current storage of information within the care files of the residents and introduces one uniformed format to allow ease of access to the information. Care Homes for Adults (18-65 years) Page 28 of 29 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 29 of 29 - 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!