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Inspection on 08/10/08 for 182 Bromham Road

Also see our care home review for 182 Bromham Road for more information

This inspection was carried out on 8th October 2008.

CSCI found this care home to be providing an Good 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: 182 Bromham Road 182 Bromham Road Bedford Bedfordshire MK40 4BP     The quality rating for this care home is:   two star good 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: Neil Fernando     Date: 0 8 1 0 2 0 0 8 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. the things that people have said are important to them: They reflect 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 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: 182 Bromham Road 182 Bromham Road Bedford Bedfordshire MK40 4BP 01234357238 F/T01234357238 noemailasat02.07.07 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Lansdowne Care Services Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: Date of last inspection Brief description of the care home 182 Bromham Road is a large Victorian House situated on the west side of Bedford. It was registered in 1996 to provide residential care for 6 adults with learning disabilities. The home currently has 5 people using the service. There are six single bedrooms on two floors and toilet and bathing facilities on both floors. The communal space, comprising of a lounge, dining room and activity room are on the ground floor as is the domestic style kitchen and utility room. There is a spacious garden to the rear. The home is conveniently situated for access to Bedford with all its amenities and bus and rail services. Weekly fees for accommodation were between £928.91 and £1228.52. this did not cover the cost for toiletries, holidays and personal items. 6 6 Over 65 0 0 Care Homes for Adults (18-65 years) Page 4 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. We, the Commission for Social Care Inspection, undertook this unannounced key inspection on 8 October 2008. We spoke with three residents, the manager and 3 staff members including the deputy manager. We spent a significant amount of time discretely observing residents and staff care practices. We had a look round the accommodation and viewed a range of records the home must keep. At the time of the visit, there were six residents accommodated with no vacancies. The AQAA (Annual Quality Assurance Assessment - a document, which gives the Care Homes for Adults (18-65 years) Page 5 of 28 manager the opportunity to tell us how well outcomes are being met for people living in the home) has been sent to the manager but we have not received this as yet. Any information received would be dealt with as appropriate. We have received surveys from four residents and four staff members. The senior operational manager was present for a few hours; the manager and deputy manager were present throughout the inspection. The last inspection was carried out on 4 October 2007. What the care home does well: What has improved since the last inspection? Six requirements were made in the previous inspection report dated 4 October 2007. These have been addressed, which has resulted in an improved quality of service and safety for residents. Arrangements are now in place to ensure that any residents with challenging behaviour have ongoing assessments, and their needs along with the other residents are met satisfactorily. A new system has been introduced, in order to ensure that staff members sign the Medication Administration Record charts, for any medicines administered to residents. This practice promotes a greater level of accountability and more importantly, safety for residents. Lockable facilities are now available in residents bedrooms, as appropriate. Appropriate device has been fitted to fire doors to ensure they shut automatically when the fire alarm is triggered. This promotes a higher degree of health and safety in the case of a fire. Effective quality assurance systems are now in place that seeks to monitor the views of residents and significant others. The outcome is analysed and corrective action taken if Care Homes for Adults (18-65 years) Page 7 of 28 any. Detailed personnel records are being maintained including the written application form for employment and proof of identity, in order to reflect the requirements of the Care Homes Regulations. 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. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Key inspection 8/10/08 The pre-admission assessment process and the good level of information available to the prospective resident and their representative, enable them to decide if the home is suitable to their needs. Evidence: Key inspection 8/10/08 The home receives detailed assessment information from the placing authority and a copy of the care plan, where appropriate. The manager, deputy manager and other staff members carry out a needs assessment using the homes own assessment form. Reports are received from other health care professionals, where required, including speech & language therapists and psychologists. There has been one recent admission to the home. Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: Prospective residents and their representatives are encouraged to visit the home as part of the assessment process, in order to ensure that the residents needs can be fully assessed and at the same time, if the services offered are suitable to their needs. Records examined indicate that a resident who has recently moved to the home had visited on five occasions, as part of the pre-admission process; a copy of the service user guide and an information pack was also given to the resident and their representative. The resident and two staff members spoken with confirmed this to be the case. There have been no significant changes to the assessment process since the last inspection on 4 October 2007. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Key inspection 8/10/08 The care planning process is good; this ensures that the identified needs and choices of individual resident are appropriately met. Evidence: Key inspection 8/10/08 The care plans for three residents were seen and these demonstrate that the staff team are proactive in addressing the residents identified needs. There is evidence that areas which need further clarification and guidelines are written in plain English and staff members spoken to were very knowledgeable about the changing needs of the people using the service. The manager and all care staff spoke of one resident who had displayed behavioral difficulties over a period of time. Records of this particular resident show that appropriate actions had been taken to address their behavioral Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: difficulties. These records include meetings assessments, monthly reports, doctors notes, behavior charts, analysis of behavior ratings, professional meetings, risk assessments and several guidelines recorded in the care plan documentation. The manager spoke at length of the various measures staff had implemented to ensure all residents received the best care. The care plans are updated as and when needed. These are always detailed documents including information on what they can do for themselves, as well as where support is needed and how, said one staff in their survey. The staff team carry out various risk assessments and could evidence the opportunities given to all residents to access the community and participate in various activities within the home. One staff member described how a resident communicated his needs and how the home accommodated the request. Where a resident refuses or change their mind to undertake a task, other opportunities are available to them. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Key inspection 8/10/08 A high level of social and recreational activities are available to suit the needs of individual residents; this ensures a good level of stimulation whilst maintaining their independence and interest. Evidence: Key inspection 8/10/08 Induction training for staff and recruitment policy encourages equality and diversity. Residents are encouraged and they are able to practice their religion, sexual preference and their culture, as appropriate. All residents are treated equally, whilst recognising the diversity and difference of individual residents. Recruitment practice Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: (interview questions) equally places emphasis on equality and diversity and anti discrimination. Residents participate in their own choice of social and recreational activities, either individually or in groups. The activities that each person takes part in are reflected in their care plans. Residents are involved in various daily activities such as the laundry, meal preparation, washing up after meal times, food shopping and their own shopping as well. One resident said, I do my own cooking with help from staff. Alterations to the plan occur only when the resident decides that they do not wish to pursue a certain activity; this shows that staff respect the wishes and feelings of residents. There have been a high level of organised social and recreational activities taking place, which have been chosen by the residents. The staff spoken with described a range of services and facilities residents are able to access. All six residents also attend day care facilities between four and five days weekly. The home has its own vehicle, which is helpful to access a high level of activities in the community. Menus are planned weekly with staff assistance; a well-balanced, nutritious diet is available to the residents. Menus take into account taste, preferences, culture and dietary requirements of each person. Mealtimes are very much a social occasion and residents are encouraged to eat at the table together with staff members. A suitable dining room is available. Records examined show that residents are supported to maintain contact with their families and friends. Staff members spoken with were clear that residents bedrooms are their own private space and Staff members would normally not enter anyones room in their absence, reported one staff member. Residents rooms were viewed and these were noted to be neat and tidy Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Key inspection 8/10/08 Residents receive appropriate health and personal care; this is indicative that their identified personal and health care needs are being met satisfactorily. Evidence: Key inspection 8/10/08 All service users are treated with dignity and their privacy is respected. Personal support is provided in private and sensitively. Mealtimes are flexible and residents get up at different times and choose when to go to bed,to suit their needs. Staff assistance and supervision is available to meet their physical needs; evidence however indicates that residents are being actively encouraged to help themselves as much as possible. Residents choose and buy their own clothes with staff support as required. Care plans viewed for three residents demonstrate that their emotional health care needs are being identified and addressed in a holistic manner. Residents are registered Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: with a GP from a local group practice. A variety of health care specialists are also available when required including psychiatrist, psychologist, speech and occupational therapists, as well as dentist and optician. Health care support offered is well documented in the daily records of relevant occurrences. There have been no further significant changes to the health care arrangements in the home since the last inspection in October 2007. The policy and procedure on medication is available and accessible to all staff members. A comprehensive and safe way of storing, administering and returning unused medication is in place. All staff receive training in the administration of medication and only when deemed confident and competent, are allowed to administer medicines. Staff have also received specific training in the administration of rectal diazepam and epilepsy. The medication administration records (MAR) charts were viewed for all six residents and these were noted to be in order. Evidence shows that the residents receive their medicines on time. Medication is stored in a locked cabinet located in the staff office. Regular checks are carried out as part of the quality assurance systems, in order to ensure that medication is being administered safely. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Key inspection 8/10/08 The home has complaints and adult protection procedures in place; this ensure that residents have their complaints or concerns listened to and acted upon properly. Evidence: Key inspection 8/10/08 The home has a complaints procedure to ensure that any concerns are dealt with and actioned as appropriate. The home has not received any complaints since the last inspection in October 2007. The Commission has also not received any complaints regarding any aspect of this service. Staff spoken with said that given the learning disability of the current residents, it is more appropriate to frequently discuss and informed the residents about the complaints procedure and how to raise any concerns they may have. The service follows the individual rights of service users well indicates a staff member in their survey. Three of the four surveys completed by residents also show that they know who to speak to if they are not happy. The home has policy and procedure regarding safeguarding of vulnerable adults. Discussions with members of staff clearly evidence that they will have no hesitation in reporting any incidents of abuse or neglect to the manager or a senior staff member Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: on shift. Staff have not received training in adult protection; however good evidence is available to indicate that arrangements were in hand for all members to receive this training on 25 November 2008. Records examined show that there have been six incidents involving one resident regarding anti-social behavior towards other residents. These matters have been reported to the local adult protection team but no action has been taken given the nature of the incidents. It was noted during the inspection that care staff spoke to residents in a friendly, social and respectful manner, at all times. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Key inspection 8/10/08 The people living in the home are provided with a safe and comfortable environment that is suitable in meeting their needs. Evidence: Key inspection 8/10/08 The home is well presented and free from unpleasant odours. The standard of cleanliness was high. An ongoing programme of maintenance ensures that the home remains in a good decorative condition and repairs are carried out in a timely manner. Bathroom and toilet facilities are adequate to meet the needs of the residents. People living at 182 Bromham Road and staff members spoken with said that the accommodation provided is of a good standard, homely and meet the residents needs. Residents are encouraged to personalise their bedrooms with additional furniture, television, photographs and other personal effects. This was evidenced in bedrooms viewed during a tour of the premises. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: Systems are in place to monitor equipment and the environment as a whole, in order to ensure a safe place for residents to live in and staff to work. Similarly, risk assessments for safe working practice within the building were also in place. There were no health and safety hazards noted. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Key inspection 8/10/08 The homes recruitment procedure and care and staff management systems are adequately robust; this ensures the safety of residents from harm. Evidence: Key inspection 8/10/08 There is a minimum of two care staff members on duty on each day shift; there is one waking and one sleeping in staff available each night. On the day of inspection there were four staff members including the manager on day duty. A member of the management team is available for guidance and support, in the absence of the manager. The day and night staff arrangements are adequate to meet the needs of the current resident group. The home has a stable staff team that are experienced and knowledgeable about the needs of people accommodated. The home operates a key worker system and staff spoken to, spoke passionately about the care they provide to the people using the service. Of the current nine care staff, four have achieved their NVQ level 2 or above Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: in care and one member is expecting to complete the same course in November this year. The manager also maintained a training profile for each staff that details mandatory training and other specific courses undertaken. Surveys from all four staff members show that they are very satisfied in the manner their traning needs are being addressed. Training has always been comprehensive and relevant, reflected one staff in their survey. There is evidence to indicate that staff receive an induction when they commence their employment; staff spoken to confirmed that they receive supervision once every six weeks. Staff meetings are held on a monthly basis and this appears to promote good communication between staff regarding how residents identified needs are being addressed and any relevant development. There is a robust recruitment procedure in operation to ensure that only appropriate people are employed. The files for three staff were examined; evidence shows that two references and CRB checks are received and cleared, prior to any new staff starting work at this home. All staff spoken with said that they are well supported by the deputy manager and manager. Supportive management team, said a staff member. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Key inspection 8/10/08 The home is being well managed; this ensures that staff are being well supported to deliver a good and safe standard of care. Evidence: Key inspection 8/10/08 The registered manager retired on 31 March 2008; the new manager has been in post since early March 2008. He has previously been a member of a management team and he has also held a registered managers post in another service for about two years. He has completed his Advanced Management in Care and he is currently doing his NVQ level 4. Therefore, he has significant experience implementing care and staff management systems, including health and safety. He is well supported by the deputy manager. The manager is in the process of submitting an application to the Commission for the registered managers post for 182 Bromham Road care home. The Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: interim management arrangements are satisfactory. Staff members spoken to confirmed that they are well supported by the manager and deputy manager. They also confirmed that they are encouraged and are able to freely raise any concerns or practice issues at staff meetings or in their one to one supervision. The manager promotes an open door policy, which is always very welcome, said a staff member. Quality assurance systems are in place to seek the views and experience of residents and their representatives regarding the quality of service offered to them. A designated person on behalf of the organisation undertakes monthly visits in order to satisfy themself with the conduct of the home; a copy of the visits reports for the months between July and September 2008 were seen. Residents were observed to be relaxed and comfortable in the company of their peers, staff members and their physical environment. Those with verbal communication skills were clear that they found the management in the home to be responsive to any issues or queries that they have raised. The manager is friendly and good to me, said one resident. A daily progress record of relevant occurrences is maintained as part of the care plan; this was noted to be in good detail. Other records viewed were in good order. Health and safety matters are being attended to. Contracts for the servicing of equipment and fire safety appliances are in place and evidence of up to date checks is maintained. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation 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 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!