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Inspection on 03/12/08 for 51 Greedon Rise (Homefield College)

Also see our care home review for 51 Greedon Rise (Homefield College) for more information

This inspection was carried out on 3rd December 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: 51 Greedon Rise (Homefield College) 51 Greedon Rise Sileby Loughborough LE12 7TE 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: Keith Williamson Date: 0 3 1 2 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. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 29 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.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: 51 Greedon Rise (Homefield College) 51 Greedon Rise Sileby Loughborough LE12 7TE 01509816091 01509815696 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Homefield College Limited Name of registered manager (if applicable) Ms Wendy Cooke Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 3 0 care home 3 learning disability Additional conditions: No additional conditions of registration apply. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 29 A bit about the care home 51 Greedon Rise is a converted 4 bed roomed, semi-detached property, situated on a residential estate in Sileby. Shared accommodation consists of a large lounge (with office accommodation at one end), kitchen (including a dining room), and an enclosed garden. There are four bedrooms, one of which is used by staff. The home is one of seven, which are managed by Homefield College. The college is a specialist provision whose underlying philosophy is that of inclusive learning. The college and the houses provide programmes of care aimed at personal, social and educational development, which are focussed on the acquisition of independent living skills as well as educational and vocational skills. Students are initially accommodated at the college site, moving to one of the houses when assessment determines the requirement for greater independence. Students at the college are placed and funded by the Learning Skills Council. These placements are generally term time only and limited to 3 years. However, some students continue to be funded by Social Services Departments and their placements become long term. The range of fees are based on individual needs and at the time of this site visit, ranged from #2219.73 and #2753.60 per month. A copy of the last Commission For Social Care Inspection (CSCI) inspection report is available in the home, and copies of this report are available from the registered manager. 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: 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 Care Homes for Adults (18-65 years) Page 6 of 29 How we did our inspection: This is what the inspector did when they were at the care home The focus of the inspection is on outcomes for Service Users and their views of the service provided. The main method of Inspection used was case tracking which involves selecting a sample number of people and tracking the care they received through talking with them where possible, and looking at their records and accommodation, in this case three Service Users were chosen. This visit took place over one day, commencing at 12.00pm and took four hours to complete. An opportunity was taken to talk with Service Users the registered manager and staff, look around the home, view records, policies and care plans. On this occasion Service Users made no formal comments that could be included in this report. Information was obtained from the Annual Quality Assurance Assessment, which gives information about the home, and is filled in by the registered manager. A copy of the last Commission For Social Care Inspection report is displayed at the homes office, and copies of this report are available from the registered manager. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well The paperwork required by law, to enable Service Users care needs to be delivered by staff, are completed promptly and give staff instruction on how to care for people safely. This is important as staff can offer care consistently. Some of these documents such as the Service User Guide and complaints information are completed using the easy read format using pictures and symbols. Medicines are administered safely. Staff were aware of their responsibilities in this area, and when questioned showed a good knowledge of the processes involved. Complaints information is displayed in the home, and staff were aware of the procedures involved in reporting suspected abuses on behalf of Service Users. Staff are also aware of how the whistleblowing procedure works. This is where staff can report on to external agencies such as the police, if any suspected abuse is not dealt with in an appropriate way. This is important as it suggests staff are aware how to keep Service Users safe in the home. Care Homes for Adults (18-65 years) Page 8 of 29 Decisions that the Service Users make are recorded in the daily notes. Service Users time during the week is taken up by college courses or social care time. These and other documents are held securely in the home. This is important as it shows personal details are held in a confidential manner. Prior to staff being employed in the home, a number of checks are carried out, to ensure Service Users safety. The policies and procedures used by staff have been reviewed and the staff numbers are reflective of current Service Users needs. Supervision, which is a meeting between the manager and staff on a one to one basis; and staff appraisals continue to take place regularly. This is important as it forms the basis for planning individual staff training needs. The home is comfortable and clean, and staff were aware of cross contamination and cross infection issues. Staff complete regular health and safety checks to help keep the home a safe place to live in. Care Homes for Adults (18-65 years) Page 9 of 29 What has got better from the last inspection All of the outstanding requirements have been dealt with. Checks relating to the safety of the electrical system in the home have been brought up to date and the made certificate available. The bedroom doors have been replaced, these and the doors mentioned in the last report, that were without locks, have now been put in place. The Responsible Individual now visits the care home on a regular basis, and produces reports on the visit with a copy kept at the home. Care Homes for Adults (18-65 years) Page 10 of 29 The medication storage area has been improved, making the storing of medicines in the home safer. What the care home could do better The policy and procedure to assist staff in enabling Service Users self medicate their own medication, could be clarified to make the process more secure. Information on medicines that are kept as stock items needs to be carried forward from one medication month to another. This shall enable staff to perform accurate audits to ensure the safety of people in the home. If policies are being updated, it is advisable to keep the old copy in the file until such times the replacement is ready. Care Homes for Adults (18-65 years) Page 11 of 29 This would ensure staff continue to have the appropriate information readily at hand to deal with any enquiry. Policies and procedures need to be dated to ensure staff have the appropriate and up to date information available. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Keith Williamson CSCI Capital Park Fulbourn Cambridge 01223 771300 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 12 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 13 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 assessment process is detailed and effective resulting in accurate information for prospective Service Users and staff. Evidence: The Service Users assessment information is well detailed and contains information relating to their needs and abilities. This is important as this information forms the basis for any care plan. This information has recently been updated and revised. This shows that All Service User assesments have been recently updated, these were held together with the original assessment documents from the Service Users placing authority. A contract is also in place. These documents are important to signify the terms and conditions of their stay. Care Homes for Adults (18-65 years) Page 14 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 individual needs and choices of people are well documented and provide staff the neccesary information to support people who live there. Evidence: We looked at the care records of people living at the home. We found individual records supporting the care given to people at the home. Care plans are in a format understood by people who live there. Care records are routinely up-dated to ensure they reflect the changing care needs of people. We saw that staff have a good understanding of the risks relating to each person who lives there, this is important as it reduces the risks involved in living in the home. Care Homes for Adults (18-65 years) Page 15 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 . Service Users enjoy a positive lifestyle, with individual support from staff. Evidence: Service Users enjoy a positive lifestyle, with individual support from staff. This is detailed in a personal timetable of social care and activities arranged around their continuing education. Two of the Service Users have courses arranged at local colleges, and staff assist with the transport. This is good as it leads to a varied and positive lifestyle. One Service User spoke of working in a local cafe. This is to provide experience of working in the community, helps toward the persons individual goals and is good for communication skills. Service Users are encouraged to continue relationships with people outside the home. Two of the Service Users spoke of having recent visits from relatives to help them with shopping prior to the Christmas holiday break. The menu book was seen, and this reflects the Service Users individual cultural dietary Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: needs, and is backed up by a likes and dislikes list. The book contains a list of what choices Service Users have opted for at meal times. Service Users enjoy a great deal of flexibility with meals, having a wide choice of self-prepared and carry out meals. No specific Service User is on a diet however healthy eating is considered by all. Service Users have the choice to take part in the weekly grocery shopping, and ongoing meal preparation . On the day of the visit the Service Users had been baking, and were clearing up from their lunch time meal. These tasks are recognised as part of the normal lifestyle experienced by Service Users in the home. Care Homes for Adults (18-65 years) Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Service Users health and personal care needs are well met. There are deficiences in the medication system that have the potential to place people in the home in danger. Evidence: Service Users personal care and support needs are clearly detailed in their care plan. The plan indicates likes and dislikes such as which staff members they preferred to receive support from. Service Users also have information in their plan of care, about their health management and have regular access to their doctor, dental and optical services. Their is also input from other people such as consultant psychiatrists and psychologists. This is important as it shows the staff cares for peoples greater health needs. Care Homes for Adults (18-65 years) Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Service users are protected by a well informed staff group. Evidence: There have been no complaints forwarded to the Commission for Social Care Inspection with regard to the home. There have been no complaints recorded by the staff, since the last visit to the service. Complaints information is displayed in the home and is enclosed in the Service User Guide, though the policy and procedure was not available for staff to refer to. The registered manager stated it was being revised at that time. It would be advisable to retain the working document for staff to refer to if neccesary. There is evidence of advocates and relatives being used in the complaints process. This is important as it shows the home involves other people in the complaints process. Staff told the Inspector what they knew about the complaints, adult protection and whistleblowing procedures. They showed a good understanding of the process involved in following such issues through. Adult Protection training for the staff is undertaken at regular intervals. Service Users personal allowances are paid on a regular basis. There are clear paper trails involved to show where individual Service Users monies are held, and what balance is available to them. There have been no protection issues forwarded to the Commission for Social Care Inspection. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Service users live in an environment that is homely, comfortable and clean. Evidence: The home is comfortable and clean. A programme for refurbishment and replacement of furniture and other items in the home is in place. Consideration to the priority of need is assessed with a number of other homes in the group. This does not currently create an issue. The Service Users bedrooms are personalised, with a variety pictures furniture and electrical equipment. Staff are aware of cross contamination and cross infection issues, and agreed that there were plentiful supplies of protective clothing. T his is important to protect Service Users and staff in the home. Care Homes for Adults (18-65 years) Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Service Users are supported and protected by well-trained staff and effective recruitment practices. Evidence: The number of staff on duty meet the Service Users level of need and enable individual support throughout the day and night. A comprehensive programme of training is in place. Staff spoke positively about the training opportunities and the ongoing, individual support that they receive. This is important as it keeps the staff up to date with information how to care for people properly in the home. Staff recruitment records were not examined on this occasion; as they are held seperately at another office. At the last visit these were up to date and in order. The records contained a written application form, two written references and evidence of identity. This is important as it ensures the college are actively working to ensure peoples safety in the home. Staff supervision is undertaken regularly, and assists the Manager plan the appropriate staff training plans. This is important as it means staff are viewed on an individual basis, and the appropriate training planned accordingly. Care Homes for Adults (18-65 years) Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Well developed management systems, and well informed staff ensure that Service Users and staff health and safety is promoted. Evidence: The registered manager is qualified and experienced to run the home. Staff have regular supervision and appraisal sessions. These provide the manager with a clear sense of where staff have training development needs, allowing the targeting of resources to particular training courses. There are now recorded visits from the Responsible Individual, as visits occur on a regular basis. These areas are important and assist in the overall Quality Assurance within the home. Areas of risk are assessed appropriately, and these are updated regularly. This is important as it increases the safety for Service Users and staff in the home. There is evidence of more Quality Assurance with questionnaires being sent to relatives. Policies and procedures are continually revised; the complaints information being reviewed at the time of the visit. This resulted in the policy and procedure being unavailable for staff to refer to. This is not good as it does not provide a consistency of information for the staff group. Health and safety is good, with staff completing tests on the fire system, hot water Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: and fridge temperatures on a regular basis. This shows the home is working with the Commission for Social Care Inspection in raising the levels of safety for the Service Users in the home. The fire risk assessment and escape plan were seen but were not dated. It is advisable to date these type of documents and ensure they are regularly reviewed to ensure the safety of people in the home. Staff were able to explain how often fire drills took place, and what was required to happen if the fire alarm sounded. Staff were also able to give a good account of safety procedures, and the operating of policies and procedures within the home. The insurance certificate was noted to be in date. Care Homes for Adults (18-65 years) Page 23 of 29 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 1 20 13 (2) The Responsible Individual must develop a policy and procedure relating to selfmedication. This is to ensure staff are aware of what to check, and how to assist Service Users with this task. 21/07/2008 2 20 13 (2) The Responsible Individual must provide proper secure storage for medication held in the home. This would protect Service Users medication to ensure proper administration could take place. 21/07/2008 3 26 12 (4) a The Responsible Individual 21/08/2008 must ensure that privacy is offered to all Service Users in the home. This is to ensure all Service Users could have the ability to lock their bedroom door. Care Homes for Adults (18-65 years) Page 24 of 29 4 27 12 (4) a The Responsible Individual 21/08/2008 must ensure that privacy is offered to all Service Users in the home. This is to ensure all Service Users could have the ability to lock the bathroom door. 5 30 13 The Responsible Individual must demonstrate that staff have been made aware of, and protect Service Users from, cross infection and cross contamination in the home. This would ensure Service Users remain safe whilst living in the home. 14/07/2008 6 39 16, 24 The Responsible Individual 21/08/2008 must look at ways of obtaining views of Service Users and others involved with the home with regard to the service offered. This would ensure that people?s views were taken into consideration when developing the home through quality assurance. 7 42 26 The Responsible Individual shall visit the care home at 21/07/2008 Page 25 of 29 Care Homes for Adults (18-65 years) least once a month; Seek the views of the Service Users and their representatives, staff, inspect the premises and check the record of events and compliance and prepare a written report on the conduct of the care home. A copy of the report must be sent to the Commission for Social Care Inspection. This would ensure the Responsible Individual oversaw continued development of the home. 8 42 26 Checks relating to the safety 21/07/2008 of the electrical system in the home must be brought up to date and the made certificate available. This would ensure a safe environment for Service Users and staff. 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 Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 20 13 The Responsible Individual must develop a policy and procedure relating to people self-medicating. 13/03/2009 This is to ensure staff are fully aware of the processes involved in assuring the safety of people in the home. 2 20 13 The responsible person must 13/07/2009 ensure that the storage of medicines in the hoome is in a cabinet that is secure and provides suitable security for the medicines held at the time. This is to ensure medicines are held safely, within the guidelines of the Royal Pharmaceutical Society. 3 42 23 The policies and procedures 13/03/2009 required to ensure the safety Page 27 of 29 Care Homes for Adults (18-65 years) of people in the home must be dated and reviewed at appropriate intervals. This is to inform the staff on the latest version of the document and so ensure peoples safety in the home. 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 20 Staff should ensure accurate records are kept of any medicine that is carried over in stock. This is to ensure an accurate audit can be carried out by staff responsible for operating the medication system, so ensuring the safety of people in the home. It is advisable to keep the current policies and procedures in the appropriate file until replacement or revised copies are obtained. This would ensure staff had the appropriate documentation to refer to in case of a complaint being received at the home. 2 22 Care Homes for Adults (18-65 years) Page 28 of 29 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 © (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!