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Inspection on 11/03/09 for Arundel House

Also see our care home review for Arundel House for more information

This inspection was carried out on 11th March 2009.

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: Arundel House 34 Garratts Lane Banstead Surrey SM7 2EB     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: Lisa Johnson     Date: 1 1 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 27 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Arundel House 34 Garratts Lane Banstead Surrey SM7 2EB 01737361076 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Surrey County Council - Adults & Community Care care home 18 Type of registration: Number of places registered: 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 18 The registered person may provide the following category 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 category: Learning disability (LD) Date of last inspection Brief description of the care home Arundel House is a large Residential Care Home. The home is registered for eighteen people with a learning disability. The home also caters for three respite care beds. All bedrooms are single. Accommodation is arranged over four units with the following names, Jade, Sapphire, Azure, and Ruby. Each unit has its own facilities to include lounge and dining areas and kitchens The grounds are extensive and there is ample parking at the front of the home. The home has its own transport and there are local 18 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home amenities nearby. The fees average £707.66 a week Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support peterchart Concerns, complaints and protection Environment Staffing Conduct and management of the home Poor Adequate Good Excellent How we did our inspection: This site visit was part of a key inspection. The site visit was unannounced and took place over five hours and fifty minutes commencing at 09.00 am and finishing at 2.50 p.m. Mrs. L Johnson Regulation Inspector carried out this visit. Information was provided to us by the service prior to this visit in the Annual Quality Assurance Assessment (AQAA). This information is reflected throughout this report. During this visit a tour of the premises was conducted and we looked at some peoples care plans, risk plans, medication records staff personnel files, training records and policies and procedures. During this visit we were able to speak to three people who live in the service, two relatives and three members of staff. Care Homes for Adults (18-65 years) Page 6 of 27 The inspector would like to thank the people living in the service and staff for their time, assistance and hospitality during this inspection. 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. 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 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with information about the service enabling them to make an informed choice about the suitability of the home as a place to live. Peoples needs are assessed prior to admission ensuring that the service will be able to meet their needs. Evidence: The home provides a statement of purpose and service user guide which describes the aims and objectives and the services it is able to offer. The service guide is written in plain English. This information would also benefit from being available in other accessible formats. Prior to any person being admitted to the service information is gained from care managers and relevant health care professionals. People and their families are invited to visit and people are also provided with the opportunity to stay for tea visits and overnight stays where further assessments are carried out to see if the service can meet the persons needs . During this visit we saw information that had been completed for one person who had been referred for respite care. Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person has a plan of care that they have been involved in making. people are supported to make decisions about their lives and they are able to take risks as part of an independent lifestyle. Evidence: Each person has a life plan in place which covers health, personal, emotional, communication , social, cultural and religious needs. During this vist we sampled three peoples plans. These included information about what people can do and where they need support. Two people spoken with said they knew about their care plan and that they attend their review meetings. Information seen demonstrated that life plans are reviewed regularly and each persons key worker completes a monthly progress report. People have signed their care plans to confirm their agreement where they are able to. The service is currently introducing pictorial support plans to make these more accessible to people which we were able to sample during this visit. We sampled some daily records which were detailed and related to peoples life plans goals. Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: The service holds weekly consultation meetings where peoples views are sought and they carry out satisfaction surveys. Some people are involved in staff recruitment interviews and participate in an activities group. People are supported to manage their finances which is recorded in the care plan. The service has provided a range of information in accessible formats which was seen on display in the service including pictorial staff rotas and they have provided information to people about culture and equality. Staff have been made aware of the mental health capacity act and staff are recieving training. Service users life plans are cross referenced to risk assessments which were regularly reviewed in consultation with people and their key workers. Risk assessments sampled included bathing, use of kitchen equipment, self medication and community access. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to take part in appropriate activities which meets their cultural and diverse needs and they are part of the local community. People maintain relationships with their family and friends and their rights and responsibilities are recognised. People are provided with a varied and well balanced diet. Evidence: On arrival at the home a number people had left the service to attend work and day service activities. At day services people are provided with the opportunities to learn work or volunteer skills, work in local charity shops and gardening group. One person told us, I work in an office at day services where i do typing. The service also has a Friday project where some people have been involved in growing vegetables. People also attend a range of recreational and leisure activities in the community including going to the cinema, visiting the pub, visiting the hairdresser , going to the Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: cafe and visiting the local shops, horse riding. One person showed us their bus pass and said that they go to Epsom and Surrey independently. Some people choose to attend local church services. Some people are involved in an activity group within the home where they discuss and plan any activities. Within the service there is pool table and karaoke machine and regular parties and social events take place. Televisions are provided in each unit and some people have their own televisions, DVDs and music centres in their bedrooms. The service has an open visiting policy and people maintain links with their family and friends which are encouraged and some people have personal relationships. During this visit one person was visited by their family and taken out for lunch. During this visit people were seen accessing all areas of the home without restrictions. One person was observed making their lunch. Good relationships were seen between people and staff. People are involved fully in household activities and person showed us their bedroom which they said that they had cleaned and dusted. This person was also washing up in the kitchen and another person said that they undertaken their laundry. The AQAA states that people are provided with keys where they are able to use this and they are supported to access their own mail. At the last general election the service provided a display to assist people in their understanding. People are able to choose their preferred meals and they are involved in menu planning which is discussed during weekly suite meetings. Peoples choices are recorded and they are able to access snacks and drinks at any time and there are no fixed times. Menus sampled were observed to be varied and well balanced. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal needs are met and their preferences and their right to privacy is respected. People using the service are protected by the homes medication policies and practices Evidence: Information included peoples care plans state their likes and dislikes and their preferred name of address. We were informed that peoples preferred gender of staff to provide their personal support is respected and the AQAA states that people can choose their preferred times for going to bed and getting up. One person living in the service told us that they like to have a lie in at weekends and that staff knock on their door before entering respecting their right to privacy. Each person has a health action plan which identifies their health and support needs. One persons plan identified that this person has been diagnosed with dementia and information seen demonstrated that they are supported by a range of health care professionals including General Practitioner, psychology and psychiatry. This persons plan identified that this person requires close monitoring with their dietary and fluid intake. Monitoring charts were in place and we were informed that this person has Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: been seen by a dietitian The home also works along side community learning disability and district nurses. Another person was identified as having emotional needs and their plan was supported by management guidelines. Records were maintained of peoples attendance to health care screening appointments including the General practitioner, dentist and opticians. During this visit we looked at the homes medication procedures and practices. Systems are in place for the receipt and disposal of medication. Medication is dispensed using the monitored dose system (MDS) and medication administration records sample had been signed. The home has implemented audit systems to identify any shortfalls and the pharmacy also visits the home to carry out audits. A list is maintained of all staff trained and authorised to administer medication and authorisation has been obtained for the administration of homely remedies. One medication administration record was observed to have some items on it that had been hand transcribed by staff. We were informed that where this takes place this is always checked by two members of staff. Although the medication record had been signed by one member of staff they are advised that the signature of the second person should be recorded to verify this. Each person has a medication profile and authorisation has been obtained from people to confirm that staff can administer their medication. We were informed that one person self administers their medication and is provided with safe storage in their bedroom which is also supported by a risk assessment. Some people require their medication secondary dispensed when they attend activities such as day services and home leave. Systems are in place ensuring that this practice is carried out safely and risk assessments have been conducted. Care Homes for Adults (18-65 years) Page 16 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is able to demonstrate that peoples concerns are listened to and they are safeguarded from abuse. Evidence: The service has a clear complaints procedure which includes timescales. Information is also made available to people in an accessible symolised format which is also made available in the service user guide. People are supported and encouraged to raise any concerns. Two people spoken with during this visit said they were happy to talk to staff if they had any issues and staff spoken with said that if they received any concerns these would be brought to the attention of the manager. Records are maintained by the service about any complaints received and the organisation has an electronic data base for recording complaints and response times for centralised monitoring. Since our previous visit there have been no complaints received and none have been brought to the attention of the Commission. Three people spoken with told us that they are happy living in the service and that the staff are respectful. We also had the opportunity to speak to two relatives who said, We are happy with the care and our relative is well looked after. The service has safeguarding vulnerable adults from abuse policies and procedures in place. Staff receive safeguarding training which was confirmed by staff training records sampled and during discussion with three members of staff. However the Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: training schedule sampled identified that one member of staff requires refresher training. Since this visit the manager has stated that are arrangements are in process for this to be completed. Staff spoken with said that policies and procedures are brought to their attention and during discussion were aware of their responsibilities should they ever witness or be made aware of any incident where the safety of people is compromised. Information provided to us in the AQAA states that since our previous visit that three matters referred following the local authority safeguarding vulnerable adults from abuse procedures have been followed up. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. people live in a clean environment but further improvement is needed to ensure that people have a safe and well maintained home to live in. People are provided with specialist equipment that encourages and promotes independence. Evidence: The home is within walking distance from Banstead village. The home is divided into four suites where five to six people live. Each unit is self contained having their own lounge/diner and kitchen, laundry room, bathroom/shower room and toilets. Since our previous visit the home has installed a new assisted bath, washing machines and tumble driers have been replaced, some bedrooms have been redecorated and carpets have been cleaned. However further improvement is need in the general decor of the service as some areas look tired and worn, particularly the toilets and bathrooms which would benefit from being modernised. During a tour of the home a carpet in one unit and another persons bedroom was identified trip hazards. We were informed that this matter has been reported but no completion date has been identified. It is required that this matter is attended to as matter of priority to ensure the welfare and safety of people living in the service. Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: During this visit we saw some peoples bedrooms which were personlised to their choice and some people have chosen to purchase their own furniture. Specialist equipment has been provided to meet the needs of people living in the service including handrails , assisted bath and shower and people with sensory impairments have been provided with flashing beacon and vibrating pad attached to their fire alarm system. Some areas of the home have been provided with signs to assist people with orientation. The home was generally clean and hygienic and cleaning schedules were seen on display. However one corridor had a pervading odour,despite the home having changed the flooring. It is reccomended that this area may need additional cleaning. The manager has supplied in the AQAA need to increase the number of staff attending infection control training. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by appropriate numbers of staff who are trained, competent and supervised people are protected by the homes recruitment practices. Evidence: On arrival at the home there were four members on staff on duty who were headed by a senior carer. The duty rota reflected the names of staff who were on duty at this time. We were informed that there is usually five to six carers available at peak times to assist people with care , support and attendance at activities. At night time people are supported by one waking and a sleep in member of staff. Information in the AQAA states that there have some difficulties in filling staff vacancies, but a recent recruitment and open day has resulted in posts being filled. The use of agency is occasionally used, although the service tries to ensure that the same staff are used as much as possible for consistency. New staff receive induction and are appointed on a six month probation period which was confirmed by a member of staff spoken with. Staff are supported to complete National Vocational Qualifications. Information in the AQAA states that currently nine out of fifteen staff currently hold National Vocational Qualifications (Level 2) or above. Two members of staff spoken with said that they receive a lot of training which Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: includes statutory as well as specialist courses. We also sampled three staff training and records and schedule. The manager has identified that further training in infection control needs to take place and arrangements are in progress for one person who has not attended safeguarding vulnerable adults from abuse refresher training recently. Staff receive training in dementia awareness and strategies for Crisis intervention and prevention (SCIP), epilepsy, autism mental health and learning disability makaton and communication. A member of staff spoken with who is a key worker for a person with a diagnosis of dementia told us that they had completed dementia awareness training which was confirmed by a certificate sen on their file Recruitment is followed on an equal opportunities policy. During this visit we sampled three members of staff recruitment files which contained the required information including an application form, two written references , protection of vulnerable adult first check (POVA) and an enhanced criminal records bureau check (CRB). A file was sampled for an agency member of staff which confirmed that required information is obtained before they commence work in the service. Information seen on staff files demonstrated that that staff received regular formal supervision which was also confirmed by staff spoken with during this visit Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an experienced registered manager in post and is run in the best interests of people living there. Peoples health and safety is mainly protected. Evidence: There is an experienced manager in post who holds a certificate in management studies ( health and social services), Registered Managers Award and National Vocational Qualification (level 4 ) in care. There are also two assistant managers. The home hold regular team meetings and staff spoken with during this visit said that communication and team work is good. The service carries out service user satisfaction surveys which are also provided to families. The most recent surveys from families were seen during this visit which contained positive comments. Information was seen that the outcomes of surveys are discussed as part of team meetings and included in the homes service user guide. The responsible individual conducts monthly quality monitoring visits which were maintained and viewed at the time of this visit. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: The service has a range of policies and procedures and staff spoken with during this visit said that these are brought to their attention and they are expected to sign that these have been read. A senior care staff member a told us that peoples understanding is also checked during formal one to one supervisions Systems are in place ensuring the safety of people living in the service which includes regular checks and risk assessments. During a tour of the service harmful substances were stored and locked away safely water temperature checks are monitored regularly which was confirmed by written records maintained. The home maintains accident and incident records and provides notifications to the Commission. We were informed that the manager is aware of our latest guidance which provides information about matters which we need to be informed about. Information provided in the AQAA and records seen during this visit the service has demonstrated that routine servicing and maintenance of equipment is carried out. The service must ensure the matter pertaining to a carpet that was identified as a hazard to people be addressed . Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 13 The registered persons must ensure the carpets are replaced in Jade unit and in one persons bedroom. This is to ensure the safety and well being of people living in the service. 31/03/2009 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 30 It is reccomended that additional cleaning is carried out in Saphirre Suite corridoor and that consideration is given to recruiting to the vacant cleaners post to maintain the cleanliness of the home. Care Homes for Adults (18-65 years) Page 26 of 27 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 27 of 27 - 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!