Inspection on 19/10/08 for Beechcroft Care Centre

This inspection was carried out on 19th 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.

Other inspections for this house

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Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Beechcroft Care Centre West Hoathly Road East Grinstead West Sussex RH19 4ND     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: Lucy Green     Date: 2 2 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: Beechcroft Care Centre West Hoathly Road East Grinstead West Sussex RH19 4ND 01342300499 01342300795 ivy.dann@sussexhealthcare.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Dr Shafik Hussien Sachedina,Mr Shiraz Boghani care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 20. The registered person may provide the following categories of service only: Care home with Nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disabilities (LD) Physical Disabilities (PD) Date of last inspection Brief description of the care home Beechcroft Care Centre is registered to provide residential and nursing care for up to twenty adults with learning and physical disabilities. The home is divided into two units each accommodating ten people. This inspection refers only to the unit that was registered on 25 April 2008. The second unit was therefore not inspected on this occasion. Unit one provides ten single bedrooms, each with ensuite toilet, wash basin and shower facilities. Communal areas comprise of a lounge, activities room, sensory room, kitchen and a fully adapted bathroom. The home is equipped with the latest technological aids including an audio loop system, hydrotherapy bath and overhead tracking hoists. A passenger lift provides level access to all parts of the home. The site Care Homes for Adults (18-65 years) Page 4 of 28 20 20 Over 65 0 0 Brief description of the care home also offers a specialist swimming pool. More detailed information about the services provided at Beechcroft Care Centre, including the range of fees can be found in the homes Statement of Purpose and Serice User Guide. Copies of both documents can be obtained directly from the Provider. Care Homes for Adults (18-65 years) Page 5 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 reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term service user to describe those living in care home settings. For the purpose of this report, those living at Beechcroft Care Centre are referred to as residents. This report reflects a key inspection based on the collation of information received since the service was registered in May 2008, a review of the homes Annual Quality Assurance Assessment and a site visit which was conducted over two days and lasted a total of four and a half hours. The first visit to the service was conducted unannounced on Sunday 19th October 2008. A follow up visit was made on Wednesday 22nd October to enable the Inspector to meet with the Registered Manager and to look at some Care Homes for Adults (18-65 years) Page 6 of 28 documentation that only the Registered Manager has access to. Alongside the process of this inspection, Beechcroft Care Centre has opened a second unit which can provide accommodation to a further ten people. This brings the total number of registered places available at Beechcroft Care Centre to twenty. This report however, only refers to the unit that was registered in May 2008, which will be referred hereafter as unit 1. The site visit included a tour of unit 1 and an examination of some care, medication and staffing records. The Inspector observed the interaction between staff and residents as they undertook their activities and observed the preparation and serving of the lunchtime. At the time of this inspection, there were seven people being accommodated in unit 1 of Beechcroft Care Centre, one of whom is staying at the service on a respite basis. One resident had also moved into unit 2 a couple of days previously and as the only resident currently living in unit 2, she spent the first day of the inspection with the other people in unit 1. Throughout the inspection process, the Inspector met and spoke with five of the people living at Beechcroft Care Centre. Time was also spent individually with the Registered Manager, and a registered nurse and two support workers were interviewed in private. 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 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. Prospective residents benefit from an admission process that ensures their individual needs and aspirations are comprehensively assessed prior to moving into the home. Evidence: There have been seven admissions to unit 1 of Beechcroft Care Centre since the home opened in May 2008 and the Inspector viewed the assessment information for three of these people. The documentation in place provided evidence that a thorough assessment process had been undertaken prior to all of these people coming to live at the home. The pre admission assessment included gathering reports and feedback from a range of professionals and relatives and ensured that a wide range of areas were covered including, long and short term goals, health, social and behavioural needs. Staff spoken with at the time of the inspection confirmed that new residents have the opportunity to visit the home prior to admission and choose their bedroom and Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: decoration. For one of the people whose care was tracked, staff from Beechcroft Care Centre had visited them at their previous placement on several occasions to assess them in their own environment and obtain a thorough handover from the people who used to support them. There was evidence that both individuals had received a settling in period, with ongoing reviews. The Registered Manager and staff all confirmed that all of the people admitted to the service since it opened in May 2008 have settled in really well. The Inspector was able to establish from the documentation in place and discussion with all relevant parties that the information gathered at the assessment stage is used to inform a comprehensive care plan which evidences that the home can fully meet this individuals needs and aspirations. 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. The high standard of care planning provides staff with a good foundation to support residents in a way that both enables and protects them. Residents are fully consulted and involved in many decisions about their lives. Evidence: Through discussion with staff and observation of their practices, it was demonstrated that they have positive relationships with the people they support and a good understanding of their needs. A review of the care plans in place for three residents revealed that staff understanding and practices are a reflection of the good standard of care planning at Beechcroft Care Centre. The care plans viewed comprehensively outline the care needs of the individual in a way that is both accessible and person centred. Observation of staff practices during the first day on inspection demonstrated that care plans are working documents that are referred to and utilised every day. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: Goal setting and monitoring are fundamental principles in the way care plans are constructed. Each care plan inspected contained individual short term goals and actions for the resident to enable them to achieve maximum wellbeing whilst either developing or maintaining their skills. Each care plan also has a dreams and aspirations section, in which longer terms goals are starting to be discussed as the staff get to know residents better. There was documentary evidence that care plans are to be regularly reviewed. Despite, the service only having been open for six months, some residents have already had a review of their care needs. A range of detailed guidelines and risk assessments are in place for each of the residents whose care was tracked. The home has a positive approach to risk taking and residents are supported to take risks to maximise their choice and independence. Evidence gathered from documentation and observation of staff supporting residents during the inspection, highlights that the home provides a service where residents are encouraged and supported to lead healthy, meaningful and fulfilling lives. 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. Residents are appropriately supported to lead fulfilling lives and despite their complex health needs have opportunities to develop their educational and social skills. Residents who are able to eat orally receive a range of balanced and nutritious meals. Evidence: On the first day of the inspection, five residents were in unit 1 of Beechcroft Care Centre (as one resident from unit 2 had come to join them). Those residents were observed being supported with their morning routines and then three of them participated in an arts and crafts session. One resident spent time in the sensory room and the fifth person spent time relaxing on a bean bag and chatting with staff. The information provided in daily diaries, care plans, observation of residents and discussion with staff and management revealed that residents have access to a good Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: range of educational and social activities. The planning of activities is arranged across morning, afternoon and evening periods, seven days per week. Residents are starting to integrate with their local community and make use of nearby facilities, including; colleges, pubs, cinema and shops. The home has a positive approach to enabling residents to maintain and develop contact and relationships with families and friends. There is evidence in the care plans that the home supports residents to meet with and receive visits from their relatives. Two of the residents whose care was tracked have access to e-mail facilities and use this method to maintain regular contact with their families. Each resident has their own bedroom and it was observed that staff respect their private space by knocking on doors before entering and giving residents the time and space to relax quietly if they wish. Due to the complex needs of the people living at Beechcroft Care Centre the majority of residents rely on staff support to help them mobilise around the home. It was noted that staff were entirely engaged with residents at all times during the inspection and supported them to move as they wished. For those residents that are able to self-mobilise they were seen to move freely about the home. Due to complex healthcare needs, only two of the seven residents currently living at the home are able to eat meals orally. The Chef on duty explained that whilst a four weekly rotating menu has been devised, with only two people to cater for a daily menu based on the preferences of those two people is currently in operation. The home has begun to build up a collection of food photographs to help residents make informed choices about what they want to eat. There was evidence in the kitchen that residents are able to have range of drinks and snacks throughout the day. The lunchtime meal prepared and served on the first day of inspection was roast lamb, cauliflower cheese, roasted potatoes and parsnips and vegetables. Followed by a dessert of apple crumble and custard. The meal was attractively presented, looked appetising and was served hot to residents. The staff support at lunchtime was provided with dignity and respect. 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. Residents are protected by the expertise of those who support them and benefit from the provision of personal and healthcare support that fully meets their needs. Medication is managed well at Beechcroft Care Centre. Evidence: The residents at Beechcroft Care Centre are entirely dependent on staff to support them with their complex range of personal and healthcare needs. Care plans provide detailed guidance for staff as to how support should be delivered and the Inspector observed care to be provided in a discreet, dignified and respectful way. There is documentary evidence of a multi-disciplinary approach to health support and the plans in place evidence working relationships with doctors, dieticians, physiotherapist and speech and language therapist. Residents are regularly weighed and records maintained. The home is registered as a care home with nursing and as such there is always at least one Registered Nurse (RGN) on duty. At the current time, one resident requires Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: one to one nursing care at all times and as such has an additional RGN on duty to support their needs. The healthcare support provided at the time of inspection was observed to be conducted in a calm and competent way. Systems are in place to ensure medication is managed appropriately. Medication systems were assessed by way of a review of records, storage and discussion with one of the RGNs. The medication policy was not inspected on this occasion. Both the administration, recording and storage of medication were judged to be satisfactory and guidelines were found to be in place regarding the use of prn medication. 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. Residents and visitors to the home benefit from and are protected by, the open culture at Beechcroft Care Centre. Evidence: The home has a complaints procedure in place that is accessible to both residents and visitors. No complaints have been referred to the Commission and all of the issues raised with the home have been dealt with appropriately. The home seeks to operate an open culture where issues are openly discussed and opinions shared. As such, the home has adopted a policy of recording every comment received as a potential complaint or concern. It is evident that this policy has made people feel valued and has proved to reduce the escalation of minor issues by resolving them professionally at the outset. The home has a number of systems in place to protect residents from abuse. All staff staff files viewed confirmed that staff receive training in the safeguarding of vulnerable adults and it was evident from discussions with staff that they are clear about their roles and responsibilities in the protection of vulnerable adults. New staff are employed subject to robust recruitment procedures and the necessary checks were found to be being undertaken. Details pertaining to residents finances are dealt with at Head Office and were therefore not inspected on this occasion. The Registered Manager Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: confirmed that the current system works well and that the records are appropriately audited. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in an environment that has been specifically designed and built to meet their complex needs in a safe and comfortable way. Evidence: Beechcroft Care Centre is a part purpose built and part converted property that is divided into two units each accommodating ten people. This inspection refers only to unit one of the service. Unit one is a spacious building which provides ten single bedrooms, each with en suite toilet, wash basin and shower facilities. A tour of the home found each of the bedrooms currently occupied to have been decorated to reflect the individual tastes and preferences of the individual. Communal areas comprise of a lounge, activities room, sensory room, kitchen and a fully adapted bathroom. The home is equipped with the latest technological aids including an audio loop system, hydrotherapy bath and overhead tracking hoists. A passenger lift provides level access to all parts of the home. The site also offers attractive grounds and a specialist swimming pool. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: The home was found to be clean and tidy throughout and the space and specialist adaptations available exceed the National Minimum Standards. 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. Residents benefit from a dedicated and competent team of staff and are protected by the robust recruitment procedures. Staff have both the skills and support to enable them to perform their roles effectively. Evidence: At the time of the inspection, the atmosphere was observed to be friendly and relaxed and the positive relationships between staff and residents were obvious. On the day of inspection, there were five residents being supported by two RGNs and three carers. Discussion with staff and the Registered Manager confirmed that due to the fact that the home still has a number of resident vacancies, staffing levels are flexible according to individual needs and activities. A review of the rota highlighted that there is always a minimum of two RGNs and four carers in the home during the day when there are seven residents. At night, the home is staffed by two RGNs and one or two carers depending on the number of people accommodated. From observation, review of the rota and discussion with staff and management, it is the Inspectors view that current staffing levels are sufficient to meet the needs of the people living at Beechcroft Care Centre. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: Discussion with three staff and the examination of three staff files identified that training is ongoing. Staff have access to a raft of mandatory and specialist training including; fire safety, first aid, safeguarding, manual handling, personal and intimate care, infection control and sexual awareness. The staff who met with the Inspector demonstrated a good understanding of the needs of the people they support and confirmed that they felt competent to carry out their roles effectively. There is documentary evidence that new carers complete an induction programme in line with Skills for Care. The Registered Manager confirmed that all Registered Nurses hold current PIN numbers. Staff files also provide evidence of a robust system of recruitment being in place, with the correct documentation and checks being in situ. The Inspector saw evidence of regular staff meetings being conducted with minutes recorded. There is a supervision system in place that provides staff with formal one to one sessions every two months. 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. Residents benefit from the home being run by an experienced Registered Manager who ensures that the home is run safely and effectively. The organisation has good systems in place to self-audit and implement improvements. Evidence: The Registered Manager is an experienced practitioner who has the necessary skills and experience to manage this service effectively. Staff spoke positively about the Registered Manager and described her as supportive and approachable. The home has a good system for assessing its own standards of quality which includes the annual surveying of stakeholders. For those residents who eat orally, there is a meal check form whereby the resident is supported to provide their feedback on meals. Each month a representative from Sussex Healthcare Trust visits the home and conducts and an unannounced visit in which they talk with residents and staff and Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: compile an action plan for any suggested improvements for the service. The AQAA provides evidence that the home has various robust systems in place to ensure the Health and Safety of the home are maintained. As the home was required to supply relevant checks and certificates at the time of registration, the Inspector did not have cause to question the way health and safety is maintained and therefore records in respect of health and safety were not fully inspected on this occasion. The records that were viewed were found to be satisfactory evidence of good health and safety systems being in place. 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!