Inspection on 31/12/08 for Birch House

This inspection was carried out on 31st December 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Birch House 03/01/07

Birch House 26/09/05

Birch House 06/06/05

Birch House 26/11/04

Birch House 02/08/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Birch House The Street Appledore Kent TN26 2AF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Geoffrey Senior     Date: 0 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Birch House The Street Appledore Kent TN26 2AF 01233758527 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Michael John Rogers,Mrs Sylvia Margaret Rogers,Mrs Sharon Ann Colton,Ms Joanne Clare Rogers,Mr Al Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 3 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 3 The maximum number of service users to be accommodated is 3. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disabilities (LD) Date of last inspection Brief description of the care home Birch House is a large, detached property situated in the village of Appledore, on the edge of Romney Marsh. It is owned by the company Nexus Direct and is managed on a day-to-day basis by a currently un registered manager. Set in its own spacious grounds, access to local facilities such as the village shop and post office, pub and recreation ground are minutes walk away. There is a train station situated a brisk 20 minutes walk from the home and an infrequent public bus service is available. The Care Homes for Adults (18-65 years) Page 4 of 29 Brief description of the care home home has access to a dedicated vehicle and is able to have access to a second company vehicle if required. The home offers accommodation to a maximum of 3 people who have learning disabilities. The house offers a large communal lounge / diner, kitchen, laundry, WC and spacious lobby on the ground floor. All bedrooms and the office are situated on the first floor, with easy access to an additional WC and large bathroom. Service users with staff support manage the garden and are currently developing a vegetable plot at the back of the garden. Copies of inspection reports can be viewed at the home on request. The basic fee for this service for a 12 week assessment is approximately 2000 pounds per week. A confirmed placement could be contracted at a lower price than the assessment or in some cases at a higher price should assessment prove the necessity of additional input being required. Details can be obtained directly from the Providers. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home on 31st December 2008. Birch House is a small community home and at this time there were not many people in. The member of staff on duty was able to answer some of our questions and give us some information. As we needed to speak to the manager and wanted to meet and talk with people who live at Birch house we decided to leave after about half an hour and come back another day. We visited again on 9th January 2009. This time the Manager and three staff were in the house as well as three people who live there. We talked with two of the service users and spent some time sitting with a member of staff and a service user who cant speak very clearly so is helped to say what they want in other ways. Care Homes for Adults (18-65 years) Page 6 of 29 We spoke with the Manager who helped gather information that we asked for. This was her first experience of a CSCI visit since becoming manager at the house. Staff told us that they enjoyed working at the house now that things have settled down after quite a few changes of staff and service users. Everyone was now settling in and working together to make Birch house a good place to live and work. We had a look round the home, one of the service users unlocked the bedroom door so we could see their room and then showed us other parts of the house. As well as the information collected on the day we also looked at the Annual Quality Assurance Assessment, AQAA. The manager had completed this in October 2008. She verbally updated some of the information and confirmed that the health and Safety checks and service certificates were still in date. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 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 9 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. Information is made available to help people decide about living at Birch House. Admissions to the home are not made until a needs assessment has been completed and the home feels it can offer the required level of support. Evidence: There are three people living at Birch House. One has lived there for two years. The other two moved to Birch House from another home within the organisation that closed just before Christmas 2008. The Manager told us that she had met with the two service users at the other home and talked to them about the possible move to Birch house. They already knew the home and the person living there through social events and holidays. They were invited to visit and stay overnight to find out more about the home before deciding whether it was where they wanted to live. It also gave the manager opportunity to assess what support needs they have and decide whether the staff skills and experience were enough to properly look after them. The manager told us that all people who are interested in living at the home, whether Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: or not they are already known to the home, would have a long introduction period and a full needs assessment to make sure it was the right place to live. People we spoke to said that they were glad to have moved in as they liked the house and it is nearer shops and the pub than where they were before. They said they felt happy and have settled in quite quickly. Another service user showed us a service user guide that was written for her individually and is about what she can expect and what is expected of her whilst she lives at Birch House. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that choices will be offered and they will be supported by staff when making decisions. Staff have access to information and guidelines to help them when they are supporting service users. Evidence: The manager told us that the old service user care plans are being replaced with new ones that have a more personal approach, to go with the individual service user guides. Staff said that the way support for the service users is described, in more manageable, clear, guided steps helps every one to understand them better and offer a more consistent approach. Keyworkers are working closely with the service users to find out who and what is important to them and recording how they liked to be supported with their care. They are also noting how people show that they are happy or upset if they are not able to say so. Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: Risk assessments are included as part of the support plans. These are written to help keep people safe in what they choose to do rather than being stopped because something may be seen as unsafe. One service user was seen letting herself, the others and staff members, into the house when they returned from an outing, with a front door key she had been given as she had shown she could keep it safe and use it properly. We saw that service users are involved in making choices about things that affect their daily lives such as where to go and what to have to eat, as well as helping prepare the food. They also told us about other things they are able to have a say in. The people who live there chose the colours for the redecoration of the communal rooms as well as the bedrooms. They spoke about being given a choice of holidays, whether to go as a small house group to a cottage somewhere or as part of a large group from all the homes going to an activities camp where they had been before. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home are supported to lead busy and interesting lives. They are helped to keep in touch with family and other people important to them. They have food that they enjoy and is well balanced. Evidence: The manager said how pleased she was that staff are now finding far more things to do with the service users or helping them think of things to do for themselves. On both visits people were out with staff. On the 9th Jan they returned from the local bowling alley. They had obviously enjoyed themselves and the service users were keen to tell the staff members who had not gone what they had been up to. They then made their own lunch or were helped to prepare something of their choosing. All had something different. One of the service users spoke about all the different things he had done Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: since moving in and then arranged with staff to go and order some special books from the library. Staff were seen paying particular attention to someone who needed closer supervision and support and were helping them find something interesting to do. People said that they could stay up late or have a lie in if they wanted to and although there are some routines, like mealtimes and helping around the house, everything is fairly flexible. People are helped to keep in touch with their family and friends. The names of people who are important to them are noted in their support plans. Staff help with taking people to visit or visitors may come to the home if service users want them to. The home does not have a cook. Staff and service users sit round the table together to plan the menu. They then shop for and prepare the lunchtime snacks and main meals of the day. Staff help with the choices to make sure every one has a well balanced diet and any special needs are catered for. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience 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 treated with respect and their privacy is respected. The health needs and preferences of the people living in the home are supported by the staff. Evidence: Staff have got to know each person likes to be supported with their personal care and, as mentioned earlier, guidelines have been written in the support plan so all the staff should doing the same thing. The manager said that she ensures that personal care of female service users is now undertaken by female staff only. Each person has their health needs assessed and any support they may require is noted in their care plan. People with epilepsy have notes on how the condition presents itself and a record chart so that the information is there if they need to see a GP or specialist. Staff support service users to attend GP, dentist or other healthcare appointment as required. The manager told us that she has arranged fortnightly visits to the home by a specialist to support people with their mental health. She was able to comment on the current health of all the individuals and gave an example of positive progress being made. Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: At the moment no one living in the home looks after their own medication. Someone has been assessed as being able to manage some aspects of their own medication but has said they prefer not to and this has been accepted. A monitored dosage system is used for medication administration in the home. It is stored in a locked cupboard in a locked room. Staff receive training in medication administration and also have to satisfy a company assessment of their competence. Service users are encouraged to be involved by asking staff for their medication at the right times and also signing a book when they have had it. One member of staff is responsible for ordering and checking medication. This is overseen by the Manager. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns about their care or safety they, or people supporting them, know what steps to take and who to go to. To avoid the risk of harm, the company undertakes checks people who want to work at the home before they are allowed to start. Evidence: Staff spoken with were clearly aware of their responsibility to safeguard service users from the risk of harm. They have attended Protection of Vulnerable Adults, POVA, training and were clear how they would proceed. They would not hesitate to contact the manager, Providers or Local Authority if they felt there was a risk to the people living at the home. Two service users said that they knew what to do if they were worried about anything and would tell the staff or the manager. Staff said that they knew what signs to look out for if a service user who is not able to speak out was in any way distressed. The organisation makes sure that anyone coming to work at the home has been thoroughly hecked out before they are allowed to start work. There was a safeguarding vulnerable adults (SVA) alert raised during the last 12 months. This was when the same Provider but a different manager was in day to day control of the home. The new manager has since made a lot of changes in response to the findings of the local safeguarding team. A settled staff group with more training, Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: improved communication and guidelines, and regular supervision has addressed the points raised. One member of staff said that morale was now a lot higher. The Local SVA team alert has been closed. 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. The house is homely, well maintained and a comfortable place to live and work. Evidence: We were shown around the home by one of the people who live there. He was fairly new to the home but said that there have been quite a few changes made to the decor since his arrival. The hallway and communal areas have been painted in a lighter colour to give a more spacious feel and to help someone with limited vision. They are still in the middle of redecoration so some parts are still showing signs of wear and tear whilst others are freshly painted. All the service users have their own bedroom. We were able to see two of them. One person said how much they enjoyed living there and how he was able to choose the colours for his room and have all his own things around him. He, like others, may have their own door key. Nowhere is out of bounds to people but staff explained how they safeguard people by supervising some activities in the kitchen and laundry area. There is a good sized garden and everybody is encouraged to play a part in its upkeep and maintenance and use it for recreation and barbeques. Everyone helps to keep the home clean and tidy. The manager told us that safety checks are carried out and the recommendation of the last report relating to fire safety Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: has been sorted. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are supported by a staff team who are safely recruited, receive training and support and know what is expected of them. Evidence: The home has a team of ten staff working day and night in the home to support the people who live there. There is a clear staff rota in place so people know who will be supporting them. The rota plans for at least three staff on duty during the day and two on the premises at night. As mentioned earlier, Birch House had a sister home that closed just before Christmas 2008. Some of the staff and two of the service users then moved to Birch house. We were told that the staff team is now settled and it is unlikely that they will be asked to help out in any other homes in the group. They are not likely to have staff from those other homes working at Birch House unless there is an emergency. This should solve the problem of service users having unfamiliar staff supporting them, something that was pointed out by the safeguarding team. All staff have the right checks in place, Criminal Record Bureau - CRB, references, induction and basic safety training. They are then encouraged to enrol on an NVQ programme. NVQ is a qualification that is work based and shows that staff have the Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: right skills for the job. They are graded; the minimum for care support workers is level 2, managers generally have level 4 or higher. We were told that, of the 10 staff, 8 have or are working towards level 2. Of those 4 have level 3 and 1 has level 4NVQ. We spoke to staff who said that they are supported to attend further training in specific areas so they can support the people who live in the home with more confidence and expertise. They told us that they have regular supervision with the Manager so they can discuss how they are working and what training they might need. They also have staff meetings to talk about how the home is doing and make plans to improve or change things. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are asked about how things are going but this needs to be further developed. The manager needs to complete the Registration process but is running the home in the interests of the service users. The Providers must evidence their role in the management, monitoring, support and quality assurance processes relating to the home. Evidence: The Manager has been working at Birch House since June 2008. She has several years experience supporting people with learning disabilities and has worked as a manager for two years with another company, She has attained NVQ level 4 and the Registered Manager Award. She said she will make an application for registration. She organises her work so that she can spend time supporting service users and staff in their daily activities. Following her arrival at Birch House a lot of her time was reportedly spent working closely with the staff and the service users, helping them to gel as group and Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: be confident and comfortable in each others company. Therefore a lot of the planned paperwork and document changes are still in the early stages. We talked about quality monitoring in the home. The manager said they do talk to people living in the home, and it is formally recorded. She also has access to QA questionnaires that have not been used yet but were to be circulated before individual case reviews. This area was the subject of a requirement from the last inspection report which noted that; whilst service users said they feel listened to and there are some good stand alone QA measures, the home was unable to provide evidence of analysis of feedback or publication ofa report of outcomes. This had a required completion date of 31.3.07. We expected this to be in place by now and evidence available. We were concerned to note that there was little evidence of monitoring or support to the service from the Providers through monthly audits. The most recent one available was dated 16.9.08. The Registered Provider is required, by Regulation, to visit the home, unannounced, at least once a month. They should discuss life in the home with the full range of people involved and prepare and make available, a report of the visit. This should contribute to a planned cycle of evaluation and improvement of the service. The AQAA was completed by the current manager who confirmed that Safety checks and equipment maintenance was all satisfactory and up to date. Care Homes for Adults (18-65 years) Page 25 of 29 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 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 39 26 The care home shall be 21/05/2009 visited,unannounced at least once a month. Interviews and inspection carried out. A written report to be prepared and made available for inspection limited evidence available of required visits taking place each month. Last available was dated 16.9.08 2 39 24 To develop and implement systems to evidence self audit and service user and staff consultation. not met from previous report 22/05/2009 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 39 The views of service users, families and other interested parties are to be sought and formally recorded as part of Page 27 of 29 Care Homes for Adults (18-65 years) the quality assurance system. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!