Inspection on 13/10/08 for Brett Vale Residential Homes Ltd

This inspection was carried out on 13th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brett Vale Residential Homes Ltd 18/10/06

Brett Vale Residential Homes Ltd 27/02/06

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Brett Vale Residential Homes Ltd Granary Barn, Sulley`s Farm Brett Vale Residential Homes Ltd Lower Raydon, Hadleigh Ipswich Suffolk IP7 5QQ 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: Tina Burns Date: 1 3 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. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 29 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (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 29 Information about the care home Name of care home: Address: Brett Vale Residential Homes Ltd Granary Barn, Sulley`s Farm Brett Vale Residential Homes Ltd Lower Raydon, Hadleigh Ipswich Suffolk IP7 5QQ 01473827497 01473822785 bodjawah@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Brett Vale Residential Homes Limited Name of registered manager (if applicable) Mr Vincent Bodjawah Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 9 0 care home 9 learning disability Additional conditions: Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 29 A bit about the care home Brett Vale is a privately owned care home providing personal care and accommodation to nine younger adults with learning disabilities. The Homes statement of purpose gives emphasis to caring for people with challenging behaviours. Brett Vale provides accommodation within a barn conversion and is located in a rural area, close to the village of Raydon, southeast of Hadleigh. Accommodation is all in single bedrooms, seven of which have en suite facilities. There are a number of communal rooms, including a recreation room, and extensive grounds available to service users. Fees for this service are variable and depend on the type of care package required and the needs of the individual resident. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 29 How we did our inspection: This is what the inspector did when they were at the care home This was an unannounced key inspection, which focused on the core standards relating to care homes for Adults. The report has been written using accumulated evidence gathered prior to and during the inspection. The process included a tour of the premises and examination of a wide range of documents and records including three service user care plans and three staff files. The inspector also met and spoke with several people who live and work at Brett Vale Residential Home. Information has also been gathered from the homes Annual Quality Assurance Assessment (AQAA) submitted to the Commission in August 2008, and survey forms completed by nine residents and two members of staff. The registered manager and deputy manager were at the home at the time of our visit and fully contributed to the inspection process. What the care home does well People who live at the home receive a service that is based on their individual needs and preferences. They are treated with respect by their care and support staff and are fully involved in the day to day life of the home. Care Homes for Adults (18-65 years) Page 7 of 29 Residents enjoy a wide range of occupational, social and leisure opportunities within the home and the wider community. The environment is safe, comfortable, homely and well maintained. The home is well managed, support workers are suitably qualified and competent to do their jobs and people tell us that they are able to raise issues or concerns. Comments from residents included; Brett Vale is good and I am happy and Its a perfect home for me. What has got better from the last inspection Six requirements were made following the last inspection and they have all been addressed; The Service Users Guide now includes the views of residents, medication is stored in a safe and suitable medication cabinet, the stock of medication is recorded and audited, repairs have been made to a broken radiator and a loose paving slab, a carpet in one of the bedrooms has been replaced, the department of health food hygiene procedures are followed and the fire alarm system has been serviced. Care Homes for Adults (18-65 years) Page 8 of 29 What the care home could do better The home must ensure that staff files include all documentation required including full employment histories and a photograph of each staff member. This is to ensure that the recruitment process is thorough and robust and fully protects people. The manager should also ensure that the homes Annual Quality Assurance Assessment is adequately completed and self-monitoring processes are used to effectively identify what the home does well and how it can improve. Care Homes for Adults (18-65 years) Page 9 of 29 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Tina Burns CPC1, Capital 1 Business Park, Fulbourn, Cambridge, CB21 5XE 01223 771300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 10 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 11 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 . People needs and preferences are assessed and they are provided with sufficient information to decide whether the home will be suitable. Evidence: People that use the service confirmed that they were asked whether or not they wanted to move into the home and eight out of nine of them said that they had enough information to help them decide the home was right for them. The home provides a detailed Service User Guide to prospective residents and their families or representatives as part of the admission process. The results of the 2008 quality assurance surveys, including the views of residents, had been attached to the Service User Guide seen during the inspection. Since the last inspection one person had moved into the home. Their records were examined and included copies of comprehensive assessments that had been undertaken prior to admission by local authority and health professionals. There was also good evidence of ongoing assessment activity by the home during and following their trial stay. Care Homes for Adults (18-65 years) Page 12 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 that use the service can expect to be involved in planning their care and support and making decisions about their lives. Evidence: People living at the home had individual care plans in place and those examined reflected the needs identified in their assessments. They included personal profiles and were written in a style that promoted person centred support. They covered areas such as personal care, nutritional needs, sleeping, physical health, social and leisure needs, occupational needs, finances, motivation and interaction and behavioural needs. They also included strategies to manage risks appropriately and in ways that promoted independance and freedom where possible. Observations made, records examined and feedback received confirmed that people living at Brett Vale are appropriately supported to make individual choices and decisions. Assessments and care plans included information about individuals personal Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: preferences and mental capacity. Where appropriate relatives, representatives, professional practitioners or advocates are consulted in decision making processes. Care Homes for Adults (18-65 years) Page 14 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 that use the service are assisted to make choices about their lifestyle and enjoy a range of social, educational and recreational activities. Evidence: Records examined, observations made and feedback from staff and residents confirmed that people living at the home are given opportunities to socialise and enjoy community based activities on a regular basis. Residents are routinely supported to get out and about and enjoy activities such as walks in the countryside, swimming, shopping and going to local cafes and pubs. They also benefiit from opportunities to have holidays individually or in small groups away from the home. Two people spoken with had just returned from a short stay at centre parcs where they had stayed with two of their support workers. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: People are also encouraged to participate in the day to day routines of the home, for example menu planning, shopping, food preperation, cooking, cleaning and laundry. They have access to a large games room and support from an activities co-ordinator who is super numerary to the support workers and dedicates their time to providing social, occupational and educational activities on an individual and group basis. A qualified teacher also provides special adult education classes one day a week. Care plans examined promoted residents rights and responsibilities and staff were observed speaking respectfully to residents. Discussions with people that live and work at the home confirmed that residents are assisted to maintain relationships with friends and families. This was reflected in the care plans examined and daily records seen. Menus had been created in consultation with residents and with their likes and preferences in mind. They looked varied and well balanced. Meals are prepared and cooked in the large communal kitchen that is homely and domestic in style. Residents are encouraged to participate in the preperation of food and meal times were flexible according to peoples plans and routines. Care Homes for Adults (18-65 years) Page 16 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 . People using the service can expect to have their personal and healthcare needs met in a way that reflects their preferences and dignity. Further more they can expect to be safeguarded by the homes procedures for dealing with medication. Evidence: Care plans were detailed and set out the support people required in relation to their personal and healthcare needs. Records examined documented individuals healthcare appointments and provided good evidence that people are appropriately supported to access community health care facilities such as dentists, GPs, opticians and where appropriate specialist clinics. There was also evidence that where appropriate residents families were kept up to date with information about their relatives health. Discussion with the manager, observations made and feedback from staff and residents confirmed that people who work at the home have a good understanding of individuals personal and health care needs and know how they should be supported. Personal support was provided in private and routines were flexible according to each persons preferences and plans. Residents dressed in styles that reflected their personal choices and personalities and they looked well cared for and appropriately supported. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: The homes policy and procedures for handling and administering medication covered the ordering, storage, administration and disposal of medicines. It also included procedures for administering as and when required medication, intrusive medication (such as suppositories) and homely remedies. Since the last inspection the home had purchased a suitable specialist drugs cabinet for the storage of medicines. A monitored dosage system was in use and Medication Administration Records were completed fully and appropriately together with a record of medication booked in and out for stock control purposes. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service can expect to have their complaints listened to and addressed, further more they can expect to be protected from abuse. Evidence: Information provided by the home tells us that they have not received any complaints in the last twelve months. In this time The Commission has received concerns from one person about the personal and health care of one resident but these were directed to the local funding authority to investigate however the outcome is not known. At this inspection there were no shortfalls identified in these areas. The home has a complaints procedure in place and people told us that they knew how to complain and who to speak to if they were unhappy. They also confirmed that staff listened to them and acted on what they had to say. Information provided in the homes Annual Quality Assurance Assessment (AQAA) and discussion with the manager and some of the residents confirmed that everyone that lives at the home has contact with an advocate, care manager or relative so there is independant support available to everyone. Records seen and people spoken with confirmed that residents are asked their views through formal quality assurance processes such as reviews and service user questionnaires. They also have more informal opportunities to discuss any issues that arise on a daily basis with support workers and the manager or deputy manager. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: In relation tho the protection of residents the home has appropriate policies and procedures in place including a whistle blowing policy and a policy on risk and abuse. The home also works within the framework of the local authority guidelines for the protection of adults. Staff recruitment files evidenced that the home undertakes Criminal Record Bureau Checks (CRBs) and protection of vulnerable adults checks (POVA first) before staff start work at the home. Care staff had also undertaken adult protection training and UNISAFE training to enable them to handle challenging behaviour safely and appropriately. Care Homes for Adults (18-65 years) Page 20 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 . People can expect to live in a safe and comfortable environment that promotes their independance and meets their needs. Evidence: Brett Vale provides accomodation in a barn conversion and is located in a rural area, close to the village of Raydon, near Hadleigh, Suffolk. The home has all single bedrooms, seven of which have en-suite facilities and two of which share adjacent WC and bathroom facilities. Communal areas include a large lounge, kitchen, dining room, utility room and recreation room. On the day of inspection three bedrooms and all communal areas were visited. All areas seen were warm, clean, comfortable and well maintained. Communal areas were decorated and furnished in a domestic, homely style and each bedroom visited reflected the individuals personalities and interests. The home is situated in large spacious grounds that are maintained by the homes gardener and accessible to the residents. The grounds included areas for planting and growing vegetables, a seating area, an area for playing football and a trampoline. The laundry area was clean and tidy and suitably equipped for people that live at the home to do their laundry with assistance from staff. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: Requirements made at the last inspection in Ocober 2006 regarding a faulty radiator, the replacement of a carpet in one bedroom and a loose paving slab and been met. Care Homes for Adults (18-65 years) Page 22 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 . Overall, people who use the service can expect to be protected by the homes recruitment procedures. Further more they can expect to be supported by a team of qualified and competent staff that know them well and understand their needs. Evidence: Discussion with the manager and staff on duty confirmed that staffing levels remained as they were at the last inspection. Generally there is three care staff on duty during the day and two awake persons at night. In addition there is an activities worker on duty mon to friday from 9am to 5pm, and there is often an extra member of staff on during the day at weekends. The manager is supernumerary and there is also a gardener/general hand who works four days a week. There is very little staff turnover with most of the team being long serving members of staff. The home does not use agency or relief staff and offers consistency of care from within the staff group. The Annual Quality Assurance Assessment tells us that there are fourteen members of staff including the registered manager. All of the care workers are undertaking or have completed NVQ level 2 or above and there was also evidence that new staff completed the skills for care induction programme through Suffolk Social Services. Staff spoken Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: with and records seen confirmed that training included basic food hygiene, first aid training, fire training, health and safety training, UNISAFE training, medication training and adult protection training. Feedback from staff confirmed that they receive regular supervision with the deputy manager and six monthly appraisals with the manager. Overall care workers reported that they felt supported, and adequately trained to do the job. Three staff recruitment records were examined and evidenced that Criminal Record Bureau checks (CRBs) are undertaken before employment begins, they also included copies of application forms, written references, and evidence of health checks and verification of ID. However they did not include a full employment history for the indivduals concerned and one of the three files did not include a photograph of the employee concerned. This appeared to be an administrative shortfall which the manager agreed to address without delay. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People using the service benefit from a well run home. Further more, their health, safety and welfare is promoted and protected. Evidence: The registered manager, Mr Vincent Bodjawah, is suitably experienced and qualified and staff and residents confirm that he is an effective and approachable manager. Records examined, observations made and discussion with the manager during the inspection evidenced that he has a good understanding of individual residents and their support needs. Comments received from residents included I can talk to Vincent, he does help a hell of a lot! and from staff Vincent is very approachable. The home has appropriate self-monitoring systems in place that include service user surveys and reviews. There is also a comprehensive and thorough self auditing system Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: in place that covers a wide range of areas. The manager also completed an Annual Quality Assurance Assessment (AQAA) when asked to do so by the Commission. The AQAA provided us with some useful information but overall it was not adequately detailed and did not provide us with clear evidence about what the home does well and how it plans to improve. This was discussed at the inspection in some detail and the manager agreed that in future they would provide us with a clearer and fuller assessment. Since the last inspection the home had addressed two requirements made concerning safe working practices, the first was regarding the outcome of an environmental health inspection in June 2006 concerning procedures to ensure safe handling of food. This was addressed through the use of the governments safer food better business documentation and the undertaking of four weekly reviews. The second was to ensure that the fire alarm system is regularly serviced. A tour of the premises and records seen confirmed that routine maintenance and health and safety tests and checks are carried out, for example fire equipment tests and water temperature checks. Further more training records indicated that staff undertake appropriate health and safety training. Procedures for reporting accidents and incidents were in place and discussion with the manager confirmed that they monitor incidents and accidents and take appropriate action where necessary to reduce risks to staff and residents. Discussion with the manager regarding strategies in place to support one resident who needed high levels of supervision because of their health care needs demonstrated that the manager understood that they must comply with fire regulations. Consequently they were proposing to install a magnetic self closure to a fire door so that it could be left open without causing a fire risk. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 34 19 Care workers records must include a photograph of the individual and a full employment history. 28/11/2008 This is to ensure that the recruitment procedures are thorough and robust and protect people living at the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (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 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. 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