Inspection on 26/01/09 for Briarways

This inspection was carried out on 26th January 2009.

CSCI found this care home to be providing an Excellent 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

Briarways 29/01/07

Briarways 17/11/05

Briarways 16/05/05

Briarways 16/09/04

Briarways 20/05/04

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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: Briarways 30 Silverlea Gardens Horley Surrey RH6 0BB     The quality rating for this care home is:   three star excellent 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: Deborah Sullivan     Date: 2 6 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 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Briarways 30 Silverlea Gardens Horley Surrey RH6 0BB 01293431310 N/A N/A Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ashcroft Care Services Ltd Name of registered manager (if applicable) Mrs Yvonne Susan Rowe Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 4. 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 disability (LD). Date of last inspection Brief description of the care home Briarways is a detached house in a residential road in Horley, Surrey. The home is registered to accommodate four service users who have learning disabilities. Service users have their own single bedrooms. The ground floor consists of a communal kitchen and dining room, lounge and utility room.One bedroom is on the ground floor. The home has a large,attractive enclosed garden and there is a small parking area at the front of the building. 4 Over 65 0 care home 4 Care Homes for Adults (18-65 years) Page 4 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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: This key inspection of Briarways took place over five hours,during the visit time was spent with the Registered Manager,service users and staff on duty.The last key inspection of the service took place on 29th January 2007. A range of documentation and records were read including service users care plans,staff records,policies and procedures and medication records.The home was toured and there was observation of staff on duty. Throughout the visit staff and service users were welcoming and helpful in providing information to assist the process. Information from the AQAA (Annual Quality Assurance Assessment)document that all registered services are required to complete annually, and staff and service user survey used were also used as part of the inspection process. Care Homes for Adults (18-65 years) Page 5 of 27 The current fee range is one thousand five hundred and eighteen pounds per week to one thousand eight hundred and fifty one pounds per week. 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 7 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users and their representatives have access to information about the service and are welcome to visit the home before a decision is made to move in. A full assessment of needs takes place before service users are offered a place and introductions to the home are individually tailored. Evidence: The home has a statement of purpose and service users guide,the information is presented pictorially for service users and it has been brought up to date. The current service user group is well established and there were no plans for any changes to take place.The most recent admission was three years ago and the last inspection report recorded that the service user had settled in well. The manager said that before a service user is offered a place there is a thorough assessment process,when the last two admissions were being planned staff visited the prospective service users discreetly in their previous residential homes and introductions were tailored to the individual.Visits to the home by relatives and Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: prospective service users are welcomed.A service user who was assisted in completing a survey form by staff stated that they were shown photos of the home before they moved in. Pre admission assessment information is included on care plans. All the current service users are funded by Surrey social services department. One service user is funded for dedicated one to one support. The home is meeting the needs of service users and demonstrates that it caters for individual needs well. Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are person centred,completed to a high standard and reflect the needs of service users. Individual risk assessments are developed and needs are regularly reviewed. Opportunities for choice are promoted,encouraged and recorded. Evidence: Each service user has a care plan that reflects their health,personal and social needs.The information is in two folders, one contains information such as on the service users background and personal,health and the behavioural support they need,the other is their individual person centred plan.The home has now introduced person centred planning,this continues to be a developing piece of work and the plans read are accessible for service users,had been completed with them and were very clearly focused on recording the persons likes,dislikes,experiences,communication Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: needs, aspirations and goals and preferences.Much of the information was pictorial and there are photos,one service user commented on some of his photos and was clearly interested to see them in the folder. The home holds person centred planning meetings and a staff member was enthusiastic about the process. Service users also have essential life style plans,one seen in a service users room was a full of photos and information such as about interests,likes and dislikes and relatives. Another bedroom had a collage on the wall with text and pictures that staff had assisted the service user to make relating to things they liked in their life.There is a keyworker system. Care plan information is reviewed monthly with a full review six monthly and annual review with the care manager. Each service user has an annual review scheduled in coming months. Risk assessments are in place. Daily recording is incorporated into the person centred plans and a record is kept of the choices that service users make on a daily basis. During the visit service users were offered choices,one chose not to attend a particular activity that day,although was happy to go out later. The ethnicity of service users is recorded and staff are having equality and diversity training. Service users participate in the daily running of the home by choosing meals,making choices about decor and activities and help to keep their rooms clean and tidy with staff support. Their views are also sought in one to one discussion and at service user meetings. Care plans and other confidential information are stored confidentially,whilst care plans are accessible to service users at all times. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have access to a wide range of activities of their choice at home and in the community. Contact with relatives is maintained and promoted. Meals are healthy and varied and service uses contribute to menu planning. Evidence: Service users have access to a wide range of activities and the home provides an individually tailored activity programme for each person.They put effort into finding activities if a service user expresses a particular interest and had sourced a music group for one person and cookery classes. The overall activity programme is on display in the dining area and service users have Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: individual programmes. Activities include mud pie(pottery),swimming,cookery,horseriding,going to the cinema,college and one service user has staff support to attend work experience with the local rights of way department.The organisation has a gardening team of service users from its homes who maintain each services garden. There are also social events and outings,one service user whose interest is trains spoke of trips to London to the transport museum and was looking forward to a trip to Brighton that was planned.Other trips include those to the coast and places of interest. Annual holidays are arranged,one service user is not happy being away on holiday,they said they had found a holiday at Butlins too noisy, so he has days out instead,one day trip last year was to Paris.Others have enjoyed holidays abroad and have been to places such as Ibiza and Menorca. Service users are supported to use community facilities,one service user was going out to have his hair cut later in the day.Service users can help with the homes weekly shopping trip. The home has a dedicated vehicle and can access other of the organisations vehicles if necessary,as far as possible a driver is always on duty. During the inspection one service user went out for a carriage drive,two others went swimming. Contact with relatives is promoted,one service user stays with their family at weekends once a month,and another stays with their relatives sometimes. The menu is on display and photos of each days meals are put up on a board which also has pictures of the staff on duty each day. Service users help with meal planning and each person chooses a meal they like to be on the menu for one day each week.The main meal is taken in the evening,during the inspection service users had a sandwich lunch.Snacks and drinks are available throughout the day. The home promotes independence and goals set are designed to help service users reach their potential.Service users can have keys to their rooms if they wish following risk assessment.During the visit staff were respectful of service users wishes and choices. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal support needs and preferences of service users are well met and good health is promoted. The homes medication practices protect service users. Evidence: Care plans include clear information on service users health,communication and behavioural guidelines and needs.Health appointments such as with a GP or chiropodist are recorded with the outcome of the visit, and regular checks are kept up such as eye and dental appointments. Any health concerns are promptly referred to health professionals and specialists are involved if necessary,such as a dietitian. One service user is supported to follow a low cholesterol diet and another to reduce their weight. The manager said that incidents of challenging behaviour at the home had reduced and one service user who used to be isolated most of the time with their one to one worker now mixes happily with others and enjoys going out, including for meals with Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: others.The service user was keen to go out that afternoon for his haircut.The manager said the improvement in behaviours had been apparent since there have been more activities and a stable staff group. Preferences in respect of personal care are respected and as the service users are all male the home has plenty of male staff.Service users require varying amounts of support with personal care,the assistance needed is recorded on care plans. Staff are very familiar with each service users individual methods of communication,staff clearly understood Makaton used by one person,gestures and spoken communication. The routines of the home are flexible,one service user chose to get up mid morning and had a late breakfast,this is their usual routine. Medication is securely stored and all staff administering medication receive accredited medication training,they now are having additional training.MAR sheets seen were correctly completed.The care plan of one service user included information on a medication review, and the manager said another service user is due for review shortly. Care Homes for Adults (18-65 years) Page 16 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users and others have access to a complaints procedure and can be confident that any concerns or complaints will be listened to and addressed. Service users are protected from abuse by the policies and procedures in place at the home. Evidence: There have been no safeguarding vulnerable adults alerts raised since the last key inspection and no complaints have been recorded. The homes complaints procedure is available for service users pictorially and is displayed in the hallway. Some service users need support to voice concerns or complaints,staff understand their methods of communication and are able to assist them.All the service users have relatives and care managers who could advocate for them and information on advocacy services is available should it be needed. Staff offer service users opportunities to voice any concerns individually or as a group. The safety and protection of service users is promoted.There are safeguarding vulnerable adults and whistle blowing procedures in place,the safeguarding procedure had been updated,the home has an up to date copy of the Surrey Multi Agency Safeguarding procedures and all staff attend POVA training which is regularly updated.Staff attend training on non violent crisis intervention and challenging Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: behaviour so that they can manage any challenging situations effectively and keep service users safe. CRB checks take place as part of the recruitment process. The last inspection recommended that service users petty cash be kept in cash boxes that were lockable this has been actioned and procedures for recording financial transactions are thorough. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from living in an environment that is homely and very well presented. Bedrooms are personalised and the home has plenty of space. The home is well maintained and the organisation regularly undertakes improvements. Evidence: The home has a friendly,homely and welcoming atmosphere.It is well maintained,clean and very attractively decorated.Downstairs there is a through kitchen and dining room,the dining room was being well used with service users sitting chatting to staff,eating or listening to music.The kitchen is well equipped and there is space for service users to help with cooking if they wish.The laundry is clean and tidy. There is a large very nicely decorated living room with a TV,again this room was being well used during the visit.The garden is well maintained and large with a summer house at the end that is used for some activities,one service user goes there most days and has a train set in it. There is one downstairs en suite bedroom,it was personalised and the service user had a pet fish.Two upstairs bedrooms were seen,again both included items that reflect the personal interests of service users and family photos, all the bedrooms seen were attractively decorated.Service users choose colour schemes. Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: The bathroom has been fully redecorated and and the downstairs toilet was being improved and awaiting fitting of a new wash handbasin. Throughout the visit service users moved freely about the home accessing areas they chose to be in. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by a well established,competent and confident staff team. The homes recruitment practices protect service users. Staff are well supported and are positive about their work. Evidence: The home is fully staffed and there had been virtually no turnover in staff during the past year.There is a deputy,shift leaders and care staff.Little turnover has led to there being a well established and stable staff team,the three staff on duty during the inspection had all worked at the home for several years.A mix of male and female staff were on duty and there was a shift leader. Staff had a very good rapport with service users,demonstrated that they understood thier individual routines,communication and preferences and provided a clear sense of direction to them when necessary in a caring and confident manner.Service users were all comfortable with staff and happy to approach them with questions or just to speak with them.Staff spent time taking service users out to activities,chatting with them and attending to daily tasks mainly in the company of service users.The home does not employ any domestic staff.The photos displayed of staff on duty each day were Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: referred to by a service user who was content having been told who would be on a later shift. Recruitment was discussed with the manager and some staff files were read.Some recruitment records are held at head office,staff records kept at the home were well ordered and accessible,they contained the necessary documents,evidence that CRB checks had been taken up,training certificates and supervision and appraisal records.Staff receive induction and attend core and service specific training.Specialist courses include autism,epilepsy,challenging behaviour and bereavement.Equality and diversity training has been introduced. NVQ training is promoted and fifty percent of the permanent staff have gained an NVQ in care at level 2 or above.One staff member stated that they hoped to enroll on the training and that the training provided overall was good and updated and that the manager monitors their training.A staff survey form included the comment that,--We receive very good support and training. Staff were positive about their work and said they liked working at the home one commented ,--it is just like being at home. Regular staff meetings are held and are well attended. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run in the best interests of service users and staff,the atmosphere is open and inclusive. Internal quality assurance takes place and the views of service are sought. Safe working practices are observed and policies and procedures are in place for the safe running of the service. Evidence: The home is run in the best interests of service users and staff and the ethos is one of inclusion.The registered manager of the home is experienced and since working at Briarways has brought about improvement in the service.Since the last inspection the manager has completed the Registered Managers Award.The manager and deputy manager keep informed of new legislation and working practices and will be attending Deprivation of Liberty training. The AQAA(Annual Quality Assurance Assessment) document was received within the Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: given timescale and the information in it is of a good standard and clear. All records and documentation seen were completed to a high standard and respected confidentiality of service users and staff. All the evidence seen during the visit shows that the home is well and efficiently run,staff like working there,service users are at ease with staff and have plenty to do and safe working practices are observed. Staff receive regular supervision,one staff member stated --it is fortunate that we have a very good management and work well together. Internal quality assurance takes place via annual surveys of service users,relatives and other representatives,Regulation 26 visits take place and there are internal audits.The organisation has a quality manager.An internal financial audit had taken place the week before.Service users meetings are held and are recorded and service users have opportunities to make their views known individually. Policies and procedures are in place and staff had signed that they had read them. Health and safety checks take place,and the organisations maintenance worker arrived during the visit to check some equipment.Staff were observing safe working practices and since the last visit accident and incident recording has improved.The two requirements and recommendations made at the last inspection are fully met. Service user specific and general risk assessments completed and reviewed as necessary,general ones include assessments relating to driving,contractors being in the home and cleaning. New fire procedures are in place including new risk assessments. It is notable that the home has put into place a range of environmental,activities and training improvements since the last visit whilst there has been no increase in local authority funding for the service users over the last year.The home has been imaginative in its use of available funds and worked hard to achieve improvements. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 34 It is recommended that the home has a checklist with details of records on each staff member that have been received by and are held at the head office. It is recommended that when staff sign they have read a policy or procedure they add the date it was read as well. 2 40 Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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