Inspection on 17/03/09 for Dale House

This inspection was carried out on 17th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

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: Dale House Front Street Dipton Stanley Durham DH9 9DE     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: Kathy Bell     Date: 1 7 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 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: Dale House Front Street Dipton Stanley Durham DH9 9DE 01207570652 01207570652 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Potensial Limited Name of registered manager (if applicable) Miss Claire Louise Carlyon 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 who can be accommodated is: 9 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Learning disability Code LD, maximum number of places 9 Date of last inspection Brief description of the care home Dale House is registered to provide care (but not nursing care) for nine people with learning disabilities. Most of the people who live there have been there for some years. The building is a large detached house, with a purpose-built extension on the ground floor. All the bedrooms are singles (one has an ensuite shower and toilet) and there is a large lounge/dining room and a small lounge downstairs. The house is near the centre of the village of Dipton with local shops and doctors surgery nearby. There are bus services to local towns of Stanley and Consett. Care Homes for Adults (18-65 years) Page 4 of 29 care home 9 Over 65 0 9 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: This inspection took place during one day in March 2009. During the visit to the Inspector looked around the home, talked to the manager, the new area manager and the deputy. She looked at records kept in the home. She met all but one of the people who live in the home and spoke with some of them. Before the inspection staff helped most people fill in surveys and all the staff completed surveys themselves. The manager sent us a report (the AQAA). This report gives their view of what the home is doing well and what it could do better. We used this information when we did the inspection. In the last report we may have told the home to improve what they do. We call this Care Homes for Adults (18-65 years) Page 6 of 29 making Requirements or Recommendations. If the home hasnt done what we told them to, but this doesnt affect peoples safety, we may not tell them to do it again. But, in future, if we have to tell a home a second time, we will probably take action to make them do what we say. 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 Care Homes for Adults (18-65 years) Page 9 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 10 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. The Statement of Purpose needs to be updated to give correct information on who is running the home. It would be better in a form which people considering moving into the home could understand more easily. The home has made sure it had basic information on people so that staff could decide whether their needs could be met in the home or not. Evidence: There is a Statement of Purpose which includes almost all the information required by law. This is the document which a home must provide to explain who is running the home and the kind of service it provides. The company which runs the home has changed and there is a new manager. So the Statement of Purpose needs to be updated. It would be better if it was written in a way which would be easier for people who might move into the home to understand. No new people have been admitted for some time but before each of the current people was admitted, a care manager assessed their needs. The home has its own Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: assessment document to make sure they look at whether they would be able to meet peoples needs. This is good because it includes looking at whether staff would need extra training. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans include a lot of valuable information about peoples needs and their likes and dislikes, so staff know what they need to do. But they had not always been kept up-to-date.Residents can make choices in their daily lives. Staff have recorded whether any activities put people at risk and described what they must do to keep people safe. Evidence: The care plans seen included a description of the support each person needs through a 24-hour period. They explain the daily routine each person likes. There was a full assessment of each persons ability to look after themselves. For some people the care plan included the guidance from a speech and language therapist about help they needed to it. There were guidelines for the staff about a resident who can become upset very easily, explaining how to avoid problems arising in the first place, and how to respond if they did. There was a place in the care plans to record any cultural or Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: faith needs. But at the time of the last inspection we found that a care plan for someone who had broken her leg had not been updated. It should have been changed because her bathing needs had changed and she needed to be assessed for the risk of pressure sores. We looked again at this care plan. It showed that staff had changed the care plan when we pointed this out but it had not been changed again when the plaster was removed and she could go in the shower again. This showed that staff had not been looking at the care plans regularly to make sure they were still correct. In this home, this was unlikely to cause major harm, because there are only five staff and they know each person very well. But care plans should always be kept up-to-date, in case of an emergency when other people need to provide the care. The new manager is working on new formats for the care plans. In surveys, the residents who could be helped to complete surveys said they could make decisions about what they did and do what they want to at all times. The records showed how one person decides whether or not she feels like going to her day placement. The records of medical treatment also showed how staff respect peoples rights to choose. But if they are refusing regular checkups, staff seek medical advice about this. There are regular meetings for people who live in the home where they can say what meals they would like and where they would like to go out on trips or holidays. For example, in a meeting, two people said they would like to go to the Metrocentre. When we talked to them, they told us that they had gone there. Staff have recorded when activities people take part in might create risks for them. These risk assessments explain what staff must do to keep them safe. For example, for a resident who likes to help in the kitchen, the risk assessment explains what staff must do to prevent scalds from the dishwasher. These risk assessments had been reviewed in December last year, so staff had made sure they were up-to-date. 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 who live in the home enjoy a range of activities, in and outside the home and use local community facilities. They can keep up contact with their families and the home provides satisfactory diet. Evidence: All but one of the people who live in the home have planned activities outside the home each week. These range from going to a local drop-in centre, where the activities include bingo or a disco, to activities specifically for people with learning disabilities. Some of these include going out and about in the local community. Some people use the local community centre for Tai chi and line dancing. For one person who does not have day care outside the home, staff make sure that there is a planned session at least once a day when they arrange a relaxation session with music or aromatherapy. For another person who spends more time in the home, the daily Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: records show that staff involve her in the daily work of running the home, and have a cooking session with her at least weekly. She described this routine to us and clearly appreciates the attention from staff. Everyone else has at least two hours a week oneto-one time with a member of staff and they can choose how to spend this time. The records showed that staff take people out to the shops, or for a pub meal, or spend time in the home. As far as possible, people are involved in the running of the home, discussing the menus in meetings, and two people said they had been involved in choosing the planned new furniture for the lounge. The staff explained how people have contact with their families where this is possible. The records of the meals provided showed that people have a varied and nutritious diet. The record showed that not everybody always had the same meal and people could choose to have something different. The care plans included information about special dietary needs. Staff had asked for advice from specialists when this was needed. Two of the people who live in the home told us that staff ask them what they want for meals. 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. Staff meet peoples personal and health care needs well. They generally look after medication safely but still need to improve the way they handle medication people take with them on home visits. Evidence: Care plans include very detailed guidance for staff about peoples everyday routines and preferences. Most of the staff have known people for a number of years and are familiar with their needs. We saw how a resident who is blind enjoyed a backrub from one of the staff, who knew how she liked this done. The care plans also included guidance for staff on how to respond if people became angry or upset. The records for one person, who has had problems in this way, showed that staff were managing to keep her calm and avoid her becoming distressed. They had asked for advice from care managers and consultants when this was needed. There were clear records of when people had seen doctors or nurses and these showed what action had been taken or advice given. For one person who cannot say when something is wrong, the records showed that, because they knew her well, staff were noticing when she seemed not quite right and took her to the doctor. The home has generally safe Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: systems for looking after medication, keeping it safely and recording when it is given out or disposed of. Staff keep very close check of stocks of each drug, so they would know if any mistakes were made. When a consultant had changed the instructions for giving out a drug when someone became agitated, a copy of the letter was with the medication and staff had signed to confirm they had read it. This made sure that everyone knew about the change. All the staff have had training in the safe handling of medicines. But at the time of the last inspection we said that they must set up a suitable system for when people take medication home with them on visits. We were told that solutions to this had been discussed but no action taken. 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 are encouraged to tell the staff if they are unhappy about anything. They are protected from harm as far as possible. Evidence: The home has a complaints procedure in different forms, with pictures or with simple English. This helps people understand it. No complaints have been recorded in the last year. In surveys, the people who lived in the home said they knew who to talk to if they were unhappy. Only one said they did not know how to complain. We looked at the records of the meetings staff have with people who live in the home. These showed that staff regularly remind people that they should speak up if there is something they dont like. All the staff have had training in the protection of vulnerable adults (now called safeguarding). The manager could not find the homes procedure on safeguarding but said she would refer any concerns to the care manager. She needs to make sure that the home has a procedure and that this matches the local authoritys arrangements for referring concerns. Satisfactory records are kept of any money looked after for people, with receipts kept. 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 home provides a comfortable place to live which generally meets peoples needs. The owners of the home are aware of work which needs to be done to improve it. Evidence: The home is a detached house with a ground floor extension, which provides three single bedrooms, bathroom and laundry. There is one other bedroom on the ground floor, with an ensuite bathroom. All the bedrooms are single and decorated and furnished in a domestic style. There are enough bathrooms and toilets around the building. There is a large lounge with a dining area and a small lounge. Some of the sofas are in poor condition and one of the people who live in the home said that they had helped choose the new furniture which is expected soon. The organisation which runs the home knows that work is needed to replace some windows and to make the garden area a pleasant place to sit. At times, someone who has a bedroom upstairs has needed to be downstairs. When this has happened, staff have discussed this with the person who moves out of the downstairs room and a relative who can speak up for him, to check he does not mind. They have requested an assessment by an occupational therapist to see if there is anything else they need to do if this happens again. Care Homes for Adults (18-65 years) Page 20 of 29 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. There are enough qualified and trained staff to meet peoples care needs. The home has taken care when recruiting new staff, to make sure they only employ people who are suitable to work in care homes. Evidence: All five of the care staff have achieved the National Vocational Qualification in care at level 2. The National Minimum Standards recommend that half of the care staff in each home achieve this qualification so Dale House has done much better than this. This is a particularly good achievement for a small home. Two of these staff now have this qualification at level 3 as well. The staff seem to have comfortable, familiar relationships with the people who live in the home and most of them have worked there for a number of years. Staffing levels take into account that most people go out through the day during most weekdays and evenings tend to be a time for relaxing at home. There are two staff on duty from 7-9 am, to help get people up and ready for the day. Then one person is on duty until 3 pm. Two people are on duty from 3-8 p.m. and one person is on duty for the rest of the evening and then does a sleep in shift. At weekends there are two staff on duty through the day. As well as this the manager is at work from 8-4 each weekday. We were told that the deputy does come in sometimes at weekends to enable staff to take people out. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: No new staff have been recruited since the last inspection but, in the past, we have found that the home has recruited people safely, by carrying out all the necessary checks to make sure they are suitable people to work in a care home. Following last inspection, the deputy made sure that all the staff received the key training they needed, in food hygiene, fire safety, safeguarding adults and the safe handling of medicines. They also received training in epilepsy, diabetes and challenging behaviour, to help them meet the specific needs of people who live in the home. Refresher training is planned for this year. In the surveys, a number of the staff commented positively about the amount of training they were receiving. 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. A new manager has started work but did not receive the support she needed at first to make sure the home was running well. The company which runs the home must continue to develop its systems for looking at the quality of care. In many ways, the home is a safe place to live and work but the company did not look at whether they needed to take action to prevent an accident happening again. Evidence: A new manager started work in the home in October 2008 and is applying for registration with the Care Quality Commission. She is being supported by a new area manager. She has the National Diploma in Care at level 3 and experience as a senior carer, but limited experience in a management role. She completed the AQAA, the self-assessment document in a way which showed she is thinking about how to improve the home. After the last manager left in spring 2008, the deputy did a good job in keeping the home running. But the organisation failed to make sure that requirements made in the last inspection report were followed up. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: The organisation which runs the home has to carry out monthly visits to check it is running properly. These have not been done as regularly as they should have but we saw that the company had recently made arrangements for these to be done. The new area manager will be doing these in the future. We were told that there was a development plan, which looked at what the home needed to do to improve the quality of care, but this was not available in the home. The area manager agreed that they need to develop their systems to check on the quality of care. The home is maintained as a safe place to live in most ways. The electrical wiring has been checked to make sure it is safe and the fire detection systems have been serviced. Staff carry out regular checks of the fire alarms to make sure the system works. They now receive the regular fire safety training they should have and they carried out a fire drill at night, to make sure that one person would be able to evacuate everybody. Some doors in the home need to be open so people can move around freely but need to be shut if there is a fire, to stop smoke and flames spreading. These doors have now been fitted with devices which will close them automatically if the fire alarm goes off. Staff check the temperature of the hot water whenever they help people have a bath or shower but staff were unclear whether the temperature was controlled by a thermostat. The area manager promised to look into this. Last year a resident suffered a serious fracture of her leg when she caught it in a radiator cover. At the time of the last inspection we told the home that they must check if they needed to take any action to prevent another accident of this kind. But this has not happened. 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 1 23 13 A safeguarding procedure must be available in the home. It must match the local authoritys procedures for referring concerns. This is so staff know exactly what to do if they have concerns about possible abuse. 22/05/2009 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 1 4 The Statement of Purpose 20/06/2009 must be kept up-to-date and include the name of the company which runs the home. This must be included so people are clear who is responsible for the home. 2 6 15 Care plans must be kept up- 20/05/2009 to-date. Care plans must be up-todate so staff will always know what they need to do for people. Care Homes for Adults (18-65 years) Page 27 of 29 3 20 13 The home must set up a 20/06/2009 safe system for handling the medication people take with them on home visits. This is to make sure that medication is given out safely when people are away from the home. 4 42 13 After a serious accident, 20/05/2009 staff must check if they need to do anything to prevent a similar accident happening. The temperature of hot water at tap is used by people who live in the home must be limited to 43 degrees Centigrade. This is to reduce the chances of accidents happening again. Hot water must be controlled to avoid scalding residents. 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 24 The garden area should be improved so that it is a pleasant place to sit. 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!