Inspecting for better lives Key inspection report
Care homes for adults (18-65 years)
Name: Address: Glendyke Road 54 54 Glendyke Road Allerton Liverpool Merseyside L18 9TH 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: Janet Marshall
Date: 0 2 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 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: Glendyke Road 54 54 Glendyke Road Allerton Liverpool Merseyside L18 9TH 01517245053 01517245053 glendykeroad@c-i-c.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Community Integrated Care Name of registered manager (if applicable) Ms Judith Scudder Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home 54 Glendyke Road is a care home registered with the CSCI to provide care for three adults with a Mental Health /learning disability. Community Integrated Care have been the registered provider for this service since December 2003. The home is situated in the Allerton area of Liverpool and is close to local amenities, bus and rail routes. The care home is a bungalow and all facilities for the service users and staff is situated on the ground floor. The home is accessible for wheelchair users and is generally well maintained. The fees for the home are #265.55 per week. 3 Over 65 0 care home 3 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home
peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use the service experience good outcomes. This was a key inspection. The report for this key inspection has been put together using information gathered in a number of different ways. This included looking at information, which we have received from other people about the service since the last key inspection. We also looked at the Annual Quality Assurance Assessment (AQAA). This is a form, which we sent to the home for them to fill in telling us about how they are meeting the National Minimum Standards for their type of service. The AQAA was filled in by the manager and sent back to us before the site visit took place then used to plan the site visit part of the inspection. Care Homes for Adults (18-65 years)
Page 5 of 27 An unannounced visit to the home also took place, this is referred to as the site visit. During the site visit residents care records and other records were looked at and checked, discussions with staff took place and parts of the home were looked at. None of the residents were spoken with because they have limited verbal communication skills, but they were observed being supported by staff. Two residents were case tracked. This is something we do to help us find out if people are being supported in the right way. We do this by looking at residents care records, talking to staff and looking around the home. 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 residents needs are fully assessed to make sure they will be met at the home. Evidence: No new residents have been admitted at the home since the last inspection. The were a number of policies and procedures available at the home for assessing and admitting a new resident to the home. Information describing the processes was also avaialble in the homes Service User Guide and Statement of purpose. These are information packs about the home, which are given out to residents who already live there and anybody who may be interested in living there. Each of the residents had up to date information packs, which were kept in their bedrooms. The manager described clearly the homes policy and procedures for assessing and admitting a new resident to the home. Care files for two residents, which were looked at contained copies of assessments carried out before they moved into the home and there were records in place, which showed that residents care needs requirements are reguarly reviewed to make sure
Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: that they can be met at the home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs and choices are clearly set out in individual care plans which are kept securely at the home. Evidence: A requirement was given as part of the last inspection report for all residents personal files to kept securely in the home. This was because at the last inspection visit residents personal files were stored in an unlocked cupboard in the main lounge which compromised their confidentiality because aunorthorised people could look at them. The AQAA told us that all residents personal records are now locked away and staff have received training in the subject of confidentiality. At this inspection visit each of the residents had an individual care plan and they were kept securely in the office. Two residents care plans were looked at in detail as part of the case tracking process. Both care plans, which were written in a person centered way covered residents care and support needs such as health and personal care, communication, likes and dislikes, finances and activities. Written records, which were seen in residents care
Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: files showed that regular reviews and updates of care plans take place involving the residents, their family and staff at the home, other health and social care professionals are also invited to take part in reviews. Staff spoken with during the inspection visit had a good understanding of care plans and explained the importance of them. One member of staff said, They tell us about the best way to support residents and about the things they like and dont like. All of the residents that live at the home have limited verbal communication although they are able to communicate in many other different ways such as by use of sounds, body language, gestures and facial expressions. Staff were observed communicating well with all of the residents and they appeared to clearly understand their needs and responded to them positively. Residents preferred way of communicating was recorded in their care plans and there were picture books available around the home to help residents make choices about things such as what they eat, where to go and what to do. Risk assessments were part of each persons care plan. Those that were looked at provided staff with information about the safest way to support residents so that they are able to take part in a task or activity, which is potentially unsafe. Risk assessments were also available for equipment used at the home such as bath aids and outdoor activities such as swimming and holidays. Records looked at showed that all risk assessments have been reviewed and updated on a regular basis. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live active and healthy lifestyles and are given opportunities to take part in the daily routines of the home. Evidence: The AQAA told us that residents are given opportunities to take part in activities of their choice. All the residents that live at the home need the help of staff to get out and about. Information about the help they need and details of their preferred interests and hobbies were recorded in their care plans. Each of the residents had an activity programme, which included things they do inside and outside the home. Case tracking showed that each persons programme has been put together based around their individual needs. Daily records, which were kept for each resident showed that they are regularly getting out and about doing the things they prefer and enjoy such as swimming, shopping, dog walking, trips to the theatre and meals out. They also go
Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: on an annual holiday, or on several short breaks throughout the year, which are paid for by the company. Activities, which they do at home include listening to music, aromatherapy and relaxation sessions. A member of staff said, residents have a really good social life. Residents are encouraged and supported to keep in touch with their family and friends. Care plans included information about important relationships and how they need to be supported. A visitors book, which was available in the hallway showed that residents receive regular visitors to the home. Staff said, visitors can come and go whenever they want and they are always made to feel welcome. Because of certain limitations residents are unable to actively take part in routines at the home such as cleaning and cooking, however staff explained that they encourage their involvement in other ways, for example they invite residents into the kitchen when they are preparing meals and they talk to them about what they are doing and encourage them to touch and smell different types foods. Residents do not hold their own keys to the front door or to their bedrooms because of their limitations. Information about the use of keys and other choices and decisions made on behalf of residents by others and the reasons why, were recorded in their care plans. The AQAA told us that residents have balanced and healthy diets and that staff have received training in nutrition. Residents likes and dislikes with regards to food was recorded in their care plans as well as information about the help they need at meal times. Records showed that residents with special dietary needs are seen by specialists such as dietitians. Residents are encouraged to choose what they eat, staff assist them to do this by using a picture book, which was in the kitchen. The book contained photographs of many different types of food. Residents usually sit and eat their meals together in the kitchen diner although staff said they can if they prefer eat in their rooms or at a the table in the main dining room. During the inspection visit staff were seen assisting residents to eat, they assisted patiently and did not rush residents. Food stores, which were checked were well stocked with a variety of fresh, frozen and tinned items. 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. Residents personal and health care is well recorded and supported to make sure they stay well. Evidence: Both care plans, which were looked at included information about the residents routines and the kind of personal and health care support they they need. Case tracking showed that residents are properly supported to help them stay well. During discussion staff said they encourage residents to carry out what ever personal care they can for themselves. During the inspection visit, staff were seen talking to residents in a polite and respectful way. Staff also talked about the some of the things they do to ensure residents privacy and dignity, which included shutting doors and curtains when helping residents with personal care, knocking on doors before entering bedrooms and bathrooms. One member of staff said, I always talk to residents, tell them what I am going to do for them before I do it and reasure them if they are anxious. I make sure they each have their own personal items such as towels, perfume and aftershave. Each of the residents had a health care action plan, which provided staff with detailed information about the persons health and personal care
Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: needs and about how best to support them in a way that ensures their privacy dignity and independence. The AQAA told us that residents are supported to attend regular health care checks with their doctor, chiropodist, dentist and opticians as well as attending hospital appointments. Medical records, which were seen also showed this, they were well kept and up to date. Staff said, they know when a resident is in pain or discomfort and were confident about what they would do if a resident suddenly became ill. On the day of the inspection visit, all residents were clean in appearance and smartly dressed. Medication and medication administration records (MAR) sheets for two residents were checked and found to be in good order. The AQAA told us that available at the home are up to date policies and procedures for the safe handling and administration of medication. It also told us that staff have received training in the subject. Staff also confirmed this during discussion with them. 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. Staff receive training and procedures are in place to protect residents from abuse, harm and neglect. Evidence: The AQAA told us that no complaints have been made directly to the home since the last inspection. The Commission also have not received any complaints about the home during this time. The AQAA detailed a number of policies and procedures, which are in place at the home that aim to protect both residents and staff. They included procedures about complaining, whistle blowing and protection of vulnerable adults. A visitors book was available in the hallway, which visitors are expected to sign when they enter and leave the home. For the protection of residents, no visitor is allowed to gain entry unless they produce some form of identification. The manager described well how she would deal with a complaint made to her and staff spoken with knew about the homes complaints procedure and said they were confident about complaining if they needed to. One staff member said, I would not hesitate if I needed to complain I would. Detailed in the AQAA and available at the home were a number of policies and procedures relating to protection of vulnerable adults (POVA). They included the companies own version and a copy of Liverpool Local Authority procedures. Staff training records, which were looked at and discussion with staff showed they
Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: have received POVA training. Staff spoken with were able to describe correctly what they would do if they witnessed or suspected abuse of a resident. One member of staff said, I would make sure the resident was safe and then report it immediately. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home, which is comfortable and safe. Evidence: The home is a detached bungalow located in a popular residential area of Allerton, Liverpool. The front of the home is flagged providing off road parking for at least two cars with parking also available directly outside the property. There is a large well maintained garden at the back of the home with lawns and planted out borders. A tour of the home took place on the day of the inspection visit. There was a warm and friendly atmosphere at the home, residents appeared comfortable and all furniture and fittings around the home were of a good standard and in good condition. Some improvements, which have been made to the home since the last inspection visit were looked at during this inspection visit, they included, the main lounge, kitchen utility room and hallway have been redecorated. The main bathroom has been re tiled following a recommendation given as part of the last inspection report. All the improvements, which were checked on the day of the inspection visit have been carried out to a good standard. A maintenance programme, which was available at the home showed there are plans to carry out further improvements at the home in the
Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: near future including the redecoration of one residents bedroom. Although there are curtains fitted to all windows around the home, it was noticed during this inspection that none of the windows were fitted with blinds or net curtains, including the residents bedrooms. This could compromise residents privacy and dignity because people can see in from outside. It is therefore recommended as part of this report that net curtains or blinds are fitted to all windows around the home. All parts of the home were clean and tidy and there were no hazards found during the inspection visit. The AQAA told us that available at the home are all the required policies and procedures, relating to the environment, they included disposal of clinical waste, infection control, health and safety and food hygiene. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by qualified and competent staff. Evidence: The AQAA told us that there are the right amount of staff employed at the home to support the needs of the residents that live there. Staffing rotas, which were looked at showed that there are at least two staff on duty during the day and evening and two staff on duty each night. A member of staff said, Yes I think there is always enough staff on duty to meet the needs of the residents. There were two staff on duty at the time of the inspection visit whilst two residents were at home. Staff spoken with showed good knowledge and understanding of the needs of the residents and clearly explained what their role and responsibilities were. Staff recruitment, selection and equal opportunities policies and procedures were available at the home. The AQAA told us that all the required checks are carried out on new staff before they are allowed to start work at the home. Personnel files for two members of staff were looked at in detail. The files contained records, which showed that the staff were recruited in the right way. Induction records were also available and showed that staff took part in induction training during the first
Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: few months of starting work at the home. A member of staff said, When I started work at the home I took part in induction training, which included working closely to more experienced staff for the first few weeks. Information we were given in the AQAA, discussion with staff and records looked at during the inspection showed that staff have completed mandatory training. This is other training they have to complete by law so that they have the right knowledge and skills to do their jobs. Mandatory training recently completed by staff includes, manual handling, POVA, health and safety, medication, fire awareness and food hygiene. Staff have also completed other specialist training to help them understand and manage certain conditions that residents have. A member of staff said, We get a lot of training and it is really good. The AQAA told us that most of the staff have got an National Vocational Qualification in Care level 2 or above. A member of staff spoken with said I have just finished my NVQ level 2. The AQAA told us about other training, which has been planned for the future including refresher courses in all mandatory subjects, NVQ level 3 in care and equality and diversity training. 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 good 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 managed to the benefit of the residents and staff. Evidence: There has been a change of manager since the last inspection visit. The company wrote to us to tell about this change. In August 2008 the new manager Judith Scudder was approved by the Commission as the registered manager of the home. She has many years experience of working in the field of care and the required qualifications including the Registered Managers Award and NVQ level 4 in Care. During the inspection visit the manager was able to show that she continues to update her skills and knowledge by attending refresher courses in all mandatory subjects as well undertaking training, which is relevant to her role as manager. Staff were complimentary of the manager and the way she runs the home, they made the following comments to support this, The manager is part of the team, She is supportive and fair and easy to talk to. The manager is always there if you need her. She manages the home really well. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: The AQAA told us that there are processes in place to check the quality of the service. They include giving out questionnaires to residents and their families to find out what they think about the home and the way it is run. A service manager also visits the home each month to check on things such as health and safety records, residents care records and the environment. During the visits they also talk to residents and staff to get their opinion about the home and the way it is run. After the visit the service manager writes a report detailing their findings. Copies of the reports, which were available at the home showed that the company carry out regular quality checks on the service. Other quality checks, which are carried out by the manager and staff include monthly care plan reviews and weekly checks on medication and residents finances. Records of these were seen during the inspection visit. The AQAA told us that the home has available all the health and safety policies and procedures, which they have to have by law to ensure the health safety and welfare of the residents and staff. It also told us that all the required checks are carried out on the systems and equipment used at the home to make sure they are safe. Records for some checks were looked at, including gas, electricity and fire records. The records were up to date and accurate. Discussions with staff during the inspection visit and information provided in the AQAA showed that staff have recently received training in subjects of health and safety such as fire awareness, lifting and handling and first aid. 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 24 All windows in the home should be fitted with net curtains or blinds 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. 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!