Inspection on 17/12/09 for High Oaks

This inspection was carried out on 17th December 2009.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

High Oaks 22/12/09

High Oaks 26/10/09

High Oaks 13/08/09

High Oaks 03/07/07

High Oaks 05/12/06

Extracts from inspection reports are licensed from CQC, this page was updated on 14/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: High Oaks Rectory Road Gissing Diss Norfolk IP22 5UU     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marilyn Fellingham     Date: 1 7 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 26 Information about the care home Name of care home: Address: High Oaks Rectory Road Gissing Diss Norfolk IP22 5UU 01379674456 01379677094 info@high-oaks.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: High Oaks Farm Limited care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home High Oaks is a registered nursing home providing residential nursing care for up to eighteen residents of both sexes, who have mental health problems. The home also provides short-term care. The current proprietor took over in July 2003, and is using all rooms for single occupancy. Communal areas are in the main part of the home, with bedrooms in a converted single storey extension. The home is in a rural setting, and affords peace and tranquillity for residents. Access to local towns and facilities, requires use of the homes own transport as access to public transport is limited. Specialist support services required are accessed via G.P referrals. Fees range from £875 per week to £1600 1 3 0 8 2 0 0 9 18 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 26 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: zero star poor 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 was an unannounced inspection that took place over seven hours. This report needs to be read in conjunction with the Random Inspection report written by the Regional Pharmacy Inspector in relation to his last visit to the home on December 22nd 2009. The key inspection for this service has been carried out using information from previous inspections and from some residents and people who work in the home. The main method was case tracking. This involved selecting individual care plans and information available about people who live in the home and tracking their experience as a result of the support provided. During our visit a tour of the premises was undertaken and the residents records and Care Homes for Adults (18-65 years) Page 5 of 26 staff files were looked at. We also took the opportunity to speak with any visitors to the home. Care Homes for Adults (18-65 years) Page 6 of 26 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 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 7 of 26 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 26 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 can be assured that pre-admission assessments and information is thorough and informative and hopefully will be maintained in the future. Evidence: The service has admitted one new resident since our last key inspection, so we looked at the records for the admission process for this resident. We noted that a new format had been used in order to make a thorough assessment of needs before making a decision if this prospective residents needs could be met. The assessment was carried out by the deputy manager and covered all aspects of need in relation to the residents mental and physical health, therapeutic needs and risk associated with the diagnosis of the resident. We spoke with the resident whose records we had looked at, they told us that they had settled in well and that they had been given a lot of information about the service before they decided if the home was right for them: they also told us that they had been given the opportunity to visit the home before they moved in. The service has been undergoing a change in the admission process as it was considered poor at the last Key Inspection; a consultant has been enlisted to help with Care Homes for Adults (18-65 years) Page 9 of 26 Evidence: the process and documentation for the admission process. The resident had been issued with a contract for care and a copy of terms and conditions. Care Homes for Adults (18-65 years) Page 10 of 26 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. The residents can be assured that they have a support plan that staff can use; however these support plans are not always sufficiently detailed to enable staff to deliver fully determined care goals in a consistent way to ensure peoples assessed needs are fully met in a safe way. Evidence: We looked at five care plans and records associated with these five residents that also included the newly admitted resident. The service has enlisted the help of a consultant to advise them on their care planning system and suggest ways to improve the format used. The care plans are refereed to as support plans and the service has been gradually introducing this new system. The support plans we looked at showed evidence of improvement, there was evidence of resident involvement in their care planning process and this was confirmed by three residents we spoke with. One resident told us things are looking up and I have helped the nurses with my care planning, another resident said the staff are friendly and helpful and they talk to me about what I want. We spoke with another resident who told us it is better than it Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: used to be, its changed a hell of a lot and we go to morning meetings and talk about what we want to do and we can also tell the staff about any problems and they are dealt with. All the support plans we looked at had evidence of review, and dates set for projected reviews of care. Although the support plans were improved there were still areas where detailed care relating to assessed needs was missing. For example one residents records showed that they were diabetic and had asthma, however there was no detailed information as how to care for this resident with these conditions. Another resident who is diabetic lacked detailed support plans to give clear guidelines for care. A resident whose daily records noted that they had had some aggressive outbursts, their records were looked at and showed no evidence of support in relation to their behaviour. This resident had been prescribed a medicine of psychotropic nature prescribed for prn (as required, occasional use), we found no records made to justify the use of this. This residents medication records showed some discrepancies, these will be discussed under the standard for use of medicines. One residents support plans we looked at had records for their assistance from staff in relation to helping them cook their own tea and the records stated the support that was needed; this support was also given with the involvement of the resident with all aspects of their care. We noted that risk assessments were in place, weights had been monitored with good records and blood sugar tests had also been well recorded except one entry was omitted by a night staff member. Care Homes for Adults (18-65 years) Page 12 of 26 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 are now supported to take part in meaningful activities on a regular basis and are helped to exercise choice and control in a number of issues affecting their lives; it is good now and hope it continues in the future. Meals and mealtimes are managed well. Evidence: During our visit to the home, and through discussions with staff members and some residents we were able to ascertain that the residents are supported to take part in activities that meet their therapeutic, leisure and social needs. We talked with a number of residents who were all very positive about the things they had been doing and about the activities they had been involved with. They told us that they had been on numerous outings, had a party, one resident said that they go to woodwork and go to a gym; another resident informed us that they visit a farm, goes home to visit their Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: mother and also said that they enjoyed going to car boot sales, this being part of their one to one therapeutic intervention. Another resident told us that they enjoy when the reflexologist visits once a week and finds it very relaxing; we did note that the reflexologist did not make a record of her visits and when we spoke with her suggested that this would be a good idea. The residents also shared with us that those who wished to, are being taken to the Pantomime in Norwich. We noted in one residents support plan that they quite often cooked their own tea, when we spoke with them they confirmed this and told us that the staff were very supportive in helping them do this. Many of the visits are arranged at the residents morning meetings where the residents are encouraged to share any concerns and put forward ideas for activities and outings. We were able to witness lunch being served, we talked to the residents about their food and the general consensus was that it was very good. On the day of our visit, roast chicken was being served with a vegetarian option, there was a choice of four vegetables and also a choice for puddings. The residents told us that they had had a lovely fruit cake for their party the previous day where visitors were also welcomed. We spoke with the cook who told us that the residents always have a roast meal on Sundays although she does not work at the weekends; a member of the care staff is responsible for cooking the meals at the weekends. Special diets such as diabetic diets are catered for and the cook is familiar with the likes and dislikes of the residents, for example one resident does not like vegetables and will only eat cabbage, we noted some had been cooked for them to go with their chicken. A milk machine has been placed in the dining room to allow the residents to help themselves to milk that has not been contaminated by flies. The drink dispensers for coffee, tea and sugar are now in canisters with lids. We noted that the residents have been given more suitable drinking vessels that have replaced the disposable plastic cups that they had been given previously. On discussion with a number of residents we ascertained that they have much more involvement in choice and overall take part in many more activities. Care Homes for Adults (18-65 years) Page 14 of 26 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The outcomes for this standard need to be read in conjunction with the random inspection report that was written by the regional Pharmacy Inspector following his inspection on December 22nd. 2009. The personal and health care needs of the residents are now being met in a more consistent way, however the way medicines are managed means that the residents are being placed at risk. Evidence: As mentioned under a previous standard the support plans we looked at although improved still lacked sufficient detail in some areas of personal health care. It was evident from the support plans we looked at and in discussion with some residents that they are encouraged to take risks in relation to their move to wards more independence. One resident told us I get the support I need especially from Annie; another said staff are very helpful and friendly and another informed us that staff are much better now. We carried out an audit of medicines associated with those residents whose support plans we had looked at. We looked at one medicine record chart and noted that Lorazepam had been prescribed to be given when necessary, there was no support Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: plan for this or a rationale for continued use. We also noted that this same resident had two medicines signed for as having been given, however these two tablets could still be found in the blister pack and had not been given. Another residents medicines did not tally with the amount that should have been left and two tablets were missing and not accounted for. We also noted during our spot audit of medicines that there were still discrepancies being made in relation to the codes being used on the medicine record charts. Care Homes for Adults (18-65 years) Page 16 of 26 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 can raise concerns about their care and know that they are listened to. Staff have the knowledge to protect the residents from abuse, neglect and self harm. Evidence: We looked at the homes complaints procedure, a copy of which is given to all people living in the home. The service has kept us informed of any complaints they have received and none have been received since the last Key Inspection. We talked with four residents who shared with us that they were aware of the complaints procedure. One resident said I know who to go to if I have any concerns, they went on to say that problems were dealt with. Another residents told us that I would go to Annie if I have any concerns, they went on to tell us that the staff do listen to them. We looked at the training records and they confirmed that all staff have had training relating to all safeguarding issues and new staff were due to start their training. We talked to some staff members who were aware of issues related to abuse and they were familiar with the procedures for this. Care Homes for Adults (18-65 years) Page 17 of 26 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 service now provides a homely and safe environment that suits the residents needs. Evidence: Since our last visit we have noted many changes to enhance the environment have taken place. One resident who was especially pleased with some of the changes pointed out to us the enhancements that had taken place in the smoke room. We noted new chairs had been installed, the residents had been given new and proper large ash trays and a new smoke extractor had been put in to avoid smoke permeating into the rest of the building. The smoke room had new window replacements and new blinds had also been added. The resident who pointed out all the changes in the smoke room told us that things are much better now. During our tour of the home we noted other improvements that had taken place, the games room had been re decorated, the television room had new windows and new roller blinds. The television room now has seating for ten people, however the acting manager assured us that there are never many more than six residents at a time who wants to watch television. A television has been provided in the games room should more than ten people wish to watch television at any given time. Many of the walls had been repainted including re plastering of the walls in the corridor. The kitchen has a new floor and all the residents rooms have had new furniture including new Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: mattresses on the beds. It has been arranged that the bedrooms will all have window replacements and work had already started on this. We noted that the home was much cleaner than we had found on our previous visit and many areas of the home had been tidied up. The home now employs two cleaners who work in the garden as well; they both have completed an infection control course and are aware of the precautions needed to keep the environment hygienic. An occupational therapist has visited the home and the service has responded to their assessment by ensuring that handrails are fitted to either side of the staircase and in a shower room to enable a resident to bathe more easily. Care Homes for Adults (18-65 years) Page 19 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are being given the skills to enable them to effectively support people who live in the home, however they still need more training in relation to specifice mental health conditions. The service have all appropriate checks in place for new employees to ensure that they are safe to work with vulnerable adults. Evidence: We looked at four staff recruitment records and all included appropriate checks and two references. One newly appointed qualified nurse told us that they had had a thorough induction for two weeks and then had shadowed other nurses for a further week. Records showed that all new recruits now have an induction period for at least two weeks and more depending on their needs and experience. The acting manager is aware of the training needs of all staff members and since our last inspection some have undergone training in numerous areas including, care planning, fire training, mental health awareness: other training sessions have been arranged that include food hygiene, manual handling and first aid. The acting manager has undergone physical intervention training since our last inspection. The two cleaners have undergone training in relation to infection control. It was evident that Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: the home had started to put into place a necessary training plan but has some way to go to ensure all staff are have the appropriate skills to carry out their roles. During our visit the newly appointed manager who had not yet taken up her post came into the home to discuss with the acting manager the way forward and plans for the future. The service has introduced a system for formal supervision, it has started with the nurses and will cascade down to all staff members; group supervision has also commenced. Staff members are given the opportunity to discuss their aspirations for their future professional development. We observed the staffs interaction with the residents, this was good and done with dignity. Those members of staff we spoke with liked the new support plans and found that they gave them a lot of information about each resident and things that they had not known. We spoke with one social worker who was visiting their client, they told us that the staff have been great and very positive and that their client seemed to be involved with all their care. Care Homes for Adults (18-65 years) Page 21 of 26 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. There are still some management shortcomings that could compromise the health, safety and welfare of people using the service. Evidence: Having carried out our inspection of the home we felt that some aspects of management of the home had improved, however there were still aspects in relation to the management of the home that needed to be further improved. These included the need for a much more robust system to account for residents monies; we found on checking residents monies held by the home that anomalies still excisted whereby the tallies of monies taken out of each residents separate envelopes did not tally with that left and what had been accounted for. We looked at health and safety related information and the records in place showed that there were servicing arrangements for all equipment including the service arrangements for the boiler and the cooker. The fire alarms were being tested on the day of our visit. Care Homes for Adults (18-65 years) Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 6 14 The care plan must contain detailed information about individuals care needs. This will ensure that residents needs are met 22/07/2009 2 41 13 The manager must ensure 24/07/2009 that there is a system in place to accurately account for all residents monies held by the home and maintained with receipts for all transactions. This will prevent the residents being at risk of financial abuse. Care Homes for Adults (18-65 years) Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 14 The support plans must contain detailed information about individuals care needs. This is a repeated requirement. This will ensure that residents needs are fully met in a safe way. 26/02/2010 2 37 24 The manager must ensure there is a system in place to accurately account for all residents monies held by the home and maintained with receipts for all transactions. This will prevent the residents being placed at risk of financial abuse. This is a repeated requirement. 19/02/2010 Care Homes for Adults (18-65 years) Page 24 of 26 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 14 It is recommended that the visiting reflexologist is encouraged to record her interactions with the residents. Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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