Inspection on 09/02/09 for Longley Road

This inspection was carried out on 9th February 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Longley Road 12/12/07

Longley Road 31/10/06

Longley Road 22/02/06

Longley Road 28/02/05

Longley Road 05/08/04

Longley Road 23/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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:     Longley Road 89 Longley Road London 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: Louise Phillips     Date: 1 9 0 2 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 28 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 28 Information about the care home Name of care home: Address: Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia sensory impairment Additional conditions: Date of last inspection Brief description of the care home 89 Longley Road provides accommodation for six adults who have a mental health need and a hearing impairment. All people who use the service have their own flat with bedroom/lounge, kitchen and bathroom. The home also has a communal kitchenette/dining room, lounge and laundry room for use. The home is situated in a quiet residential area in Tooting and has an attractive, large back garden. It is close to local amenities and public transport links. The property is owned by Wandle Housing Association and operated by SignHealth, a charitable organisation. The service users and staff communicate by using British Sign Language (BSL). The weekly charge for £1089.90 per week. 6 6 6 Over 65 6 6 6 SignHealth care home 6 Longley Road 89 Longley Road London 02087679933 02087679966 cward@signhealth.org.uk Care Homes for Adults (18-65 years) Page 4 of 28 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 over one day an included a visit to the service by a Regulation Inspector. We were accompanied by a British Sign Language (BSL) interpreter for part of the inspection to enable us to talk to people who use the service and some staff. When we visited we spoke to five staff and three people who use the service. We also sent surveys to people who live and work at the service and relevant health/ social care professionals involved with the service, and these are referred to in the report. We also looked at records, observed what was going on and looked at the environment. Since the last inspection the Registered Manager has left the service and the team leader was in day-to-day management of the home, with the support of another Care Homes for Adults (18-65 years) Page 5 of 28 manager of a different SignHealth service. the team leader has been referred to as the manager in this report. 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 28 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 28 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. Assessments are carried out by the service to ensure the service can meet peoples needs. Evidence: We looked at two of the care files of people who live at the service. Evidence was seen to demonstrate that the then manager of the service assessed the people in all areas of daily living, and the levels of support that they will need when they moved to the home. For one person there is referral and assessment information that was carried out by different members of the multi-disciplinary/ care management team. However, for one person this information was dated 1996, despite them having only recently moved to the service. Although they had moved from a different Sign Health service, they should have been thoroughly re-assessed by care management prior to moving to this home, to ensure that it is the best place for them. Care Homes for Adults (18-65 years) Page 9 of 28 Care Homes for Adults (18-65 years) Page 10 of 28 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. Care plans and risk management plans are in place for people who use the service to ensure they get the right support and the risks are minimised. Improvements are needed to the records about what people do each day, to ensure this are accurate and detailed. Evidence: Individual Needs and Choices: 7, 8, 9 and 10 We looked at the care files for two people who use the service. Each person has care planned around their individual needs, and these detail support for areas such as help with medication, activities, interests, finances, mental health, communication, each depending on the need of the person. These provide appropriate detail to demonstrate the care and support provided. One person has a move on care plan, which is very detailed and takes into account the facilities at the place they are hoping to move to. Staff we spoke to described the pride and satisfaction they feel in their work, Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: particularly where they help people to move on to more independent accommodation, where one staff commented that: ..best thing is when you see a client who is ready to move on... One professional fedback to us that people who use the service are ..gradually helped towards increasing independence and confidence... People who use the service say they are involved in planning their care, and that they meet with their key-worker monthly to discuss their care plan. This is positive, although the service should look at implementing a more person-centred approach at the home, and developing the care plans into a more accessible format for the people who use the service. Risk assessments and risk management plans are in place for each person, relating to any specific safety needs they may have, or behaviours which may be of risk to other people. These include areas such as managing medication, allegations people make and help with managing finances. The risk management plans are detailed and provide appropriate information. The daily record that states what people who use the service do each day is in a numbered bullet point list (1, 2, 3, etc) in relation to each care plan. Such entries in the daily record are: have weetabix, hygiene was good and he keeps his money. Some entries also include things that people have not done, such as no activities. This current system does not provide an accurate, detailed daily account of what people who use the service have done each day, such as the interactions they have had or things they have been involved in, and it is required that the record-keeping in this area is improved. Care Homes for Adults (18-65 years) Page 12 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make decisions about what they do each day and are supported to spend each day as they wish. Evidence: During the inspection we observed people who use the service coming and going from the home, going about their daily lives. We spoke to a number of people who use the service, who described different activities that they get involved in throughout the week. One person spoke about their going to college once a week and doing their food shopping, whilst another said they enjoy doing artwork and going to the pub. Other people spoke about how they go and see their friends and family, and that they are able to invite them back to the service when they want. Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: Each person has their own flat, and there are a communal kitchen and lounge area, with a computer where people can access the internet, as well as videos and a DVD player for use. One health/ social care professional who responded to our survey said that they would like to see the staff take some people who use the service out more. Staff told us that most people who use the service are very independent in their lives, and that they provide support where necessary. People have their own flats, where they buy and prepare their own food. We were informed that staff will assist where necessary if people need support with shopping and cooking. Care Homes for Adults (18-65 years) Page 14 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to have their visits physical, emotional and medical needs met through the service and its positive links with relevant professionals. Improvements are needed to medication stored at the service. Evidence: A record is maintained in each persons care files of appointments that they have with doctors, dentists, and relevant mental health professionals, etc. Health/ social care professionals who responded to our survey said that the staff usually seek their advice and act on what say. One commented that ..they seek advice and also think and act spontaneously to improve peoples healthcare needs.., whilst another said ..updates from the staff are sent to me... They also said that they feel peoples healthcare needs are met by the service, and that people who use the service have their privacy and dignity respected by the staff. There is a communication support worker who visits the service a couple of times a week to assist staff and people who use the service with any particular communication Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: needs they may have, such as grammar in letter writing. We looked at the medication system in use at the service and found that the medication for each person corresponds with that which is prescribed. The previous inspection required that a weekly audit takes place to check the medication. Whilst evidence was seen to demonstrate that this has taken place, this had not been done for some time and this must continue to ensure that medication is administered safely to people who use the service. The medication is kept on a shelf in a cabinet in the office, which is lockable, though was observed to be unlocked thoughout the duration of the inspection. Care Homes for Adults (18-65 years) Page 16 of 28 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. The service has appropriate procedures for addressing complaints and ensuring people who use the service are protected. Evidence: There is an appropriate complaints policy which details the procedure and timescales for investigating complaints. A form is available for logging complaints and recording the actions taken to resolve issues. People who use the service said that they would know who to talk to if they were unhappy about something and know how to raise a complaint. The service holds a copy of the most up-to-date safeguarding procedures from the local authority, and have managed safeguarding incidents appropriately. Staff said they have done training in safeguarding vulnerable adults and demonstrated and awareness of what to do in the event of a safeguarding issue being raised at the service. Care Homes for Adults (18-65 years) Page 17 of 28 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 environment is welcoming and homely for the people who use the service, though some improvements are needed to ensure risks to people are minimised. Evidence: Each person who use the service has their own flat that they clean themselves, with the support of staff if needed. Within their flat, people have their own bathroom and kitchen areas. During the inspection three people showed us their flat. We saw that each flat is laid out differently and is individually decorated. People said that they were able to choose the colour of the carpets and paint for the walls, and that they like that they are able to personalise their flat with their own belongings. People are also able to use the communal lounge and kitchen areas, on the the ground floor of the service. All areas were observed to been clean and tidy. Some areas were seen to need to need addressing, such as cleaning of the stained Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: carpets in the hallways, replacing the missing tiles in the laundry room and lowering of the high cupboards in the communal kitchen area. One person who uses the service also told us that the hot water takes a long time to heat up, and that there have been problems with the boiler. There was evidence that this has been followed up by the service, though we noticed that this was still the situation in their flat, and also that when the water did heat up, it was very hot to touch. Some of the radiators in their room were also very hot to touch. In one persons room, it was also noticed that some of the furniture provided by the service was damaged, and in need of replacing, particularly a broken leg on the sofa and broken drawer on unit. One person also wanted to re-position their bed, but was unable to because of the location of the plug socket needed for the vibrating fire alarm pad that they need in their bed. This socket should be re-located so that the person can position their bed where they wish. Care Homes for Adults (18-65 years) Page 19 of 28 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. Risks to people who use the service are minimised through appropriate recruitment checks. However, a number of improvements are needed to ensure all staff are appropriately trained for their role. Evidence: The staff team comprise of people who have worked at the home for a number of years and staff who are newer to service and their role. Staff say that they feel there is good teamwork at the service, and good support provided to the people who use the service. Some staff said that they feel there should be more staff, particularly deaf staff, employed at the service to enable better communication with people who live at the home. People who use the service say that the staff treat them well, with one commenting that there are ..very nice staff... We observed that staff have a good rapport with people who use the service. The recruitment files for two staff were looked at. These contain information to demonstrate that appropriate recruitment checks are carried out on staff prior to their starting work at the home. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: New staff receive an induction to the service and undertake a period of probation to ensure that the service is the right place for them to work. The induction includes orientation to the procedures around health and safety and fire safety. One staff member said that their induction took place over two weeks and they felt it covered most relevant issues. They said that during this time they felt well supported and able to ask questions about their role. Staff we spoke to said that they receive regular supervision with their line manager, and that the most recent of these was their annual appraisal. The staff we spoke to spoke about different training that they had undertaken, which we followed up by looking at their training records. Some staff have completed relevant National Vocational Qualifications (NVQ) for their roles, whilst others said they are hoping to start theirs soon. The training records indicate that some staff have been trained in such areas as mental health awareness, health and safety and first aid, yet some of these were seen to have been done some years ago. An example of this was for one staff member whos training records indicate that they last had food hygiene training in 2003, mental health awareness training in 2002 and first aid training in 2002. There was no evidence to indicate that staff had done recent training in fire safety, moving and handling, medication administration, food hygiene, first aid or health and safety. One staff member said that they feel that they need to do some refresher training, where another said training should be provided in breakaway/ how to defend yourself techniques. Training in these areas must be provided to ensure that people using the service receive the most up-to-date support, and that staff are appropriately trained for their work. Each staff member should also have a training and development assessment and profile in place, and this should be used to develop a trainig and development plan for the service. Care Homes for Adults (18-65 years) Page 21 of 28 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 is appropriate management in place at the service. However, improvements need to be made to ensure the safety of people who use the service, and to ensure that robust quality monitoring is taking place at the service. Evidence: Since the last inspection the registered manager has left the service, and the team leader is managing the service on a day-to-day basis with the support of a manager from another SignHealth service. At the time of inspection the team leader had been in post for approximately two weeks. The team leader said that she receives good support from the manager, and the team are very supportive, helping out with duties. She said that she also received an induction from the previous manager of the home. The team leader said that she has previous experience of managing a similar service and has achieved the BSL level 1, and is currently undertaking BSL level 2. Comments received from staff are that the team leader is: ..confident.., another said that the previous manager was very good, and the ..new manager seems good too... Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: Quality monitoring of the service takes place through regular house meetings and the people who use the service completing satisfaction questionnaires about the staff, support they receive and activities provided. It is not clear how this information is summarised and the results published and used to develop the service, as this information was not available at the service. Also regarding quality monitoring, the most recent visit, in accordance with Regulation 26 of the Care Homes Regulations 2001 is recorded as having taken place in January 2008, where it is required that these are carried out monthly, with a record held at the service. A requirement has been made to address this. The service holds certificates to demonstrate that relevant health and safety checks are carried out on the Portable Appliances, fire system and equipment and electrical systems. The gas safety certificate said that this was next due to be carried out on the 5th February 2009, though this had not yet been done, and must be done annually. As stated earlier in the report, the service must ensure that the hot water is properly regulated, and actions taken to ensure the safety of the people who use the service as necessary, where a requirement has been made for the service to address this. Care Homes for Adults (18-65 years) Page 23 of 28 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 24 of 28 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 10 17 The daily records must provide an accurate account of what people who use the service have done throughout the day. This is so that accurate records are maintained at the service. 31/03/2009 2 20 13 The medication cabinet must 31/03/2009 be kept locked at all times. To assure people who use the service that their medication is stored securely. 3 20 13 Audits of medication 31/03/2009 administration and checking of medication administration records (MAR) charts must take place weekly, and records maintained of this. To ensure that medication is administered safely to people who use the service. 4 35 18 Staff must be provided with training for the work they 31/08/2009 Care Homes for Adults (18-65 years) Page 25 of 28 are expected to perform, including: mental health awareness, fire safety, moving and handling, medication administration, food hygiene, first aid and health and safety training. This is to ensure that people who use the service receive support from appropriately trained staff. 5 39 24 The Registered Persons must ensure that a quality assurance system is established and maintained at the service. 30/04/2009 To assure people who use the service that qulaity is beig monitored and the service is run in their best interests. 6 39 26 The Registered Persons must ensure that visits in accordane with this regulation are carried out, and a report maintained of this at the service. 31/03/2009 So that people who use the service are assured that the quality of the service is monitored and actions taken where necessary. 7 42 23 An up-to-date gas safety 31/03/2009 certificate must be held at the service to demonstrate that these checks have been Care Homes for Adults (18-65 years) Page 26 of 28 carried out. This is to ensure the safety of facilities for people who use the service. 8 42 23 The service must ensure that the hot water at the service is properly regulated and actions taken to reduce risks to people and ensure that water is dispersed at around 43 degrees centigrade To ensure that people using the service are not put at risk. 31/03/2009 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 2 Evidence of a care management assessment should be obtained to inform the homes own assessment of people who move to the home. The care plans should be developed into a more accessible format for people who use the service. If people who use the service wish, then more group-based activities should be arranged and provided by the home, eg. outings to places of interest. A proper medication cabinet should be installed and used at the service. Each staff member should have a training and development assessment and profile in place 2 3 6 12 4 5 20 35 Care Homes for Adults (18-65 years) Page 27 of 28 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 28 of 28 - 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!