Inspection on 07/10/08 for Nationwide Community Care Limited

This inspection was carried out on 7th October 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Nationwide Community Care Limited 10/10/07

Nationwide Community Care Limited 27/10/06

Similar services:

Coopers Mill Ltd

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Paradise Lodge

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Upaya Ananda

Newton Court (1-2)

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Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Nationwide Community Care Limited 35 Mede Way Wivenhoe Colchester Essex CO7 9HW 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: Neal Cranmer Date: 0 7 1 0 2 0 0 8 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 31 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 31 Information about the care home Name of care home: Address: Nationwide Community Care Limited 35 Mede Way Wivenhoe Colchester Essex CO7 9HW 01206828011 01206824972 medeway_manager@communitycaregroup.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Nationwide Community Care Limited Name of registered manager (if applicable) Mrs Janine Formoy Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 2 0 care home 2 learning disability Additional conditions: Persons of either sex, under the age of 65 years, who require care by reason of a learning disability Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 31 A bit about the care home 35 Mede Way is a twobedroom bungalow situated in a residential area of Wivenhoe, near Colchester. The property has been changed to make it easier for the residents to get around the home. Each bedroom has separate en suite facilities. Communal areas include a lounge/dining room and a fitted kitchen with laundry facilities. There is an office/ staff room with sleep-in facilities and a staff toilet. To the rear of the property are a patio area and a compact garden. There is a small Care Homes for Adults (18-65 years) Page 5 of 31 area for parking in front of the property that can be used by people visiting the home The service supports younger adults with complex needs to live in an ordinary home environment. Information about the service may be obtained by contacting the manager. The home charges £1,700 a week. This information was given to the Commission in December 2007. Care Homes for Adults (18-65 years) Page 6 of 31 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 Care Homes for Adults (18-65 years) Page 7 of 31 How we did our inspection: This is what the inspector did when they were at the care home This was an unannounced visit to the home that took place on the 7th of October 2008 lasting six hours. During our visit we looked at all of the information that had been sent to us since the last inspection, including the home’s Annual Quality Assurance Assessment (AQAA) (this is a document that the home uses to tell us what they do well and how they intend to make any improvements). Care Homes for Adults (18-65 years) Page 8 of 31 During the inspection the inspector observed people being supported by staff going about their everyday lives. We also talked with staff and members of the home’s management team. We also asked service users to fill in surveys to tell us what they liked about living at the home, and some of the information provided from these has been included within the main part of this report. Care Homes for Adults (18-65 years) Page 9 of 31 What the care home does well The process to be followed for admitting new people into the home was good and provided people with a good level of information to enable them to decide if the home could meet their needs. The home was light, modern and well maintained, and decorated to a good standard. People’s bedrooms were nicely decorated and contained personal items. Care Homes for Adults (18-65 years) Page 10 of 31 What has got better from the last inspection The home’s recruitment practice has been improved, so that any gaps in new peoples employment history is explored during interview. Staff are provided with a good level of training and induction. A new registered manager started at the home in the summer of 2008. A sample signature is now kept of all staff who are involved in supporting people to take their medication. The hours that the manager works in the home are recorded Care Homes for Adults (18-65 years) Page 11 of 31 on the homes staff duty rota. What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 12 of 31 If you want to speak to the inspector please contact Neal Cranmer CPC1 Capital Business Park Fulbourn Cambridge CB21 5XE 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 13 of 31 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 14 of 31 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 . People who may use the home can be assured that they will be provided with the necessary information to enable them to decide if the home will be able to meet their needs, which will be assessed prior to admission. Evidence: Both the Service Users Guide and Statement of Purpose were current and up to date, and both documents provided prospective service users with a good level of information about the home to enable them or their representatives to make an informed choice as to whether their needs could be met when moving into the home. The last admission made to the home was in September 2007, review of the assessment indicated that a good level of information had been obtained in respect of the person including: a summary of their health care needs, daily living needs, social interests and past medical and mental health history. The assessment also included information relating to risks including the person’s ability to make decisions and provide consent. From the information in the assessment a detailed plan of care was seen to have been developed and implemented. Care Homes for Adults (18-65 years) Page 15 of 31 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 . People living in the home can expect to have care plans in place which clearly identify their health, personal and social care needs, they can also be assured that they will be supported to take risks as a part of developing an independent lifestyle. Evidence: Two care plans were sampled, each contained a pen picture of the person giving information about their likes and dislikes and interests. Each contained a section titled What I like and What support I require. Both of the care plans held a good degree of information about peoples likes and dislikes, and included clear guidelines for staff about how to support and interact with people. Both care plans contained comprehensive daily records, relevant to the plans of care in place, and both were seen to be subject to regular review. Makaton continues to be used with one of the people living in the home, and this was seen to be detailed within their plan of care. Support plans were in place for choosing clothes, management of continence, choosing menus, drinking, dressing and emotional Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: needs. A daily diary was in place designed to enable the person to be able to stay in contact with their family. The second care plan sampled focused on supporting the person to maximise their independence, both within the home and in the wider community and included Practical Independence Assessments including supporting the person in the home, supporting them with managing their money and finances, and managing independent travelling. At the time of the site visit the person was away abroad visiting their family independently. Risk assessments were in place to support the person and minimise any risk. Discussion with the manager indicated that the person made similar visits on previous occasions. Within both care plans there was evidence of people living in the home being supported to make decisions about their lives. A weekly planner was seen to be in place, which was provided in pictorial format for ease of use by the person. A copy of the plan was seen to be held in the person’s bedroom. Care Homes for Adults (18-65 years) Page 17 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living in the home can be assured that they will be supported in a way that enables them to make choices about their social and leisure activities; they can also be assured that they will be supported to maintain links with their family and friends, and partake in activities within the wider community. They can also be assured that they will be provided with a healthy diet that is varied and nutritious, and which will be provided flexibly to meet their needs. Evidence: Neither of the people currently in residence at Mede Way take part in any form of paid or voluntary employment. However one person at the time of the site visit was about to commence attending a local resource centre where they were going to be joining a gardening group for one day a week. The same person according to records was also attending adult education college, where they were taking part in an I.T class and local history class. Both people living in the home have an activities planner, sampling of which showed that they were taking part in a range of activities both in-house as well Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: as in the wider community, these included: trampolining, shopping, cookery, horse riding, arts and crafts sessions, family days, cards nights, meals out and going bowling. The home maintained an activities file in respect of each person which included information about how the person needed to be supported. One of the two people living in the home was able to use public transport independently, and there was evidence in their care plan of them regularly making trips into the local town and the Capital by train. Risk assessments were in place to support and protect the person during these activities. Menus were in place covering the lunchtime meal and dinner, lunch usually consisted of a snack, with the main meal being provided in the evening, and this was to facilitate peoples daytime activities. The main meal was always cooked and sampling of the menu indicated that it was varied and nutritious The homes food stocks were sampled and appeared to be adequate for the number of people in residence. Evidence was seen of fresh fruit being available, and one person was seen to be enjoying a banana. Each person has in their own room a small fridge where they can keep personal food items that they may have chosen to purchase whilst out shopping. Sampling of peoples activity plans evidenced that people assisted in shopping. The home kept a daily record of food that people had eaten, and a record was kept of freezer and fridge temperatures, this was so that staff could track back in the event of somebody becoming unwell with a stomach type upset that may or may not be related to something that they had eaten. Care Homes for Adults (18-65 years) Page 19 of 31 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 can be assured that their health and personal care needs will be met, as specified in their plans of care. Evidence: From observation the people who lived at the home were able to make choices with regard to clothes, times for getting up and going to bed. This was seen to be detailed within their plans of care. The homes AQAA states that we listen to service users regarding how they want to be assisted with all aspects of their care. An example of this was observed when a member of staff was witnessed interacting with a person with a profound auditory impairment regarding whether they wished to go out for a walk to the shops or not. The member of staff was seen to use non-verbal communication skills (Makaton) with the person to make themselves understood. Both service users residing in the home are registered with a local General Practitioner, and are further supported by a variety of other health care professionals including a consultant psychiatrist, community nurse and speech and language therapists. Records sampled showed that service users were supported to attend outCare Homes for Adults (18-65 years) Page 20 of 31 Evidence: patient appointments and records of the outcomes of such appointments were maintained. Service user’s medication is dispensed from blister packs or individually named containers by staff who have been assessed as being competent. A sample signature of staff dispensing medication was maintained. Medication administration records were sampled and were found to be in order with no evidence of any gaps or omissions. Medication that is no longer required or in use is returned to the dispensing chemist via a pharmacy returns book. Neither of the service users in residence self-medicated, although the manager reported that one person had been assessed as being competent to do so, although they chose not to. The home does not maintain any controlled medicines, and medication coming into the home is stored in a locked cabinet kept in the office. Care Homes for Adults (18-65 years) Page 21 of 31 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 living in the home can be assured that any complaints or concerns raised will be listened to and responded to. They can also be assured that they will be protected from harm and or abuse by the homes practice. Evidence: The home had a complaints policy in place, which included the contact details of the Commission for Social Care Inspection (CSCI). The policy also identified to who any complaints or concerns should be addressed to, and the timescales within which any complaints or concerns would be responded to. reference to the homes complaints policy was also included in the homes Service Users Guide and was available in pictorial format for ease of use by service users. No complaints or concerns had been received in respect of the service. As with complaints the home has in place a policy and procedure for safeguarding vulnerable adults. The policy included a definition of abuse, the possible indicators that might indicate that abuse was taking place relating to all types of abuse, what staff should do if they suspected that abuse was taking place and how to refer a suspected incident on to the appropriate agency. Attached to the policy was a staff signature sheet that staff were required to sign confirming that they had read and understood the policy. The home employs eight care staff and sampling of the homes training records showed Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: that all staff had received safeguarding training with the last year. Discussion with staff on duty indicated that they had a good level of knowledge and understanding of the subject matter. The homes AQAA states that staff receive induction training in safeguarding and receive regular updates to ensure competence and understanding. It also stated that staff have previously experienced a referral and know how important it is to voice any concerns to ensure the safety and well being of the service users. No safeguarding referrals had been made in respect of the home since the last key inspection. Care Homes for Adults (18-65 years) Page 23 of 31 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 . People living in the home can be assured of a homely, comfortable and safe environment, which is kept clean and hygienic. Evidence: A tour of the premises was undertaken as part of the site visit. The home continued to be well maintained throughout. The home was equipped throughout with good quality furnishings and fittings that were modern in design. The general decor of the home was good and it was well maintained. The bungalow is designed with the lounge and dinning room situated in the centre of the building, this area was comfortable and homely. On the day of the site visit there were no unpleasant odours and the home was clean and tidy. The homes laundry facility was fitted with domestic style equipment which was suitable to meet the needs of the service users in residence. The kitchen was a modern domestic fitted kitchen that was clean and well maintained. Care Homes for Adults (18-65 years) Page 24 of 31 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 . People living in the home can be assured of being supported by a staff team who are competent, trained, appropriately qualified and available in sufficient numbers to meet their assessed needs, and who receive regular supervision. Evidence: The homes duty rota was sampled for a two week period; at the time of the inspection only one service user was in residence who was being supported on a one to one basis during the day, with waking night and sleep-in support provided at night-time. When both service users were in residence then service users were supported on a one to one basis. Staff spoken with confirmed that the staffing levels were as those cited, and they felt that the staffing level provided were adequate to meet the needs of the number of service users in residence. The registered manager works 9-5 Monday to Friday supported by an assistant manager. The registered manager works in a supernumerary capacity, and is available on-call via phone at all times. At the time of the site visit the home employed eight care staff three of who were qualified at national Vocational Qualification (N.V.Q) level two or above, with a further three staff in the process of undertaking the award. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: Overall the homes staff recruitment procedure and practice was in good order and well managed. Three staff files were sampled all of which contained copies of application forms, two written references, criminal records bureau check (CRB), evidence of induction, supervision and training. All new staff appointed in the home are employed on a three monthly probationary period, following which their performance is appraised. The home maintains a staff training matrix sampling of which indicated that all staff had received training in fire awareness, health and safety, appointed persons first aid, manual handling, safeguarding, food hygiene, infection control and medication administration. Two staff were spoken with during the course of the inspection, both of who indicated that access to staff training was good. Both staff spoken with also indicated that they received formal recorded supervision on a monthly basis. Care Homes for Adults (18-65 years) Page 26 of 31 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 . People living in the home can be assured of being supported by a staff team who are managed by a manager who has the skills, competency and experience to run the care home in a way that ensures that their health and welfare is promoted and protected. Evidence: The home is managed by a registered manager who has eighteen years experience of working in the care sector supporting people with severe epilepsy, autism and behaviours that can be challenging. The registered manager is nearing completion of the National Vocational Qualification (N.V.Q) level four in Management and Care. The homes AQAA states that the manager has the knowledge and experience to enhance the quality of the care provided and has undertaken various courses and training to develop and enhance their skills. The home has a quality assurance policy in place, which incorporates the views of service users, family and staff involvement. Views are sought via questionnaires and sampling of responses were all positive. Staff meetings are held every six to eight weekly and minutes were seen to be kept. Staff reported that these meetings were Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: well attended and informative. The registered provider visits the home on a monthly basis to carry out a Regulation 26 visit of the home (these visits are like mini inspections) meeting with service users, staff and the manager to carry out their own review of the service. Copies of these reports are provided to the home and were seen to be held on file. The home maintains Control of Substances Hazardous to Health Assessments (COSHH) in respect of all hazardous substances used within the home. In addition to these assessments a range of safety certificates were sampled all of which were seen to be current and in order these included: record of fire alarm tests, record of last fire evacuation, emergency lighting tests, health and safety audits, vehicle check reports, record of portable appliance tests, electrical installation certificate and gas safety certificate. records sampled indicated that the homes safe working practices were good and ensured the health and safety of both service users and staff. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes  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 34 19,Schedule 2 People who use the service (5) must be safeguarded by thorough recruitment practices and procedures, namely the gaps in the employment record are explored. 19/12/2007 2 35 18(1)(c) People who use the service 19/12/2007 must be assured that they are safeguarded through the introduction of induction training and a training and development programme for all staff. Care Homes for Adults (18-65 years) Page 29 of 31 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 Description 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 Description 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 Care Homes for Adults (18-65 years) Page 30 of 31 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 31 of 31 - 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. 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