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Inspection on 12/11/08 for Royal Avenue Residential Home

Also see our care home review for Royal Avenue Residential Home for more information

This inspection was carried out on 12th November 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Royal Avenue Residential Home 77, 81-83 Royal Avenue Lowestoft Suffolk NR32 4HJ 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: John Goodship Date: 1 2 1 1 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 32 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 32 Information about the care home Name of care home: Address: Royal Avenue Residential Home 77, 81-83 Royal Avenue Lowestoft Suffolk NR32 4HJ 01502572057/566490 01502531405 p.barnard@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Patricia Barnard Name of registered manager (if applicable) Mrs Patricia Barnard Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 0 1 Care home 16 learning disability Additional conditions: 1 81 and 83 Royal Avenue may accommodate persons of either sex, under the age of 65, who require care by reason of a learning disability (not to exceed 9 persons). 2 77 Royal Avenue may accommodate persons of either sex, under the age of 65, who require care by reason of a learning disability ( not to exceed 7 persons). 3 The total number accommodated must not exceed 16. 4 One person aged 65 years old and over who requires care by reason of a learning disability (not to exceed one person). Date of last inspection 2 8 0 2 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 32 A bit about the care home The service at Royal Avenue offers accommodation and personal care to 16 younger adults with a learning disability, including one person over 65 years old. The residents live together in three large terraced houses in a pleasant residential area of North Lowestoft. Two of the houses, Numbers 81 and 83 adjoin and the other, Number 77, is next but one on the same side of the street. There is rear access to all the houses via a small service road. Each has a small, secure garden where service users can enjoy the open air. The fees currently range from 320 pounds to 670 per week. Care Homes for Adults (18-65 years) Page 5 of 32 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 6 of 32 How we did our inspection: This is what the inspector did when they were at the care home This was a key unannounced inspection. The previous one took place on 28 February 2007. An Annual Service Review which did not include a visit to the home was undertaken in December 2007. We looked at the outcomes for residents measured against the national standards. When we visited the home, we met residents and staff. We spoke to two residents in particular, one of whom showed us their bedroom. We spoke to all the staff on duty, and interviewed one person in depth. We observed how the staff supported the residents during the day, and how some residents took their part in doing household duties. Care Homes for Adults (18-65 years) Page 7 of 32 During the visit, we gave the manager some survey forms called Have your say about Royal Avenue to give to residents, staff, and visitors to the home. We received three forms back from professional visitors, six from residents and nine from staff. The manager was also required to complete a selfassessment form (AQAA) about the home. Information from all these sources has been used in the report. The manager showed us two care plans, two staff files, training records, and records of health and safety checks. What the care home does well Care Homes for Adults (18-65 years) Page 8 of 32 There is friendly and caring support from staff, which is shown by the excellent rapport between them, and by the comments of residents and visitors. The staff at Royal Avenue are like a caring family for the residents. Everyone seems happy and there is a warmth felt here whenever I visit. I always regard Royal Avenue as a big family. The home has prepared a substantial guide to the home with photos and text which help prospective residents decide if the home is right for them. Residents needs are kept under regular review, with clear recording of changes in needs and instructions to staff on how to best support residents. Residents are supported to express their views about the home and to determine what they do each day. Care Homes for Adults (18-65 years) Page 9 of 32 The home has a good programme of staff training. ‘The staff know their residents well. Health and safety monitoring is well recorded and up-to-date, to protect residents from harm. What has got better from the last inspection The supervision of staff has been formalised without losing the open attitude of the manager. This ensures that matters of care practice and training are dealt with to give residents the best support. Care Homes for Adults (18-65 years) Page 10 of 32 A bathroom has been refurbished to provide a walk-in shower for easier access by residents. There is a programme of redecoration of rooms where needed, using colours chosen by residents. The possibility of cross-infection has been reduced by the introduction of paper towels in the communal washing areas. What the care home could do better The AQAA told us that the manager would continue to look for new activities, which residents had asked for, to widen their choice. Care Homes for Adults (18-65 years) Page 11 of 32 The policy on the protection of vulnerable adults should make clear how referrals are made through Customer First. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact John Goodship Commission for Social Care Inspection CPC1 Capital Park Fulbourn Cambridge CB21 5XE 01223 771 300 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. Care Homes for Adults (18-65 years) Page 12 of 32 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 32 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 32 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 expect to be shown full information about the home in a suitable format for them. They can be assured that they and the home will each be able to assess if the home can meet their needs. Evidence: We looked at the Statement of Purpose and the Service Users Guide.They contained all the information to help people decide if they wished to live in Royal Avenue. The information included how the home was run, the training of the staff, what activities were offered, and how to make a complaint. Also included was information about residents meetings and satisfaction surveys. The Service Users Guide was in the form of a large album. It included many photos of the buildings, the fire procedures, the rooms and the activities available. We were told that because of its size, prospective residents were not given a copy but were taken through it when they visited before taking up residence. We were told that one couple had visited this year to see if the home was suitable for their family member. They had looked at the Guide, and decided that the home was not appropriate. There had been one resident admitted to the home this year. They had chosen to Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: come after the manager had talked to them at the service where they were living and had assessed that the home would be able to meet their needs. This person was able to confirm to us that they came to visit the home, then had stayed for short periods before finally becoming a permanent resident. Care Homes for Adults (18-65 years) Page 16 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents can be assured that their care needs will be identified, monitored and reviewed to ensure that these needs are met. They are able to make decisions about what they do. Evidence: We examined the care plans for two residents, one who had only recently come to live in the home, and one who had lived at the home for over ten years. One plan picked up care needs that had been assessed prior to the person entering the home, gathered from the manager and the deputys own assessments, and information from the service where the person was living. Guidance was given to staff on how to support this person especially in settling in. Risk assessments included issues of personal safety when outside the home because the location and the circumstances were new to them. The other plan was in a similar format. There was evidence that the plan was normally reviewed every six months by the keyworker, although this one had been reviewed Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: more frequently recently because of concerns over the persons health and behaviour. Both plans had assessments of all aspects of daily living, personal care, mobility and safety. Both highlighted guidance to staff on how to support each person, such as maintaining their continence, good nutrition, and remembering appointments. Care plans identified needs and set objectives for meeting those needs or eliminating them. Each need was detailed with specific strategies for achieving the outcomes. One example was a strategy for coping with a persons attention seeking behaviour. This had been drawn up with advice from specialist health service staff. Like and dislikes for food, activities and personal care were listed in the care plan. Several residents were able to tell us about these, and staff we spoke to were well aware of them also. Residents showed us by their conversation that most of them were able to say what they wanted to do, whether it was the choice of food for lunch, or whether their day activities were to their liking. We saw the homes policy on confidentiality. New staff signed that they had read and understood it and the staff we spoke to were aware of the policy. Care Homes for Adults (18-65 years) Page 18 of 32 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 can expect to choose what they want to do, and be supported to do those activities. They can expect to be offered a healthy and nutritious diet, suited to their needs. Evidence: Many residents went out to a daytime activity on some days of the week. Locations for these included college, Aspire, the Lowestoft centre, and Aid and Assist. Residents told us what they had been doing that day, and one told us that they changed their activity to something more interesting to them. The oldest resident did not attend an organised activity but they were mobile enough to go out each day by themselves to local cafes and shops. Other activities were arranged by the staff in the home. During our visit, some residents played Bingo. We noted that some residents helped others with playing this. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: Those who did not want to join in, went into the conservatory to draw or look at magazines. A person came in once a week to give foot massage. They were present during our visit and we noted that residents who used this service were very appreciative of it. An exercise session was held three times a week which the manager said helped some of the residents with their weight control. Yoga sessions had also started. Some residents also went out in the evenings to organised clubs, and once a week to the pub. The manager told us in the AQAA that she was trying to find a dance instructor to come to the home as some residents were interested in dancing. The home had its own 14 seater minibus which was used for taking residents to their day activities, for group outings and on holidays. Photos of recent holidays to the owners caravan at Skegness were on the walls and residents talked to us about these trips. The manager told us that all residents had been reviewed by their placing authority to check that the accommodation and support was appropriate for their needs. No one had chosen to move elsewhere. Lunch on the day of our visit was quiche, baked beans, roast or wedge potatoes with homemade bread made that morning, and for dessert, semolina (made to the managers special recipe), egg custard or bread and butter pudding. Those in for lunch sat round the dining table or in the conservatory. Lunch time was a friendly and chatty occasion with residents talking to each other and to staff. One resident helped another during the meal. Afterwards some residents helped to clear away, wash and wipe up. Others went into the garden to feed the birds. A relative told us: The home helps my relative keep in touch, sending cards and photos to me and talking to them about their family. Care Homes for Adults (18-65 years) Page 20 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents can expect that their health needs will be monitored and action taken to meet them. They can be assured that they are protected by the homes medication procedures. Evidence: The care plans contained information on the health care needs of residents together with records of attendances by chiropodists, dentists and reflexologist. One resident was causing the manager much concern as they were refusing care and not eating properly. The resident was seen regularly by health service professionals but there was disagreement on whether the person should be admitted to a specialist unit for assessment. We spoke to this person with the manager. They seemed able to understand the consequences of their actions. They told us that they did not want to leave the home. The manager had been advised by the community nurse to give the resident notice to leave in order to trigger a response to their needs. The manager believed this was an unsatisfactory way to achieve the appropriate care for the resident but had given the notice to the placing authority. Health staff from a specialist unit were coming to the home in a few days time to talk to the staff about managing the attention-seeking behaviour of one resident. The Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: manager said that the home received excellent support from this unit. A health professional told us in their survey: I believe the staff are good at observing changes and contacting the surgery appropriately. The home had information on file from residents or their relatives on the preferred arrangements at the end of life. The manager supported the comments of one survey which pointed out that some residents were ageing and becoming less mobile. There would be a need to consider issues of access for those with impaired mobility and issues of care for those with increasing health needs. Two of the oldest residents, one of them 88 years old, had moved into No:77 which had a less active group of residents and was quieter. A relative told us: As my relative is getting older, I feel that the staff are taking this on board and have changed a few things that will make their life quieter. I feel this has been good. We inspected the medication system, checking records and stocks. The practice in the home was that two staff witness the administration of medication and both sign the record. All records were in order. A doctor told us that any changes they requested in medication were actioned appropriately. We saw records that staff had been trained in administration by the supplying pharmacy. Care Homes for Adults (18-65 years) Page 22 of 32 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 . Residents can be assured that their views will be listened to, and that they will be protected by the homes policies and staff training. Evidence: We saw the homes complaints policy which set out the procedure on how to raise a complaint. Information was also included in the Statement of Purpose and the Service Users Guide, the latter being in picture format. We also saw this displayed in each residents room. Although the home had received no complaints itself, staff had supported a resident with a complaint they had regarding a family member until it was resolved. Training records showed us that staff had received training in the protection of vulnerable adults. New staff were required to sign that they had read and understood the policy and procedure. When we spoke to a member of staff, they were able to describe examples of abuse and understood their responsibility on reporting allegations. The procedure needed to be updated to reflect the current route which the home must use to make referrals. Care Homes for Adults (18-65 years) Page 23 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents can expect to live in a homely environment which is clean and hygienic. Evidence: We saw that the home was well maintained both internally and externally. Several residents rooms had been redecorated, and some had new carpets. The bathroom in number 77 had been refurbished with a walk-in shower. This improved the facilities for residents particularly those with some mobility problems. New flooring and a new ceiling had also been installed. One resident showed us their room. It was light and clean, with good views over the road. I can watch the traffic. The resident was able to tell us what they would do in case of fire as they had had a fire drill the day before our visit. We saw clear instructions to staff in the bathrooms on the correct procedure when disposing of soiled waste to prevent cross-infection. The manager told us that one of the staff was designated as the link worker for cross-infection, keeping up-to-date on their knowledge through contact with the NHS infection control service. There had been an inspection by the environmental health officer of the local authority in November 2007. We saw the report which described standards as satisfactory. No Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: requirements were made. Care Homes for Adults (18-65 years) Page 25 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents can expect to be cared for by well-trained staff and protected by the homes policy on recruitment. Evidence: Two new members of staff had joined the home in the last year.We examined the recruitment files for these persons. All documentation needed to confirm the persons identity and to protect residents was in the file. Initial protection information had been received before each person had started employment. Their training records were seen showing that one had started an NVQ Level 2 course. The other was booked to start. We saw that seven out of the twelve staff had completed an NVQ at Level 2 or above, and the rest were either on a course or booked to start. One person told us that having achieved NVQ level 3, they were now starting training to become a qualified assessor. Training records for other staff showed that staff received training in fire , health and safety, cross-infection and the administration of medication. We spoke to a staff member who had also completed a course in dementia awareness, healthy eating and nutrition, and First Aid. Staff confirmed that they were receiving supervision sessions on a more formal basis, but all of them were anxious to stress that the managers style encouraged them to Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: raise issues of care practice and training at any time. Staff told us that they often had staff meetings to keep updated on new information. One of the surveys said:Someone is always on hand to deal with any problems that arise, and I have always felt that the home runs very smoothly and efficiently. Another comment was: I have always felt that the staff at Royal Avenue are like a caring family for the residents. Everyone seems happy and there is a warmth felt here whenever I visit. A health professional said: The carers know their residents well. Care Homes for Adults (18-65 years) Page 27 of 32 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 . Residents can expect to live in a well-run home with a family-like atmosphere, and protected by the homes policies. Evidence: All the surveys stressed that the home was run like an extended family. The owner/manager had many years experience of supporting people with learning disabilities, and the home felt welcoming with friendly and supportive staff, who interacted well with the residents. The AQAA stated that at their reviews, residents said how much they enjoyed living there. Relatives said how welcome they felt and how happy they were with the care provided to their family member. A visiting therapist told us: I enjoy my visits and time with the residents. It is a happy, safe and relaxed environment. We heard staff asking residents about their views on what they wanted to eat, whether they wanted to join in an activity and what they were going to do later that day. The staff were able to assist those residents who had some difficulty with communication. Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: We were shown the homes policies which covered all the required topics and were reviewed annually. We examined health and safety records such as the fire risk assessment, records of fire drills and equipment tests, and portable appliance tests. All were up to date. Care Homes for Adults (18-65 years) Page 29 of 32 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 Care Homes for Adults (18-65 years) Page 30 of 32 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 1 22 The protection of vulnerable adults procedure should make clear the correct route which referrals should take. Care Homes for Adults (18-65 years) Page 31 of 32 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 32 of 32 - 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!