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Inspection on 11/11/08 for Seven Springs Cheshire Home

Also see our care home review for Seven Springs Cheshire Home for more information

This inspection was carried out on 11th November 2008.

CSCI found this care home to be providing an Excellent 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.

What the care home does well

The views of the people who use this service are listened to and acted upon. The parent organisation employs a mentor to support service users and help them express their views. The service promotes equality and diversity and helps the people who use the service to maximise their independence. The home promotes the health and well-being of the people that use the service. There is an enthusiastic and committed staff team. The people that use the service say that the staff are, "Really great, they help us without taking over our lives".

What has improved since the last inspection?

There have been major environmental improvements. New rooms with state of the art overhead hoists and en suite wet rooms have been created. Work continues to provide every service user with a large single room with en suite facilities. Nutritional services in the home are very good. There is a substantial food budget, plenty of locally sourced fresh produce and residents are offered a good choice of what to eat.

What the care home could do better:

No requirements or recommendations were placed as a result of this inspection. The service should maintain the continuous improvement programme and continue to implement the robust quality assurance programme.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Seven Springs Cheshire Home Seven Springs Cheshire Home Pembury Road Tunbridge Wells Kent TN2 4NB     The quality rating for this care home is:   three star excellent 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: Wendy Mills     Date: 1 1 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. the things that people have said are important to them: They reflect 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: Seven Springs Cheshire Home Pembury Road Seven Springs Cheshire Home Tunbridge Wells Kent TN2 4NB 01892531138 01892533522 jason.semple@lc-uk.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Jason Robert Semple Type of registration: Number of places registered: Leonard Cheshire Disability care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 32 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability - PD Date of last inspection Brief description of the care home Seven Springsis a registered care home providing care and support for up to twentyeight people. It occupies a large building part of which is within a period house, and part developed around the premises. Accommodation for residents is on two floors with access to the upper level via stairs or a shaft lift. The premises include a day centre, hydrotherapy pool and physiotherapy unit. The home is currently undergoing a major regeneration programme which will eventaully mean that every service user will have their own room and en suite facilities. In order to facilitate the building work the home Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 32 Brief description of the care home has not admitted any new service users since the last inspection and currently has three vacancies. There is plenty of communal space in the home. There are attractive grounds that include patio areas with seating. There are independent living bungalows situated within the grounds of the home but these are not included in the registration. The home is situated approximately one mile from the centre of Tunbridge Wells; a bus service is within a short distance and there is a railway station in the town centre. The basic weekly fees for this service range between £700 and £1050 per week. Fees are dependent on assessed needs and are calculated separately for each individual service user. Further information about this service can be obtained directly from the registered manager of this home. Care Homes for Adults (18-65 years) Page 5 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: three star excellent 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 visit was unannounced and formed part of the inspection process of the Commission for Social care inspection (CSCI) under the Care Standards Act 2000. This report is complied using evidence gathered during this visit and information we have received about the home since the last inspection. This includes information required under the Act that the home has sent us, such as their Annual Quality Assurance Assessment (AQAA) and notifications of significant events that have occurred. We also take into account the views of the people who use the service, relatives and health and social care professionals. The findings of this inspection will result in the home being given a star quality rating. During this visit six service users and four members of staff were spoken to in private Care Homes for Adults (18-65 years) Page 6 of 28 to seek their views about the home. Other service users and staff members were spoken to during a tour of the home. Documentation, including care plans, staff files and samples of policies and procedures, was examined. Case tracking, based on three service users, was carried out. This means that the care given to three of the service users was looked at in detail and that their views, needs and wishes were noted and records checked to ensure these had been accurately noted and carried out. Direct and indirect observations were made throughout the visit and detailed discussion was held with the registered manager. 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 8 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 9 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. The home gives prospective service users and their supporters the information they need to make an informed decision about moving into the home. All prospective service users will receive a thorough pre-admission assessment prior to being offered a place at the home. Evidence: There is good information available about what is going on in the home. Discussion with some of the service users showed that they are well aware of their rights and responsibilities whilst living in the home. The registered provider, Leonard Cheshire Disability, employs a mentor to support service users throughout the Leonard Cheshire homes in the region. This means that they are supported to understand their rights. No new service users have been admitted to the home since the last inspection. This is because the home is currently undergoing major alterations and refurbishment. However, there are sound admissions policies and procedures in place and the Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: registered manager is clear that no service user would be admitted to the home without a thorough pre-admission assessment to make sure the prospective service users needs can be met and that they would suit the life in the home. Care Homes for Adults (18-65 years) Page 11 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides a wide range of opportunities for the service users and supports them to make informed choices. This helps them maximise their independence. Evidence: Service users said that they are able to make decisions about how they live their lives in the home. They said that they are free to do as they please and that there is plenty of choice about how they spend their time. They said that the home supports them to be as independent as possible. One service user spoke of how the home supports him to get to the station to take the train to visit his family. There is a written plan of support for each service user. These are important documents. This is because they form one of the means by which the service users and their supporters can be tell that they will be supported in the manner of their choice. Also, the plans are a source of reference information for the care workers who need to ensure that they assist people in a consistent and appropriate manner. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: The people who use the service said that they are kept well informed about what is going on in the home and that they have plenty of opportunities to have their say in the day to day life of the home if they wish. There is a key worker system and regular residents meetings. A sample of care plans was inspected. The cultural and religious needs, care needs and likes and dislikes of the individual service user are recorded in the care plans. Where service users have wished, a personal profile has been written. Care Homes for Adults (18-65 years) Page 13 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. The home positively promotes the independence of the people that use the service by consulting with them and providing a wide range of opportunities. Evidence: Care plans show that lifestyle choices are noted and the people who use the service are fully involved in decisions about how they spend their time. There is a written plan of support for each service user. These are important documents. This is because they form one of the means by which the service users and their supporters can tell that they will be supported in the manner of their choice. Also, the plans are a source of reference information for the care workers who need to ensure that they assist people in a consistent and appropriate manner. The home provides a wide range of opportunities for the people who use the service. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: There is plenty to do in the home itself. There is a hydrotherapy pool, a day centre with a computer room, arts and crafts facilities and other activities such as cookery and gardening. Service users said that they have been able to discuss the activities they would like to take part in and that they are supported to try new things. There is good access to transport and, where possible, service users use public transport facilities as well. They said that they go to to watch football and rugby, make trips to France, go out to the pub and for meals. Some like to shop and others like to go to the cinema and theatre. They also said that they have entertainments systems in their own rooms and sometimes just like to enjoy these. The service users are encouraged, where possible, to find part-time, paid employment or to do voluntary work if they wish. There is a large dining area in the home that comfortably accommodates wheelchairs. On the day of this visit there was plenty of fresh, locally purchased produce in the home. The cook said that she has a generous budget for food. Service users said that they enjoy their meals and have plenty to eat. They are able to have input into menu planning and can take part in other aspects of the day to day life of the home, such as helping with various household chores, if they wish and are able. There are regular house meetings and reviews where the people who use the service are able to express their views and put forward their ideas about all aspects of life in the home. Service users said that their views are listened to and taken into account when activities are planned. Major building work is going on in the home and grounds at the present time. The renovations have already made a significant improvement to accessibility around the home but they have also meant that some aspects of life in the home have been a little restricted. For example, access to the grounds has been limited and, on occasions, one of the lifts has been out of action. The service users spoken to said that they were happy about this as they know that, in the end, the improvements would make a positive difference to the home. Care Homes for Adults (18-65 years) Page 15 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home positively promotes the health and well being of the people that use this service. This means that they can enjoy as healthy a life as possible Evidence: The care plans show that the health and personal care needs of each person who uses the service have been recorded appropriately. There are regular care reviews in which the service users and, if wished, his or her supporters, are fully involved. There is good evidence that arrangements are made for input from all necessary external health and social care support. All service users are registered with local General Practitioners (GPs) Other health and social care professionals, such as chiropodists and district nurses, visit as required. The home employs a physiotherapist who is registered with the Chartered Society of Physiotherapy and two physiotherapy assistants. There is a hydrotherapy pool and a physiotherapy room. All the service users spoken to said that they are very well cared for and that the home supports them to look after their own health as much as possible. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: There are sound policies and procedures for the management and administration of medicines in the home. Only staff trained in the administration of medicines are permitted to administer medicines. Storage of medicines is safe and secure and there are regular checks on temperatures. Service users participate in as far as is possible in the management of their own medication needs. For example, one service user who is unable to physically manage his medication ensures that he is clear about the times at which he needs to take his medicines and what to take at which time. There are good arrangements for the ordering of new prescriptions and the return of unused medicines. Care Homes for Adults (18-65 years) Page 17 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. There are sound policies and procedures for handling complaints, concerns and safeguarding which are clearly understood. This means that the home does all in its power to protect the service users from harm. Evidence: There is a sound complaints and concerns policy that is contained in the Service User Guide and the Statement of Purpose. This is also displayed on notice boards throughout the home. There are regular staff and service user meetings. The home employs a mentor to act as an advocate for the service users. He was visiting the home on the day of inspection. Time was spent talking to him in private and it is clear that he acts independently of the home and the providers despite being employed by them. He listens to, and deals with, any concerns that service users may find difficult to express for themselves. Service users said that they can easily talk to their keyworker or the manager if they have any concerns. They said that things are generally sorted out on a day to day basis and they have not had cause to make a formal complaint. They know how to do this if necessary. Staff said that they have regular supervision and that they can bring up any concerns at the time. They also said that they would be prepared to make a formal complaint on Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: behalf of a service user if necessary. They said that they can talk to the manager and that he listens to their concerns. Staff have received training in safeguarding vulnerable people from harm. Those spoken to were very clear about their responsibility to report any concerns to the manager or appropriate authority. The service users spoken to said that they are confident that the staff act in their best interests. Care Homes for Adults (18-65 years) Page 19 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 home is clean, safe and appropriately adapted so that it is accessible to all. Once the work is completed the people who use this service will have a pleasant and homely place in which they can maintain a good level of mobility. Evidence: The home is spacious and set in good sized grounds. It is currently undergoing a major refurbishment programme. The bedrooms have been completely redesigned and refurbished. There are state of the art hoisting systems, all new rooms have en suite wet rooms with toilet, wash hand basin and showers and there are additional accessible bathrooms and additional toilets. There has been some disruption to the running of the home whilst the work is being carried out. However, good safety precautions are in place and some service users said they have enjoyed taking an interest in the progress of the work. The grounds were not completely accessible on the day of this visit due to the work but service users spoken to said that they understood that the restrictions are necessary if the home is to be improved. All spoke very positively about their new rooms and the improvements so far. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: Despite the ongoing work, the home was clean and welcoming on the day of inspection. the housekeeping staff are commended for the way they have managed to keep the home clean and safe during the upheaval. Care Homes for Adults (18-65 years) Page 21 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels, staff training, staff recruitment practices and staff morale are all good. This means that the people who use the service are supported by a well trained and cheerful staff team. Evidence: Staffing rosters show that staffing levels are sufficient to meet the needs of the people who use the service. There is a keyworker system. Service users spoken to said that staff are very good and are quick to respond to their needs. Staff said that they really enjoy working at the home and some described it as the best place they have ever worked in. They said that there is plenty of training on offer and that the registered manager and the organisation are very supportive. Direct and indirect observation showed that the staff relate well to the service users and there is plenty of friendly banter and conversation. The service users said that they can talk easily to their keyworkers. Examination of a sample of staff files showed that there is a good level of staff supervision and training taking place. There was good evidence on file to show that the Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: organisation takes every precaution when recruiting new staff. Criminal Records Bureau checks are carried out, two written references obtained and there is close scrutiny of employment history before a post is offered at the home. Care Homes for Adults (18-65 years) Page 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and has robust quality assurance systems in place. The views of the service users and their supporters are regularly sought and acted upon. This means that the home is run in the best interests of the people who use the service. Evidence: The registered manager has been in post for over four years. He holds the Certificate in Management, a diploma in management, the National Vocational Qualification in Care at level four (NVQ IV ) and the Registered Managers Award (RMA). He has recently studied for the Advanced Certificate in Health and Safety and is waiting for the results of this. He has over ten years experience working in care settings. The service users spoke positively about his skills as a manager and said that they know they can talk to directly to him if they wish. Staff said that he runs an open door management policy and that there are regular staff and residents meetings. One said, I think the communication in the home is pretty good, we know we can bring up anything we need to. We can speak up for the service users if necessary but most are Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: able to express their views, especially if there is something they dont agree with. As previously mentioned in this report, Leonard Cheshire Disability employs a mentor to help those service users who may have difficulty in expressing their views directly. Time spent talking to the mentor showed that he is able to act as an advocate for the service users. On the day of this visit he was in the home and spent time with the registered manager, discussing ways in which service user feedback could improve the way the home is run. Direct and indirect observation showed that the registered manager has an easy rapport with staff and residents. In discussion it was clear that he has a good understanding of the needs of the service users and the mechanisms of the running of the home. Staff said that he is well liked and respected and is open and honest. Leonard Cheshire Disability is the registered provider. The organisation is a registered charity that is committed to promoting equality and diversity for disabled people. It strives to support the people who use the services to maximise their independence. The organisation also works to raise public awareness of the needs of disabled people and has an excellent record of taking service user views into account. Although there are major building works being carried out in the home at present every effort has been made to ensure that the home is safe for the people who use the service. Conversation with the registered manager showed that he is very well aware of health and safety issues and appropriate risk assessments are in place. There are sound quality assurance systems in place. The information that the service gave us in their AQAA explained these systems in detail. They include regular visits from nominated representatives to carry out checks in line with the requirements of Regulation 26, annual service user surveys and ongoing feedback from service users and their supporters. Care Homes for Adults (18-65 years) Page 25 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 26 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 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 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!