Inspection on 29/01/09 for Sudbury House

This inspection was carried out on 29th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Sudbury House 30 Sudbury Avenue Sudbury House Wembley Middlesex HA0 3AR     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: Jackie Derbyshire     Date: 2 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Sudbury House Sudbury House 30 Sudbury Avenue Wembley Middlesex HA0 3AR 02089033818 02089033818 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Seva Care (Respite and Residential Services) Ltd care home 4 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 4 The registered person may provide the following category of service only: Care Home only ? Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories Learning Disability ? Code LD The maximum number of service users who can be accommodated is: 4 Date of last inspection Brief description of the care home Sudbury House is a care home for four men and women with a learning difficulty. The Seva Care Group own the property and all of the staff will be employed by Seva. Sudbury House is located in a residential area of North Wembley. The home opened in September 2008. The house is on two floors, the ground floor has two spacious bedrooms that have wheel chair access and have en suite bathrooms. There is also a lounge, dining room and kitchen on the ground floor with a large garden at the back of the premises that is accessible to all. The first floor has two bedrooms with en suite, a bathroom and the staff office. Access to the first floor is by stairs, people with a physical disability would not be able to access the first floor. Care Homes for Adults (18-65 years) Page 4 of 28 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: 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 peterchart Poor Adequate Good Excellent How we did our inspection: Throughout this report the word we will be used as meaning the CSCI. This unannounced inspection took place on Thursday 29th January 2009. We spent four hours visiting the home. We spent time talking to the acting manager and the responsible person. We looked at the care records of one individual who has not yet moved into Sudbury House but has had a lot of introductory visits and will be moving in imminently in February 2009. We looked at the procedures for medication and the safe keeping of residents finances. We had a tour of the home and all areas were looked at including the four bedrooms. The home was tidy on the day of this inspection. The weekly fee for Sudbury House is from 850-1600 pounds depending on the care and support provided. Care Homes for Adults (18-65 years) Page 6 of 28 Care Homes for Adults (18-65 years) Page 7 of 28 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. Admissions are not made at the home until a full needs assessment has been undertaken. This is to make sure that the home can provide all individuals with the care and support they require. Evidence: We looked at the statement of purpose and service user guide, the statement of purpose was very comprehensive the service user guide requires more information for prospective people. In discussion with the acting manager and responsible person we were told this will be completed imminently. We spent time looking at the information in place for the only resident that is having introductory visits to the home. The needs assessment completed by the acting manager is very comprehensive showing how the person communicates, what their interests are, likes and dislikes and how the staff will support them living at Sudbury House. The information included all contact details of the multi disciplinary team involved in the placement. Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: We looked at the care plan that links into the assessment of the person showing how the home was going to continue the care and support that the individual was receiving whilst living at their own home. The information in place includes all other areas of support the individual will continue to receive including attending a local day centre. We looked at some very comprehensive records of the individual spending introductory visits to the home at different times of the day and staying over for sleep overs. The acting manager has involved the individuals family and shows how they are working closely together to make sure the transition period of the move into Sudbury House goes well and does not cause any distress for the individual. The contract has not been agreed for the individual and is still being completed. In discussion with the acting manager we were told that the contract will be signed and agreed with the individual, their family and the placing Local Authority when the person moves into the home permanently. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service involves individuals in the planning of care which affects their lifestyle and quality of life. Care plans are person centred and are agreed with the individual. Plans are written in plain language, are easy to understand and look at all areas of the individuals life. Evidence: Sudbury House is new and has one individual that is imminently going to move permanently into the home. This individual has been spending a lot of time at the home on introductory visits to make the transition into the home as stress free as possible for the person. There are no other people currently living at the home. We looked at the care plan of the person that was very informative and showed how the person was going to be supported in the home. The care plan worked in conjunction with the assessment and all areas of care and support were well recorded to show how the persons daily routines were important. The information included the persons likes and dislikes and any triggers for when the individual becomes upset. The plan was Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: compiled with the individual, their family, care manager, staff at the day centre, the psychologist and the acting manager. Included in the care plan was information on how the individual makes decisions including what they like to wear, when they go to bed and get up, when they like to go out into the community. We looked at the risk assessments for the individual that show any risk identified and what actions the home has put in place to minimize or reduce the risk. The risk assessments were very comprehensive and covered all identified risk areas. The home has a confidentiality policy, we were told by the acting manager that all staff will be informed of this policy as part of the induction procedure. All of the records and documents are kept in the office in a lockable cabinet or on the computer that has a password required for access. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a strong commitment to enabling residents to develop or maintain their skills, including social, emotional, communication, and independent living skills. Individuals are supported to identify their goals and work to achieve them. Evidence: We looked at the activity programme that has been set up for the individual moving into the home. The programme has details of the aims of the person and what they like to do and what support they will require from staff in achieving their goals. There was a lot of information on a day centre that the individual attends five days a week and what they participate in doing whilst there. The care plan included information on what the person likes to do in the community including going out for a walk in the evening. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: The information we looked at shows that the family of the person moving into the home are very involved in the placement and are working closely with the acting manager to make sure the placement is successful. Records show that the family have visited the home on numerous occasions spending time with the individual. The acting manager has put in place a daily living plan that shows the daily routines of the person, what time they like to get up, their personal care programme, how they make decisions on what they like to wear. The daily living plan is also in a pictorial format for the person to look at and agree with. We saw a lot of information to show how the home is endeavoring to work closely with the individual and provide a support plan that they are comfortable with and that is workable with support from staff. We discussed meals and menus with the acting manager, we were told that menus will be put in place working with the individual their cultural preferences and dietary requirements. We looked at templates of menus and templates for food and drink intake. We were told that all meals will be monitored for nutrition to make sure that all of the people that would be living at the home receive a balanced nutritional diet that suits their individual preferences. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to health care services both within and in the local community. People can choose to stay with their own GP or register with a GP in the local community. There is a medication policy which is accessible to staff, staff need to have training in the medication policy and procedure of the home so that residents are safeguarded. Evidence: We looked at the personal support plan of the individual that is imminently moving into Sudbury House. The plan had in place all of the relevant information showing what personal care support was required and how staff would support the individual. The person moving into the home has had a lot of introductory visits to the home and has been working closely with the acting manager and a member of staff who will be their key worker. The individuals daily programme of support has been completed and the support will be provided in the way the person is used to. We discussed the registration of a local GP for prospective residents and we were told that the acting manager has liaised with a local group practise that would register any Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: residents moving into the home. The person moving into Sudbury House has a GP that they will continue to stay registered with. We looked at the healthcare plan of the individual that had been completed with the family and staff from the day centre. The healthcare plan shows all of the relevant information on health checks including optical, dentist visits, psychology input and relevant appointments. We discussed the medication policy and procedure with the acting manager, we were told that all staff will have training in medication as part of the induction training programme. The medication storage cupboard is in the office and is lockable, we spent time in the four bedrooms all of which have a lockable secure cupboard that can act as a storage for individuals that will be responsible for their own medication. 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. The service has a complaints procedure that is clearly written and easy to understand. It can be available on request in different formats including other languages to help the people living at the home or people involved with the home to make a complaint or make a suggestion for improvement. Evidence: We spent time looking at the complaints and safeguarding policies and procedures with the acting manager. There is comprehensive policies in place, we were told by the acting manager that all staff will have training in how to deal with a complaint and the records that have to be taken as part of the homes procedure. We looked at templates of the complaint forms that have all of the relevant information in place. We discussed the safeguarding procedure with the acting manager who told us that all staff will be attending training as part of the induction programme. The acting manager is liaising with the local authority to make sure that the home has all of the up to date information in place if an incident occurs. Sudbury House has had no complaints or safeguarding incidents since it opened in September 2008. Care Homes for Adults (18-65 years) Page 18 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 well lit and comfortable for residents to relax. The environment promotes the privacy, dignity and autonomy of residents. Evidence: We had a full tour of the premises looking at all of the communal areas and the four bedrooms. The premises are a converted house with space for four residents all with their own bedroom and en suit bathroom. The premises has an intercom system, the house has a security alarm throughout. The home is close to local transport and local shops. The premises has been decorated with all fixtures and fittings being new. The ground floor has two bedrooms that have been designed for people that use a wheelchair, the two bedrooms on the first floor are only accessible by stairs and the people would have to be physically able to climb the stairs. We spent time in each of the four bedrooms, all have an en suite bathroom with either a walk in shower or a walk in bath. There is a bed, dressing table and a built in wardrobe in each bedroom. All four bedrooms have a telephone point and a TV point, we were told by the acting manager that broadband could be available in a bedroom if requested. There is one person that has had a lot of visits to the home and is moving in imminently, we saw some personal items in the bedroom they were moving into. We Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: were told by the acting manager that residents would be able to bring in personal items into the home including their own furniture if requested. There are sufficient toilets throughout the home for residents and staff use, one on the ground floor and one on the first floor. All four bedrooms have an en suite bathroom. We spent time in the communal areas, there is a comfortable lounge, dining room and kitchen area accessible to all residents. There is a large garden at the rear of the premises that has a ramp to make it accessible for people that use a wheelchair. The home was tidy on the day of this site visit, in discussion with the acting manager and responsible person we discussed the home being cleaned as all of the areas that have not been used required cleaning to freshen it up. All of the fixtures and fittings in the home are new and of good quality. There is a washing machine and dryer with space for two more if required. Care Homes for Adults (18-65 years) Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a recruitment procedure in place that safeguards the people who are going to live there. The training programme requires to be in line with Skills for Care and all staff must have a full induction so that all residents are provided with the standard of care as written in the statement of purpose. Evidence: We spent time discussing staffing with the acting manager and the responsible individual. There are four staff currently employed by the home, only one member of staff has actually been given a contract and has been on a shift spending time with the new person who has been having introductory visits to the home. We were told by the acting manager that all of the staff are having a full induction training programme from the 4th February to the 7th February being provided by an external training provider. The acting manager informed us that all staff will have a full induction before the prospective resident moves in permanently. We looked at the AQAA Annual Quality Assurance Assessment that had been completed by the acting manager, there was information on the training and qualifications of the four staff employed. One member of staff has an NVQ with one member of staff currently working to complete an NVQ qualification. We were given Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: documentation showing that the acting manager has liaised with a training organisation to provide NVQ training to staff who have not got the qualification. We spent time looking at the staff handbook, not all of the relevant policies including the medication and safeguarding policies were included. We were told that the handbooks would have all of the relevant information and given to each member of staff when they attend the induction training. We looked at the CRB disclosure records of all four staff, all are up to date. We looked at two staff recruitment files for all relevant information. The acting manager must make sure that all references are checked to make sure they are valid references, there was two references in each of the staff files. One of the staff files did not have a current photograph of the member of staff, the acting manager told us that he would put it in place on the file ASAP. We spent time discussing the continual training and supervision of staff with the acting manager. We were told that a programme of regular structured supervision will be put in place for all staff. Care Homes for Adults (18-65 years) Page 22 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The acting manager is qualified and has the necessary experience to run the home. All sections of the AQAA were completed and the information gives a reasonable picture of the current situation within the service, although there were areas were more information would of been useful to give a clearer picture of the home. Evidence: We spent time with the acting manager who has been employed at Sudbury House since November 2008. The acting manager has liaised with the CSCI to become the registered manager. The acting manager has an NVQ 3 and 4 and passed the Registered Managers Award in 2008. The acting manager has 8 years experience of managing residential homes. We spent time with the acting manager and responsible person discussing the quality assurance procedure. We were given copies of the questionnaires that will be used to send to family members, professionals involved with Sudbury House, advocate services and also given to residents. The acting manager told us that the information Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: Will be collated and any areas that require reviewing and improving will have an action plan in place. We spent time looking at documents and records throughout this site visit, the only information at present was written by the acting manager in relation to supporting an individual in visiting the home. All forms and templates were looked at for care plans, risk assessments and other working practises that show the home has everything in place to make sure records will be in place for all of the people who live at the home. We spent time with the acting manager and responsible person looking at all of the health and safety checks that are completed in the home. Records were up to date for fridge freezer temperatures, water temperatures, we looked at the certificates for the fire alarm system, gas, electric and other areas, all were seen to be well recorded. The home was inspected by the LFEPA Fire and Community Safety Directorate in August 2008 and were found to be suitable for the intended purpose.The acting manager told us that all staff will have fire safety training, food hygiene training, moving and handling and health and safety training as part of the induction training. Care Homes for Adults (18-65 years) Page 24 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 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 The organisation to make sure that all of the relevant information is included in the service user guide. To provide prospective people with all of the relevant information on how the home will care and support people living there. 29/03/2009 2 20 13 The organisation must provide all staff with medication training. To make sure all residents are protected and the correct medication procedure is followed. 28/02/2009 3 34 19 The organisation must validate all staff references before they are employed to work at the home To protect all of the people living at the home. 28/02/2009 Care Homes for Adults (18-65 years) Page 26 of 28 4 34 19 The organisation must make 28/02/2009 sure that a recent photograph of the staff member is kept on the recruitment file. To protect the people living at the home. 5 35 18 The organisation to make sure the staff handbook has all of the required information in place. To provide staff with a handbook that has up to date information in place that they can refer to when required. 29/03/2009 6 35 18 The organisation must provide all staff with induction training and make sure all mandatory training has been completed before working with residents at the home. To make sure all staff are competent in their role and safeguard all residents. 28/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 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!