Inspection on 06/11/08 for The Bay

This inspection was carried out on 6th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Bay 15/05/07

The Bay 02/05/06

The Bay 08/09/05

The Bay 03/05/05

The Bay 02/12/04

The Bay 22/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Bay 29 Dymchurch Road St Marys Bay Kent TN29 0HF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kim Rogers     Date: 0 6 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 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 26 Information about the care home Name of care home: Address: The Bay 29 Dymchurch Road St Marys Bay Kent TN29 0HF 01797367538 Telephone number: Fax number: Email address: Provider web address: dymchurch.road@craegmoor.co.uk Name of registered provider(s): Type of registration: Number of places registered: Parkcare Homes (No2) Ltd care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 11 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: Learning disability (LD). Date of last inspection Brief description of the care home The Bay is a residential care home for up to eleven people with learning disabilities. It is part of the Craegmoor group of companies and the registered provider is Parkcare Homes (NO. 2) Ltd. The Bay consists of two detached, adjacent houses with a communal garden at the rear. It is situated in a small close about a mile from the coastal town of New Romney. The sea, churches and local shops are within walking distance. Larger shopping areas, colleges and other amenities are available at Ashford, Hythe and Folkestone. The Registered manager of the home is Louise Ford. The fees range from about 391.47 to 871.25 pounds per week. For information about fees and services please contact the Provider. 11 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection which means that all of the key National Minimum Standards were assessed. The last key inspection was 15.05.07. We carried out an Annual Service Review (ASR) on 7.05.08. These reports can be obtained from the Provider. We looked at the information we have received about the service including the Annual Quality Assurance Assessment (AQAA). This gives information about the service and about what they do well and their plans to improve. We had a look around the home and spoke to the manager, staff and service users. We sampled records including care plans, staff files and health and safety records. Care Homes for Adults (18-65 years) Page 5 of 26 Care Homes for Adults (18-65 years) Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessments of peoples needs are obtained before a person moves in. Information about the home must be right and meaningful so people have the most up to date information about the service. Evidence: We found that an assessment tool is used by the company to assess a persons needs. This is done to ensure the home can meet the persons needs. We found that this does not include the persons aspirations so staff may not be aware of personal aspirations at an early stage. We sampled the service user plan of a person who recently moved in to the home. We found that the manager obtained a joint assessment by health services and care management but did not carry out their own assessment. This means that they may not have a complete up to date picture of the person to ensure they have the right staff mix, skills etc to meet those needs. There is some information about the home which is written. Some information has coloured clip art pictures with text. We found that the Statement of Purpose has some Care Homes for Adults (18-65 years) Page 9 of 26 Evidence: incorrect information like the wrong number of places the home offers. The AQAA says they plan to update this so prospective residents have the most up to date information about the service. They have also produced a welcome pack giving people more information about the service. The Statement of Purpose is displayed across the hallway wall with other information like the certificate of public liability insurance. You see this as you enter the home and it does make it feel homely but like an obvious care home. Staff and the manager agreed and said they would talk to service users about this. We found that people have the opportunity to have trial stays and visits to help them decide about moving permanently into The Bay. Care Homes for Adults (18-65 years) Page 10 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Without detailed plans of support people will not achieve their goals, develop new skills and grow in independence. People cannot be sure that all of their needs and potential risks to them will be recorded and supported and this may place them at risk. Communication should be better supported so people can make real choices and decisions and have more control. Evidence: Two service user plans were sampled and we spoke to staff, the manager and service users. Service user plans should detail the persons needs and goals as well as show what staff support is needed to support the person. Some people have health and other needs but we found not all needs are recorded. This means that there are no plans for staff to follow and people may not have the support they need to keep them healthy and safe We found that some personal goals are recorded but there are no plans in place to say how staff should support goals, what they should do and by when. Without detailed plans of support people will not achieve their goals and learn Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: new skills. For example one person would like to cook, go fishing and play badminton but there is no plan to say how this will be supported. We found that some people are at potential risk of harm but no assessment has been carried out. This means that there are no strategies in place to minimise risks to people. We found that plans have an evaluation sheet but it is unclear who carries out the evaluation and who else is involved. This means that service users may not be involved in the review of their plans. We found that there is only very basic information about communication needs. For example one plan just said verbal when it was apparent that the person has communication needs that need support. Without detailed plans of support people may not have the support they need to make choices and decisions about their lives. One person said they would like extra support with communication. The manager said she will make a referral. We found that not all information is presented in a way that is meaningful to all service users. For example people said they only know who is on duty or what is happening that day if they ask staff. This means that they are not in control of finding out for themselves. Due to lack of communication support and support plans we found that choice and decision making is limited. For example choices about holidays have not been made by individual service users but have been dictated by staffing levels and events at the home. This means that some people have not had a holiday this year. Due to the lack of clear time bound plans choices about activities and wanting to learn new skills have not been supported. Care Homes for Adults (18-65 years) Page 12 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have access to a range of activities. There are limited opportunities for personal and skills development. Relationships are supported. There is potential for people to be more involved in the running of the home. Evidence: We found that there is a range of activities on offer that people have the opportunity to take part in. Most of the activities are group activities provided by the company and held at a local community centre. Evening activities like discos are also offered. Some people access a local resource centre and some people have jobs. Each person has an activity planner covering seven days and evenings. One persons planner said own choice for most of the days. The manager said this person does not like structured activities however if nothing is planned in advance there is no opportunity to opt in or out. We found opportunities for one to one support is limited. Service users repeatedly Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: requested this through service user meetings but we found no evidence that this was supported. The AQAA says that there is no funding for one to one support so service users may not have the opportunity for this valuable time. This could be achieved with creative staff deployment. We found that relationships are supported and people have opportunities to make friends. People have the support they need keep in touch with family and friends. We found that staff do most of the cooking and cleaning which means that service users do not get much opportunity to learn to cook etc. Staff order food on line and have it delivered. This means that service users do not get the opportunity to experience supermarkets. Some said they go to the local shops to buy small personal items. There is potential for service users to be more involved in the running of the houses especially the cooking, laundry and cleaning. Some staff were observed doing for people rather than doing with them. This means that service users will not develop their skills and grow in confidence. People have support to access the community like local pubs, shops, and cafes. People said they use the local shops and churches. We found that people are charged for an annual holiday as part of their fee for living at The Bay. However not everyone has had a holiday. The manager said this is due of staffing related issues, which could have been avoided with better planning. We found that there is a lack of opportunity for individual holidays. For example the staff meeting minutes of 16.6.08 say client holidays will happen in September, as at present there is a lot of staff annual leave. The manager said at the service user meeting of 29.05.08 that service user holidays will happen in the first week of July. This means that service users are not having the choice of when and where they holiday. Staff agreed that service users have different tastes and interests and would benefit from individual holidays. People said they enjoy the garden especially feeding the birds and would like a green house. Care Homes for Adults (18-65 years) Page 14 of 26 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. Without detailed support plans, people cannot be sure their personal and health needs will be supported. Medication practice is safe but there is potential for more people to have some control over their medication. Evidence: We found that some significant personal care needs are not recorded in service user plans. The manager said this information might have fallen out. Needs that are recorded have only basic information. Without clear records of peoples needs staff will not have the guidance they need to give the right support. We found no plans in place to develop or increase peoples skills with personal care. This means that skills may not be developed so people have to continue to rely on staff We found that not every ones health needs are recorded. One persons goal is to remain healthy but there is no other information about this. The manager explained in detail what this meant but there was no record to give staff this information. Everyone has a GP and people said they see their GP when they need to. Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: We found that medication storage is safe and there are records of receipt and administration of medication. We found that staff have training before they administer medicines. The manager said there are plans to site peoples own medication safely in their rooms to give people some control. We found that information in one service users plan was incorrect as it said that the person does not self medicate when they actually do. This means that there may not be safe monitoring and assessment in place. Care Homes for Adults (18-65 years) Page 16 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service know who to complain to. Staff must know about safeguarding procedures to keep people safe and protect them from harm and abuse. Evidence: We found that there is a written complaints procedure displayed in the home. The manager said this is also produced with text and symbols. The manager agreed that this is not meaningful to everyone so people who use the service may not know about the complaints procedures. Records show that there have been no complaints for some time. We have received no complaints about the home since the last inspection. Service users said they would talk to staff about any complaints and said staff are very helpful. There is a safeguarding vulnerable adults and whistle blowing policy and procedure. We found that staff are aware of these policies and procedures. Staff attend training in safeguarding vulnerable adults. Staff said that they would report any concerns to the manager. The manager was not clear about the safeguarding protocols. The manager said she has had training in safeguarding vulnerable adults but has had no experience in this area. The manager must be aware and familiar with safeguarding protocols so she knows what to do if a disclosure is made or staff raise a concern. Care Homes for Adults (18-65 years) Page 17 of 26 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 maintained and a pleasant safe place to live. Evidence: The home is well maintained with adequate furniture and fittings. There are spacious communal areas and each bedroom is single with a wash hand basin. People said there are enough bathrooms and showers for them and that they are happy with their rooms. Some of the carpets are stained, the manager said there are plans to replace some carpets. There is unrestricted access to the back garden so people can get fresh air when they want. People have a key to their bedroom if they want one but not everyone can let themselves in the front door so have to wait for staff. On entering the houses from the front doors we found lots of company information displayed on the walls. This does not make the home feel homely and ordinary but like a care home. The manager said she would discuss with service users about putting this information in a file so it looks more homely. Care Homes for Adults (18-65 years) Page 18 of 26 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. There are enough trained staff to meet service users needs. Recruitment checks are robust protecting service users. Staff need access to regular staff meetings and supervision to feel valued, supported and mentored. Evidence: We found that access to mandatory training is good and the induction is adequate. Some staff have attended training relating to service users needs like epilepsy and autism although training is person centred planning is very limited. This means that staff are not competent in developing person centred plans with individuals to support them achieve their goals and live the lives they want. One house is to become a supported living service, however staff have had no training in areas they will need like supporting people to learn and develop skills like cooking and paying bills. We found the culture of the home is staff do for rather than do with. For example we found that staff do the cooking for people, change beds for people when they are out, clean peoples rooms when they are out. This means that service users will not develop their independent living skills and increase their confidence and control. Most of the staff have a National Vocational Qualification in care but would benefit from training in empowering and enabling people to do as much for themselves as possible. Care Homes for Adults (18-65 years) Page 19 of 26 Evidence: We found that recruitment checks are carried out before a person starts work at the home. The home employs some overseas staff and commissions a company to carry out the required checks on these staff. This protects service users. The manager said that the home is fully staff with some long standing staff who know service users well. The manager says that there are plans to involve service users in recruiting staff, this means they will have a say about who may potentially support them. We found that there is usually one staff on duty during the day in each house and one staff in each house at night. Staff said extra staff could be called in for activities planned in advance. People said they like the staff and the staff are good. We found that staff meetings are not as regularly as the Minimum Standard requires, only four held this year. This is also the case for supervision meetings with one team leader only having one supervision meeting this year. This means staff may not have the opportunity to talk about issues like performance, development and training and get the mentoring and support they need. The manager said she plans to meet with all staff for their yearly appraisal. Care Homes for Adults (18-65 years) Page 20 of 26 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 home is adequately managed and peoples health and safety is protected. Service users cannot be sure their views will underpin the review and development of the service. Evidence: Since the last inspection there has been a change of manager. The manager has been at the home for just over one year and is the Registered manager. This means that she has passed the fit person process. The manager has support from an area manager and previously managed another company home so has good experience. The manager has a Registered managers award qualification but has no qualification in learning disabilities. The manager has had person centred thinking training recently but has not yet started to translate this theory into practice to make a difference to outcomes for people who use the service. We carried out an Annual Service Review of the home on 7.05.08. Due to the lack of information in the Annual Quality Assurance Assessment (AQAA) the date of this key Care Homes for Adults (18-65 years) Page 21 of 26 Evidence: inspection was brought forward. The manager then sent us another AQAA with much more detail. We found that there are some quality assurance systems in place. The manager completes weekly and monthly returns for head office. The manager said that surveys are sent out to stakeholders by head office but the manager was not aware of any responses or action plan. We found that service users meetings are held so people get to air their views. Unfortunately we found that service users views are not always listened to an acted on. For example people have requested things including some one to one support, support to plan and book outings and support to learn new skills. We found no evidence that this has been supported. The AQAA gives only basic examples of changes that have been made based on service users views and this is limited to paint colour choices, menu choices and holidays. An area manager or other senior manager makes monthly visits to the home. We found that reports are completed and show that service users and staff are spoken to. We found that this monitoring has not picked up the shortfalls in care plans and risk assessments or the lack of staff meetings and supervision. The AQAA shows that health and safety checks are carried out. We found that staff attend training related to health and safety including food safety and first aid. We found that regular fire drills are held and fire equipment is checked regularly. We found that some sensitive information about people who use the service is not held securely and in line with the Data Protection Act. This means that service users confidentiality is not protected. Care Homes for Adults (18-65 years) Page 22 of 26 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 23 of 26 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 6 15 Each persons needs and personal goals must be recorded and a plan in place to support this which is kept under review. To ensure that peoples needs are met and that they have the support they need to achieve their goals and aspirations. 31/12/2008 2 9 13 All potential risks to people must be identified, recorded and kept under review. Strategies must be in place to reduce risks to people. To ensure that risks are recognised and people are kept safe from harm by the homes strategies. 30/11/2008 3 14 12 Everyone who pays for a holiday as part of their fee should have the support they need to have the holiday of their choice. People who have had no holiday should have their 31/12/2008 Care Homes for Adults (18-65 years) Page 24 of 26 money back. People should be paid back within the timescale. To ensure that people get the holiday they want that they have paid for. To give people something to look forward to and a change of scenery to aid well being. 4 23 13 Staff and the manager must be aware of safeguarding vulnerable adults procedures. To ensure that they know what to do if a disclosure is made or reported to them and to keep people safe. 30/11/2008 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 32 To improve outcomes for service users and help support people to achieve staff should have training in Person Centered Planning. To ensure staff have the opportunity for coaching, mentoring, discussion and support they should have the opportunity to attend at least 6 supervision meeting and 6 staff meetings each year. 2 36 Care Homes for Adults (18-65 years) Page 25 of 26 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 © (2008) 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 26 of 26 - 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!