Inspection on 01/10/08 for The Elton Unit

This inspection was carried out on 1st October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Ruskin Lodge

Dystlegh Grange

The Good Companions

Springfield Cottage

Cuerden Grange Rest Home

Cornmill Nursing Home

Vitalise Sandpipers Centre

Sue Ryder Care Birchley Hall

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: The Elton Unit The Priory Highbank Centre Walshaw Road Bury Lancashire BL9 3AS     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: Grace Tarney     Date: 0 1 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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 © (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 28 Information about the care home Name of care home: Address: The Elton Unit Walshaw Road The Priory Highbank Centre Bury Lancashire BL9 3AS 01617970374 01617636732 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sarah Rushton Type of registration: Number of places registered: Priory Rehabilitation Services Limited care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N The people of the following gender: Either Whose primary care needs in admission to the home are within the following categories: Physical Disability - Code PD The maximum number of people who can be accommodated is 24. Date of last inspection Brief description of the care home The Elton Unit is a single storey building situated in its own grounds in a residential area of Bury. It is not too far from Bury Town Centre and is easily accessible by public transport. There is plenty of car parking within the grounds. The unit is registered to care for up to 24 younger people who require intensive rehabilitation. The residents have very intensive specialised needs and they are cared for by a range of professional staff. The staff involved in their care are the Specialist Brain Injury Team. This team consists of a consultant in rehabilitation neurorehabilitation nurses,psychologists,physiotherapists, occupational therapists,speech and language Care Homes for Adults (18-65 years) Page 4 of 28 24 Over 65 0 Brief description of the care home therapists and dieticians. The unit has received international recognition at the highest level from the Commission on Accreditation of Rehabilitation Facilities (CARF). This international body has recognised that the unit and the company is a provider of the highest quality rehabilitation. The fees for the care provided depend on the residents care and rehabilitation needs. 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: The unit was not told that this inspection was to take place although many weeks before the inspection we (the commission) asked the manager of the unit to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they did at present, what they felt they did well and what they needed to do better. This helps us to determine if the management of the unit see the service they provide the same way that we do. We spent 8 hours at the unit and during this time we examined care and medicine records to make sure that the health and care needs of the residents were being met. We also looked around the building at some of the bedrooms, bathrooms, toilets and Care Homes for Adults (18-65 years) Page 6 of 28 sitting areas to check if they were clean, warm, well decorated and suitably equipped. We also looked at the menus and looked at what the residents were having for their lunch and their evening meal. We also checked how many staff were provided on each shift to make sure the residents needs were being met, and also looked at how management recruit and train their staff. We also looked at how management check that the care and services that they provide are what the residents and their relatives want, or expect. In order to get further information about the unit we also spent time speaking to 1 resident, 2 visitors, 2 care staff,the manager, a senior nurse manager, the support service manager and the chef. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are properly assessed before they are admitted to the unit. This gives an assurance to everybody that a person is only admitted if the staff feel they can meet their needs and can involve the correct healthcare professionals to try to improve their medical condition and their quality of life. Evidence: Before any person is admitted to the unit a very detailed assessment of their condition is undertaken by suitably qualified and relevant staff. This could be for example, the specialist consultant or a physiotherapist but always involves an experienced qualified nurse. An assessment looks at what help and support a person who may be admitted to the unit needs to help them make the most of their daily life. The assessment helps the staff to decide on what is the best form of therapy and who are the best professionals to be involved in their care. We looked at 2 assessments of the most recently admitted people. They were very detailed and showed very clearly what needs the person had, how these were to be met and who was to be involved in their care and rehabilitation. Care Homes for Adults (18-65 years) Page 10 of 28 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 care plans show in detail what care needs the residents have and how they are to be cared for and by whom. Evidence: The residents within the unit have very intensive specialised needs. They require intensive nursing care and, in order to improve their quality of life and reach their maximum potential, they need to be cared for by a range of other professional staff. The staff involved in their care are the Specialist Brain Injury Team. This team consists of a consultant in rehabilitation neurorehabilitation nurses,psychologists,physiotherapists, occupational therapists,speech and language therapists and dieticians. Each professional has input into the care plan. This ensures that all the people involved in the residents care know exactly what is going on as far as the residents condition and treatment. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: We looked at the care plans of 2 of the most recently admitted residents. They were very detailed and showed very clearly what care was required and what treatment was being given. 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. As part of their rehabilitation the residents are supported and encouraged by staff to make choices, as far as they are able, about what they do in their daily life. This helps them to find as much enjoyment and fulfillment as possible. The residents are given a choice of well-balanced and nutritional meals. Evidence: The residents are not well enough to be able to have any sort of job or take up any further education. This does not however stop them from finding enjoyment in the activities that are available to them, both within the unit and out in the community. The unit has a full time activities person who is very aware of what the residents are able, and like, to do. There is an activities room which is full of various things such as: games, crafts, videos and DVDs. We saw large flat screen televisions, DVD & CD players in the lounges. We were told that some nights the men and the women have Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: their own special movie nights. Whist we were in the unit we watched some of the residents having a music session with the care staff. They had the karaoke machine on, some residents were singing and many of the residents had musical instruments so that they could join in the fun. One of the care staff was playing the guitar. There was lots of laughter and happy banter. On the day of our visit, in the late afternoon, we saw some of the residents going off to Blackpool in the companys minibus. They were going to see the Blackpool Illuminations. Care staff were accompanying them. We were told that some of the residents are often taken shopping into Bury Town Centre. We were also told that some of the residents are taken home to spend time with their families. How long they stay and if care staff stay with them, depends on their medical condition. During the visit we saw visitors coming and going. The visitors that we spoke to had nothing but praise for the staff. 1 told us that You only have to ask and its there. They are marvellous. On the day of the visit it was the Muslim celbration of Eid. The staff,in accordance with Muslim tradition, had decorated the bedroom of one the residents who was of the Muslim faith. It looked lovely and his family told us that they were very pleased it had been done. The bedroom of another resident had previously been decorated for the Chinese New Year. We went to the dining room at lunchtime to see what the residents were having for their lunch. The dining room is in the conservatory area. It is a very pleasant room with new chairs and tables. The tables were at varying heights so that it made assisting some of the residents to eat, much easier and more dignified. The kitchen is situated off the dining room and leads onto the servery. We spoke to the chef who told us that the menu is developed with the assistance of the dietician. This is to ensure that the meals are nutritious and meet the individual needs of the residents. The menus were displayed in the dining room and residents are asked there and then for their choice. There is a choice of main meals and desserts. Fresh fruit was available. The food served looked appetising and of good portions. A hot drinks dispenser was in the dining room and we were told that this is for the use of residents and their visitors. We were also told that the kitchen is left open at night so that residents can have a snack if they are feeling hungry. 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. Care practices ensure that the residents needs are met in a very safe, caring and dignified way. The involvement of the Specialised Brain Injury Team ensures that everything possible is being done to improve the residents quality of life. Evidence: The Specialist Brain Injury Team are responsible for the care of the residents on the unit. This team consists of a consultant in rehabliltation medicine, neurorehabilitation nurses and therapists, psychologists, physiotherapists, occupational therapists, speech and language therapists and dieticians. Whilst every member of the team has a specific job to do to help with the rehabilitation of the resident, the whole team is kept aware of any changes to a residents condition by the regular team meetings and reviews that are undertaken. The residents nursing needs are met by very experienced qualified nurses who are supported by suitably trained and experienced rehabilitation assistants. The nurses and care staff have specialist training so that they can look after the residents who have very complex medical conditions. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: The residents have access to NHS services. We saw evidence of this in their care notes. We were told that the unit now has the services of a mobile dental service that is able to, in most cases, treat the resident at the unit. We also were told that the residents have access to health screening programmes such as breast and cervical screening. We looked at the system for managing the medicines. A safe system was in place. The qualified nurses are the only people allowed to have responsibility for managing the medicines. There is a locked medicine room and a locked medicine trolley that is secured to the wall when not in use. Medicines and Controlled drugs were stored securely and recorded accurately. 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 systems in place to ensure that people know how to and to whom they can complain. Staff have a good knowledge and understanding of what abuse is and know what to do if it happens. This helps reduce the possible risk of harm to the residents. Evidence: There is a booklet displayed on the wall in the entrance hall that explains how any complaints will be handled. This booklet is also given out to the residents and their relatives. It is easy to understand and tells people that complaints will be looked into within 2 working days and a full written response given within 20 days. A record is kept of any complaint made and includes details of the investigation and any action that the management may have taken to put things right. No complaints have been made to us in the last 12 months. We spoke to some of the staff and asked them to tell us what they would do if they felt that a resident had been mistreated in anyway. They were very aware of what to do and how to report it. They told us that they had been trained so that they could, as far as possible, protect the residents from harm. We saw evidence of this training in their training files. We were also told that senior staff had recently been on some protection/safeguarding training with the Local Authority. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: There have been 2 safeguarding incidents recently. Staff have acted appropriately by informing us and the Local Authority, and taking the correct action to protect the residents. 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 residents have a very clean, safe and pleasant place in which to live and be cared for. Evidence: The Elton Unit is a single storey building situated in its own grounds. There are garden areas to the front of the unit and there is plenty of parking. There is level access to the unit making it easy for wheelchair users or people who have difficulty mobilising. The corridors are wide, nicely decorated and well lit. The bedrooms are spacious and clean. Despite nearly all of the bedrooms having essential clinical equipment in place necessary for the residents care, they still managed to be as personalised as possible. The bathrooms and shower rooms are also very spacious and have very specialised bathing equipment in place so that the residents can be bathed or showered in comfort and safety. There are 2 lounges in the unit, plus a dining room and a designated smoking room. These rooms were well decorated and comfortably furnished. The dining room which is situated in the conservatory, has recently been redecorated and new flooring has been laid. New tables and chairs have also been provided. Every area throughout the unit had call bells in place so that the residents and staff could summon assistance. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: The unit was clean and free from any unpleasant smells. Disposable hand washing equipment was in place in bedrooms, bathrooms, toilets and all clinical areas. Staff had also been supplied with antibacterial hand cleaning gel and disposable gloves and aprons were also provided for them to wear. Providing all this equipment helps to reduce the spread of infection and therefore helps to protect the residents health and wellbeing. We were also told that every resident is screened for MRSA on admission to the unit and it is their intention to start undertaking this screening on a 3 monthly basis. All sinks, baths and showers have thermostatic control valves so that the water discharges at a safe temperature and therefore reduces the risk of accidental scalding. Radiators were guarded to protect the residents from harm. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are extremely well cared for by very experienced staff that are suitably trained. Evidence: A check of the duty rotas and inspection of the training files showed that there was enough suitably trained staff on duty at all times to meet the very intensive needs of the residents. The information received from the AQAA form showed that management provide a staff induction programme for all newly employed staff. This is to make sure that they understand what is expected of them and that people are cared for properly and safely. We looked at some of the training files and saw evidence of this. We also saw evidence of further training that has been undertaken by different grades of staff. The company has its own learning and development officer and each staff member has computer access to their training file. The information received from the AQAA form showed that 56 of the staff had obtained their NVQ (National Vocational Qualification) level 2 in care. This is good progress. The recruitment files of 2 staff members were checked. A safe recruitment system is essential so that residents are protected from being cared for by unsuitable people. 1 of the files was in order and this staff member had been safely and properly Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: recruited. The file for the other staff member showed that whilst the company had sent off for a new CRB (police record) check and this was now in place, she had been employed before the company had received it. This was because this staff member had recently had a CRB check done elsewhere and brought it to the unit. This is called a portable CRB and it is not legally acceptable. From a discussion with management it became apparent that there had been some misunderstanding about the guidance. They informed us that they would revisit their policies and procedures about recruitment to make sure that this did not happen again. 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 unit is safe and very well managed. Management continually look at the care and facilities they provide so that the residents welfare is protected. Evidence: The Registered Manager of the Unit is a qualified nurse and has many years experience of management and working in the field of neurorehabilitation. She has worked for the Company for over 9 years and she has a management qualification. She keeps herself regularly updated with training, both in management and care issues. She is very well supported by other senior nurses in the Senior Management Team of the company. Staff made the following comments :She is very approachable. I have learnt a lot from her. Information from the AQAA document sent to us and documents that we looked at showed that a great deal of work continues to be undertaken to provide a good quality assurance system within the company. This is to ensure that the people who use the Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: service receive the best possible facilities and care. Management regularly have to check on lots of things that affect the health, safety and well being of the residents. They also hold regular resident and relative meetings and this gives them the opportunity to discuss anything that they want to. Management also send out surveys to residents, relatives and staff asking for their views of the service and facilities provided. The unit has received international recognition at the highest level from the Commission on Accreditation of Rehabilitation Facilities (CARF). This international body has recognised that the unit and the company is a provider of the highest quality rehabilitation. Information received from the AQAA sent to us and from random checking of servicing records showed that the units fixtures, fittings and equipment are properly maintained and regularly serviced. We saw that regular weekly checking and testing of fire detection system, fire exits and emergency lights was undertaken and documented. 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 1 34 19 A person must not be employed by the company until a current Criminal Record Certificate check has been sent for and received. To ensure the safety of the residents within the unit by ensuring that they are not being cared for by unsuitable people. 31/10/2008 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 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 © (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 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!