Inspection on 08/01/09 for The Hollow, Chetan Park

This inspection was carried out on 8th January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Hollow, Chetan Park 18/01/08

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Hollow, Chetan Park 11 School Road Marshland St James Wisbech Cambs PE14 8EY     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: Lella Hudson     Date: 0 8 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. 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 29 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 29 Information about the care home Name of care home: Address: The Hollow, Chetan Park 11 School Road Marshland St James Wisbech Cambs PE14 8EY 01945430934 01945430906 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Swanton Care and Community Ltd Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following categories of service: Care Home - PC to service users of the following gender: Both Whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding Learning Disability or Dementia - Code MD Learning Disability Date of last inspection Brief description of the care home The Hollow, Chetan Park is a detached property situated in Marshland St James, which is a Fenland village near to Wisbech. The home provides care and support for 4 residents with either mental health needs or a learning disability. The accommodation comprises 4 ensuite bedrooms, lounge, kitchen, wc, laundry and gardens to the rear of the premises. There is a car parking area at the front of the building. The weekly Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 0 4 4 Brief description of the care home charges range from £1597.36 to £1755.26 Copies of CSCI reports are made available to residents. Care Homes for Adults (18-65 years) Page 5 of 29 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: This report contains information gathered about the Home since our last Inspection (January 2008). We received a completed Annual Quality Assurance Assessment which is the organisations review of the improvements that they have made since that time and of further improvements that are planned. The report includes information gathered during an unannounced visit to the Home that was carried out on the 8th January 2009. During our visit we spoke to one of the residents, spoke to staff and the Manager as well as looking around the Home and looking at some records. The current Manager of the Home was appointed in September 2008 and is currently Care Homes for Adults (18-65 years) Page 6 of 29 going through the registration process to become the Registered Manager. The organisation has recently been bought by its sister company Barchester Healthcare and as a result of this there is a new Responsible Individual. The organisation also has a new Operations Manager. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 29 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 9 of 29 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 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home provides information about the service that they provide. The assessment process is detailed and is centred around the needs of the prospective resident. Evidence: We spoke to the Manager about the admissions process and this clearly involves speaking to the resident, their relatives if appropriate, and health and social care professionals involved in their care. At the time of our visit to the Home the Manager was going to a meeting as part of the admissions process for a prospective resident. The process includes as many visits to the Home as that resident needs. The Statement of Purpose has been updated to reflect the fact that there is a new Manager at the Home but there will be a futher need to update this if the Home continues with their plans to provide a service for people with Downs Syndrome and dementia. The Manager is working with health/social care professionals to ensure that a suitable Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: place can be found for one of the residents who has expressed a desire to move. Care Homes for Adults (18-65 years) Page 12 of 29 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. The care plans and risk assessments are not clear enough to provide clear guidance to staff about how to meet the residents needs. The views of the residents are sought on a regular basis. Evidence: We looked at both of the care plans and risk assessments. These contain some good personal information about how to meet the needs of the residents and of the need to respect the residents privacy and dignity. For example, one of the care plans reminds staff of the importance of not patronising the resident who has communication difficulties. Whilst the care plans and risk assessments have greatly improved since the last Inspection there is still a need for further improvement to ensure that the residents needs are being met in a consistent way. For example, there are no written guidelines in place for supporting one of the residents at times when their behaviour can be Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: difficult. Currently there are only two residents living at the Home and one has good verbal communication and so the risks of not having clear care plans is reduced. The staff who spoke to us were clear about the care needed by the residents. However, there will soon be more residents living at the Home and it is likely that they will have communication difficulties and so the risks of poor care plans are greater. The residents views are sought on a regular basis about a range of issues. One of the members of staff is going to attend the Communication Co-ordinators course and will then be able to take a lead on ensuring that the communication within the Home is as effective as possible. There is currently some signage around the Home but the Manager said that this will be increased before more residents move to the Home. We looked at the arrangements in place for looking after residents money. The cash held corresponds to the records that are kept. Care Homes for Adults (18-65 years) Page 14 of 29 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 residents are supported to take part in meaningful activities. Residents are provided with a varied menu and their dietary needs are met. Evidence: The care plans contain information about activities that the residents are interested in but these would benefit from being clearer. For example, one of the care plans states that the resident likes to go to church but there are no plans in place for how often this should take place or who should support the resident to do this. One of the residents attends a formal day service between Monday to Friday whereas the other resident does not attend any formal day service. Discussions with the staff and one of the residents show that the residents are supported to access a range of activities in the nearby town of Kings Lynn. The Home is situated in a rural area and so Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: the residents need to have transport provided for them. The Home has a car which is used for this purpose. Some staff at the Home are no longer able to drive this car as the new organisations insurers requires drivers to be 25 when previously they could drive at 21 years of age. One of the residents has requested to move as they do not like living in such a rural area. The Manager has taken action to refer this to the residents social worker to enable this to happen shortly. Staff said that recently a lot of money has been spent on games and other activities for use within the Home. There are art and craft materials as well as books, computer games and board games. The Home also has a television and DVD player. One of the members of staff has taken on the responsibility of planning the menus with input from the residents. We looked at the menus and spoke to staff and one of the clients about these. The menus are very good, they are varied and contain some interesting and unusual meals. The staff clearly recognise the importance of nutrition to the residents and the need to make meals interesting as well as tasty. The member of staff responsible for the menus has also prepared detailed recipes to enable all of the staff, and residents if they wish to, to be able to cook them. The menus are on display on the dining table. Staff said that one of the residents likes to be involved in cooking. She explained how this can be broken down into small steps to enable the resident to be involved even though they are unable to complete whole tasks. Residents have access to drinks at any time and one of the residents was observed to get their own breakfast. There are snacks and fruit available on the side in the lounge. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents health and personal care needs are met at the Home. Medication is managed in a way which protects the safety of the residents. Evidence: We looked at the care plans with regard to the residents health and personal care needs. Only one of the residents needs assistance with personal care and this is recorded within their care plan. As previously mentioned in this report the gaps in the care plans are not presenting the residents with risks at the moment as there are only two residents living at the Home and a consistent staff team. However, the Manager is aware of the need to improve the recording to ensure that consistency is provided as more residents move in to the Home and therefore the staff team also increases. The care records contain evidence that the residents have been supported to attend healthcare appointments such as dentist, opticians and also meetings with social workers and care managers. The Manager said that the Home is going to focus on providing care for people with a Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: learning disability and dementia. She has found relevant training which will be provided to the staff team with regard to dementia. Staff will also be attending training with regard to learning disability and mental health. We looked at the system in place for the administration of medication. There is currently very little medication prescribed to the residents. The medication is stored correctly and a record is kept of medication received at the Home. A seperate record of medication returned to the pharmacy is not currently kept. There is no guidance available for the use of PRN (as required) medication. The Manager has plans in place for additional training for the staff with regard to medication. Care Homes for Adults (18-65 years) Page 18 of 29 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. Complaints would be taken seriously and action taken to address them. Procedures and staff training are in place to protect the residents from abuse. Evidence: We spoke to one of the residents who said that if they were unhappy about something then they speak to the staff. They confirmed that the Manager is taking action to help them to move from the Home. The Manager said that there have not been any complaints made to the Home. The staff and Manager described a situation where the Manager took steps to enable a resident to move from the Home recently due to risks to the other clients from the residents behaviour. The training matrix shows that the majority of staff have attended Safeguarding training and that dates are booked for those staff who need an update. Staff who spoke to us were aware of the correct procedure if they have any concerns about safeguarding issues. The Homes Safeguarding procedure does not include reference to the local procedure for making referals but the Manager is aware of the procedure and has put a copy of this in the Homes procedure file. Care Homes for Adults (18-65 years) Page 19 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home provides a high standard of accommodation for the residents. Evidence: We were shown around the Home. A high standard of accommodation is provided to the residents. All of the bedrooms have ensuite shower and toilets. The communal areas on the ground floor are of an open plan style. There is a lounge and a kitchen/dining room. There is a homely feel and the residents have been encouraged to personalise their own rooms and the communal areas. Two of the bedrooms are on the ground floor and two are on the first floor. There is no lift to the first floor. There is also an office on the first floor. The Home has a conservatory which is used as a laundry room. There is a attractive garden which is well maintained. There is a smoking area in the garden as the Home is a non-smoking Home. As previously mentioned in this report, the Manager intends to improve the signage around the Home prior to other residents moving in. This will provide better orientation for residents who have some level of confusion. Care Homes for Adults (18-65 years) Page 20 of 29 Care Homes for Adults (18-65 years) Page 21 of 29 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. Effective recruitment procedures are followed to ensure that staff are suitable to work with vulnerable adults. Staff receive regular supervision and review of their work practices. Training is currently not adequate to ensure that staff all have the correct skills and experience to meet the needs of the residents. Evidence: We spoke to one of the residents who said that the staff are nice and that they are kind. We observed staff supporting the resident in a positive and friendly way. The views of the resident were sought about how they wished to spend their time and about meals. Staff who spoke to us were enthusiastic about working at the Home with the residents and gave consistent answers when asked about the care needed by the residents. The staff team is now more settled than it has been in the past although currently both of the senior care staff are off work. We looked at a selection of staff files and these show that appropriate recruitment procedures have been followed with the necessary checks having been carried out prior to the staff starting work. The rotas confirm the information from staff that there Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: are always two members of staff on duty. The Managers hours are in addition to the care staff hours. There are two waking night staff on duty also. The Manager said that the staffing will increase depending on the needs of any new residents who move to the Home. The Home has their own bank staff but do use agency staff on occasion although the Manager said that this has greatly reduced. The agency provide confirmation of the staffs training and experience as well as confirmation that they have had a suitable Criminal Records Bureau check. The Manager showed us the plan of supervisions that she carries out. This shows that supervision takes place on a regular basis. This was confirmed through discussions with staff. They also said that regular staff meetings take place. The Manager said that training is usually provided by the organisations own training provider but she said that she has found some additional training which is provided by the local social services department and that she has booked staff on some of this training. The training that staff receive is a mixture of mandatory, such as fire training, and that which is specific to individual residents needs such as dementia. The training matrix shows that there are some gaps in the training undertaken by a lot of the staff but the Manager is aware of this and has plans to address these gaps. Just over 50 of the care team have achieved NVQ at Level 2 or 3. Additional staff are booked to attend this. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home is well managed in a way which puts the needs of the residents first. Health and safety is given a high priority and action taken to address any issues. Evidence: The organisation has recently been taken over by its sister organisation Barchester Healthcare. There is a new Responsible Individual. There is also a new Operations Manager who started work three days before our visit to the Home. We met her briefly during our visit. There have been three Managers of this Home since it was first registered in 2007. The current Manager was appointed in September 2008 and is currently in the process of applying for registration with the Commission. Whilst the Operations Manager post has been vacant the Manager has received support from one of the Managers from another Home within the organisation. This Manager was also at the Home at the time of our visit so we were able to speak to him about the Home also. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: The new Manager of the Home has relevant experience of working with residents and has completed NVQ Level 3 in Care. She is going to start the new Managers Award this year. She has also attended other relevant training such as the Mental Capacity Act and intends to do further training in this area as she is aware of the relevance of this for the residents who live at the Home. Discussions with the Manager show that she has a good understanding of the needs of the residents and of how these should be met. She is enthusiastic about her role and has lots of ideas for further improvements. She has addressed some difficult staffing situations and is clear about the need for high standards of care to be provided for the residents. Discussions with staff provide evidence that the Manager provides good, clear leadership and motivation to the staff team. They said that she is very supportive and always approachable for discussions. They said that she involves the residents and staff in decisions to be made about the running of the Home. The Home had two senior care staff but, for differing reasons, neither are working at the time of our visit to the Home. This means that the Manager is solely providing the on call system and does not have any assistance with management tasks. The Manager will discuss this with the new Operations Manager to ensure that this situation is addressed as soon as possible. We discussed quality assurance with the Manager and she described the range of audits and checks that are carried out about different aspects of the service. She said that the organisation used to carry out quarterly audits of the service and expects that the new organisation will continue to do so. Currently there is no overall document which brings together all of the strands of the quality assurance process. The organisation has not carried out a monthly visit since October 2008 but the Manager said that she expects this to be started again now that a new Operations Manager has been appointed. We looked at a selection of health and safety records and these show that regular maintenance and checks are carried out on equipment. The fire risk assessment has not been reviewed in the last 12 months. The Manager said that the hot water temperature is regulated and that window restrictors are fitted to the first floor windows. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 6 15(1) The home must ensure that the care plans and associated risk assessments are completed so that staff have clear guidelines regarding the care and support that residents require. 31/01/2008 Care Homes for Adults (18-65 years) Page 26 of 29 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 It is required that the care plans contain detailed, accurate information about how to meet the residents needs To ensure that the staff provide consistent care which meets the residents needs 28/02/2009 2 7 13 It is required that a financial care plan is available for each resident To ensure that the arrangements for looking after residents money are clearly recorded 28/02/2009 3 9 13 It is required that risks are 28/02/2009 assesed and that clear guidance is available about how to best manage the risk To ensure that risks are assessed and that staff have guidance about how to safely manage the risk Care Homes for Adults (18-65 years) Page 27 of 29 4 20 13 It is required that clear written guidance is available for the use of PRN medication To ensure that the residents receive their medication at appropriate times 30/01/2009 5 35 18 It is required that staff receive appropriate training To ensure that staff have the right skills and experience to enable them to meet the residents needs 30/06/2009 6 39 26 It is required that monthly visits are carried out by the organisation To ensure that the organisation carries out its own audit of the quality of the service provided 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 1 2 20 42 It is recommended that clearer records are kept of medication returned to the pharmacy It is recommended that the fire risk assessment is reviewed and updated Care Homes for Adults (18-65 years) Page 28 of 29 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 29 of 29 - 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!