Inspection on 30/04/09 for The Mount

This inspection was carried out on 30th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Mount 17/04/08

The Mount 18/04/07

The Mount 19/12/05

The Mount 07/09/05

The Mount 03/11/04

The Mount 21/04/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Mount 6 Liverpool Road, North Burscough Nr Ormskirk Lancashire L40 5TP     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: Phil McConnell     Date: 3 0 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 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.cqc.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 Mount 6 Liverpool Road, North Burscough Nr Ormskirk Lancashire L40 5TP 01704893907 01704896181 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Social Services Directorate Name of registered manager (if applicable) Mrs Sarah Birtwell Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 4 Date of last inspection Brief description of the care home The Mount is owned and run by Lancashire County Council and provides respite and short term care for a maximum of four people over 18 years of age with learning disabilities. The Mount is on a busy main road and is in walking distance of local amenities and public transport. The home is a dormer bungalow with 4 single bedrooms. Care Homes for Adults (18-65 years) Page 4 of 29 care home 4 Over 65 0 4 Brief description of the care home There is a lounge/dining room and conservatory area communal space. There are facilities such as a ramp, disabled toilet and other aids to help service users remain as independent as possible. A large, well-maintained and secure garden to the rear of The Mount gives additional space when the weather is good. The Local Authority usually funds service users. There was information available to potential service users and their families advising them of the service and giving them details about the type of service they could expect. 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: 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: Various information was gathered in order to be able to assess the National Minimum Standards for Care Homes for Adults (18 - 65) including: The Annual Quality Assurance Assessment, this is a document which the registered manager completes every year and it contains information about the service being provided. We use this information, in part to focus on our inspection activity. An unannounced Key Inspection, which was carried out on the 29th of April 2009 by the Care Quality Commission (CQC).The manager (Sarah Birtles) was present in the home throughout the visit. There was also the opportunity to speak to some of the staff during the visit, with all of the comments being positive. Peoples files were examined, with most of the documentation being in place. A number Care Homes for Adults (18-65 years) Page 6 of 29 of the staff files were examined and they contained all of the necessary documentation needed for inspection purposes including, recruitment information and Criminal Record Bureau (CRB) checks. The organisations policies, procedures and the health and safety documentation was examined and they were found to be up to date and satisfactory. A full tour of the premises was completed and it was observed that many improvements have been carried out since the last inspection that was undertaken by the Commission for Social Care Inspection (CSC1). 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 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 9 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. There is a good pre admission assessment process in place, helping to give peopole who will use the service a confidence and an assurance that their needs will be approriately provided for during their stay. Evidence: Six service users files were observed and it was clear that pre admission assessments had been completed, with assessments having been carried out by a representative from the Local Authority Social Services Department. The Annual Quality Assurance Assessment (AQAA) says, we have a clear assessment and admission procedure, which ensures the care needs of people are met and Introductions and/or home visits prior to overnight stays are very well undertaken, enabling people to become familiar with the environment and build up trust and relationships with the staff. A member of staff on duty said, A referral usually comes from Social Services and Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: then the manager makes a home visit to the person, then the person might have two or three tea visits to The Mount and an overnight visit. This helps a person get used to the building and the staff another person said, We always try and arrange to have people who are of a similar age and have the same interests. Compatibility is the main thing. The manager said, I usually take a member of staff with me on home visits and regarding introductions, we go as quick or as slow as the person needs. It was apparent that the assessment procedure is carried out in a way that would promote confidence and trust, for a prospective new service user. Care Homes for Adults (18-65 years) Page 11 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care plans need to be more person centred, with appropriate and relevant information documented. This will help show that peoples assessed needs are being provided. Evidence: A new care planning document has been introduced since the last inspection visit. This document was observed to contain a large number of sections requiring specific information for each person using the service including, a one page profile, communication needs, circle of support, relationships, people involved in supporting the individual, general lifestyle, daily occupation and activities, health needs and overall what support staff need to know to support a person?. It was apparent that the document requests a large amount of information, however not all of the sections are relevant for each person. It is recommended that future care plans be more more concise and person centred. In order to focus on the individuals needs and not give an exhaustive list of what a person might need or a possible medical condition. Six care Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: plans were examined at random and they were all lacking in detail and information and although the plans contained the afore mentioned questions, many of the plans contained blank pages, where important and necessary information for the individual should have been. This shortfall regarding the lack of information in care plans has also been identified in the regulation 26 monthly reports, which are completed by the area manager. For example, care plans require full completion (January 2009), Ensure care planning format is completed to reflect staff not knowing the person with easy to follow assessment and guidance in place (February 2009) and Care planning requires completion ASAP within the people we support files (March 2009). The manager acknowledged this shortfall during the inspection visit saying, We do have the knowledge, but it should be documented and evidenced. I know its not good enough. It was also observed that some of the wording and terminology in the document is out of date and is no longer used in social care. An assurance was given by the manager that all care plans would be immediately reviewed and audited. There was some documented evidence to show that people are consulted about what they would expect from the service. Some of the comments received from people using the service were, Keep me safe at all times keep me occupied and treat me with respect and to be cared for at all times and make sure my stay is enjoyable. This helps to demonstrate that peoples opinions and wishes are positively considered. It was apparent in discussion with members of staff, that they have a full awareness of peoples individual needs and the paperwork is not a true reflection of the dignity and respect that is shown to people using the service. Care Homes for Adults (18-65 years) Page 13 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. It is evident that the provision of activities that are meaningful and enjoyable are positively provided. Although there is the need to ensure that all interests and hobbies are recorded in peoples care plans. Evidence: The Annual Quality Assurance Assessment (AQAA) states, we provide opportunities for personal development and community participation through care plans and ensure people using the service have a lifestyle which meets their needs and expectations, We recognise the importance of working closely with parents and carers to ensure the needs and wishes of people we support are met, especially as they are only staying a short period of time. The AQAA also says, we consult with people prior to their stay to ask of any particular activity they would like to do whilst at the Mount? This ensures staffing levels are correct and does reflect their needs. As already mentioned some of Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: the care plans were lacking in detailed information, although it was apparent from discussions with the staff and in some feedback from relatives that people are enabled and empowered to take part in meaningful activities,however it is essential that any activities, outings, leisure pursuits and any event is recorded on individual care plans. Some good work has taken place with regards to assisting and supporting people in accessing fulfilling pursuits. One example of this, is a planned holiday for some of the people using the service. It was stated by the manager, This is the first time that people are being supported on holiday away from the Mount. This also has the added advantage of freeing up accommodation at the home. The manager said, the decision to access a holiday came from the service users themselves at their reviews. As previously mentioned a lot of planning and consideration is given to ensuring that people are compatible with each other. For example, being of a similar age, having the same interests and hobbies. In discussion with some of the staff, it was clear that people using the service benefit from being with people, who have similar interests. Overall it appears that the staff team are proactive in promoting community participation, community presence and supporting people to enjoy their stays at The Mount. Regarding the provision of meals. It was evident that meals are varied , with people having the opportunity to have meals out. This is an activity that most people seem to enjoy. Care Homes for Adults (18-65 years) Page 15 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a need to ensure that care plans contain fully detailed information, with regards to peoples health care support. This is necessary to give assurance that all staff are familiar with a persons needs, in order for them to be satisfactorily provided. Evidence: The AQAA says, Our care plans are well updated and inputted, these give clear guidance on the best way to support people, so that staff can assist in the manner which meets the individuals needs and choices. As already mentioned the care plans were quite limited in detail and information. This was also evident in the sections in the care plans that asked for information regarding a persons health care needs. For example one persons plan indicated they had epilepsy and needed medication to help manage the epilepsy. The section in the care plan for giving details of this medication information was blank. Although it was clear that the person does have regular medication and the staff were fully aware of this persons health needs. It was also apparent in discussion with some of the staff team, that they are fully aware of the health needs of all of the people using the service. However, because of the limited evidence in care plans, there is no guarantee that peoples health care needs are being Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: met. If it is decided to continue to use the generic care plans, then it essential that they are fully completed. This will help ensure that people using the service are protected from possible errors or mistakes occuring. All of the neccesary information needed to provide a service to a person at The Mount is available, however it is located in different areas. It was evident that records are maintained regarding any visits to hospital, the need for a person to visit a GP or any other health related appointment, that may occur during a persons stay at The Mount. The recording and administration of medication was observed to be satisfactory, with up to date and relevant policies and procedures in place. It was observed that all of the staff have received appropriate training in medication procedures. Care Homes for Adults (18-65 years) Page 17 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. There are clear procedures in place, helping to give the assurance that people using the service are protected and safeguarded from harm or abuse. Evidence: A complaints policy and procedure were in place, giving the assurance that any complaints would be appropriately dealt with. People using the service or their Representative are given a copy of the complaints procedure, when they first go to stay at The Mount. The complaints process is also verbally explained to service users and their representative. No complaints have been received since that last inspection visit. The previous inspection carried out by the Commission for Social Care Inspection (CSCI) highlighted the need for more up to date Safeguarding Adults training, with a requirement being made. This has been satisfactorily addressed, with eight of the ten staff team having recently completed the training and the remaining two people booked to attend the course in June. The comments received regarding this training were, it was done in drama form the training was really good and the people doing the drama, were excellent. It really made you think. Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: In discussion with some of the staff it was clear that they have appreciated this training, giving them further assurance that they would know exactly what to do, in the event of an alleged or suspected abuse situation. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Requested improvements have been carried out by the provider since the last inspection visit, making The Mount a comfortable, safe, clean and pleasant place to live and work in. Evidence: A full tour of the premises was carried out and it was apparent that a number of improvements have been made since the last inspection visit including, redecoration in many areas of the home, making the home more modern and much brighter. The energy saving light bulbs have been replaced with conventional bulbs, giving much more light and improving safety. There was a problem with water temperatures, this has also been satisfactorily addressed. The outside grounds continue to be very well maintained, with a large rear garden. It was stated that during the summer the garden is used a lot. The homes window frames have been replaced, as was also recommended, however there is still a need to repaint the outside of the building. This will greatly improve the overall appearance of the home, making it look much more appealing and well kept. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is regular, consistent, appropriate and relevant training being provided. This helps to give the assurance that people using the service are supported by well trained, skilled and equipped staff. Evidence: There is an established, committed and dedicated staff team working at The Mount. This was apparent in the discussions that took place with the staff during the inspection visit. There was an up to date policy and procedure in place regarding staff recruitment. Staff files were examined and they contained all of the required information needed for inspection purposes including, criminal records bureau checks (CRB) and all documentation relating to the recruitment of staff. As previously mentioned there has been an increase in the provision of safeguarding adults training. The training programme was observed and it was evident that all other training is being regularly provided. Some of the comments from members of staff regarding the training were, It was a really detailed and interesting introduction to the service training has helped me gain my LDQ, (Learning Disability Qualification) Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: which I am really proud of training is always available I really enjoyed the safeguarding adults training and the training is excellent. More staff members have obtained the national vocational qualification (NVQ) in care. This has increased from 30 to over 50 since the last inspection visit. Supervision records were observed and it was apparent that individual staff supervisions take place every six to eight weeks, with team team meetings taking place every eight weeks. One person said, I receive regular supervisions. This helps to show that the staff are regularly consulted and given support by management. 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 Mount is well managed, with good health and safety procedures in place. This gives the assurance that people using the service will be protected. Evidence: The homes manager has been in post for just over eighteen months and it was evident that many positive changes within the home have taken place in that time. She is well qualified, with many years of experience in social care and particularly in working with people who have a learning disability. The manager has applied to be the registered manager with the Care Quality Commission (CQC). Feedback received from some of the staff is that the manager has made significant and positive changes, which have improved the service. Some of the comments were, the manager is very approachable and supportive and the manager is great, always ready to help. The manager also commented on her line manager saying, The last three months have been great with the new area manager and I have a monthly supervision. I really feel as though I can move the service on much better. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: The health and safety policy and procedures were observed to be up to date, with all of the required health and safety inspection certificates being in place and up to date including, gas inspection certificate, electric, fire alarm and fire fighting equipment, portable appliance testing (PAT) and records of daily water temperatures being carried out. The previous inspection report from The Commission for Social Care Inspection (CSCI) highlighted the need for monthly Regulation 26 visit reports to be completed. This has been satisfactorily addressed, with the visits being carried out by the area manager. The previous three months reports were observed and they were found to be detailed, honest and constructive, giving assurance that the provider is committed to identifying any shortfalls in the service delivery and carrying out regular internal assessments. Care Homes for Adults (18-65 years) Page 25 of 29 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 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 The registered person shall prepare a written plan (service users plan). This is to show and inform support staff of a persons individual assessed needs. This will help ensure that a persons health and welfare needs are met. 31/05/2009 2 18 15 Care plans must be fully completed, in order to reflect a persons needs. To enable a persons assessed needs be fully known, so that care staff can provide an individuals needs. 30/06/2009 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 6 Care planning documentation needs to be reviewed, so that it is more person centered and with up to date and correct Page 27 of 29 Care Homes for Adults (18-65 years) wording and terminology. This will help promote dignity and respect. 2 12 It is recommended that peoples interests, hobbies, daily routines and activities are fully recorded in their care plans. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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!