Inspection on 24/02/09 for The Old School House

This inspection was carried out on 24th February 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Old School House 20/02/07

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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 Old School House 2 Norwood Road Norwood Sheffield S5 7BD     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: Valerie Hoyle     Date: 2 4 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.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 Old School House 2 Norwood Road Norwood Sheffield S5 7BD 01142564639 F/P01142564639 kj@valeoltd.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): VALEO Limited Name of registered manager (if applicable) Peter Brear Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 4. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD. Date of last inspection Brief description of the care home 2 Norwood Road provides a service for up to 4 younger adults with learning disabilities. The home offers a specialist service for young adults with Autistic Spectrum Disorder and behaviours that can challenge. The home is situated in a residential area and is close to a bus route, which goes to the town centre and main line train station. All bedrooms are single occupancy and have en-suite facilities. In addition to the bedrooms there is a communal lounge, dining room, a kitchen, laundry room, toilets, bathroom and office. The home has a good-sized private garden. The home offers high staffing levels to enable 1:1 support for access to the community, leisure and Care Homes for Adults (18-65 years) Page 4 of 28 care home 4 Over 65 0 4 Brief description of the care home educational amenities. The home also has its own transport for the benefit of service users. The current scale of charges are 1719.04GBP to 2781.54GBP. The home provides information to people who use the service and their relatives prior to admission into the home. Service Users Guides are available in all bedrooms or on request from the manager. The last published inspection report dated 20th February 2007 is available on request from the manager. In addition people are required to contribute towards transport costs but the manager informed the inspector that all activity costs are included in the contract price. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. This unannounced inspection took place over 6 hours starting at 11:00 to 17:00, this included a partial inspection of the home.Three people who use the service and three members of staff were spoken to during this visit. Three relatives were contacted by telephone to gain their views on the service. We have reviewed our practice when making requirements, to improve national consistency.Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is Care Homes for Adults (18-65 years) Page 6 of 28 considered that people who use the services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Occupancy at the home remains high with all of the four beds occupied. Care plans were looked at. Policies relating to medication, complaints, protection of vulnerable adults and handling of peoples monies were looked at. Four recruitment and training records were looked at to assess how people were protected. Procedures and risk assessments relating to health and safety were looked at and discussed with the manager. The manager, Peter Brear commenced employment with the organisation a number of years ago and was employed as the manager in July 2008. He is awaiting confirmation if his registration with CSCI. He has the required skills and competencies and holds NVQ Level 4 in management and the Registered Managers Award. He is awaiting the commencement of a NVQ Level 5 qualification and undertakes regular updates as required by the organisation. The Annual Quality Assurance Assessment was completed and returned on time which demonstrates responsiveness and cooperation. the information gained is included in the report. An AQAA is a self-assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using the service. The AQAA also provides us with statistical information about the individual service and trends and patterns in social care. The inspector would like to thank everyone who agreed to be interviewed as part of the inspection process, and the friendlyness of staff. What the care home does well: What has improved since the last inspection? What they could do better: Quality assurance systems could be improved to include annual surveys of stakeholders and people who use the service. The home should consider the use of advocacy services to ensure the best interests of people are taken into account when advising about personal monies. The frequency of supervisions could be improved to ensure staff have the opportunity to discuss their work practise and their training and development needs. Care Homes for Adults (18-65 years) Page 8 of 28 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 9 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 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. Evidence: All new people receive a comprehensive needs assessment before admission. The service was highly efficient in obtaining a summary of any assessment undertaken through care management arrangements, and insists on receiving a copy of the care plan before admission. Individuals and their families were supported and encouraged to be involved in the assessment process. Information was gathered from a range of sources including other relevant health professionals, and social care professionals. The assessment focuses on achieving positive outcomes for people and these includes ensuring that the facilities, staffing and specialist services provided by the home meet the needs of the individual. A relative was able to confirm the admissions process. She said the home had provided an excellent environment for their relative to develop as an individual including becoming more independent. She said information provided Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: before admission was excellent, pre-admission visits helped her relative settle into the home. Information provided to people who use the service had been improved using easy word and pictures. The manager said there were plans to improve the way other information is provided like menus and care plans. Care Homes for Adults (18-65 years) Page 12 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 home promotes philosophies to enable people at the home to meet their full potential, with clear care plan instructions and risk assessments to maximise their safety and protection. Evidence: The manager said new person centred plans were being developed for all people who use the service. The plans completed were well presented with comprehensive directions for staff to support people. Two care plans were looked at and they follow good practice guidelines to ensure the plans were person centred. Staff was able to describe in detail the needs of the people who live at the home. Keyworkers help people to be fully involved in developing their care plans and people said they were aware of why support plans are required. Health care plans provided clear information about how people were supported to attend medical appointments. People confirmed staff helped them to attend appointments Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: including dentist and doctors appointments and they attend reviews. Staff have helped one person to communicate his wishes and needs by developing a picture bank used to identify activities and moods. The staff also use Makaton signing to communicate with the person. Staff were observed throughout this inspection assisting people appropriately to undertake daily living tasks and make informed decisions. Risk assessments were comprehensively written including behavior reaction plans which gives clear instructions to staff where needed. Plans were regularly reviewed, and updated as peoples need changed. One person said staff were helping in the preparation to move into supported living. Staff support people to manage their finances, although most were independent in this area. One person said I go to the bank on my own and I know how to keep my money safe when I am out shopping. Care Homes for Adults (18-65 years) Page 14 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. People who use the service were able to make decisions and choices about their lifestyle and were supported by staff to develop new skills. Social, educational and recreational activities meet individual needs. Evidence: People who use the service were able to enjoy a full and stimulating lifestyle with a variety of options to choose from. Regular meetings take place to enable people to discuss activities, outings and holidays. People said they enjoyed going out to the local pub to meet friends and have a game of snooker, while others enjoy shopping in the town. One person showed the inspector their bedroom after returning from shopping. The room was personalised and the person said he liked spending time watching his large TV, listening to music and playing video games. He described himself as very independent and was looking forward to moving into supported living accommodation Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: in the near future. Staff had supported one person to find paid employment and the person said he really enjoyed going to work and socialising with his friends. All of the people who use the service had a structured weekly activity schedule and most use public transport to get to work and leisure placements. The home also has the use of a vehicle which people contribute to the running cost. One person enjoys traveling in the vehicle and this forms part of his activity programme. Staffing was organised to enable 1:1 support for individuals so that they can lead a full and active lifestyle. One person attends PTI (Progression to Independence) centre and the person said he enjoyed baking and practising literacy skills. A relative said the staff helped to set up placements and this made their son very happy. People were encouraged to make choices and decisions about holidays away from the home including holidays in caravans and hotels. Staff support people to maintain contact with family and friends which included overnight stays. One persons mother had travelled from a distance away to see her son and staff helped to arrange the visit which was successful. People were encouraged and supported to go shopping for their food. Staff spend time making shopping lists and people help to do the shopping at the local supermarket. People were encouraged to eat a healthy diet and staff support people to make their meals. All the people contribute to choosing meals on the menu and they can also have takeaways if they dont like the meal on the menu. Care Homes for Adults (18-65 years) Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy were put into practice. Evidence: People who use the service were encouraged and supported to manage their own healthcare including visits to the doctors, dentist and opticians. Health care plans were well-established providing clear written instructions about what help people may need to attend appointments. Staff members were very alert to changes in mood, behaviour and general wellbeing and fully understand how they should respond and take action. The staff have developed a good understanding of one persons health needs as he was unable to express his needs verbally. Relatives said they were confident that staff would act swiftly if they had any concerns about health or well being. People were supported with appointments with consultants, to ensure their mental health needs were met. Relatives were encouraged to attend the appointments, with the agreement of the individual. Relatives spoken to confirm this arrangement. The home has a robust procedure to ensure people receive their medication as Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: prescribed. A number of project workers had enrolled on an accredited course to administer medication, and all staff had undertaken basic training provided by Boots the chemist. A local pharmacist undertakes regular audits on the medication held at the home, and the last audit in February 2009 confirmed good outcomes for people. Medication Administration Records (MAR) and stocks were looked at and found to reflect that medication was administered safely. Comprehensive guidelines for the use of as required medication was looked at for all people that use the service. Staff said they were clear about when to administer as required medication based on risk assessments and peoples behaviour. Care Homes for Adults (18-65 years) Page 18 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. People who use the service were able to express their concerns, and have access to robust, effective procedures, and were protected from abuse, and have their rights protected. Evidence: There was a complaints procedure that was available to people who use the service and visitors. It had recently been updated to make it more user friendly. It was written in easy word and included pictures. The procedure was also referred to in the Service User Guide, including the stages to follow. This included the time scales required to respond to complaints. Complaints looked at showed that there had been one complaint recorded since the last inspection at the home. The manager said the complaint has been passed to the regional office and was still being investigated. People who use the service and their relatives said although they had not made a complaint they were aware of the procedure and who to contact. There was a comprehensive safeguarding adults and whistleblowing policy and staff follow the procedures to those standards. The manager would investigate fully any allegations of abuse if any situations came to light. The AQAA confirmed that there had been no safeguarding referrals since the last inspection of the service. People said they felt safe at the home and would tell there keyworker if they were worried about anything. Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: The induction and foundation training covers all aspects of safeguarding and the manager was able to confirm the date when all staff were to attend refresher training. Care Homes for Adults (18-65 years) Page 20 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 physical design and layout of the home enables people to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: A partial tour of the home was undertaken and all areas were clean, safe and fresh. Procedures and equipment for ensuring appropriate infection control was evident throughout the home. The home was decorated to a good standard throughout and people told the inspector that they liked the home especially their bedrooms which were decorated to their own tastes. All bedrooms were single occupancy and had ensuite facilities. Information taken from the AQAA and a sample of maintenance records seen during the inspection showed that the homes equipment and facilities were maintained appropriately. 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. Staff at the home were trained, skilled and sufficient in numbers to support people who use the service, in line with their terms and conditions, and supports the smooth running of the home. Evidence: Staffing ratios were high usually one:one to ensure people living at the home can be independent. Staff training plans confirmed there was sufficient numbers of staff and they had the right skills to meet the complex needs of people. The atmosphere created by everyone involved at the home, makes it a homely place for people to live. Staff are commended for their commitment to providing a good service. The manager said that although there had been some changes to the staff group, a number of staff had worked at the home for a good length of time. Staff said they enjoyed working at the home and feel supported by their managers. There was a robust induction and probationary package which was service specific including deescalation training and training in Autism. Staff induction programmes were looked at and discussed with the manager and he said staff also attend a two week induction programme provided by the organisation. The manager only confirms permanent employment when satisfied that the person has made the required progress against Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: their high standards. Information received in the AQAA confirm that nine of the thirteen staff employed at the home held NVQ Level 2 or above, while other staff were working towards a NVQ award in care. There were robust recruitment and selection procedures that ensure people were safe and protected. A number of staff recruitment files were looked at and there was evidence that all the required employment checks had been undertaken prior to commencing work at the home. Evidence confirmed that all staff had a Criminal Records Bureau check and the manager said CRB checks were renewed after two years to ensure information was updated. Supervision records show that the frequency needs to be improved and yearly appraisals have not been undertaken. It is important that staff have the opportunity to discuss their personal development. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service were protected by sound management practices, and they said they enjoyed living at the home. Evidence: The manager has undertaken the Registered Managers Award and has several years experience of working with this client group. He was currently awaiting confirmation of his registration with CSCI and he undertakes periodic service specific training to update his skills and competencies. He is working towards NVQ level five which demonstrates his commitment to training. Observation on the day, records looked at and discussion with staff evidenced that the manager delivers an effective people led service. He presented as a motivated, enthusiastic person who wants to improve the service for people who live at the home. The ethos of the home promotes team-working and all staff were involved in making decisions about the way they want to support people to be as independent as possible. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: The area manager visits the home at regular intervals and undertakes quality audits on behalf of the organisation. She produces a report and the manager has responsibilty to take action to improve areas identified within the report. There appeared to be no formal methods of seeking the views of people and other stakeholders. The manager said they would re-introduce quality assurance surveys in the near future. Regular residents meetings take place and people said they were comfortable talking to the manager or their keyworker if they had a problem. Managing risk was given a high priority within the service. Records looked at confirmed individual and environmental risk assessments were detailed and regularly reviewed. Records looked at on the day of the inspection confirmed that the home was maintained to a good standard in terms of health and safety. 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 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 7 36 Advocacy services should be considered to ensure the best interests of people are explored. The frequency of supervisions could be improved to ensure staff have the opportunity to discuss their personal development. Quality assurance surveys should be undertaken to enable stakeholders and people who use the service to formally give their views on the service. The data should be collated and the results should be shared with people who use the service. 3 39 Care Homes for Adults (18-65 years) Page 27 of 28 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 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!