Inspection on 24/03/09 for Turning Point House

This inspection was carried out on 24th March 2009.

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

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

Other inspections for this house

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Turning Point House 95 Blake Avenue Barking Essex IG11 9SB     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: Harina Morzeria     Date: 2 4 0 3 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 27 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 27 Information about the care home Name of care home: Address: Turning Point House 95 Blake Avenue Barking Essex IG11 9SB 02082150840 02082150840 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Florence Ojuolape Bello care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 3 The Registered Person may provide the following categories 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: Mental Disorder, excluding Learning Disability or Dementia - Code MD Date of last inspection Brief description of the care home Turning point house is a privately run care home registered to accommodate three adults, with mental health problems who are subject to the care programme approach (CPA). Turning point house is an ordinary terraced property in keeping with neighbouring properties, and is situated in the London Borough of Barking and Dagenham. There are three single bedrooms with shared toilet and bathroom facilities. There is also a lounge and kitchen leading to a small garden outside. It is situated Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 3 Brief description of the care home within easy access to the town centre and local shops. Community facilities are available in the town centre. The home is staffed on a 24-hour basis, and is not registered to provide nursing care. Physical health needs are met by the local GP, with input by specialist professionals such as the local Community Mental Health team (CMHT) and CPN service. The registered person provides a Statement of Purpose that sets out the objectives and philosophy of the service. A Service Users Guide is also available which provides information about the home and the service they expect to deliver. All service users are given a copy of the guide. The fees charged are available upon request from the manager. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place on 24th March 2009. The inspection included a site visit to the home as well as a discussion with the manager and a service user. Information for the inspection was also gathered from the Annual Quality Assurance Assessment ( AQAA ) completed by the manager. A number of records and the staff files were also checked. Care Homes for Adults (18-65 years) Page 6 of 27 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 7 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 27 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. 1,2,3,4 Admissions are not made to the home until a full assessment is made of the persons needs and new residents are given good information about the service. Evidence: The statement of purpose gives a full description of the service. The Service User Guide includes the fees charged and what they cover/exclude. New service users would be given this information upon placement at the home. When requested the service can provide a copy of the Statement of Purpose and Service User Guide in a format which will meet the capacity of the resident. This home is a newly registered service but was dormant since registration. One referral was made in the recent past and the manager carried out a full needs assessment as well as gathering essential information from a care management assessment prior to accepting the resident to stay at the home on an introductory/trial basis. On the day of the inspection, only the one resident was present, who is currently on a trial five day overnight stay at the home . Evidence was seen that he has had previous day visits to the home as well as short overnight stays. The resident is funded by the health authority and the case file Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: contained comprehensive assessments by the community mental health team. The manager of the home also carried out her own assessments of the resident to ensure that the home could meet their needs. Care Homes for Adults (18-65 years) Page 10 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service experience a good outcomes in this area. This judgment has been made using the available evidence including looking at service user care plans and risk assessments. The service involves individuals in the planning of their care, which influences their lifestyle and quality of life. The home ensures that service users are consulted on a regular basis regarding their views about the service they receive, which enables their involvement in the development and review of the service. Evidence: As stated previously this is a newly registered service which was dormant since the registration. On the day of inspection, one resident was present who is currently placed on a trial basis and doing introductory visits. Hence a preliminary care plan was in place. This confirmed that a thorough needs assessment was carried out by the manager. Information was gathered from the multidisciplinary teams working with the service user at the hospital as well as the care co-ordinator. The care plan gave Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: detailed actions to guide staff about the care and support to be provided and it includes relapse indicators so that staff can take appropriate action should the service user display any of the signs and symptoms identified. The care plan was person centred and was linked to and reflected the assessed needs of the individual. They identify goals that need to be acheived for example, encourage and develop independent living skills, consider job opportunities and training. The manager stated that the care plan is a working document and will be reviewed regularly involving the service user. The service user was present at the time of inspection and confirmed that he is consulted about daily living and was keen to move into the home. Each care plan includes a comprehensive risk assessment, which will be reviewed regularly. The management of risk is positive in addressing safety issues while aiming for improved outcomes for people. Where there are limitations, the decisions have been made with the agreement of the person and are accurately recorded, for example, for the current service user risk assessments are in place regarding non-compliance with the medication, and risk of violence due to substance abuse and identifies how staff should respond. The residents are responsible for cleaning their own rooms and doing the laundry with the support of staff. Care Homes for Adults (18-65 years) Page 12 of 27 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 this service experience good outcomes in this area. This judgment has been made using the available evidence speaking to service users and examining their records. People who use this service are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. They are also encouraged to maintain social communication and to develop independent living skills. The service users like the food and the meals are well-balanced. Evidence: The service has a strong commitment to enable service users to develop and maintain their skills, including social, emotional, communication and independent living skills. Individuals are supported to identify their goals and work to achieve them. Evidence was seen that extensive information is sought regarding the lifestyle of choices of the individual. The service user wants to do HGV driving and the manager has contacted Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: HGV training schools to seek information and explore how to obtain funding for the service user to enable him to pursue this goal. The service user is enrolled to do a literacy course at a local education centre and is supported by the manager to complete his homework. The service user receives weekly psychological sessions at the hospital which will continue and will be supported by the community mental health team with regular one-to-one sessions to be held in the home. People who use the service have the opportunity to develop and maintain important personal and family relationships. This promotes peoples emotional well-being. The staff practice promotes individual rights and choice but also consider the protection of individuals in supporting them to make informed choices. The service respects the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. The service users are involved in the domestic routines of the home. They take responsibility for their own room, menu planning and cooking meals, making sure that they are able to enjoy the food they prefer and like. This is in accordance with the stated aim of the home, which is to promote the service users independence. On the day of the inspection the service user was making his own lunch stating he enjoys this and also cleared up afterwards. The kitchen was clean and tidy. There were colour-coded chopping boards to prevent cross contamination during the preparation of food. This protects the health and well-being of the people living in the home and the staff who work there. Care Homes for Adults (18-65 years) Page 14 of 27 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. People use this service experience good outcomes in this area. This judgment has been made using the available evidence including looking at health records and medication in the home. Personal health care needs, including specialist mental health, are clearly recorded in each persons care plan and appropriate support is provided to promote service users well-being. People are protected by the homes policies and procedures in relation to the homes administration and recording of medication. Evidence: The person present at the home on the day of the inspection does not require support in their personal care, but reference is made in their care plan about the need for staff to remind and encourage/be attentive to personal care issues. The current service user was placed for introductory stay and therefore there was no record of health care appointments. However procedures are in place to record peoples health care appointments and support to be received from the community mental health team and Community psychiatric nurses. Medication was appropriately stored and the medication administration records for the person living in the home was inspected. The records were found to be in order. Clear Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: instructions were available for staff to ensure that the service user complies with the medication administration process. This promotes the good health of the people living in the home. No one in the home was receiving controlled drugs, however the manager is required to obtain a controlled drugs cupboard for safe storage of controlled medicines should these be required to be stored. A recommendation has been made to ensure compliance. Care Homes for Adults (18-65 years) Page 16 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service experience adequate outcomes in this area. This judgment has been made using available evidence including looking at records and speaking to the service user. People living in the home can be confident that their views are listened to and acted upon. People are not protected by clear safeguarding adults policies and procedures and staff have not completed safeguarding adults are training. Evidence: The service has a complaints procedure, however this was not up to date as it did not contain timescales within which the complaints will be resolved. However, at the time of completing this report, the manager had amended the complaints procedure which is now fully compliant with the National Minimum Standards and Regulations. The manager is aware that the procedure should be available in alternative formats if required. The service user present was aware of how to make a complaint and the manager is aware of the importance of listening to and acting on peoples concerns. There are insufficient policies and procedures for safeguarding people who use the service. The manager and staff have not completed safeguarding training which has implications for inconsistent knowledge and practice within the service. Two requirements have been made for the manager to develop adequate policies and procedures for safeguarding adults which give clear specific guidance to those using them. A second requirement has been made to ensure that the manager and staff Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: complete safeguarding adults training so that they know when incidents need external input and who to refer the incident to. Care Homes for Adults (18-65 years) Page 18 of 27 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. People who use the service received a good outcome in this area. This judgment has been made using available evidence including a visit to this service. The home is decorated to a good standard. People benefit from a home that meets their personal needs, style and taste. Evidence: Turning point house is a small three bedded home which provides a physical environment that is appropriate to the specific needs of the people who live there. Service users are encouraged to personalise their bedrooms. All the homes fixtures and fittings meet the needs of individuals and can be changed if they need to change. The environment promotes the privacy, dignity and autonomy of the service users. The shared areas provide a choice of communal space and service users can meet their relatives and friends in private. There are sufficient bathrooms and toilets to meet the needs of the people who use the service. The home as well lit, clean and tidy. Care Homes for Adults (18-65 years) Page 19 of 27 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. People who use this service receive adequate outcomes in this area. This judgement has been made using available evidence. The recruitemnt procedure is not sufficietly followed to ensure that service users are safeguarded and their interests protected. Staff do not receive relevant training that is focused on delivering person centred care to people using the service. Evidence: This home has recently started operating and at the present time there is only one service user being introduced into the home. Hence, at the time of inspection only the manager was present with one other person arriving for work in the afternoon. A job description is in place so that staff are clear regarding their role and what is expected of them. The person using the service was happy with the support provided to him by the people working at the home. The two people (the manager and another staff member) present at the time of inspection are suitably qualified and experienced in Mental health work to meet the needs of service users. However, it was not clear that prospective staff, whose files were checked, had the qualifications and training in mental health issues to work effectively with the service user group in order to meet their needs. The service does recognise the importance of training and the manager is aware that there needs to be a robust and relevant training programme (particularly Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: in mental health), in place to enable staff to work in a person centred way, so that they can deliver care and support to the people using the service. A requirement has been made. The files of two people/staff were examined. One person has been appointed to work at night. One other person has been interviewed but not appointed. Although the service has a recruitment procedure this was not followed in practice as there was no evidence to show an up to date CRB check or POVA first check on the files checked. References were not clear in one staff file. Hence, the recruitment procedure does not meet statutory requirements. A requirement has been made. Care Homes for Adults (18-65 years) Page 21 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who used the service experience adequate outcomes in this area. This judgment has been made using available evidence including a visit to the service. The registered manager has the required qualifications to run the home in the best interests of the service users and must ensure that service users rights and best interests are safeguarded by thorough implementation of the homes policies and procedures. Evidence: The manager is a Registered Mental Health nurse and has worked in various mental health settings in hospitals and the community for eight years. She therefore, has the necessary qualification and experience to operate the service. The manager has started training for the Registered Manager Award and NVQ level 4 in management studies. She is aware of the need to keep up to date with practice and continuously develop her management skills. The manager needs to ensure that staff receive sufficient and relevant training so that there are competent and knowledgeable to meet the specific mental health needs of the service users living at the home. Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: The home has a Statement of Purpose that sets out the aims and objectives of the service. The manager is improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home. More work is needed in this area once the home becomes fully operational. The manager completed all sections of the AQAA, which gave limited detail about the areas where they still need to improve. This will become evident once the home becomes fully operational. The manager is aware of the need to promote safeguarding and must develop an appropriate safeguarding policy and procedure and ensure that staff are sufficiently trained in safeguarding issues to protect and safeguard the service users living in the home. A thorough recruitment procedure must be followed when employing staff so that service users are protected and safeguarded at all times. Appropriate health and safety policy and procedures are in place that generally meet health and safety requirements and legislation. The manager to ensure that all staff working in the home are aware of these and receive training in order to promote and protect the health, safety and welfare of service users. The manager is aware that an effective quality assurance and quality monitoring system based on seeking the views of service users is in place to measure success in achieving the aims, objectives and Statement of Purpose of the home. All records required to be kept by the home, must be clearly completed and kept up to date at all times to meet with legislation requirements. Care Homes for Adults (18-65 years) Page 23 of 27 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 24 of 27 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 23 13 The registered manager 23/05/2009 must develop a robust policy and procedure for safeguarding adults and whistleblowing To ensure service users are protected from abuse and neglect and self harm. 2 23 13 The registered manager must ensure that all staff receive full safeguarding adults training. To ensure that service users feel safe and are protected from abuse through awareness of staff knowledge and training in this subject. 23/05/2009 3 34 19 The registered person must 27/06/2009 ensure that a thorough recruitment procedure which meet statutory requirements, is operated at all times. Care Homes for Adults (18-65 years) Page 25 of 27 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 To ensure service users are supported and protected by the homes recruitment policy and practices. 4 35 18 The registered person must ensure that suitably trained, qualified, competent and experienced people are working in the care home at all times. Service users individual and joint needs are met by appropriately trained staff, especially in mental health issues. 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 27/06/2009 1 20 The registered person to purchase a controlled drugs cabinet, in order to safely store controlled drugs, which complies with current regulations and guidance issued by the Royal Pharmaceutical Society of Great Britain. Care Homes for Adults (18-65 years) Page 26 of 27 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 27 of 27 - 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!