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Inspection on 21/01/09 for Winthorpe Residential Home

Also see our care home review for Winthorpe Residential Home for more information

This inspection was carried out on 21st January 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

We saw all staff at Winthorpe being friendly to people who live there and treated them with respect. People are supported to maintain relationships with family and friends. The menu is varied, and people living at Winthorpe say they like it and get good variety. Winthorpe is clean and tidy, and standards of hygiene are maintained. Members of staff have received training in different areas of care practice to help them improve their skills.

What has improved since the last inspection?

There was evidence of more activities for individual residents. Health and safety systems have been strengthened to protect residents. Rotered staffing hours have been reduced so as to prevent fatigue. Staff training has been extended to increase staff skills in essential areas of work.

What the care home could do better:

Care plans need to contain detail as to all the individual needs of residents so that staff can always effectively help them. Reference should be made to professional agencies if a residents behavior is challenging. Activities need to be in place and tailored to residents individual preferences. The refurbishment of the premises needs to continue. The Provider must ensure that staff do not commence employment prior to the receipt of two written references to ensure residents are protected from unsuitable staff. Residents health and safety is always protected, e.g. from substances that might harm them.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Winthorpe Residential Home 84 Westcotes Drive Leicester LE3 0QS     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: Keith Charlton     Date: 2 1 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Winthorpe Residential Home 84 Westcotes Drive Leicester LE3 0QS 01162332107 01162339170 winthorperch@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Patricia Smith Name of registered manager (if applicable) Mrs Patricia Smith Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: That the home is able to admit the person of category LD(E) named in variation application number V10279 Date of last inspection Brief description of the care home The last key inspection of this service was on 21/7/2008. Winthorpe Residential Home is registered to provide care to up to seventeen adults with learning disabilities. The home is a three-story Victorian house situated close to the centre of Leicester. Residents are accommodated in one single and eight shared rooms. In addition to their rooms, residents have access to two lounge / dining rooms and a kitchen. There is a garden to the side of the property. Fees typically range from 344 to 648 pounds per week - this information was provided on the day after the inspection. There are costs for extras - hairdressing, toiletries, holidays, transport etc. The Deputy Manager has stated that residents and representatives can be provided with the homes Statement of Purpose, describing the homes services, and reference to the last Inspection Report, upon request. Care Homes for Adults (18-65 years) Page 4 of 29 care home 17 Over 65 0 17 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: This key inspection included a visit to the service. We (the CSCI) visited Winthorpe Home on the 21st January 2009. The Registered Provider, Manager (the current Deputy Manager), and staff in the home helped us during the visit. The main method of inspection we used was case tracking. This means looking at the care given to people in different ways. We did this by, - talking to the people who live in the home, - talking to staff and management, Care Homes for Adults (18-65 years) Page 6 of 29 - watching how people are given support, - looking at records. We also looked at the Annual Quality Assurance Assessment (AQAA). This is a document the provider (the person who owns the service) sends to us at the CSCI, and it tells us what the provider thinks about the service they deliver to people who live at Winthorpe. As well as this, we looked at information that had come to our attention since the last key inspection in July 2008. We spoke with five people who live at Winthorpe during our visit. People told us that staff were friendly and helpful. One person said staff are more like our friends. None of the people spoken with had any complaints about the attitude of staff. We spoke with two members of staff during our visit to the home who told us about working in the home and gave us their views. They all positive about working at Winthorpe and wanted to provide excellent care to people living there. Their comments were, We have had lots of training recently. Everyone knows the residents very well because we are a small home and they have lived here a long time and we all get on. We checked all the standards that the Commission for Social Care Inspection has decided are key standards during this inspection. The information below is based only on what we checked in this inspection. We have kept details about individual people out of the report to make sure we respected their confidences. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Care Homes for Adults (18-65 years) Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Winthorpe will have had their needs properly assessed before moving into the home. Evidence: We could not case track a person living in the home who had recently moved in as all residents have lived there for over ten years. We checked that prospective residents can receive information to help them with the choice of home. It would be easier for people to understand this if it was done in a user friendly, easy read format, like the excellent Quality Assurance format which is composed of a series of photos. The AQAA states that the prospective resident can have a number of short stays so they can gradually get to know what the home is like for them and get used to the idea of living there. We also checked that the person living at the home had their needs properly assessed prior to moving in, to ensure that the staff at the home could meet their needs. Care Homes for Adults (18-65 years) Page 11 of 29 Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The individual needs and choices of each person living at Winthorpe are not fully documented so as to be able to be completely acted upon by staff supporting the people who live there. Evidence: We looked at the care records of people living at Winthorpe. We found detail to support the care given to people who live at the homes. Plans set out residents needs from medical and social needs and included mental health conditions of residents, and supplied detail to staff as to how to approach any challenging behavior they may meet. We saw that plans included important issues such as the low weight of a resident and what was being done to tackle this. There was little detail as to the residents life history and their daily living preferences. The Deputy Manager said that plans are to be redone in a person centered way so as to include this relevant information and to give the resident and staff a more detailed Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: picture of individual needs and characteristics. A staff member said that she had not read all care plans. Staff can then not be certain of being aware of all residents care needs. We saw that care plans records were routinely reviewed to ensure they reflected the changing care needs of people living in the homes. During our visit we observed staff being very friendly to residents. There was some evidence that residents are able to live their own lives, e.g. going out to places in the community on their own if they are safe to do so, choice of meal etc and evidence that residents are consulted through regular Residents Meetings as to the running of the home, though this was sometimes limited, e.g. no reference to what communal activities residents would like to do, or a representative of the residents being able to contribute to staff meetings and staff recruitment, though the Deputy Manager said there are plans to include residents comments in future staff recruitment. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people living at Winthorpe have opportunities to have a lifestyle they enjoy.This needs to be extended to all. Evidence: Residents spoken to said they were content to go out or stay in their home, some doing housework or following activities such as painting or knitting, others watching the TV. I like washing up and doing the laundry. Its better than going to a day centre where I used to get bored, one resident said. There were some comments that it would be nice if staff had the time to sit down and chat to them every day. We looked at the life plans of people who live at Winthorpe. These showed us a varied social life was being experienced. People go to the day centre, go out to activities in the community (shopping, walking a dog etc) or choose Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: to stay at home. One person said she worked in a charity shop, which she enjoyed. Residents said they looked forward to a holiday on the East Coast every year. We observed residents undertaking activities though two residents just sat watching the TV, with staff contact at times. The Deputy Manager said that care plans were being reviewed so that people would be asked what they would like to do so that activities would be tailored to the individual. We saw that staff are sensitive to the needs of people living at the homes. They were aware of the preferences of people in terms of where they prefer to sit, and when they like to have company or be alone. We saw staff talk to and interact well with people who live at the home. We saw lunch being served and people living at the home having a healthy meal of pilchards or beans on toast/crumpet, with fresh tomato. The staff member serving said there was no dessert. The Deputy Manager said that a dessert should have been supplied as this was normal practice and she would follow this up. Food records showed a varied diet. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Winthorpe receive generally good support in meeting their personal and healthcare needs. Evidence: Residents said that they were well looked after by staff. If we are sick then staff will get the doctor, one resident said. Staff were seen to assist a resident with a swollen ankle to put her feet up on a cushion as per medical advice. We looked at the personal and healthcare records of people who live at Winthorpe. We saw that they have generally good access to healthcare services to meet their personal and healthcare needs. We saw that an incident had happened with regard to the behavior of one resident and there was evidence that this had been referred to the Social Worker, but this had not been reported to us under the legal procedure or the home taking up the offer of other professional support to discuss a way of handling this behavior. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: We looked at medication management and found that a staff member administered medication appropriately to people. We also looked at how medication is stored and this was stored safely. Staff informed us that they have undertaken training in the administration of medication and this was recorded on the staff training plan. A policy and procedure on homely medicines is not yet in place to ensure there are no ill health effects (contra indications etc) for residents. The Deputy Manager indicated this is being progressed with her Advisor. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Winthorpe can be confident that their concerns are listened to and acted upon, and they are protected from abuse. Evidence: Some residents told us they never had cause to complain. Why would I complain? There is nothing to complain about, one resident said. There have been no formal complaints. The complaints procedure is in place but not in easy read format, so it would be difficult for some residents to understand it. The procedure in the Statement of Purpose does not give the complainant the choice to go directly to the Lead Agency if they wish, instead of the home. We saw very good interaction between people who live in the home, and staff who support them. Staff have a good understanding of safeguarding policies and procedures. Staff know what to do if they suspect that a person who lives in the home is being abused in any way. 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. People living at Winthorpe live in a generally homely, comfortable environment. Evidence: Residents said that they liked their bedrooms. I like my bedroom now. I was able to move and I like this bedroom better. I go there when I want, one resident said. We looked at the communal areas of the homes and the bedrooms of people who live there. We found the communal areas to be satisfactorily decorated and homely. Most of the bedrooms have been newly decorated to reflect the personalities and preferences of the people using them. The decor of three of bedrooms is to be completed. The home was found to be warm and cosy on a cold day. One bedroom had a slight odour, and had incontinence supplies on view, which did not look homely. Two bathrooms had baths with enamel coming off, which did not look attractive.The Deputy Manager said that this would be followed up. There has been new attractive furniture installed in bedrooms. Some furniture still looks dated, e.g. easy chairs in some bedrooms.The Deputy Manager said that new easy chairs would be bought to replace the dated, worn ones. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: The AQAA told us about the maintenance and renewal programme for furniture and fittings in the home. It said that there have been new carpets installed and that the refurbishment of the home is continuing. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home have satisfactory staffing levels and support from a motivated staff team, though all staff checks and training needs to be in place to fully support residents welfare. Evidence: Residents said that staff provided good care. Staff are friendly. They are more like our friends, one resident said. There were comments that staff duties need to be looked at so that staff can spend more time with residents. The staff rota indicated that when residents were in the home, there were a minimum of two staff on duty with three staff often on duty when all residents are in the home, and a sleeping staff member at night with on call management as needed. The hours of the Registered Proprietor have now decreased on the rota as excessive hours has been worked in the past, though if extra hours not on the rota are worked then this needs to be kept in check if this produces fatigue and decreased job performance, that stops the Registered Provider from providing a good service to residents. The Manager said that staff are currently being recruited and there was Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: evidence of this. This will help to decrease the hours of existing staff and provide better continuity of care if Agency staff are not continually used. We talked to staff and saw them supporting people who live in the home. We saw good interaction between staff and people who live in the home, and staff demonstrated a good understanding of the needs of people living there. We looked at a sample of staff records, and saw that necessary checks were made to safeguard people who live at the home. Staff staff said they were well supported to do their job and there was evidence of on going training relating to the job they do. The Deputy Manager has ordered training DVDs that staff said were very useful in adding to their care skills though there was no evidence that there had been training on a number of residents conditions, e.g. incontinence, hearing impairment, mental health conditions etc. We were told by the Deputy Manager that one staff is to enrol on the NVQ 2 course and new staff would also be asked to enrol on this course. We looked at training records and this did not clearly confirm that staff have undertaken all relevant training to help them in their roles. Training included health and safety, medication management, first aid, health and safety etc though it was hard to see that all staff had relevant training. A staff training matrix would indicate which staff need training in what issue. The Deputy Manager said this would be drawn up. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and safety systems need to be improved to fully protect residents welfare. Evidence: The previous Registered Manager/Owner has moved to a different role in the home. There is a new Manager for the home, the current Deputy Manager, who said an application to become the registered manager is to be sent to the CSCI in the near future. There are quality assurance and monitoring systems in place, and we saw the last audit undertaken, which are in an excellent user friendly format - photographs which make it easier for residents to participate in this process.We recommended that an advocate, rather than staff, help residents to complete this so that there is independeance in this process. The AQAA informed us of the policies and procedures the service works to, to ensure good health and safety practice in the home. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: The temperatures of water in a bath on the ground floor was measured at 37c, which protects residents from scalding, though this may be too tepid for residents comfort. Risk assessments are still needed regarding window restrictors and communal radiators to ensure residents are safe. The Deputy Manager said this would be followed up. Fire risks were seen to be covered by regular testing and a fire risk assessment in place, including fire doors being kept shut. Two potentially risky products were seen by us in a ground floor laundry room, with open access for residents. The Deputy Manager removed these and said she would carry out a risk assessment to assess the risk to residents safety. 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 42 12 Risk assessments need to be 28/03/2009 carried out for all identified risks, e.g. COSHH products, communal radiators and window restrictors. To protect the health and safety of residents. 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 plans need to cover all aspects of residents individual needs and staff should be aware of the plans so as to meet all identified needs. Residents should be able to contribute to all aspects of the running of the home. The provision of activities for individual residents needs to be developed to meet their individual needs and for staff time to be allocated to encourage and assist some residents. If residents behavior presents challenges it is recommended that professional agencies advice is sought to seek solutions and to protect other residents and staff. 2 3 7 12 4 19 Care Homes for Adults (18-65 years) Page 27 of 29 5 22 The complaints procedure in the Statement of Purpose should be changed to give complainants the opportunity to go directly to the Lead Agency. The refurbishment programme of completing bedroom decor and replacing furniture and carpets needs to continue. Bedrooms should always be kept in a homely way, e.g. by storing incontinence supplies away. A Training Matrix needs to be set up to indicate what issues staff need training in. An application should be made to us for the post of Registered Manager as the current Provider/Manager does not currently carry out these duties. 6 24 7 8 32 37 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!