Inspection on 31/10/08 for Woodlands

This inspection was carried out on 31st October 2008.

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

Woodlands 08/08/06

Woodlands 19/01/06

Woodlands 03/08/05

Woodlands 29/03/05

Woodlands 03/09/04

Woodlands 10/02/04

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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: Woodlands 4 Gaskells End Tokers Green Reading Berkshire RG4 9EW 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: Delia Styles Date: 3 1 1 0 2 0 0 8 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 30 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 30 Information about the care home Name of care home: Address: Woodlands 4 Gaskells End Tokers Green Reading Berkshire RG4 9EW 01189724913 01189724913 haroon@caretech-uk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Caretech Community Services Ltd care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: The maximum number of service users to be accommodated is 3. The registered person may provide the following category/ies of service only: Care home only - (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 (LD). Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 30 A bit about the care home Woodlands is a three-bedroomed detached house in a quiet cul-de-sac in a small village. It is registered to accomodate three people with a learning disability. CareTech is the provider organisation and is a national company providing accommodation with personal care to people with learning disabilities. The service provides long-term, rather than respite or emergency accommodation and Woodlands has been home to two of the three current residents for many years. The home accesses local services for both health and social activities. Care Homes for Adults (18-65 years) Page 5 of 30 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 Care Homes for Adults (18-65 years) Page 6 of 30 How we did our inspection: This is what the inspector did when they were at the care home The last inspection of Woodlands was completed in August 2006. This is what the inspector did when she was at the home. This visit lasted for just over 3 hours on a Friday afternoon in October 2008. The inspector met all 3 people who live at the home and was shown around so that she could see some of their rooms (if they said it was alright to do this). The inspector looked at some of the policies and procedures in the office. Policies are rules about how to do things. Procedures tell people how to follow the rules. The inspector talked to the person in charge and some of the support workers about how they help people to go to college and work and trips out so that they have interesting things to do. We left some surveys and questions for people to fill in and send back to us to let us know what they think about living and working at Woodlands. We would like to say thank you for helping us to find out what you think about living at Woodlands. Page 7 of 30 Care Homes for Adults (18-65 years) What the care home does well What has got better from the last inspection The people who run Woodlands come and visit more often and write about what they find when they come. This shows that they want to make sure that people living here are happy and well supported. They make sure that the staff know about the rules and what they have to do to follow them so that everyone is safe. And they check that the house is clean and repairs have been done. The last time we visited we found that some people did not have a holiday. Now everyone can have a holiday and support Care Homes for Adults (18-65 years) Page 8 of 30 to do this if they want to. The people who run Woodlands have done a lot of the things to make the house nicer for people to live in and the garden is better too. The house has had new carpets and furniture and has been painted since we last visited, so that it looks bright and cheerful and clean. The kitchen is much better now, with new cupboards and cooking equipment People have had their rooms decorated and had new curtains and pictures that they have chosen. What the care home could do better The people who run the home know that they need to do some things better and have told us how they are going to do this by making sure that support staff always know how best to support the people who live here. The home wants to have more staff who can drive, so that everyone can go out on trips whenever they want to. The people who live here need to have the way they like to be supported written down or explained in ways that they and the support workers can understand. Things about the home could be made easier to know about if there were photos, symbols or DVDs to explain them. We know that the home is already working on some of the things that could Care Homes for Adults (18-65 years) Page 9 of 30 be better and we look forward to seeing these new changes when we next visit. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Delia Styles 33 Greycoat Street London SW1P 2QF 02079792000 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 10 of 30 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 11 of 30 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 . A comprehensive assessment of the needs of a person who wants to move to the home is completed following guidelines and a procedure available at the home. Evidence: A third person came to live at the home shortly after our last inspection in August 2006. The other two residents have lived at Woodlands for a long time. The homes records showed that a full assessment had been completed before the most recent resident had come to live at Woodlands, and that the both the person who had moved in and the staff, were confident that the home would suit the individuals needs and lifestyle. The assessment information included information from various professionals who have supported this person in the past, and showed that they had been involved in the decision making about whether to move into the home. Since our last visit, CareTech has developed new information about the service it provides in the Statement of Purpose and Service Users Guide. These have been made easier for people to understand by producing them in picture formats. Further improvements are planned to make the infomration available in photo and DVD formats, and to have a shorter version of the service users guide so that people can Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: have their own copy in their room. Care Homes for Adults (18-65 years) Page 13 of 30 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 . Peoples individual preferences and aspirations about their support and personal goals are set out in care plans that reflect their choices. Staff have the information they need about how to assist people living here to achieve their goals and to manage any risks appropriately. Evidence: All three residents care records were examined. These showed that the home has acted on the recommendation made at our last inspection and has developed and improved peoples care plans through the use of pictures, photos and objects of reference that help the people living here to communicate their choices about their day to day support, menu choices and meal planning, activities and outings. One person is able to manage their own money allowances with minimal support from staff. Peoples support plans and information about them is set out in well organised and indexed files. Risk assessments are undertaken and allow people to take responsible risks - for example, when traveling alone on public transport, swimming or using kitchen equipment. Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: The home manager acknowledges that there could be further improvements to the ways in which the some of the policies and procedures, about smoking and complaints for example, could be written in a more user-friendly formats, so that they are more accessible to residents. Care Homes for Adults (18-65 years) Page 15 of 30 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 are supported to make lifestyle choices that generally recognise their individuality and since the last inspection staff are improving ways in which they engage people in activities in the home. Important relationships and contact with family members is supported and encouraged. Food in the home is of a satisfactory quality. Evidence: One service user continues to attend an NVQ course in horticulture twice a week and travels by bus to do this. Residents social diaries show that they are supported to attend a range of activities and social events outside the home as well as at home. They are also encouraged to try new experiences with staff support. The use of photos, visual symbols and pictures in individuals communication profiles Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: has improved the ways in which people who have limited speech can make known to staff their choices about what they want to do. The home has its own car and most support staff are drivers and take people out to local amenities such as swimming, bowling, pub and cafe visits and shopping. Residents had enjoyed a Halloween party on the night before the inspection. Relatives and friends are invited to any social events held in the home and are welcome to visit. Those residents with family members are encouraged to keep in contact by home visits and phone calls. Residents choose their menus with the use of picture and photo cards and are encouraged to help with the weekly food shopping. One resident enjoys cooking and had made cakes earlier in the day of the inspection. Another person enjoys preparing the vegetables for the meals. Regular drinks and snacks are available through the day. Care Homes for Adults (18-65 years) Page 17 of 30 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 people who live at Woodlands are supported to meet their personal care needs. Access to additional support from health care professionals is consistent and meets individuals health needs. Medication is stored securely and administration is accurate, ensuring the safety of the people who live at the home. Evidence: The care and support plans for all three residents were examined. These contained detailed information about peoples personal and health care support, with individual health action plans. The records show that residents are helped to access specialist health care support where needed and that staff act on any concerns about health and medication matters. Records showed that staff support people to attend routine medical and dental appointments. The arrangements made for the receipt, storage, management, and the records of peoples prescribed medicine taken in the home, are satisfactory and show that people are protected by the homes policies and procedures for dealing with medicines. Recommendations made at our last inspection have been acted upon - namely, that the home keeps information leaflets and up to date information about medicines prescribed for residents, and maintains a sample of the usual signatures and initials Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: used by all staff who are authorised to give medicines. Medicines are securely kept in a locked medicine cabinet that meets the required safety standards. Medicines are supplied in individual blister packs from a high street pharmacy. A GP reviews each persons medicines every 6 months (or more frequently if they have made changes to their prescriptions). The supplying pharmacist also visits the home to check the medicines and procedures twice a year. Staff confirmed, and training records showed, that they have received training in safe administration in medication. Care Homes for Adults (18-65 years) Page 19 of 30 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 . The home has an effective system in place for responding to, investigating and recording complaints. Systems and procedures are in place to ensure the protection of the people who live in the home. Since the last inspection staff training has been improved to ensure people living here are appropriately protected. Evidence: The homes AQAA (completed in December 2007) tells us that they had received no complaints in the preceding 18 months and this was shown to be still the case when the homes complaints record was checked during this visit. The Commission for Social Care has received no information relating to any complaints or concerns since our last inspection visit. Residents who live here have regular opportunities to talk with staff through their preferred method of communication and Talk Time to raise any concerns or worries they have. They each have a clear and accessible explanation of the complaints procedure kept in their files. One person has an advocate and another has family who could raise any concerns on their behalf. Staff training records showed that staff have training about safeguarding of adults and how to whistle blow if they have concerns about the safety and wellbeing of people living here. The home has access to information about the local safeguarding procedures and to the website at www.oxonsafeguardingadults.org.uk so they know how to report any suspected or alleged abuse appropriately. Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: Care Homes for Adults (18-65 years) Page 21 of 30 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 . Further improvements have been made to the environment since our last inspection and the home presents a comfortable and domestic environment that meets the individual needs of the people living here. Evidence: The home is a large semi-detached house providing all three people who live here with their own individual bedrooms, a large ground floor lounge, dining room and kitchen and laundry room. A tour of the home, and visit to two of the three residents room (with their permission) showed that peoples personal space is attractively decorated and that everyone is encouraged to have choices in the colours and soft furnishings for their rooms and the shared space in the home. Since our last inspection improvements have been made that have created a more homely and comfortable environment. New leather furniture has been bought for the lounge, new furniture for the dining area, and the lounge has been re-carpeted. The whole home has benefited from redecoration and the kitchen has been re-fitted, together with the utility room. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: The garden has also been improved; new fencing has made the garden more private and safer environment for residents to use. The sensory garden has been improved with new lighting. A circular pathway has been added that has made the surface safer for those who like to walk in the garden. Various animal sculptures have been placed to add visual interest. The AQAA tells us that further improvements are planned for the garden, such as a greenhouse and vegetable plot which will encourage one of the residents who is completing a course in horticulture and enjoys helping to maintain the garden. The home was clean and tidy throughout and there were no unpleasant smells. Staff have allocated cleaning tasks and these were up to date. Those residents who are able to assist with some domestic tasks. There were some minor maintenance matters that needed attention - such as a broken wardrobe door in one residents room, and missing curtain hooks. Several light bulbs were not working downstairs, including the strip light in the kitchen. Staff replaced bulbs where they could and confirmed that they would request a visit from the maintenance man to repair the damaged furniture. CareTech tell us they have implemented a system of environmental audits for all its services and a regional development plan and new budgets were agreed from November 2007 that have improved the reporting and resolution of faults and breakages. Care Homes for Adults (18-65 years) Page 23 of 30 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 . Safe recruitment practices are in place, which safeguard the people who live at the home. Staff are offered mandatory training, which ensures that the needs of people who live at Woodlands can be met by appropriately trained staff. Evidence: The manager and 5 staff completed our survey. Their answers showed that they feel that there are always or usually enough staff to meet the care and support needs of the people living here and that their induction and on-going training gives them the information and skills they need. Staff on duty during the inspection confirmed that there are regular opportunities for training and updating their skills and said that all but one of the support workers employed by the home has achieved their National Vocational Qualification (NVQ) level 2. CareTech has used an external consultant to review the training programme for staff. The new learning disability specific training is incorporated, as are values and principles of care, the Mental Capacity Act and specialist training such as non-crisis intervention and management training. Training will focus on shift leaders to ensure that these staff are prepared for management. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: A senior CSCI manager has met with CareTech managers to follow up recommendations made following our last inspection about how the company checks the references and Criminal Records Bureau (CRB) disclosures made on prospective staff (these are held at the CareTech head office). An audit of a sample of the companys recruitment records (from January to July 2008) showed that the company has a thorough system of checks in place to make sure the people they employ are suitable to work with people living in its homes. As part of the recruitment process new staff are invited to the home for informal interview with the manager and service users. The homes AQAA tells us that staff have monthly staff meetings to discuss any issues affecting the residents and how the home is run. Individual staff supervision meetings are also held so that staff can discuss their progress and any training needs they have. Many of the staff have worked at Woodlands for more than 4 years and so work well together as a team and are a consistent and familiar support to the people living here. The home very rarely uses agency staff - any staff absences are usually covered by the homes own permanent staff and the manager. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is well managed. Improvements have been made to staff training and record keeping since our last inspection. The health and safety of people living at Woodlands is well promoted and monitored. CareTech has developed new strategies to ensure that it reviews and improves aspects of the service and quality of life for the people living here. Evidence: The home manager has seven years experience in managing the home and was registered with the Commission in 2002. She is nearing completion of National Vocational Qualification Level 4 and Registered Managers Award that are nationally recognized qualifications required by CSCI for registered managers of care establishments and agencies. Therefore standard 37 is rated as standard almost met and scored 2. The registered manager has the necessary experience to run the home and also attends monthly training forums for managers held at CareTechs Head office to further extend her knowledge and to share ideas with other managers. The homes AQAA was returned to us by the date we asked for it and was completed fully so that we have a good picture of the service, their plans for improvements and Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: how these will be achieved. Residents and their families and representatives are asked for their opinions about the home through regular review meetings and, for residents, through Talk Time sessions with staff using the communication methods best suited to each individual. From our observations and conversations with the senior support worker and shift leader it was clear that the paperwork and procedures in place for the running of the home are well organised and maintained. Information and records about the routine maintenance and management of the home were readily available in labelled files in the office. An area manager for CareTech continues to visit the home and report on her findings as required under Regulation 26 (provider visits) of the Care Homes Act. Records showed that the last provider visit had taken place for August 2008 and that there are action points to be followed up to make sure that any shortfalls are promptly attended to. The home has good systems in place to make sure that all the staff are alert to, and follow the health and safety policies in the home to safeguard residents. For example staff have to complete monthly safety checks and a fire safety check at the beginning of each shift. Staff on duty confirmed that they have attended mandatory training in first aid and food hygiene and safety. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 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 Description 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 Description 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 Care Homes for Adults (18-65 years) Page 29 of 30 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 © (2008) 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 30 of 30 - 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!