Care Home: 4 West Street

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 4 West Street 4 West Street Biddulph Staffordshire ST8 6HL     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: Kathryn Marks     Date: 0 6 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: 4 West Street 4 West Street Biddulph Staffordshire ST8 6HL 01782514141 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) : Choices Housing Association Limited care home 4 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 4 The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 4 Date of last inspection Brief description of the care home 4 West Street was registered in March 2002 to accommodate four younger adults with learning disabilities. It is a large detached bungalow, which has been extended to provide suitable accommodation, including 4 single bedrooms, a spacious bathroom and a walk in shower room. Communal space includes a large lounge and a kitchen/dining room. The service also provides a separate laundry and large storeroom housing the food freezer and other household items. Externally there are good-sized gardens and a patio area, all are accessible to the Care Homes for Adults (18-65 years) Page 4 of 29 Brief description of the care home people using the service. A large garage is used for storage purposes, the drive way provides parking space. The home is located in the village of Biddulph, within a short walk from the main shopping area, local pubs, church and other facilities. 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection was carried out on Monday 6th April 2009 by one inspector who used the National Minimum Standards for Care Homes for Younger Adults, aged 18 to 65 as the basis for the inspection. On arrival for this inspection there were two staff on duty and four people using the service. The Acting Care Manager provided written information regarding staffing, staff training, menu and dietary provision that was observed to be in place at the home. On arrival at West Street, one person who uses the service was going by taxi with a Care Homes for Adults (18-65 years) Page 6 of 29 member of staff for an appointment. The National Vocational Qualification assessor was visiting the home. Arrangements for the day were discussed with us, and to avoid disruption to people using the service, the deputy came on duty to enable people to continue with their plans. We spoke to the four people using the service, sat with them chatting and having refreshments. We reviewed two peoples care records in detail with their permission. We discussed food and menus with the people living here. We also looked at the Annual Quality Assurance Assessment (AQAA) this is a self assessment tool, and had been completed and sent to us prior to the Key Inspection. Completion of the AQAA is a legal requirement and it enables the service to undertake a self-assessment, which focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to move into the home receive the information they require and they are assessed so that they can be assured the home can meet their needs. Evidence: The AQAA we received prior to the inspection told us that the home has in place a Statement of Purpose, Effective Admissions Policy, Pre admissions trial period with 6 and 12 week reviews. Social worker involvement prior to admission. Liaison with health professsionals, and full family involvement. Comprehensive assessment by RNMH manager and deputy during trial period. Full involvement of person using the service and significant others throughout the whole process of assessment. We saw that the service users guide provided clear accessible information for people in a pictorial format. People we talked to were able to explain information in the guide, a copy of which is in peoples bedrooms. The guide is currently being updated. The service carries out detailed assessments prior to admission, with people making Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: day visits, overnight stays, and all people involved in the care of the person are involved in the assessment. We saw details of assessments on peoples care records, reviews of assessments are documented. Care plans were compiled and agreed with the person using the service following the assessment, and a key worker allocated. This means that people could be assured that the home could meet their needs. We talked to people using the service who told us they liked living at the home. People had good relationships with the staff on duty. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are involved in decisions about their lives, and play an active role where able to do so in planning the care and support they need. Evidence: The AQAA we received prior to the inspection told us that All plans are developed using person centred planning principles. The service present each individuals plans in a format that is understandable to them. Plans are reveiwed to ensure their on-going relevance. People are involved in the reviewing of their care and are actively consulted regarding how the service is run. Individual plans reflect the support needs for all aspects of their life. The service continually review the deployment of staff to ensure that levels, skill base and interests remain appropriate to the needs of the person. Risk management, safeguarding adults training for all staff, each person has a named personal carer, with a qualified care co-ordinator. Peoples involvement is promoted through personal care plans and meetings. Family involvement is also active and the service have a comprehensive admissions assessment. All staff follow a model of Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: active support in care delivery with evidence of care planning and risk assessing for individual people. The service adopts a proactive approach to managing people who may display difficult behaviours. We saw that all four people have individual plans of care that they were aware of and able to discuss with us. Care plans are active and reviewed on a daily basis, the deputy told us that if something is not working it is changed. We were told that each person is consulted on their care plan and is encouraged with their family to take part in reviewing them, two people confirmed this to us. Care plans are agreed with people, depending on the comprehension of the person. The personal care plan covers Health Assessments, Medication, and Risk Assessments. The care plan identifies procedures for dealing with challenging behaviour, all staff are trained to deal with this. Each person has two key workers so generally one of them is on duty. We saw staff encouraging people to make decisions about daily routine, what they would like to eat, if they wanted to go out. Staff accompanied one person to an appointment and another person to a social event. One person talked to us about their advocate and told us how supportive they found the advocate to be. People are assisted to manage their finances, personal allowance that was checked by us balanced with records maintained. Individuals are supported to take risks, we saw risk assessments in place for people using the service. The Deputy and staff on duty had a good awareness of Health and Safety. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people using the service are given the opportunity to enjoy fulfilling lives and relationships with others. Evidence: The AQAA we received prior to the inspection told us that the service encourages all people to lead a varied and valued lifestyle based on their individual preferences, needs, wishes and choices. The AQAA tells us this is reflected in the persons individual care package which is person led rather than service led. This means facilitating choices and also respecting a persons individual preferences and tastes, reinforcing their sense of self and identity. Although there are routines, the staff team have a flexible approach, they are focused around a structured support plan but also to the changing needs and desires of the people. Individuals open their own mail. Staff always knock on doors before entering peoples rooms, staff always ring the front door Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: bell to be invited in to the home. Contact with friends and family is maintained for all people, this includes weekend and evening visiting. People are supported to develop social, emotional, communication and independent living skills. People are involved in planning their activities and are involved in their own personal care plan reviews. Spiritual support is encouraged including visits to family and friends. Nutritional assessments are carried out by the dietician and care plans are developed for those in need of additional support with their diet. We saw on arrival at the home that four people were living at West Street. We saw one person going out with a staff member by taxi for a pre-arranged appointment, this person greeted us at the front door on our arrival at the home. One person using the service works at Choices office one day a week for one hour and gets paid for this. Staff told us that this boosts the persons confidence, and that they enjoy going. The person confirmed this to us themselves. One person goes to Leek college for Drama and one goes to pottery. Both people told us that they enjoy this. All people using the service go out to various social venues on a daily basis, they regularly meet with friends and family. Peoples families visit them weekly at the home. We observed staff talking to people throughout this visit in a respectful and sensitive way. All people have keys to the front door of the home and their bedroom doors. Staff were observed waiting to be asked to enter bedrooms. We saw menu in place and discussed food with the people using the service. People told us they enjoyed their food and that they had enough to eat. We saw fresh fruit and Yoghurt freely available for snacking. People and staff talked about food and put together a menu for the week, this is subject to change if people want something else. A record of changes to the menu is kept. A healthy nutritional diet is offered with people shopping locally for produce. Mealtimes were observed to be flexible and people we talked to confirmed this. A yearly nutritional assessment is carried out by the dietician and was on care records. Care Homes for Adults (18-65 years) Page 15 of 29 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. The home meets the health and personal care needs of people using the service. Evidence: The AQAA we received prior to the inspection told us that The service ensures that clients health needs are assessed and monitored and that they have full access to any required healthcare services. The service ensures that both client and staff have a sufficent understanding of any related health needs and personal support plans. Tailor made care packages are in place. Comprehensive assessment of care needs and risk. Comprehensive staff induction. Promotion of privacy, dignity, choice and independence. Links with primary and health care teams. Prompt referrals to specialist services. Medicine training for all staff including regular bank staff. Consumer friendly information. Aids and adaptions for people where necessary. Accurate records retained for medicine administration, storage and disposal. We saw staff supporting people as necessary in a sensitive way with peoples preferences being taken into consideration. One person who has moving and handling needs was assisted in a caring way with their dignity being promoted. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: We saw peoples physical healthcare needs are met by accessing local healthcare practices, and registering with a General Practitioner. Records tell us that there is regular monitoring of peoples health, all attend Well Man or Well Woman clinics. We saw policies and procedures in place for the administration of medication, staff we spoke to were aware of and familiar with policies in place. We saw staff training records that identified staff who administer medication, have been trained to do so, and receive in house refresher training in administration. Medication is stored in a locked metal cabinet and is signed for individually as it is administered. There is a monitored dosage system in place at this service. No people using the service are currently self medicating. 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 use the service are able to make complaints and are safeguarded by the homes procedures. Evidence: The AQAA we received prior to the inspection told us that The service have a clear complaints procedure that is formatted for both clients and family members, the procedure is a regular focal point at peoples meetings. The service respond to all complaints within 28 days. The service tailor support to minimise risk of harm, and all staff are trained in recognising any signs of abuse and the correct actions to take if any abuse is suspected. We saw that the home has in place a complaints procedure. The procedure is included in the service users guide in a pictorial format, the deputy told us this is explained to people using the service. One person when asked if they know who to talk to if they are unhappy about something, told us they would talk to an advocate and gave us the advocates name. Complaints information needs to be updated to include the Care Quality Commission details for people using the service, so that they have up to date information. The deputy told us she would arrange for this to be done. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: People are protected from abuse by systems in place at the home. We were told that all allegations of abuse are acted upon immediately. We saw staff training records that told us that all staff are trained in recognising signs of abuse and the actions to take if any abuse is suspected. The staff we talked to were aware of and follow Staffordshire Social Services Safeguarding procedures. Criminal Record Bureau and Protection of Vulnerable Adults checks are carried out prior to employment of staff. Care Homes for Adults (18-65 years) Page 20 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. The design and layout of the home enables people using the service to live in a safe, well-maintained and comfortable environment, which encourages independence. Evidence: The AQAA we received prior to the inspection told us that The service provide a safe, comfortable and homely environment with a style and ambience that is welcoming, and which reflects the individual personalities of the people using the service. The home is situated in a lovely area with beautiful views and accomodates four people. The service manage the reliability and safety of equipment, and continually invest in the upkeep of the home. The service respect the privacy of all clients. We observed the home to be comfortable, safe and well maintained with views across to Mow Cop Castle. Communal areas are bright and spacious with plenty of room to move around. There are lots of homely touches to enhance the environment. Peoples bedrooms are very personalised and contain photographs, and pictures that individuals have painted themselves. One bedroom had some woodwork the person Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: had made. A new kitchen has been fitted and redecorated, people using the service were involved in the choice of colours. Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A well-trained and consistant staff team support the people using the service and keep them safe. Evidence: The AQAA we received prior to the inspection told us that The service have sufficient appropriately trained staff, and have a good reputation for retaining staff and exceed the National Minimum Standards for the number of staff holding the NVQ qualification. Staff performance reviews via appraisal with supporting development plan. Emotional needs survey used to measure emotional satisfaction of all staff at work. Personnel records held for all staff including copy of application form, 2 x references, copy of formal identification, Criminal Records Bureau reference, Protection of Vulnerable Adults check. The service have a full recruitment programme in line with equal opportunities and employment legislation. There is a 6 month induction programme with ongoing reviews and end of period assessment. Learning Disability Qualification for all new employees. NVQ 2 for all employees. General Social Care Council code of conduct and contract of employment issued to all care staff. Mandatory training to all staff including 1st aid, food hygeine, fire safety, personal safety, lone working, origins of behaviour and behaviour management, moving and handling, safeguarding adults, medication, 100 staff trained to this level by end of 6 month induction programme. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: Good practice training including sexuality, values and attitudes, what is a learning disability. We saw staff training records that identified that staff receive mandatory training with regular updates. Staff we talked to demonstrated their skills and knowledge when meeting the needs of people using the service. The home has in place an extensive recruitment policy that ensures staff who are appointed are suitable. We were told by staff that recruitment takes place four times a year, following open days that are held at Choices main office. We saw staff files that contained two references, Criminal Records Bureau and Protection of Vulnerable Adults checks. These checks are carried out prior to employment being offered. This means that people using the service are protected by the homes recruitment policy and practice. We saw training and development records where training is provided for the staff team, to ensure the staff are adequately trained to enable them to carry out their duties safely. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are safeguarded by competent management systems. Evidence: The AQAA we received prior to the inspection told us that The management continually check the quality of the service, and encourage an open culture of enquiry, set team targets and objectives. The Acting Manager is recognised as a fit person at previous Choices Home. Managers Qualifications, moving and handling trainer, Registered Managers Award, Mentorship programme completed. IOSHH certificate, A1 Assessor, First Aid trainer. All mandatory training completed. The service ensures staff are trained to minimum standard and good practice training encouraged. Regular team meetings are held. Relationships are maintained with peoples families, staff, and people using the service. We observed the home to be well run with people involved in decisions, about their daily routine and the running of the home. The people we talked to told us they were happy at West Street and did not want to leave. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: We saw records of reviews on peoples files, people told us that they had meetings with staff to discuss what they wanted to do. We were told by one person that they wanted to move to a home with more staff, an alternative placement is being sought for this person due to mobility difficulties. This indicated that the persons review had highlighted increased need and the home were acting on this. We saw safe working practices in place, records told us that appropriate checks are carried out. Health and Safety training is carried out and, there is safe storage of hazardous substances. Care Homes for Adults (18-65 years) Page 26 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 27 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 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 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!