Care Home: 8 Piggy Lane

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What the care home does well People have been supported to review their support plan/ELP. The support plans include really good information about individuals life choices and personal care routines, they explain how much support the person needs and how to provide the support. The personal and healthcare needs of individuals are also well met. We think that this home would be able to meet the needs of lots of people and would take into account their religious, racial or cultural backgrounds. People who live in the home are encouraged and supported to take part in a variety of activities that reflect their choices and assessments are completed to ensure that people are safe. There is a friendly, relaxed and welcoming atmosphere at the home and there arepositive relationships between individuals and the staff. People are provided with the information about how to complain, and how their concerns will be listened to. The home has a good level of staffing to support the needs of the people who live there. Staff are attentive and respectful, they are well managed, supervised and trained to ensure peoples needs can be met. The home continues to have a good range of policies and procedures to assist staff to do their job well. What has improved since the last inspection? The layout of one persons bedroom has been changed ensuring that their needs can be met. The grass in the back garden is now cut regularly offering a tidy and nice space for people to use. What the care home could do better: The manager must submit an application for registration with the Care Quality Commission to ensure the home meets all legal requirements. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 8 Piggy Lane 8 Piggy Lane Bicester Oxfordshire OX26 6HT 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: Nancy Gates Date: 2 2 0 5 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. 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 31 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 31 Information about the care home Name of care home: Address: 8 Piggy Lane 8 Piggy Lane Bicester Oxfordshire OX26 6HT 01869249533 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) : jacki.berry@oldt.nhs.uk Oxfordshire Learning Disability NHS Trust care home 5 Number of places (if applicable): Under 65 Over 65 5 5 0 0 learning disability physical disability Additional conditions: 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 Physical disability - PD The maximum number of service users who can be accommodated is: 5 Date of last inspection 2 3 0 5 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 31 A bit about the care home 8 Piggy Lane is a bungalow that is part of a purpose built complex situated close to local amenities in Bicester, North Oxfordshire. A housing association owns the property and the Oxfordshire Learning Disability NHS Trust / Ridgeway Partnership manages the home. The Trust is in the process of changing its name to Ridgeway Partnership NHS Trust. The home is registered for five people with learning and physical disabilities. The home employs experienced, trained staff who are led by a team leader. The home provides 24-hour support. The fees range from 1, 135 GBP to 1501.50 GBP per week. Care Homes for Adults (18-65 years) Page 5 of 31 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 31 How we did our inspection: This is what the inspector did when they were at the care home Before visiting the service we reviewed the previous inspection report, viewed information provided by the manager of the home and reviewed any information we have received about the service since the last inspection in May 2007. We visited the home on the 22nd May 2009 to complete an unannounced key inspection. We arrived at the home at 9.30 am and finished the site visit at 3.30 pm, we were at the home for 6 hours. During our visit we discussed changes made and any proposed changes to the service with the manager/team. We also talked with one person who lives in the home and with two staff members who were on duty at the time of the visit to gain their views. We looked at a number of records including care/support plans, staff records, training records, complaints and compliments and health and safety information. We also made a tour of the Page 7 of 31 Care Homes for Adults (18-65 years) premises and looked at meals and refreshments provided to people. What the care home does well People have been supported to review their support plan/ELP. The support plans include really good information about individuals life choices and personal care routines, they explain how much support the person needs and how to provide the support. The personal and healthcare needs of individuals are also well met. We think that this home would be able to meet the needs of lots of people and would take into account their religious, racial or cultural backgrounds. People who live in the home are encouraged and supported to take part in a variety of activities that reflect their choices and assessments are completed to ensure that people are safe. There is a friendly, relaxed and welcoming atmosphere at the home and there are Care Homes for Adults (18-65 years) Page 8 of 31 positive relationships between individuals and the staff. People are provided with the information about how to complain, and how their concerns will be listened to. The home has a good level of staffing to support the needs of the people who live there. Staff are attentive and respectful, they are well managed, supervised and trained to ensure peoples needs can be met. The home continues to have a good range of policies and procedures to assist staff to do their job well. What has got better from the last inspection The layout of one persons bedroom has been changed ensuring that their needs can be met. The grass in the back garden is now cut regularly offering a tidy and nice space for people to use. Care Homes for Adults (18-65 years) Page 9 of 31 What the care home could do better 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 Nancy Gates 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. Care Homes for Adults (18-65 years) Page 10 of 31 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 11 of 31 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 12 of 31 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 . Information is available to help people decide whether the home can provide a service to meet their needs, however amendments are needed. A clear assessment process that takes into account the needs of prospective house members and the needs of existing household members is completed before people move into the home. Evidence: A Statement of Purpose and Service User Guide are available to the people who live in the home but do not contain the specific details of what 8 Piggy Lane has to offer. The documents also have details of the CSCI and should be updated to include the details of the Care Quality Commission. The manager agreed to update the information to ensure the documents meet the Care Home Regulations and National Minimum Standards. One person who lives in the home benefits from the information presented within the current format, however the other people who live in the home are supported to gain an understanding of whats on offer in a one-to-one situation, ensuring people have Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: time to gain an understanding of whats available on a day to day basis. There is a vacancy at the home, with an individual currently expressing an interest to move into the home. Numerous assessments and information gathering is underway, with the individual being given opportunity to visit on a number of occasions to assess whether the service is able to meet their needs and whether the people currently living at Piggy Lane feel comfortable with the new person. The process also includes the views of people who support the individual currently to ensure the move is in the interest of all parties. The people who live in the home have license agreements with a housing provider and contracts for their support and care are held with the local authority and the Trust. Relatives or advocates are involved in the contracting process to assist individuals and ensure the rights are safeguarded. Care Homes for Adults (18-65 years) Page 14 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The needs and personal goals of people who live in the home are recorded within support plans of a high standard, although accuracy in recording in daily diaries needs to be improved. People are appropriately supported to make decisions and take risks. Evidence: We looked at the support plans of all of the people who live in home. The new manager of the home with the assistance of staff members has supported people to review their support plan and make the presentation of information unique to each person. The plans are based around the principles of Essential Lifestyle Plans (ELPs) which identifies and prioritises life choices by reflecting the individuals wishes. The support plans include excellent information about individuals life choices and personal care routines, they explain how much support the person needs and how to provide the support. How each person communicates is also included within support plans, When X says...it means...we should. Clear descriptors of response required from staff Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: are available within each plan. Specialist needs are recorded and staff are informed of identified needs and areas of training for staff can also be identified. Each plan represents the person as an individual presented creatively in a photo album style describing people in pictures, images and within written information. Each person also has a daily diary recording events within each day and at night to inform staff of the format of each persons day. We looked at the diaries of all of the people who live in the home and found that not all of the entries were signed by staff, at times the entires made were not a clear account of an event, X has been trying her luck with X this morning and everyone else this afternoon, or that there was very little detail about what an individual was engaged in or a descriptive account of the persons day. Future needs and goals are noted within reviews attended by individuals and people who they feel are important in their lives ensuring that the future goals accurately reflect the persons wishes. There remains clear descriptions of individuals abilities with regard to decision making and how to ensure people are given appropriate choices in relation to lifestyle and activities. From the evidence seen and comments received we consider that this home would be able to provide a service to meet the needs of individuals from various religious, racial or cultural backgrounds. Risk assessments remain detailed and regularly reviewed to support individuals needs and choices. Care Homes for Adults (18-65 years) Page 16 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live in the home are supported to take part in a variety of activities that reflect there individual needs and wishes. Evidence: The support plans for each person at the home provides lots of information about what people like to do and how they would like to be supported to engage in activities. Whilst we were at the home staff demonstrated a clear understanding of individual need and supported people to engage in activities described in their support plan. Many of the activities provided in-house are based on what people prefer to do in their leisure time; these included listening to music, watching TV, videos, DVDs, magazines, puzzles and games, arts and crafts, cooking, and hand and foot massage. Activities Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: outside the home include going to the shops, out for coffee, organised groups, for walks and organised trips to places people have identified they would like to visit. The local community remains very much part of the activity programme. There remains pictorial evidence of peoples outings and holidays and also of the contact people have with friends and family. Peoples rights and responsibilities continue to be respected and these are recognised in ELPs supported by the appropriate assessment of risk. We were in the home when lunch was being prepared and served. Lunch is generally a snack due to people going out during the day with the main meal eaten as a group in the evening. People are encouraged to take an active part in the selection of the daily menu, participating in shopping and preparation of meals. Regular drinks and snacks are available; a varied menu is provided, including fresh ingredients and individuals special dietary needs are catered for. Care Homes for Adults (18-65 years) Page 18 of 31 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 personal and healthcare needs of individuals are supported appropriately in accordance with assessed needs. Evidence: Personal and healthcare needs are described for all individuals within support plans. A number of plans in addition to ELPs hold clear guidance of how people wish their needs to be supported and it is apparent that a number of people are consulted when a person is unable to communicate their needs. This continues to ensure that staff can meet individual support needs in a manner in which people prefer to be supported. The records held are clear and showed us that people are supported to have regular health checks and attend healthcare appointments as necessary. Staff continue to support people to look after their medication. Individuals medicines are held securely in locked medicine cabinets located in each bedroom. The service continues to use a standard medication administration record (MAR) which is provided by a pharmacy and no errors or omissions were noted within the records held. Staff are trained and assessed to ensure they are competent to administer medication and a Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: member of staff confidently demonstrated how an individual is helped to take their medication. Care Homes for Adults (18-65 years) Page 20 of 31 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 people who live in the home are provided with the information about how to complain which enables individuals to have their views listened to and acted upon. The people live in the home are protected from abuse, neglect and self-harm through safeguarding guidance, appropriate staff training and staff awareness. Evidence: Information on how to make a complaint, which has been produced in a user-friendly format is available to the people who live in the home. No complaints have been recorded at the home since the last inspection visit. Clear policies and guidance regarding complaints, concerns and allegations are available to staff to ensure they are aware of how to respond appropriately to concerns raised by guests and their families. The Care Quality Commission has received no information in relation to complaints. One safeguarding matter has been raised at the service which was appropriately notified to the local authority and the CSCI with all necessary action taken to safeguard guests and staff. All staff complete training regarding safeguarding and protection which reflects the multi-agency codes of practice. Staff were able to describe a good understanding of Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: protection issues and how to respond to allegations. Refresher training is available to ensure knowledge remains up to date. We were assured that individuals finances are appropriately managed and monitored by external agents on a regular basis. Care Homes for Adults (18-65 years) Page 22 of 31 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 service provides a homely and safe environment for individuals that meets their assessed needs. Evidence: We looked around all areas of the home and found that people are provided with a comfortable, homely place to live. The furniture and fittings are modern and domestic in style. A sensory room offers quiet space for relaxation. With individuals permission we were shown bedrooms, which we found to be individually furnished and reflected people personalities and interests. Changes have been made to the layout of an undersized bedroom and a ceiling mounted hoist has been installed, offering the individual more room and offering staff a safer working space when assisting the individual. Specialist equipment continues to be provided to those who need it. Toilets and bathrooms continue to offer privacy and comfortable safe areas in which to bathe. One bathroom needs minor repair and decoration to the wall space behind the bath where tiles have been removed. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: Staff clearly aim to provide a clean and comfortable home for individuals. All areas of the home were seen to be clean on the day of the inspection. Care Homes for Adults (18-65 years) Page 24 of 31 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 . The home has an appropriate level of staffing to support the needs of the people who live there. Staff are attentive and respectful. The recruitment of is supported by a clear process that protects the welfare of the people who live in the home as far as possible. Training provided to staff ensures that they are competent and qualified to meet guests needs. Evidence: 8 Piggy Lane has an appropriate level of staffing to support the needs of the people who use the service. The staff supporting people when we visited the service were enthusiastic and motivated, offering respectful support to individuals. Staff described a robust recruitment and selection process conducted by the provider. It is clear that the selection of employees aims to ensure that competent and motivated people are available to support individuals at the home. We looked at four staff files held at the home. The manager confirmed that two written references are obtained before the start of employment. Criminal Record Bureau Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: checks, including POVA first are held centrally within the organisation, appointments confirmed following the receipt of acceptable references and CRB check. Each file contained a checklist of records held centrally confirming information has been received. An agreement has been established with the provider to ensure that registered services retain a checklist of information that can demonstrate that appropriate information has been received in relation to all staff. The checklist was not available within the home but held within a site office. A copy of the checklist must be held within the home to confirm relevant to recruitment information is held within the organisation. Staff spoken with were clearly knowledgeable regarding the needs of people who live in the home and described how courses provided by the organisation have supported their development and knowledge. This was confirmed by information held within staff files regarding the training that is provided and has been completed by staff members. Staff also confirmed that regular supervision is being provided to ensure staff remain supported and that any training or support needs can be identified and acted upon. Care Homes for Adults (18-65 years) Page 26 of 31 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 and staff work as team, which benefits all of the people who live in the home. The organisation has good systems in place to monitor the quality of care and to ensure that standards are being maintained. Health and safety practices safeguard the the people who live in the home. Evidence: A manager for the home has was appointed in July 2008 and has management experience, skills and knowledge relevant to supporting people in the home. The manager has worked for Ridgeway Partnership/OLDT for a number of years and has a good understanding of the needs of the people who live in the home, ensuring that the outcomes for and best interests of individuals remain the most important factor in planning and developing the service. The manager stated that an application for registration has not yet been submitted to the Commission due to not completing the Registered Manager Award. An application must be submitted to the Care Quality Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: Commission as soon as possible to meet the requirements of the Care Standards Act 2000 in relation to registration. Staff describe the manager as being supportive and knowledgeable, ensuring that the needs of individuals and staff members are met as far as possible. The manager has regular meetings with the people who live in the home and with staff to ensure continuity of support as far as possible. Regular visits to the home are completed by a representative of the organisation to look at the quality of care/support. Reports of the visits are held at the home and no issues are apparent. Policies regarding safe working practices are available and staff are required to undertake training. Health and safety is promoted; training is provided to staff in induction and all staff receive regular training updates. The manager confirmed within information provided to the CQC that records held in relation to health and safety are accurate and up to date. Risks assessments are in place for the individuals who live in the home and for safe working practices. Care Homes for Adults (18-65 years) Page 28 of 31 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 29 of 31 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 30 of 31 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 31 of 31 - 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!