Care Home: 86 London Road

Similar services:

• Coopers Mill Ltd
• Bramley Avenue (73)
• Paradise Lodge
• Grangewood
• Upaya Ananda
• Newton Court (1-2)
• Kings Lane (32)
• Pemdale

What the care home does well People were able to choose to live here and had their needs checked before moving in.People are helped to choose what they want to eat.People are helped to go out to day centres, shops and pubs.People`s complaints are listened to and acted upon.The home is clean and tidy.People are looked after by the same staff that treats them well. What has improved since the last inspection? The home`s information paperwork now contains full details of fees and charges.AGENCY STAFFThe agency staff is now mainly regular agency staff, so people see the same faces.There is now enough staff to meet the needs of the people living in the home.THE BOSS The provider does regular monthly inspections to make sure the home is run well.Some of the carpets and furniture have been replaced. What the care home could do better: LIST OF STAFF NAMES The home should have an up to date list of names and signatures of the people that give out the medication.The provider should make sure that they tell the Care Quality Commission of any changes that are made to the management of the home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 86 London Road 86 London Road Wickford Essex SS12 0AR 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: Pauline Marshall Date: 3 0 0 6 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 34 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 34 Information about the care home Name of care home: Address: 86 London Road 86 London Road Wickford Essex SS12 0AR 01268562660 01268562660 paul.saunders@estuary.co.uk 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) : Estuary Housing Association Ltd care home 4 Number of places (if applicable): Under 65 Over 65 4 0 learning disability Additional conditions: Date of last inspection 0 3 0 7 2 0 0 7 A bit about the care home Care Homes for Adults (18-65 years) Page 4 of 34 86 London Road provides a home for four people with learning disabilities. It is a large detached house that has four bedrooms, one bathroom, one shower room, two lounges, a kitchen, a utility room and a nice garden. The home is close to Wickford town centre and the shops and it has its own people carrier so people can easily go out. Everybody who lives at the home has their own bedroom. Nobody has to share a room. Care Homes for Adults (18-65 years) Page 5 of 34 It costs £1551.76 per week to stay at 86 London Road and people pay a contribution towards this. You will have to pay extra for some things like the hairdresser, magazines, chiropody toiletries, outings and transport. Care Homes for Adults (18-65 years) Page 6 of 34 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 7 of 34 How we did our inspection: This is what the inspector did when they were at the care home We visited the home and looked at some of the files. These included some of the staff files and some of the files belonging to the people that live in the home. We also looked at the policies that explain how the home does things. We looked around the home and spoke to the staff. We read the information (AQAA) sent to us by the manager. Care Homes for Adults (18-65 years) Page 8 of 34 We sent surveys to people living at 86 London Road, their relatives and to the staff to see what they think about the home. What the care home does well People were able to choose to live here and had their needs checked before moving in. People are helped to choose what they want to eat. Care Homes for Adults (18-65 years) Page 9 of 34 People are helped to go out to day centres, shops and pubs. People’s complaints are listened to and acted upon. The home is clean and tidy. People are looked after by the same staff that treats them well. Care Homes for Adults (18-65 years) Page 10 of 34 What has got better from the last inspection The homes information paperwork now contains full details of fees and charges. AGENCY STAFF The agency staff is now mainly regular agency staff, so people see the same faces. There is now enough staff to meet the needs of the people living in the home. Care Homes for Adults (18-65 years) Page 11 of 34 THE BOSS The provider does regular monthly inspections to make sure the home is run well. Some of the carpets and furniture have been replaced. What the care home could do better LIST OF STAFF NAMES The home should have an up to date list of names and signatures of the people that give out the medication. Care Homes for Adults (18-65 years) Page 12 of 34 The provider should make sure that they tell the Care Quality Commission of any changes that are made to the management of the home. 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 Pauline Marshall 03000 61 61 61 Care Homes for Adults (18-65 years) Page 13 of 34 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 14 of 34 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 15 of 34 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 receive good information and their needs are fully assessed. Evidence: The Statement of Purpose and Service User Guide were reviewed in June 2009 and contained up to date information. A pictorial copy of the Statement of Purpose was displayed on the homes notice board and each of the care files we examined contained up to date copies of the Statement of Purpose and Service User Guide. We looked at the pre admission assessment of the last person admitted to the home, which was in March 2007, and we found that it had been carried out by the home manager and covered the persons physical, mental and social needs. The assessment showed the participation of other healthcare professionals that had been involved in the care of the person. The assessment documentation was clear and provided detailed information on the support needs of the person using the service. In addition to looking at the persons physical, mental and social needs it looked at their preferences, such as how they liked to spend their time and how they interacted with other people. There were no pre-admission assessments available for inspection for any of the other Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: people living in the home, however, the person in charge of the home said that they may have been archived as it had been many years since they moved in. The records showed that the person had visited the home on several occasions and that they had an overnight stay before moving in, and that notes were made regarding the experience of the person moving into the home and the impact that the move could have on the people already living in the home. Each of the four care files that we looked at contained a contract showing the cost of staying at 86 London Road and the contribution that people had to pay; the Service User Guide identified the items that people would need to pay for in addition to their weekly charges. Care Homes for Adults (18-65 years) Page 17 of 34 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 receive appropriate individualised care based on their identified needs. Evidence: The care files have been divided into three separate folders, one being for the daily notes, another for the health action plans and the third for care plans and risk assessments together with their management plans. We looked at the care files belonging to all of the people living in the home and we found them to be detailed and informative. There was information on all areas of care and risk, such as, bathing/showering, getting up/going to bed, expression and understanding, relationships, interests and hobbies, exercise and managing finances. There was management plans in place for all areas of identified risks. Each of the care files that we looked at contained a care plan for areas of need that was specific to the individual. People spoken with throughout the day said that they were involved in their care plans and there was signatures on the care plan documentation to confirm this. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: We looked at the folder containing the notes of meetings that had been held for people living in the home and we found that they were clearly written and included pictures; subjects included the homes 2008 quality survey results, activities and the day to day running of the home. The manager said in his AQAA we encourage the service users to participate in decision making in all aspects of their day-to-day life for example by offering different choices of food, drinks and clothes and people spoken with confirmed this. Care Homes for Adults (18-65 years) Page 19 of 34 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 well supported to live a lifestyle that meets their identified needs and preferences. Evidence: People living in 86 London Road participate in a range of activities both inside the home and out in the community, which includes, pub lunches, horse riding, shopping, fabric painting, jewelry making, soap making, trips out to London to see shows and annual holidays. The manager said in his AQAA we now have a far more diverse range of activities and run taster sessions to help people find a wider range of activities to take part in. People spoken with talked of visits to local clubs and day services, college and the seafront in Southend. The daily notes confirmed that many activities take place and that people living in the home were able to choose what they wanted to do. One person living in the home showed us photographs of the many activities that they did and said how much they enjoyed trips out and their annual holiday. Another Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: person living in the home had been on holiday to Scotland last year and said they were planning to go there again as it was so good. People are encouraged to maintain family relationships and friendships; the daily notes showed that people were supported in doing this and people spoken with said how they were helped to visit friends and relatives. The records showed that people were involved in the running of the home and there were details of any infringements to peoples rights documented in the care plan and signed by the individual. Each person holds a key to their bedroom and staff were observed knocking on the door and waiting for the persons response before entering. People spoken with said that the staff treats them well and that their wishes are always respected. The manger has recently devised a four week rolling menu that offers people a good range of healthy food; people living in the home were involved in the creation of the menu and it includes the foods that people have chosen. This menu has just been put in place, prior to this people chose what they wanted to eat on a daily basis and the staff supports people living in the home to do the weekly shop. The nutrition records showed that people ate various meals of their choice and this was confirmed by the people living in the home. Care Homes for Adults (18-65 years) Page 21 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People receive personal care in a way that suits them and their health care needs will be fully met. Evidence: The care files that we looked at showed peoples preferences with regard to their personal and healthcare needs such as if they preferred a shower or a bath and when spoken with people said that the staff supports them in the way that they prefer. One of the care files that we looked at contained an epilepsy care plan which detailed how staff was to support the person in the event of a seizure; there was also an epilepsy diary where information about any seizures was recorded. The health action plan set out the details of each individuals planned health care including routine checks such as dental, chiropody and psychology. All other healthcare appointments together with the outcomes were recorded in the health action plan, these included visits to GPs and hospitals. The home uses a monitored dosage system for its medication administration and all staff has had medication training and receive annual updates to ensure that they Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: remain competent. The medication file contained copies of patient information leaflets that describe what the medication is for, how to take it and any possible side effects. There was also a reminder of good working practices and problem solving with medication documentation that had been recently reviewed. The folder contained a list of all of the medication used in the home and there was a drugs history for each individual. There were PRN protocols for all as and when prescribed medication showing how, when and why it was to be administered. The medication administration list of staff names and signatures was out of date and included incorrect information; this list should always be up to date to identify the staff that currently administers medication. The person in charge of the home said that one staff member is responsible for ordering and returning any medication and that they were more familiar with the recording and stock keeping although all staff was medication trained. Care Homes for Adults (18-65 years) Page 23 of 34 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 will be protected from harm and abuse. Evidence: There was a brief one page notice about complaints displayed on the notice board in the office; the person in charge of the home provided us with a copy of Estuary Housing Associations customer service policy dated 4.3.04 that included information on complaints. The information provided in this policy was out of date. The manager said in his AQAA that the policy was last reviewed in 10/06 but this version could not be located in the home. The manager said in his AQAA the complaints policy is accessible to all and all staff are aware of these policies and they are discussed at team meetings and 1:1 sessions, both of the staff that were on duty were unable to confirm this. The complaints records showed that the last complaint was made in October 2007 and that it was dealt with appropriately. All of the staff files that we looked at showed that staff had received safeguarding training and that there had been regular updates taking place. Staff spoken with had a good awareness of the steps to take if they suspected abuse. The manager said in his AQAA that there had been five safeguarding issues since the last inspection; we have not been notified of these, however we were notified of the some of the injuries that people living in the home had sustained. The safeguarding issues have been closed under safeguarding and measures have been put in place to manage the issues. Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: The home does not hold individuals monies, however the provider gives the home a cash float of £200 through its imprest system to enable people to purchase personal items such as toiletries, hairdressing and clothing and reclaims any cash spent by individuals as recorded on the cash sheets. Care Homes for Adults (18-65 years) Page 25 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People live in a homely, comfortable safe environment. Evidence: We looked around the building and we found that each of the bedrooms was nicely furnished and decorated and each person had their own individual belongings such as posters, pictures, ornaments and games. People spoken with said that they had chosen the colours of paint and purchased items to put in their rooms. The communal areas were tidy and clean and a new sofa and chair, two new flat screen televisions, a new cooker and a fridge freezer had been purchased. The person in charge of the home said that the empty upstairs room is in the process of being converted into a quiet room where people can sit and relax if they want to. The person in charge of the home said that repairs were carried out in a timely manner and the maintenance records confirmed this. There was some minor damage to the lounge door and the kitchen cupboard doors which had been caused by one of the people living in the home that is currently experiencing behavior problems. People living in the home have access to a well maintained good sized garden with a Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: table and benches for them to use in nice weather. The person in charge of the home said that the sandpit had been made for one particular resident that enjoyed using it. Another person living in the home said when spoken with I also enjoy using the sandpit and I make shapes in it. Care Homes for Adults (18-65 years) Page 27 of 34 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 . People are cared for by a competent, well-trained and supervised staff team, who are safely recruited. Evidence: We looked at the staff duty roster over an eight week period, which covered six weeks prior to the inspection and two weeks after. The rosters showed that the home provided appropriate levels of staffing throughout the period and that permanent staff were supported by the use of regular agency staff to ensure consistency of care. All staff works a twelve hour shift pattern which includes regular waking night shifts. Staff is allocated specific duties, such as being responsible for medication and organising activities; when spoken with staff said that they were happy with this arrangement. The manager said in his AQAA that four of the eight staff employed have achieved their NVQ level 2 or above in health and social care. Two of the staff files we looked at contained copies of certificates confirming their NVQ qualification. We looked at three staff files, including that of the most recently transferred member of staff and they contained all of the required documentation including a criminal records bureau check, two written references and evidence of induction, supervision and training. There was no evidence of fitness on the staff files that we looked at, Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: however, the acting manager has since confirmed that it is now in place. There was evidence that all staff had received training and regular updates; subjects included food hygiene, health and safety, moving and handling, first aid, medication, safeguarding adults and risk assessment. There was also evidence of more service specific training such as epilepsy, autism, diabetes, anger management and challenging behavior. Staff spoken with confirmed that regular training and update’s are provided and that this is discussed at team meetings and at their supervision sessions. Each of the three staff files that we looked at contained a supervision agreement and notes to confirm that regular supervision has taken place. Care Homes for Adults (18-65 years) Page 29 of 34 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 . Whilst people live in a generally well run home, they do not always benefit from a stable management team. Evidence: The person in charge of the home said that the registered manager was no longer working there and that an acting manager was in post but on paternity leave. The duty roster showed that the registered manager had been on a period of sick leave and returned to the home for a two week period then was taken off the rota from 15th June 2009. The person in charge of the home said that the new acting manager started work at 86 London Road as soon as the registered manager left. The new acting manager was not shown on the staff duty roster; all staff working in the home must be included on the duty roster. At the date of writing this report we had not received a notification from the provider informing us of the changes in the management of the home and the service is required by law to notify the Commission when this occurs. The person in charge of the home was not able to provide details of the homes quality Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: assurance system; however the notes of a recent meeting that was held for people living in the home showed that a survey had taken place in 2008 and that the outcomes had been discussed. The manager said in his AQAA “we are going to commence a service satisfaction questionnaire for our service users and stake holders to help further develop our service. The person in charge of the home said that he was not aware of any quality assurance report. The provider carries out regular monthly checks on the home and there was copies of the reports to confirm these visits kept on file at the home. The manager did not return his AQAA by the due date and had to be sent a reminder, however, once received the completed AQAA contained all of the information that we had asked for. The providers health and safety officer carries out an annual health and safety check. A random sample of safety certificates was checked and we found them to be in place and up to date. A recent fire officer’s report showed that the fire risk assessment and the homes fire equipment, records and training was satisfactory. Care Homes for Adults (18-65 years) Page 31 of 34 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 32 of 34 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 1 37 39 The provider must notify the 28/08/2009 Commission in writing of any changes to the management of the home. To ensure that the Commission has up to date information. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 It is recommended that an up to date list of the names and signatures of staff that administers medication is kept to ensure that it is clear who administered it. Care Homes for Adults (18-65 years) Page 33 of 34 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 34 of 34 - 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!