Care Home: Allen & Whitworth Homes

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What the care home does well Whitworth Rd is a warm and friendly home. You will be made welcome during your visit. Bedrooms viewed were clean and pleasant and contained personal items.Person centred support plans are being developed with people who use the service. People who use the service are involved with decisions.People using the service are supported to be as independent as possible.Your privacy will be was respected. What has improved since the last inspection? Required employment checks are met. Infection control measures are in place What the care home could do better: The staff need to continue developing support plans to be person centred.Practice in the administration of medication needs to be reviewed to meet regulations that came into force in 2007The manager must review how controlled drugs can be safely stored to ensure that they and meet the new regulations that came into force in 2007.Risk assessments need to be in place to ensure safe access to the cellar for people that use the service and staff.The home needs to be refurbished to improve the environment for people that use the service. Key inspection report Care homes for adults (18-65 years) Name: Address: Allen & Whitworth Homes 119 Whitworth Road Northampton Northants NN1 4HQ The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Judith Roan Date: 2 0 0 7 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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 Care Homes for Adults (18-65 years) Page 2 of 35 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 mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 35 Information about the care home Name of care home: Address: Allen & Whitworth Homes 119 Whitworth Road Northampton Northants NN1 4HQ 01604632565 01604632565 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Allen & Whitworth UK Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 3 Number of places (if applicable): Under 65 Over 65 3 3 0 0 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 3 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-code LD, mental disorder excluding learning disability or dementia-code MD Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 35 A bit about the care home One of three homes run by Allen and Whitworth Homes Limited. The home is registered for three people with a Learning Disability and who additionally may have a Mental Disorder. The home is a terraced property situated in a residential area near to the town centre and offers a small family environment, similar to other properties in the road. All bedrooms are single all situated on the first-floor. The ground floor communal space includes a lounge/ diner, kitchen and conservatory, and there is a small paved garden to the rear of the house. The home offers good access to local facilities. Care Homes for Adults (18-65 years) Page 5 of 35 In an effort to have the homes Statement of Purpose and Service User guides userfriendly they are made available in a written format supported by pictures. Care Homes for Adults (18-65 years) Page 6 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 35 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We randomly selected two people who use the service and tracked the care they receive through review of their records, discussion with them, the care staff and observation of care practices. We also received information other people who use the service, relatives, support staff and social care professionals. The homes registered manager also completed an Annual Quality Assurance Assessment (AQAA) a document required by CQC (Care Quality Commission). The inspection was unannounced and was undertaken during the morning and early afternoon lasting 4 Hours. People using the service said that Its a nice house they look after you and we go out I like all the staff they are good to me Care Homes for Adults (18-65 years) Page 8 of 35 Relatives said: They look after my relative as I would like them to be looked after I have no complaints Staff Said: We are well supported Improve the variety of activities available Social Care Professionals said: There are areas of the service that need to be developed to ensure that it is person centered. Prospective users of the service are advised to contact the office to obtain up-to-date charges about the fees. Care Homes for Adults (18-65 years) Page 9 of 35 CQC received an application from the provider to change the registration. The service was reregistered in January 2009 as a limited company. What the care home does well Whitworth Rd is a warm and friendly home. You will be made welcome during your visit. Bedrooms viewed were clean and pleasant and contained personal items. Person centred support plans are being developed with people who use the service. People who use the service are involved with decisions. Care Homes for Adults (18-65 years) Page 10 of 35 People using the service are supported to be as independent as possible. Your privacy will be was respected. Care Homes for Adults (18-65 years) Page 11 of 35 What has got better from the last inspection What the care home could do better The staff need to continue developing support plans to be person centred. Practice in the administration of medication needs to be reviewed to meet regulations that came into force in 2007 Care Homes for Adults (18-65 years) Page 12 of 35 The manager must review how controlled drugs can be safely stored to ensure that they and meet the new regulations that came into force in 2007. Risk assessments need to be in place to ensure safe access to the cellar for people that use the service and staff. The home needs to be refurbished to improve the environment for people that use the service. Care Homes for Adults (18-65 years) Page 13 of 35 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 Judith Roan Care Quality Commission Inspection East Midlands Citygate Gallowgate Newcastle upon Tyne NE1 4PA Tel: 03000616161 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 35 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 35 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 considering the service will have their needs assessed to ensure that the service can meet their needs. Evidence: The people living at the home have lived their for many years. There have been no new admissions. In viewing the records we found that pre-admission assessments had been carried out before people had moved to the home. These assessment identified the individual needs of people using the in relation to health, social and emotional needs. This enabled staff to work with individual to develop their support plan. An assessment of need is completed in conjunction with the funding authority prior to admission. All people said in the surveys that they had been asked about moving into the home, families confirmed that they were fully involved. A copy of the most recent inspection report is available on request. Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: The Annual Quality Assurance Assessment (AQAA) that was submitted to CQC prior to the inspection visit gave information on how the home introduces potential new people into the home. Within the AQAA the home has identified the admission process involved Service users are always encouraged to visit home prior to admission. A full needs assessment is completed prior to admission. Care Homes for Adults (18-65 years) Page 17 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people who use the service are mostly met through support plans. Evidence: During the inspection we met with people using the service who said that they were well looked after The care files of two people using the service were case tracked. Both were in the process of being updated to reflect a person centred approach. The current plans did not contain specific details on how a persons needs were to be meet. The files contained some risk assessments in support of the plans. In relation to smoking and home alone. There was no evidence in one file of risk assessments in relation to medication, mental health needs, support in the community, finances and personal care support. These were specific in relation to activities undertaken by people using the service. Support plans were reviewed and where necessary updated to meet changed needs. Support workers spoken with were knowledgeable about the care and support each Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: person required. In observation of the work undertaken by support workers they were seen to be professional in their approach and respected the people they were supporting. Surveys confirmed that they were encouraged to make choices and decisions about their life. House meeting are undertaken informally. These have not been traditionally recorded in the past. The AQAA confirms that there is a need to Increase the frequency of house meetings. Care Homes for Adults (18-65 years) Page 19 of 35 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 have good support to access to a range of activities within the community. Evidence: Several people who us the service attend a variety of day placements in day centres and individual activities to suit their needs. The AQAA confirms that Service users attend day care centres several days a week. Service users go for planned day trips and for shopping for personal items with staff support .They go for walks in the park. Holiday at the destination of their choice booked by staff. Service users are always in contact with their relatives and do visit whenever they wish. One service user occasionally arranges a get together with his other siblings in the local authority care. Services users are treated with dignity. Their rights are recognised, healthy diets are offered and enjoyed. We also support service users to go out and vote on election day. Individuals have a weekly activities programme that is updated to take account of various events and personal choices. During the period of observation it was noted how Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: individuals were supported with everyday activities around the house to enable them to be included and to take on joint responsibility for their environment and their belongings. Individuals confirmed in surveys and in discussion that they choose daily routines, like times of getting up and going to bed when they choose. The menu is chosen by people that use the service with support to promote healthy choices and have a balanced diet. The AQAA states that future support will be to Promote activities that will keep service users healthy and reduce excess weight. Families commented that There was good the communication and any concern was explained and dealt with to their satisfaction. They look after my son, as I would like him to be looked after. Life history work was not evident at present but joint work between staff at the home and social care professionals is ongoing to develop person centred planning. Care Homes for Adults (18-65 years) Page 21 of 35 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 adequate 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 not fully protected by the administration of medication practices at the home, which leaves them vulnerable. Evidence: People who use the service confirmed within the surveys and in discussion that they were well cared for. The health care information kept was limited and it was unclear how people using the service are supported to attend medical appointments and check ups. Health check and health action booklets were found but these were not kept updated and cross referenced to support plans. Support plans which are in development to be person centred will need to cover all aspects of health care needs for people using the service so their needs are met. Accident and incidents should be formally notified to the commission to ensure that the service is meeting regulations. Medication records were checked and found unsatisfactory. Some records contained gaps. Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: Prescribed medication was kept in a locked filing cabinet and there was no evidence of a fitted controlled drugs cabinet. A controlled drugs cabinet must be installed at the home to ensure the safety of these drugs and to comply with the new regulations that came into force in 2007. Care Homes for Adults (18-65 years) Page 23 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people using the service have not been fully protected. Evidence: The home has policies and procedures regarding the Protection of Vulnerable Adults and staff training records evidenced that this training has been provided to staff on adult protection. However there has been one safeguarding referral in relation to the fire procedures within the home. See environment section. Recruitment procedures ensure that there is robust checking of new staff through references and criminal record bureau disclosures (CRB). The present administration and storage of medication is not meeting the standards required under the present guidelines and these place people using the service at risk. The manager states within the AQAA that the service has a Complaints policy and adult protection procedures in place, implemented and adhered to within the home. Staff training and easy to follow chart for staff use - identifying responsible people within the procedure. Time scale for complaints investigations is 14 days. All staff undertake Enhanced CRB and Protection of Vulnerable Adults Checks prior to employment. The complaints procedure was not displayed within the home. The manager confirms in the AQAA that they need to Encourage service users to complain about issues they are not happy with. Policy and procedure to be reinforced during meetings. The manager also stated that no complaints had been received at the homes level in the last 24 months. Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: Staff records seen confirmed that all required employment checks are undertaken for all staff employed by the organisation. Care Homes for Adults (18-65 years) Page 25 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a family setting with individual space that is clean and hygienic but some areas are not fully safe. Evidence: The communal areas provide a choice of space where individuals can watch TV or spend time relaxing. Standards of cleanliness and odour control in all areas of the home were good. The home was subject of requirements made by the Fire Safety Officer in March 2009. The AQAA confirms the action taken Fire doors have been fitted in all the doors specified by the fire officer fire risk assessment done and approved by the fire officer. Interlink alarm has also been fitted in the entire house including the cellar. The front and back entrance have also been fitted with thumb operated locking device. CQC has also received confirmation from the fire officer that the service has complied. During the inspection we noted that the access to the cellar was not provided with a handrail to the steep stairs. People that use the service do have access to this area. CQC have sent an urgent action letter to the provider asking them to review the situation. The manager within the AQAA indicates that the organisation intends to Carry out further refurbishment in the home. Service users bedrooms were clean and they are supported by staff each week to keep them maintained. Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: Care Homes for Adults (18-65 years) Page 27 of 35 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. Staff skills and recruitment practices ensure that the needs of people who use the service are supported and protected. Evidence: The staffing levels at all time of the visit were sufficient to meet the needs of the people using the service. Staff files seen have the required employment checks, application form, two references, criminal records bureau disclosures. The support worker team have a sound knowledge base about the needs of people that use the service. Through observation during the inspection they showed that they had a range of skills to support individuals and were proactive in developing everyday living skills. Support workers are offered a range of opportunities to train. The AQAA confirms the training undertaken with staff at the home. 60 Staff trained to National Vocational Qualifications (NVQ)in Care Level 3 and above. Staff motivated and empowered, more opportunities created for development and experienced staff encouraged to further career within and outside the home. The support worker team is well established and this has clear benefits for the people that use the service. A newly appointed staff member confirmed that they had completed their induction and that they are awaiting a placement on the NVQ level three course. Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: Staff have had access to person centred planning training and are implementing their learning within their work. Staff supervision is undertaken on a regulation with all staff confirming that they felt well supported. A Staff use the communication systems within the service to full effect, these include the communication book, diary and telephone. Support workers spoken to had a good knowledge of the needs of people using the service and were committed to providing a good service. Care Homes for Adults (18-65 years) Page 29 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is not yet fully person centred and effectively managed in the best interest of people who use it. Evidence: Homes Manager has gained the Registered Managers Award and a Masters degree in Business Administration. A deputy manager is employed to oversee management within the home. The deputy manager is working on the implementation of a person centred approach within the home and to ensure that records held meet regulations and National Minimum standards. Specific shortfalls in relation to safety and protection of people using the service have been identified in previous areas of this report. The provider has since the fire safety officer and contract monitoring officers visit undertaken all health and safety checks and kept clear records of all checks required. Risk assessments need to be implemented for all areas of identified need. Health and Safety Policies and Procedures are in place and support workers are aware of Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: these. Induction training ensures staffs knowledge and understanding of these. Care Homes for Adults (18-65 years) Page 31 of 35 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 35 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 9 13 Support plans must be underpinned by risk assessments of identified needs. 30/10/2009 This is to ensure that appropriate measure are taken to protect people using the service. 2 20 13 A controlled drugs cabinet must be installed at the home. 31/12/2009 to ensure the safety of these drugs and to comply with the new regulations that came into force in 2007. 3 23 13 Practices within the home must demonstrate that people using the service are safeguarded. 30/10/2009 To ensure that people using Care Homes for Adults (18-65 years) Page 33 of 35 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 the service are fully protected. 4 24 13 20/08/2009 Access to the cellar which has steep stairs without a hand rail within the home must be assessed for the risk they present to the people that use the service and action taken to minimise any identified risk. This is to ensure that people using the service are fully protected. 5 42 42 That the provider ensures compliance with all health and safety regulations. 30/10/2009 This is to ensure that medications practices within the home and the environment are safe for people that use it. 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 34 of 35 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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