Care Home: Arliemoor

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What the care home does well Arliemoor provides people with a warm, friendly, family type environment. People who currently live at the home speak very highly about the environment. One person said ``This is by far the best place I have lived, I love having the horses to look after and I really like my room.`` The expert by experience stated ``My initial impression as I turned into the drive was that this is a working farm and that I had come to the wrong address. However, it transpired that it was indeed the care home that I was looking for and I experienced an incredible sense of peace and comfort of a farm with it`s attendant feeling of time is unimportant.This, to me, was a breath of fresh air, after my previous experience of care in institutional establishments, ranging from Category 1 prisons to care homes catering for people suffering from dementia. Arliemoor truly deserves the title of Care Home. The clients, that David, the proprietor, calls his guests, are treated as part of his own family. The establishment did not have the clinical feel of an institution but it manages the difficult balancing act of a care home with it`s attendant official status and a proper family home. On interviewing the clients, they told me that they had never been so happy in their previous lives.`` Arliemoor strives hard to ensure that individuals have a good range and choice of activities that suit their individuals needs and wishes. They have good staffing levels to ensure that individuals can be transported to activities and the local community. The staff team are experienced, trained and supported to understand the needs of people with mental health issues. Individuals who live at Arliemoor spoke highly about the staff and the care and support they receive. Arliemoor have good systems in place to ensure the views of the people who live there are listened to and used to help improve the quality of the service. What has improved since the last inspection? The home have followed up on a requirement made from the previous inspection, and have purchased a controlled drugs book, which is signed by two staff if controlled drugs are administered. What the care home could do better: The plans of care should be readily available to all staff to refer to at all times, so that the home can ensure that consistent care is delivered. Any medications should be checked and recorded as soon as they arrive at the home, to ensure that a good audit trail is available, and to check for any errors in prescriptions. Staff supervision should be recorded to show that the staff group are offered regular one to one support to enable them to do their job effectively. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Arliemoor Halsdon Cross Holsworthy Devon EX22 6NX     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: Joanne Walsh     Date: 0 2 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Arliemoor Halsdon Cross Holsworthy Devon EX22 6NX 01409254232 Telephone number: Fax number: Email address: Provider web address: arliemoor@tiscali.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Jacqueline Rowe Type of registration: Number of places registered: Mrs Jacqueline Rowe care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Arliemoor is a large farmhouse providing residential care for younger men and women suffering from poor mental health. They do not provide facilities for blind people or those with a history of arson. It provides accommodation for 8 service users and has a new recreation room and office facility. It is set in ten acres of countryside and has no close neighbours. The owners have a number of dogs and horses and are happy for service users to become involved in their care. The grounds currently include a spacious garden, poly tunnel with tropical plants, a basic gym and a workshop area. Transport is provided by the home so that service users have access to education, social and leisure events, individual interests, families and friends and links with health services. There is also a bus service in the vicinity, although some service users prefer to use their bikes or walk to Holsworthy, which is two miles away. The range of fee are 425 pounds to 450 pounds per week and do not include holidays, toiletries and Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 8 Brief description of the care home hairdressing. A copy of the inspection report is held in the office and available for anyone to read. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place during a weekday in October and looked at all the key standards and focused on listening to the views of the people who live at the home. We did this by using surveys prior to the inspection taking place, and by the use of an expert by experience. CSCI are trying to improve the way we engage with people who use services so we gain a real understanding of their views and experiences of social care services. We are now using a method of working where experts by experience are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term experts by experience used in this report describes people whose knowledge about social care services comes directly from using them. The expert helped to speak to people about their experiences of living at the home as well as making some general observations. His comments are Care Homes for Adults (18-65 years) Page 6 of 28 included throughout this report. We also spent time talking to staff and looking at some of the key documents used including plans of care, risk assessments, staff recruitment files, records relating to individuals monies and medication records. This helps us to understand how well the home is meeting the standards and protecting the people who live there. Prior to the inspection the home completed an Annual Quality Assurance Assessment (AQAA), which gives us information about how the home maintains a safe environment, what training has been completed and tells us how they are reviewing their services to improve the care and support provided. This information helps to inform the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: The plans of care should be readily available to all staff to refer to at all times, so that the home can ensure that consistent care is delivered. Any medications should be checked and recorded as soon as they arrive at the home, to ensure that a good audit trail is available, and to check for any errors in prescriptions. Staff supervision should be recorded to show that the staff group are offered regular one to one support to enable them to do their job effectively. Care Homes for Adults (18-65 years) Page 8 of 28 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 28 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 10 of 28 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. Potential new people to the service have their needs fully assessed prior to moving in, to ensure that Aliemoor are able to provide the care and support needed. Evidence: We looked at the assessment information for the newest person admitted to the home. The individuals file contained a detailed assessment completed by their funding body as well as background information from the psychiatrist who had been involved with this individual in previous hospital admissions. The information was sufficient to enable the home to make a clear decision about whether they could provide the right care and support for this person. The provider said that individuals are always invited to visit the home usually for more than one occasion, which gives them an opportunity to meet with the other people who live at Arliemoor as well as the staff. The home would also take this opportunity to complete their own assessment of the individual. Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: One staff member was unaware of what information was available for the new person living at the home and the registered manager has been asked to ensure that all staff have access to and time to read through and understand peoples assessments and plans of care. Care Homes for Adults (18-65 years) Page 12 of 28 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. Individuals care is usually well planned so that staff have good information to ensure that identified needs are met in a way that allows people to have choice and control over their lives. Evidence: Three plans of care were looked at and discussed with the provider and with staff on duty on the day of the inspection. Two contained a document called an holistic care plan, which gives information about how care and support is to be delivered and what risks have been identified and how these are to be managed. The home tries hard to ensure that individuals are involved in the care planning process and aim to have weekly reviews to look at whether any changes are required to how care and support is provided. One person told us they enjoyed having regular meetings to discuss how they were doing, but that often they were busy and weekly meetings did not always happen. Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: We found that although plans of care for two of the people looked at did contain details about their needs, risks and how staff should support them, that the holistic plans of care need updating and placing at the front of the file so that they are more accessible for staff to refer to. The provider suggested that they may look at having one folder with all the holistic plans of care in that staff could then see without having to take out bulky folders for each individual. One person did not have a holistic plan of care or risk assessment in their main folder. The manager explained during feedback that this was being worked on as they had recently reviewed and updated the plan. The home are reminded that plans of care should be available at all times for staff to refer to to ensure a consistent approach to care and support provided. Information is available to show how individuals are supported to to make decisions such as what activities they wish to participate in, control over their finances, or if safeguards are in place that limit choices, the reasons for these are clearly stated and agreed in their plans of care. One person has a daily allowance of tobacco for example and some individuals are assisted with their finances due to their vulnerability or lack of awareness in budgeting. These restrictions are detailed as part of risk assessments and are reviewed on a regular basis. Care Homes for Adults (18-65 years) Page 14 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arliemoor offers individuals a good range and choice of activities that suits their needs and wishes. Evidence: The expert by experience spent time talking to people who live at Arliemoor and this is his report. My initial impression as I turned into the drive was that this is a working farm and that I had come to the wrong address. However, it transpired that it was indeed the care home that I was looking for and I experienced an incredible sense of peace and comfort of a farm with its attendant feeling of time is unimportant. It is, to me, was a breath of fresh air, after my previous experience of care in institutional establishments, ranging from Category 1 prisons to care homes catering for people Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: suffering from dementia. Arliemoor truly deserves the title of Care Home. The clients, that David, the proprietor, calls his guests, are treated as part of his own family. The establishment did not have the clinical feel of an institution but it manages the difficult balancing act of a care home with its attendant official status and a proper family home. On interviewing the clients, they told me that they had never been so happy in their previous lives. It was not at first obvious who were the clients and who the staff. This is not meant as a criticism; rather, the complete reverse. The clients, all of whom it appeared to me, had suffered serious trauma and mental illness in their lives found that they were now being shown a respect and recognition of themselves as people in their own right, by the Arliemoor staff. This had been something new in their experience and they had reacted positively to this by participating as much as their illnesses allowed in the running of their new home. There were six clients in residence at the time of our visit and I spoke individually to them all. They ranged in age from early 20s to about 40 years of age and the home catered for both men and women. With the exception of one client who appeared to suffer from a particular mental distress that I feel clouded the rationality of the answers given to my questions, the response to Arliemoor as their home and care centre was decidedly positive. I found some of the clients happily helping to clean out the horse stables, whilst others have been invaluable in the garden producing healthy produce that were then used in their own kitchen. Again, the clients helped here in preparing their own food and having an input into the menu. Five of the clients were answering my questions in such a positive way that not only were they singing from the same hymn sheet, but they were also signing the same hymn. My conclusion is that Arliemoor Care Home, with the accent on Home, should be proud of the service it offers its clients and the community. This is such a pleasant and reforming way of treating clients with mental health problems and light years away from some institutions I have visited. The expert by experience also gave some verbal feedback about the sorts of activities people were engaged in. These range from work within the home, helping with the Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: horses and vegetable growing, to classes in felt making, swimming, and drama. Discussions with people who live at the home showed that although the location is fairly rural, the staff team work hard to ensure that a good range and choice of activities are available to people. They also try to ensure that individuals have access and be part of the wider community. This is also reflected in the individuals plans of care. The home provides opportunities for people to engage in menu planning shopping and meal preparation. People spoken to said there is always a good range and choice of meals offered. On the day of the inspection several people were observed to be helping with preparing food and drinks and one person was making some cookies. Access to the kitchen is not limited and people can make drinks and snacks throughout the day. Care Homes for Adults (18-65 years) Page 17 of 28 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 who live at Arliemoor can be confident that their personal and health care needs will be fully met. Evidence: Plans of care looked at give details on how personal and health care needs are to be met. For most people support is only needed in prompts for personal care. Staff spoken to said that they try to encourage independence as far as possible but do need to remind some people about attending to their personal hygiene. By including this in an individuals plan that they have agreed to, the home ensure that it is clear that staff will remind and prompt individuals if needed. Health care particularly emotional well being is very well documented within plans of care and a daily diary. Individuals are encouraged to keep a daily diary and are assisted to write in this at the end of each day to help them to reflect on their emotional well being and what achievements or difficulties they have had. People spoken to said that they found it useful to keep daily diaries and that if they did not feel like writing much they could keep it brief. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: Reviews completed by funding authorities show that they are confident that individuals personal and health care needs are well met. The medication records and storage were checked and overall there is a safe system in place to ensure medications are administered and recorded accurately. The new monthly medication had arrived two days prior to the inspection being completed, but had not been signed in, so there was no accurate record of what had been received into the home. The registered provider said that this was due to the fact that one of the providers and the registered manager were away for three days on a training course. Normally medications are checked and recorded on the day they arrive into the home. Care Homes for Adults (18-65 years) Page 19 of 28 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. Individuals views are listened to and acted upon Evidence: Individuals are encouraged to keep a daily diary, which is read by the manager or provider and they add comments as evidence that they are listening to any concerns or worries. One person said this worked well for them and they liked to have some feedback to their diary entries. The home have a more formal complaints process, but try to encourage individuals to discuss any concerns they have on a daily basis so that issues do not become a major complaint. Regular house meetings are held where people can voice their views about how things are going good or bad. Staff have training in the protection of vulnerable adults and staff spoken to knew want to do if they suspected any form of abuse was taking place. Robust systems are in place to ensure there is a good audit trail for the safekeeping of individuals finances. Care Homes for Adults (18-65 years) Page 20 of 28 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. Arliemoor provides people with a clean safe and well maintained environment. Evidence: Arliemoor is very much a family home with the providers living on site with their dogs. The communal areas are all comfortable and available for everyone to use. There is a separate smoking lounge for people to use. Bedrooms all have locks to allow privacy, but can be accessed by staff in an emergency. People are encouraged to personalize their rooms and keep them reasonably clean and tidy. Care Homes for Adults (18-65 years) Page 21 of 28 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 who live at Arliemoor are supported by a staff team that are experienced, knowledgeable and well trained. Evidence: Staff spoken to during the inspection said that they had good opportunities for training and they work well as a team. Staffing levels are usually at around four throughout the day, which allows individuals to be supported to do some one to one work, to be transported to various activities and to access the local community. Individuals who live at Arliemoor spoke highly about staff, the support offered and that there was a good mix of age range as well as gender. Staff files viewed showed that generally robust recruitment processes are in place to ensure people are only employed once relevant checks are completed. Some references were missing from two files, The registered manager stated these were obtained but had not been filed. Formal supervision does take place according to staff spoken to but records to Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: evidence this were not available. Staff should be offered regular one to one time to discuss how they are doing and look at ongoing training needs. This will ensure that the staff team are supported to do their job effectively. Care Homes for Adults (18-65 years) Page 23 of 28 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. Arlimoor is well managed and run in the best interests of the people who live there. Evidence: The registered manager is qualified and experienced to run the home. She has a good understanding of the needs of the people who live at the home and together with the registered providers they ensure that the home is run in a way that is inclusive and gives individuals a say in everyday decisions. Ways this is done is by regular community meetings, staff meetings and supervision sessions and being available for people to talk to. The home also uses surveys to gain views on the quality of support and care. People who live at Arliemore said that they did feel their opinion was listened to and that the manager and providers who live on site are approachable. Staff have training in all areas of health and safety to ensure they can do their job safely and competently. Policies and procedures are in place for all safe working Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: practices and the home provided information prior to the inspection to show the maintain the environment and all equipment, so these were not directly checked during this inspection. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 The Home should ensure that all staff have access to and opportunity to read and understand assessment and care plan information for all people living at Arliemoor. Plans of care should be updated and be accessible to the individual and the staff group to ensure that consistent care and support is provided. Medication should be checked and recorded on the day they arrive into the home so that a robust audit trail is available. This should also be completed to ensure that the right medication and dose has been prescribed by the pharmacist. Any changes to medications should be double signed on MARS and recorded in plan of care who authorized the change. 2 7 3 20 4 20 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - 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!