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Care Home: Barlby Road

  • 37 Barlby Road North Kensington London W10 6AN
  • Tel: 02089648543
  • Fax: 02089648156

37 Barlby Road is a residential home for four people with a learning disability. The service is provided by Yarrow Housing Limited. All of the service users, two men and two women, are supported by the Royal borough of Kensington and Chelsea. The building is a semi-detached house in North Kensington, which has been adapted on the ground floor for wheel-chair access. The lay-out of the house provides one bedroom on the ground floor and three on the first floor. All rooms are single and of a good size. There is an office/sleep-in room in a loft extension. Service users attend day services 042009 in the Borough and are supported to pursue a range of interests in the home and in the community.

Residents Needs:
Learning disability

Latest Inspection

This is the latest available inspection report for this service, carried out on 30th November 2009. CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

For extracts, read the latest CQC inspection for Barlby Road.

What the care home does well 37 Barlby Road provides a person-centred service to 4 people with a learning disability who have high needs. Each of the service users communicates non-verbally and communication is well supported by the use of multi media, signing and objects of reference. A high priority is given to ensuring that people`s health care needs are identified and met through multi professional working with the Learning Disability Team and health care colleagues. A good standard of community presence has been established, with participation in a range of activities in the community as well as specialist day services. The ethnic and cultural background of service users is recognised and celebrated. Good relationships are maintained with families. Feedback from one family who are in very regular contact with the home, confirmed that `they keep us up to date` and that they are `happy with the service`. The accommodation is well adapted and close to local services. Yarrow Housing has an established programme of developing the use of multi media to support service users` communication. A range of documents are available in accessible formats and staff attend training in use of the change picture bank. What has improved since the last inspection? Each of the nine requirements from the previous inspection in April this year has been met. Following the resignation of the Manager in June, Yarrow`s Care Services Manager (referred to in this report as the Manager), has been responsible for the day to day operation of the service and has been based at the home. The leadership that she has provided and the recruitment of a permanent staff team has resulted in work with the people at the home regaining a sense of direction and purpose. A permanent Manager is being actively sought. Steps have been taken through training and written guidance to ensure that a consistent approach in working with service users is adopted, with strategies in place to manage any challenges. Positive behaviour support plans have been developed following workshops with members of the Learning Disability Team.The Manager is awaiting the comments of the Learning Disability Psychologist before fully implementing the plans. All staff have received training in safeguarding policies and procedures and in the safe use of restraint (SKIP). The number of incidents and challenges has reduced significantly. Action taken in relation to decisions reached at reviews and at other meetings is monitored by means of monthly summaries, which include a record of activities attended. The handling of medication has improved. A change of Pharmacy was being negotiated at the time of the inspection visit to provide pre-printed medication administration record (MAR ) sheets. Much of the day to day guidance for staff has been re-written and made specific to the service, including handling medication, night staff and sleep-in duties and emergency procedures. A permanent domestic assistant is in post. What the care home could do better: There are no requirements from this inspection. Key inspection report Care homes for adults (18-65 years) Name: Address: Barlby Road 37 Barlby Road North Kensington London W10 6AN     The quality rating for this care home is:   two star good 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: Sheila Lycholit     Date: 3 0 1 1 2 0 0 9 This is a review of 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 2 1 0 stars - excellent stars - good star - adequate 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 26 Information about the care home Name of care home: Address: Barlby Road 37 Barlby Road North Kensington London W10 6AN 02089648543 02089648156 info@yarrowhousing.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Yarrow Housing Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: PC Care home only 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 Date of last inspection Brief description of the care home 37 Barlby Road is a residential home for four people with a learning disability. The service is provided by Yarrow Housing Limited. All of the service users, two men and two women, are supported by the Royal borough of Kensington and Chelsea. The building is a semi-detached house in North Kensington, which has been adapted on the ground floor for wheel-chair access. The lay-out of the house provides one bedroom on the ground floor and three on the first floor. All rooms are single and of a good size. There is an office/sleep-in room in a loft extension. Service users attend day services Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 4 1 4 0 4 2 0 0 9 Brief description of the care home in the Borough and are supported to pursue a range of interests in the home and in the community. Care Homes for Adults (18-65 years) Page 5 of 26 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: The unannounced visit took place on Monday 30th November 2009 from 11am until 3.45pm. A Deputy Manager was on duty with 4 support workers. The Manager ( Yarrow Housing Care Services Manager) was at Yarrows head office and returned later in the morning. One service user was out doing his food shopping with staff, one person was initially in bed, having been reluctant to get up. He was supported to get up soon after the start of the visit. Two people were up, had eaten breakfast and later left to take part in planned activities. Survey questionnaires were received from 2 service users who had been assisted by the advocacy service and by 1 family.. Care Homes for Adults (18-65 years) Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: There are no requirements from this inspection. Care Homes for Adults (18-65 years) Page 7 of 26 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 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. Well produced, up to date information about the service is available in an accessible format. Service users needs are regularly assessed with the involvement of the multi professional learning disability team. Evidence: Each of the four service users individual files were looked at. These were in good order and contained recently updated copies of the service users guide, statement of purpose and contract in accessible formats. No new people have moved to 37 Barlby Road for two years since the admission of the last person following a careful and well planned transition. Service users needs are regularly reviewed by relevant members of the multi professional team. For example, a new eating and drinking plan had recently been introduced for one person following a reassment by the Speech and Language Therapist. Care Homes for Adults (18-65 years) Page 10 of 26 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. Person centred plans are of a very good standard. Steps have been taken to ensure that action agreed at reviews is implemented promptly. Risk assessments are comprehensive and regularly updated. Evidence: Person centered plans consisting of photos and text were seen on each persons file. In addition electronic versions are available, which were not viewed at this visit. All PCPs were reviewed in September and October, with the involvement of each service user, using objects of reference and multi media. Copies of actions plans which had been drawn up following reviews were available for each person. The Manager has implemented a system of monthly summaries, which are used elsewhere in Yarrow services, to monitor progress in meeting objectives agreed at reviews and to provide an overview of support provided and action taken during that period. Guidance on communication was seen on each persons file, including objects of reference and Makaton signs used. Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: Risk assessments are regularly reviewed and include risk assessments for specific events such as recent holidays and attendance at the Notting Hill Carnival. Risk assessments seen were written positively focussing on the persons abilities but also anticipating problems and noting strategies to reduce risks. Care Homes for Adults (18-65 years) Page 12 of 26 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. A considerable increase has taken place in the number of activities, both at the house and in the community, in which people at 37 Barlby Road take part. Menus include a wider range of evening and other meals. Evidence: Steps have been taken to ensure that service users take part in a range of activities in line with their plans. Activity plans in an accessible format are displayed on the ground floor. These show that each person takes part in a range of activities each week, in addition to attending Scope, the Councils day service and The Gate, Yarrows own service. Participation is monitored by means of monthly summaries, which record the number of activities and reasons for any not taking place. One person whose attendance at Scope was suspended has still not been offered sessions, other than for very short periods, even though his return has been recommended by the Psychiatrist and by others. The Manager is hoping that agreement to his return will be reached Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: shortly. Three of the four service users have gone on holiday this year, two to Cornwall and one to Blackpool. The fourth persons holiday was postponed because of health concerns. Photos displayed in the house indicate that people had an enjoyable time. Each person is increasing involved in shopping for and in preparing food. Photos show people taking part in preparing meals and guidance in providing support is available for staff. Menus, which are in a pictorial format, are more varied, especially for the main evening meal. Staff encourage healthy eating and takeaways are seldom purchased. Service users occasionally eat out at local cafes and restaurants, including those that reflect their cultural background. Care Homes for Adults (18-65 years) Page 14 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Support profiles provide detailed information, sensitive to peoples needs, on how people wish to be supported with personal care. The health care needs of service users continues to be given a high priority. Steps have been taken to improve the handling of medication. Evidence: Support profiles for each person have been updated and provide detailed guidance on how personal care should be given. The guidance is person centred and service users likes and dislikes, for example, regarding hairwashing and bathing are clearly stated. Service users independence in self-care is promoted as far as possible. Specific guidance on protecting one service users dignity has been developed since the last inspection, which staff were observed to follow. Records show that service users health care needs are regularly reviewed. Concerns, for example regarding loss of weight, are followed up with referral to the relevant health care professional. Eating and drinking plans have been compiled by the Speech and Language Therapist who was running a training session for staff on the afternoon of the inspection visit. Service users are now receiving regular dental treatment. Medication has been reviewed by GPs and consultants. Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: The Manager discussed steps taken to improve the handling of medication, including changing to a Pharmacy that could supply pre-printed MAR sheets. Staff guidance on handling medication at Barlby Road has been updated. MAR sheets seen were up to date and fully completed. A protocol for leave medication for one person who regularly stays with family is now available. Care Homes for Adults (18-65 years) Page 16 of 26 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. An accessible complaints procedure is available and service users have good support from the local advocacy service. Action has been taken to ensure that safeguarding procedures are followed and prompt action taken when there are concerns. Evidence: No complaints have been received since the last inspection. The complaints file has been brought up to date, with details of complaints raised earlier in the year. A copy of the complaints procedure in an accessible format is displayed in the house and copies were seen in each of the service users files. Service users have regular access to the local advocacy service, which has raised complaints and concerns on their behalf. It is recommended that in addition to formal written complaints, other concerns and issues raised, for example by relatives, should be noted to obtain a wider picture of dissatisfactions and to contribute to quality monitoring. These issues are currently noted in daily logs or in the communication book. Safeguarding investigations that were taking place at the last inspection resulted in action being taken both regarding the performance of individual staff and to ensure that a permanent staff team, with relevant skills and training was established. Since the last inspection concerns were raised under whistle blowing procedures, which have been investigated. Training records show that all staff have received training in safe methods of restraint (SKIP), in Yarrow Housings values and in safeguarding policies and procedures. A Care Homes for Adults (18-65 years) Page 17 of 26 Evidence: number of staff have attended training in the Mental Capacity Act. Positive behaviour support plans, to prevent and to manage challenges, were seen on file but the Manager explained that she was waiting for the views of the Psychologist in the Learning Disability Team, who has been involved in training staff, before implementing the guidance. Recent financial transactions for two people were seen. A running total is noted on the finance sheet and receipts are kept for all expenditure. The Manager explained that a recent taxi fare paid by a service user to his day service would be reimbursed, as he had mislaid his taxicab card that morning. Care Homes for Adults (18-65 years) Page 18 of 26 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. 37 Barlby Road is indistinguishable from neighbouring houses, close to local services and provides well adapted accommodation that meets the needs of the four people who live there. . Evidence: The house provides pleasant, well adapted accommodation for the four service users. Each has a bedroom of above average size. The Manager said that the sensory room has been rearranged and provides people with an alternative setting to the sitting /dining room. One persons room was seen, with his agreement, which was suitably furnished and equipped. Since the last inspection a permanent domestic assistant has been appointed and the house was clean and tidy. Care Homes for Adults (18-65 years) Page 19 of 26 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. Considerable progress has been made in establishing a full staff team, including covering the Deputy Manager posts. A training programme based on the needs of the service is being implemented. Evidence: The majority of the 6.5 support staff vacancies noted at the previous inspection in April this year have been filled. The remaining vacant post is covered by a longstanding bank worker who knows the service users. One Deputy Manager who was previously working part-time at Barlby Road has been full-time since June. The other Deputy Manager post has been covered temporarily by an experienced member of staff transferring from another service. As the previous Deputy Manager has confirmed that she will not be returning after maternity leave, a new Deputy Manager was starting the following day. On the day of the inspection visit one member of staff had called in sick. However another member of staff had started her shift at an earlier time and service users planned activities were not affected. The rotas show that sufficient staff are on duty to provide support, including accompanying people on community activities, where a ratio of two staff to one person can be needed. Staff are recruited by Managers and Yarrows HR staff. Staff recruitment records for a number of projects were checked at Yarrows Head Office on 2nd December and found Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: to be in good order, with all required information on file. The Manager confirmed that satisfactory criminal record checks were received for all staff and provided a list of reference numbers. Staff have access to an established training programme, including mandatory training, specialist workshops based on the needs of the service and NVQs. All staff, with the exception of the four most recently appointed staff, have at least NVQ2. The Manager confirmed that staff would be enrolled on NVQ 2 and 3 later in December and in January. Staff are supported and performance monitored by induction, probation reports, annual appraisal and regular supervision. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Head of Care Services in managing the day to day operation of Barlby Road has provided leadership to the team and has re-established the services person centred practice. Evidence: The Care Services Manager has been based at Barlby Road and directly managing the service since the resignation of the Manager in June. Her direct involvement has been very beneficial in addressing the concerns raised by other agencies earlier in the year and in the previous inspection report. In discussion the Care Services Manager confirmed that Yarrow Housing has been actively seeking a permanent Manager. She herself has interviewed approximately 20 people recruited by a specialist agency. She was planning to interview 3 more candidates later in the week of the inspection. Yarrow Housing has a range of quality assurance systems, which include the involvement of users, including a regular forum, membership of the Board and an annual survey. Training records show that staff receive training in health and safety, including refresher training. Guidance regarding emergency procedures and duties of night staff Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: and sleep-in staff have been revised. Health and safety records seen were up to date. Night staff carry out a range of health and safety checks which include testing fridge and freezer temperatures, hot water temperatures and cleaning equipment. Visits on behalf of the provider under regulation 26 are taking place regularly, with reports available. Progress in addressing concerns at Barlby Road has been regularly reported to Yarrows Board. Care Homes for Adults (18-65 years) Page 23 of 26 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 24 of 26 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 22 It is recommended that all concerns raised are noted in the complaints file, in addition to formal written complaints, to inform the development of the service. Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 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 26 of 26 - 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. 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