Care Home: Boniville House

What the care home does well `I go out every day. The staff will always help me if I ask them`. Comment from a resident. `I always like the food, there`s plenty of choice`. Comment from a resident. `It`s my job to help people to be as independent and safe as possible`. Comment from a member of staff. `The service uses a client centred and holistic approach`. Comment from a health care professional. `I have complained and the staff dealt with it for me`. Comment from a resident. During this visit, residents told us that they were happy with the care and support they received at Boniville House. They told us that the manager and staff worked to provide them with opportunities to develop their independence. We saw that the home had good care planning systems and people`s care needs were regularly assessed and reviewed, involving other people whenever possible. The home provides a good standard of homely accommodation and residents told us that they were happy with their bedrooms. The records we checked during this visit were up to date and well maintained by staff. What has improved since the last inspection? When we inspected the home in 2008, we made eight requirements to improve standards of care planning, safeguarding adults practice and the management of complaints. During this visit we found that all of these requirements had been met. Standards of care planning and safeguarding practice were good, the owner / manager told us about significant incidents affecting people living in the home and people`s dietary needs were met. What the care home could do better: Following this visit we have asked the home`s owner / manager to make sure that the Statement of Purpose and Service User Guide are updated to reflect recent changes in regulation and the role of the Care Quality Commission. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Boniville House 17 Melrose Avenue London NW2 4LH     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: Tony Lawrence     Date: 0 1 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. 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 © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Boniville House 17 Melrose Avenue London NW2 4LH 02084501755 02088306984 boniville_house@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Mabel Dingiswayo care home 5 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 5 The maximum number of service users who can be accommodated is: 5 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: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Boniville House is a registered care home that provides accommodation and support for a maximum of 5 residents with mental health problems. When we visited, two men and two women were living in the home and there was one vacancy. The home is located in a residential part of Willesden and is close to local shops and transport links. Parking is restricted in the street outside the property during the daytime, Monday to Saturday. There is off street parking for 2 cars. The property consists of a ground, first and second floor. There are 5 single bedrooms, one of which has en-suite facilities. There are two bathrooms, each containing a toilet. The office is situated on the ground floor. There is a small garden at the rear of the premises. Information regarding the level of fees may be obtained, on request, from the manager of the home. Care Homes for Adults (18-65 years) Page 4 of 28 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 unannounced key inspection of the home took place on Friday 29th May 2009 from 09:15 - 10:15 and Monday 1st June 2009 from 09:30 - 12:30. During these visits we reviewed the outcomes for residents against the National Minimum Standards for Care Homes. We did this by talking with residents, the manager and staff and checking care records kept in the home. We also received surveys from four people who live in the home, four of the staff team and two health care professionals and we have included their comments in this report. The manager also sent us the Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service and we have used information from the AQAA in this report. Care Homes for Adults (18-65 years) Page 6 of 28 Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: 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 8 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 9 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. The provider has developed clear information to help people understand what specialist services the home can provide. Admissions are not made to the home until a full needs assessment has been completed and the provider is confident staff have the skills needed to meet the persons needs. Evidence: We provide a statement of purpose and service user guide to provide information on the services and facilities that the home provides. Our statement of purpose positively promotes residents rights and encourages equality and diversity. Extract from the providers Annual Quality Assurance Assessment (AQAA). During this visit there were two women and two men living in the home and one vacancy. The manager told us that she was considering a referral for the vacancy and she had visited and completed a full assessment of the persons care needs. The person was due to visit the home the day after our inspection to meet other residents and staff and see the accommodation offered. Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: We saw that the home had a good Statement of Purpose and Service User Guide that gave potential residents and placing authorities good information about the services provided. The manager should make sure that these documents are updated to reflect recent changes in regulation and the role of the Care Quality Commission. Care Homes for Adults (18-65 years) Page 11 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. The home involves residents in the planning of care that affects their lifestyle and quality of life. Staff understand the importance of residents being supported to take control of their lives and individuals are encouraged to make their own decisions and choices. Evidence: We assess all residents and develop individual care plans which are based on a comprehensive assessment of changing needs, aspirations and goals. All care plans are drawn up in conjunction with the service user and their families, if applicable. Extract from the providers Annual Quality Assurance Assessment (AQAA). We fill in a questionnaire every month to tell the staff what we think about the home. Comment from a resident. Its my job to help people to be as independent and safe as possible. Comment from Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: a member of staff. During this visit we spent time talking with three of the people who lived in the home and we checked the care plans for two of these people, with their permission. We saw that both of the care plans had been reviewed and updated in April 2009 and the residents had each signed to say that they had agreed their own plans. The care plans we saw included information about each persons personal and health care needs and how these would be met in the home. Both of the plans included good information and guidance for staff on how each person should be supported. The manager told us that each person living in the home was given the opportunity to complete a Putting Residents First survey each month. We saw that people were supported by staff or other people to complete the surveys and the results were used to develop an action plan to improve outcomes for residents. Residents also told us that they had a house meeting every two months with the manager and staff to talk about how the house was running. We saw evidence that these meetings took place regularly and a good record was kept of issues discussed and agreed actions. We also saw that the manager and staff had completed risk assessments for each of the people living in the home. The assessments covered people going out alone, smoking, medication and aggression. We checked the risk assessments for two people and saw that these had all been reviewed and updated in April 2009. The assessments clearly identified potential risks for each person and included good guidance for staff on how identified risks should be managed and minimised. Care Homes for Adults (18-65 years) Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are involved in meaningful day time activities of their own choice and according to their individual interests, diverse needs and capabilities. The home is committed to the principles of inclusion and promotes and fosters good relationships with neighbours and other members of the community. Evidence: We encourage residents to maintain social, emotional and independent living skills. We support residents in maintaining personal relationships with their families and friends. We also encourage them to forge new contacts within the local community. Extract from the providers Annual Quality Assurance Assessment (AQAA). I go out every day. The staff will always help me if I ask them. Comment from a resident. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: I always like the food, theres plenty of choice. Comment from a resident. During this visit we spoke with residents about their daily lives and their involvement in activities in the home and the local community. Two people told us that they went out independently every day and we saw that this was recorded by staff in the daily care notes. People told us that they went shops, cafes, hairdressers and the library in the local community and further afield. We also saw that people had the opportunity to take part in a range of activities in the home. A selection of books, DVDs and games was available in the lounge and residents bedrooms. Residents had also completed a questionnaire from the provider, asking for their interests, hobbies and activities they preferred. The two care plans we saw during this inspection included good information about residents relatives, friends and other significant people. Three residents told us that staff supported and helped them to keep in touch with these people. We saw that peoples rights and responsibilities were detailed in the Service User Guide and their care plans. Three residents told us that they were registered to vote in local and general elections. We checked the homes menus and saw that a varied and nutritious selection of meals was provided. Residents told us that they enjoyed the food provided in the home. Care Homes for Adults (18-65 years) Page 15 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 receive personal and health care support using a person centred approach with support based on the rights of dignity, equality, fairness, autonomy and respect. Residents have access to appropriate health care and remedial services. Evidence: We provide sensitive and flexible personal support to enhance our residents independence and control over their own lives. We ensure the health care needs of all our residents are assessed and procedures are put in place to meet them. Extract from the providers Annual Quality Assurance Assessment (AQAA). The staff help me with my medication and I can always see the doctor if I need to. Comment from a resident. The service uses a client centred and holistic approach. Comment from a health care professional. Staff at the care home have very good working relationships with service users and Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: those who attend to them. There is a homely atmosphere any time I visit. Though I only care and attend to my client, the other service users also come and chat with me. This shows the sense of freedom and respect among the service users. Comment from a health care professional. During this visit we checked the health and personal care records for two people living in the home. We saw that the care plans detailed the support that each person needed with their personal care and how this would be provided by staff. The plans emphasised what each person could do for themselves and any additional support they needed. Two residents we spoke with told us that staff always respected their privacy and dignity. Residents health care needs were very well recorded in their care plans. The two residents we reviewed during this visit had both had an annual health check and medication review with their GP, one in April and the other in May 2009. We saw that staff kept a good record of all health care appointments and recorded each residents weight and blood pressure each month. Both of the residents whose care we reviewed during this visit had seen the dentist, optician and chiropodist during the previous 12 months. The home used the Boots Monitored Dosage System for each residents prescribed medication. We saw that all medication was securely stored and administration records were well completed by staff working in the home. Care Homes for Adults (18-65 years) Page 17 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. Residents tell us they are happy with the service provided, feel safe and well supported. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. The policies and procedures for safeguarding adults are available and give specific guidance to those using them. Evidence: We ensure there is a clear and effective complaints procedure in place, which includes the time scales and stages of the complaints process. We have clear policies and procedures in place regarding the protection of residents and the safeguarding of their rights. Extract from the providers Annual Quality Assurance Assessment (AQAA). If I wanted to complain, Id speak to the staff or manager. Comment from a resident. I have complained and the staff dealt with it for me. Comment from a resident. When we last visited the home in 2008, we made requirements to improve the recording of complaints and to make sure that staff were aware of local safeguarding adults policies and procedures. During this visit we spoke to staff and checked the complaints and safeguarding records kept in the home. We found that staff had a good awareness of local procedures and knew what to do if they had concerns about residents. The recording of complaints had also improved and now included details of Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: actions taken by the manager and staff when they received complaints. The manager and staff also told us that all staff working in the home had completed training on the Deprivation of Liberty Safeguards, the Mental Capacity Act and safeguarding adults. We saw that there had been no safeguarding adults issues since our last visit. Care Homes for Adults (18-65 years) Page 19 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. The home provides an environment that is appropriate to the needs of the people who live there. The home is a very pleasant, safe place to live. The environment promotes the privacy, dignity and autonomy of residents. Evidence: We provide a well maintained, safe, comfortable and attractive home environment which meets all our residents individual needs. All windows throughout the home have been replaced. Extract from the providers Annual Quality Assurance Assessment (AQAA). I am happy with my room, it has everything I need. Comment from a resident. I like my room, I can spend time there whenever I want. Comment from a resident. Boniville House is located in a residential street in Willesden. It is close to local shops and transport links, including Willesden Green underground station. Parking is restricted in the street outside the property during the daytime, Monday to Saturday. There is off street parking for 2 cars. The property consists of a ground, first and second floor. There are 5 single bedrooms, one of which has en-suite facilities. There Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: are two bathrooms, each containing a toilet. The office is situated on the ground floor. There is a small, attractive garden at the rear of the premises. During this visit we saw all communal parts of the home and two of the residents bedrooms, with their permission. All of the parts we saw were clean, hygienic, well decorated and comfortably furnished. Residents bedrooms were spacious and very individual and people told us they were very happy with their rooms. 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 have confidence in the staff who care for them. People who live in the home tell us that staff working with them are very skilled in their role and are consistently able to meet their needs. Evidence: All staff have the correct level of competency and qualifications to meet our residents needs and the homes high standards. All prospective members of staff are subjected to a stringent vetting process with background checks and the obtaining of satisfactory references before a position of employment is offered. Extract from the providers Annual Quality Assurance Assessment (AQAA). The staff are all very, very good. They always help me if I need them to. Comment from a resident. I like all of the staff, they always help me if they can. Comment from a resident. I can do all of the training I need to do my job. Comment from a member of staff. During this visit we spent time talking to residents, staff and the homes owner / Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: manager. All of the residents we spoke to were very positive about the care and support they received from the homes staff team. Staff were also very positive about working in the home and were able to tell us about each of the residents care and support needs. We saw that a good record was kept of staff meetings that were held every two months. The meetings were used to discuss the day to day running of the home and individual residents care and support needs. During the day we spent in the home, we saw that all staff worked well together to make sure that people were supported appropriately. We also checked the staff files for one person working in the home and a second person who had just been recruited. We saw that all of the staff necessary checks were in place, including references and Criminal Records Bureau (CRB) checks. The owner / manager demonstrated a very good awareness of the importance of completing all of the required checks before employment. We saw records for permanent staff that showed people had access to regular, relevant training. All permanent staff were qualified to National Vocational Qualification (NVQ) level 2 standard and the manager also told us that one person was working towards her NVQ Level 4 in Health and Social Care. 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. The owner / manager has, or is completing, the required qualifications and she has the experience to manage the home. She has a clear understanding of the key principles and focus of the service and works continuously to improve services. Evidence: The registered manager has created an ethos within the home that is open, transparent, positive and inclusive. The views of the residents and staff are listened to and valued. The views of residents are sought and considered in order to protect the residents and achieve efficient running of the home. Extract from the providers Annual Quality Assurance Assessment (AQAA). We have a questionnaire each month and meetings where we talk about changes we want to make things better here. Comment from a resident. The homes owner / manager is a qualified nurse and midwife. She told us that she was completing the national Vocational Qualification Level 4 award for registered Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: managers. During this inspection the manager demonstrated an excellent awareness of current best practice and developments in social care, including the Mental Capacity Act and Deprivation of Liberty Safeguards. Residents told us that they met regularly with the manager and staff and had the chance to complete a Putting Residents First questionnaire each month. People told us that this was a good way of making sure that their views were heard and they were involved in the day to day running of the home. During this visit we checked a selection of records kept in the home, including residents care plans and risk assessments, medication and staff records. We found that all records were well maintained and up to date. care plans and risk assessments were updated regularly and we saw good evidence that people were involved in these reviews. We checked health and safety records and saw that all of the required testing and servicing took place regularly. 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 1 The manager should make sure that the Statement of Purpose and Service User Guide are updated to reflect recent changes in regulation and the role of the Care Quality Commission. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 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. 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