Care Home: Bourne House

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What the care home does well Bourne House is well run by a manager who supports the staff team well, and who makes sure that the views and thoughts of the people living in the home are listened to and acted upon. The home uses pictures to help people to express how their needs should be met and the activities that they like to take part in. These picture also help people who live in the home to make decisions about things that are important in their lives. The manager meets with all of the staff often to discuss any issues that they have, and to ensure that the home is running well . At this time the manager talks to staff about what they need to do and how they need to do it, to ensure that people living in the home are given good support. What has improved since the last inspection? Since the last key inspection undertaken in May 2007, staff who support, and provide help and guidance to more junior staff members have received training to help them carry out this role. What the care home could do better: The person in charge needs to develop a way of ensuring that they can keep a record of any concerns or complaints that may be made about the home, so that they are able to keep a record of any action taken. The person in charge of the home needs to make sure that the staircase to the left of the laundry room is made safe, so that the risk of people falling is kept to a minimum. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Bourne House 119 Mersea Road Colchester Essex CO2 7RL     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: Neal Cranmer     Date: 1 6 0 7 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 29 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 29 Information about the care home Name of care home: Address: Bourne House 119 Mersea Road Colchester Essex CO2 7RL 01206573336 01206573336 kp@essexautistic.org.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) : The Essex Autistic Society care home 4 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 4 The maximum number of service users who can be accommodated is 4 The registered person may provide the following categories of service only: Care Home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Date of last inspection Brief description of the care home Bourne House is a family sized home and was opened in September 2002 by the Essex Autistic Society. The house provides accommodation and care for up to four adults with autism. The house is well decorated and furnished. There is a garden to the side of the house providing some privacy for service users. The service has good links with educational establishments and leisure services in Colchester, to the benefit of service users. The house is within walking distance of Colchesters main shopping area. Small shops and health services are very close to the house. The range of monthly fees supplied to the Care Quality Commission and charged by Care Homes for Adults (18-65 years) Page 4 of 29 Brief description of the care home the Society is currently between £1,154.79 and 1,172.33 per week. There are additional charges for activities during the evenings and weekends. Individual service users meet all personal clothing, and items such as magazines and haircuts. Individual service users contribute £10:00 weekly towards transport costs in the evenings and weekends. Holidays - staffed accordingly with appropriate ratios. Staffing costs, transport and food between 9.00am and 5.00pm are met by the Society. Information regarding the homes fees was provided to us during the key inspection visit undertaken on the 16th of July 2009. Information about the service, including inspection reports, are made available to prospective service users through a pack containing information about all of the services provided by the Society, the Statement of Purpose, a current Newsletter, and literature regarding the Societies Jigsaw Study Centre. Care Homes for Adults (18-65 years) Page 5 of 29 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: We visited Bourne House on the 16th of July 2009, without telling the person in charge of the home that we would be doing so. We spent a total of four hours at the home during which time we spoke with people living in the home, the staff supporting them and one of the homes managers. As well as speaking to all of these people we spent time looking through paperwork and files. These documents and files help us along with the talks we have with people to get an idea of what it is like to live in Bourne House. To help us further we also spent time looking around the home, this included looking in rooms that people share, as well as peoples own living areas. To help us write the report. The manager sent us their AQAA which is required by law and provides information about the home, and which told us what they thought the Care Homes for Adults (18-65 years) Page 6 of 29 home did well, as well as anything that had been done to make the home nicer, and anything that was being planned to make the home even nicer. 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 29 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives are provided with the necessary information needed to enable them to make an informed choice about the homes ability to meet their assessed needs. Evidence: The home had a Statement of Purpose and Service Users Guide, copies of which were seen to be held in the care plan files of the people who were case tracked as part of our inspection. Both documents provided information about the structure of the service, the qualifications of the staff and the facilities provided. Both documents also included information about the homes complaints and admission processes. Both documents were well detailed and together combined to provide prospective service users or their representatives with a good level of information to enable them to decide if the home would be able to meet their needs. Both documents were last updated and reviewed in August 2008. There have been no new admissions made to the home since 2001, all of the people Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: living in the home have lived together since they first moved into the home. However as mentioned previously reference to the homes admission process was contained in the homes Statement of Purpose. The homes AQAA states that any referral for admission would be thoroughly assessed as to the suitability of the person both environmentally as well as their compatibility with the people already living in the home. The AQAA goes on to state that following assessment a comprehensive transition package centered around the person would be set up and reviewed throughout the transition period. This would suggest that the home has in place processes which would enable them to assess the needs of future service users well and enable them to initiate a plan of care for the person. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported to be involved in making decisions about their lives and to have a part in planning the care and support that they receive. Evidence: Four care plans were case tracked as part of our inspection, all were person centered and clearly detailed the care and support required for people living at the home. Changing needs and personal goals were also reflected on in the plans seen. The deputy manager reported that a key-worker system operates in the home to enable staff to work on a one to one basis with service users, an example was seen of this when a key-worker was seen supporting a service user to attend an activity (sailing) that they take part in on a weekly basis, during the summer months. Records sampled indicated that service users were supported to make decisions independently within a risk management process, or through a consultative process which included group meetings and close working arrangements with the staff who Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: supported them on a daily basis. General and more specialist risk assessments were seen on individual files inspected that helped to ensure that staff were aware of any issues that might restrict people living in the home from certain activities, both in the home and within the community. Discussion with the deputy manager as well as sampling of records indicated that one person living in the home was accessing an advocacy service and had an advocate who visited them periodically as a befriender. Sampling of records and the homes visitors book indicated that the advocate usually visited twice yearly. None of the people living in the home were able to manage their own financial affairs, therefore it was reported by the deputy manager that the registered manager acts as their appointee in regard to their benefits. Records were sampled for two of the people who were being case tracked and were found to be in order, with a clear audit trail of any income and expenditure. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service are supported to make choices about their lifestyle and are supported to develop their life skills. Evidence: From information gained through notices around the home, including service users accommodation, it was evident that the society has a strong commitment to enabling, organising and supporting programmes of educational, social and recreational opportunities for the people living in the home. On the day of the inspection visit the programme of activities confirmed the movements of the service users and the staff who were supporting them. The care plans that were case tracked contained details regarding activity planning and recording and these details included the likes and dislikes of the individual. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: On the morning of our visit one service user was observed preparing to go out sailing with their key-worker. Discussion with the service user and the member of staff indicated that this was a regular activity that took place bi-weekly. A second service user was seen to be supported to go out on a railway trip and indicated both verbally and by their facial expression how much they were looking forward to their trip. The activity planner for the home is posted in the hallway of the home and was presented in a pictorial format to assist service users with reading difficulties. Observation of service users using the planner indicated that they were aware of their activities and the activities taking place on the day of our visit were those that were identified on the planner. All of the people living in the home attend the local educational college or the Societys Study Centre where they participate in life skills training. Overall service users access a wide range of educational, social and leisure pursuits. The home operates a key worker system and the key workers support service users to maintain contact with their families by telephone and the writing of cards and letters. One person living in the home is supported to maintain contact through the sending of e-mails because their family live abroad. This particular person has an advocate who they maintain contact with throughout the year. Sampling of the homes visitors book showed that relatives were regularly visiting the home and evidence was also seen of the advocate having also recently visited. Menus are planned weekly in consultation with the service users who confirmed that they were consulted with about their wishes of what should be on the menu. One person confirmed that their favorite meal of curry was on the menu and also when they had last had a curry. Service users are supported to assist in meal preparation and also help with the tidying up after the meal. The menu sampled was varied and nutritious and clearly showed where service users had made a choice. The manager reported that the main meal of the day is usually taken in the evening to facilitate peoples day time activities. people living in the home are supported to participate in shopping, this was identified on the homes activity planner and recorded in peoples care plans. The homes food stocks were sampled on the day of our inspection visit and were adequate to meet the needs of the people living in the home. Service users spoken with during the course of our visit indicated that the meals were nice, evidence was seen around the home of fresh fruit being available and service users were observed helping themselves to fruit as and when they wanted some. Care Homes for Adults (18-65 years) Page 15 of 29 Care Homes for Adults (18-65 years) Page 16 of 29 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. The health and personal care that people receive is based upon their individual needs and the principles of respect, dignity and privacy are put into practice. Evidence: Service users care plans included health care requirements with records in place to evidence referrals, visits and outcomes of visiting professionals. Also service users visits to General practitioners and hospital appointments. All of the service users access community based services including dentists and opticians. Records seen indicated that a reflexologist and a chiropodist however do visit the home. This indicated that thier was a commitment by the staff team to ensure that service users healthcare needs were adressed. Records sampled and discussion with the manager in charge at the time of our visit indicated that all of the service users were fully independent in terms of meeting their personal care needs. At the time of our inspection visit none of the service users living in the home were Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: able to take responsibility for their own medication. Medication records examined were fully completed and showed that all relevant entries had been made. The home operates a Measured Dosage System (MDS). All staff working in the home are responsible for administering medication following receipt of training provided by the dispensing chemist. Sampling of staff records confirmed that staff had attended training in the administration of medicines. The homes storage arrangements regarding medication were satisfactory, medication was stored in a metal locked cabinet in the staff sleep-in room. The homes arrangements for the administration of peoples medication were sufficiently robust enough to ensure that people were being protected by the homes practice. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can expect to be supported to express their concerns and to have access to a robust, effective complaints procedure. Evidence: The home has a complaints procedure that is made available to people who live in the home and which is clearly written and easy to understand (the procedure was also available in a pictorial format, to assist people with comprehension difficulties to have access to it and a copy was displayed prominently in the home. At the time of our inspection visit no complaints had been received in respect of the home since out last key inspection visit was undertaken in May 2007. It was however noted that the home does not have a complaints log for recording any complaints that they may receive and it was recommended that they should develop one. The homes adult protection policy and procedures, including Whistle Blowing, were comprehensively detailed and provided staff with the necessary information to enable them to know what to do in the event of being presented with an adult protection issue. Viewing of staffs training records indicated that they had received training on Adult Protection, which was periodically updated. Staff spoken with were knowledgeable about adult protection and were confident that they would know how and to who they should report any concern too. No adult protection referrals had been made in respect of the service since our last key inspection undertaken in May 2007. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: Care Homes for Adults (18-65 years) Page 20 of 29 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 physical design and layout of the home enables people to live in an environment that is safe, well-maintained and comfortable, in which they may with support develop their independence. Evidence: A conducted tour of the premises was undertaken with the manager and included service users personal living space, bath and toilet facilities, as well as communal living areas. The environment was generally good, although it was noted that the bathroom was rather tired and worn. However the manager reported that estimates had been sought in regard to this issue. These estimates were provided to confirm this at a later time during the inspection. The kitchen had recently undergone refurbishment and was awaiting the tiling to be completed to complete its refurbishment. Bedrooms visited were seen to contain evidence of personal items and possessions and were clean and tidy. No offensive odours were noted during the tour of the home. The homes laundry facility is located away from the main building and contains sufficient equipment that is domestic in style and suitable for the needs of the people living in the home. However the laundry room is positioned at the top of a small flight Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: of steps, to the left of which is a further steep flight of steps which leads down to a side foot path( not in use).This flight of steps may pose a serious fall hazard to both service users and staff and it is recommended that some action should be undertaken to minimise this risk. Service users were supported by their key workers to be involved for caring for their clothing and on the day of our visit people were tidy and well presented. Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are well trained and are available in sufficient numbers to support the people who use the service and to enable its smooth running. Evidence: Staff training continues to be supported by the Society both internally and externally.The training needs of staff continues to be identified during supervision sessions and the Societys induction programme. The home employs six care staff Discussion with the manager and comments taken from the homes AQAA indicated that of these six three have a National Vocational Qualification (N.V.Q) at level two or better. Discussion with staff and sampling of records indicated that access to staff training is good, records sampled indicated that staff had received a good level of training to enable them to meet the diverse needs of the people that they were supporting, this training included: infection control, adult protection, deprivation of liberties, food hygiene, fire safety, medication administration, first aid and supervision and appraisal. In addition staff confirmed that health care professionals employed by the Society provide them with the advice, support and specialised training that they found beneficial to the work they undertake with people living in the home, particularly regarding communication techniques. This training indicated that staff had the necessary skills and knowledge to meet the needs of the people who they were Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: supporting. The homes recruitment practice was sampled through the viewing of three staffs files, all of which contained evidence of all of the required information and checks being undertaken by the home before staff commenced working in the home. These checks included obtaining references, proof of identity and adult protection and criminal records bureau checks. All of these checks indicated that the home was carrying out a robust recruitment process that protected service users. The registered manager and their deputy carry out staff supervisions with appropriate records kept. Since the last key inspection undertaken in May 2007, staff providing supervision have attended supervision and appraisal training to assist them in their task relating to providing supervision and appraisal. Care Homes for Adults (18-65 years) Page 24 of 29 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 management and administration of the home is good and there are systems in place that enable peoples views to be sought. Evidence: The registered manager is experienced in caring for and supporting people who are autistic and has progressed through the Societys ranks to the role of registered manager and holds the registered managers award. Discussion with staff during our inspection visit about the management of the service were positive, they spoke of support and good communication always being at hand. Staff also commented on the managers commitment to working towards improving services with a strong focus on equality and diversity. The home uses surveys to obtain the views of service users and other interested parties. These surveys are sent out on an annual basis and sampling of relatives surveys returned for the year 2008 were very positive. Comments included: I think Bourne House is run excellently and the staff are efficient and friendly We as parents Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: are more than happy with our relatives care and placement. Health and safety issues within the home are well managed, with all appropriate checks and servicing of equipment being undertaken as required. These checks included: portable appliance testing, gas installation, electrical installation and fire drills. As mentioned elsewhere in this report staff have received training in infection control, health and safety and fire safety. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 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 the home develop a complaints log, to enable them to maintain a record of any complaints that may be received in respect of the home. Care Homes for Adults (18-65 years) Page 28 of 29 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 29 of 29 - 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!