Care Home: Bracken Villa Care Home

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Bracken Villa Care Home 6 Bracken Lane Retford Nottingham DN22 7EU     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: Dawn Podmore     Date: 0 5 0 3 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: Bracken Villa Care Home 6 Bracken Lane Retford Nottingham DN22 7EU 01777719720 01777719645 jimstusimpson@aol.com 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) : Voyage Ltd care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 8 Bracken Villa is a detached house, set within its own grounds, close to the centre of Retford. There are also 2 small self-contained flats, which provide accommodation for 2 service users who are semi-independent. Car Parking is available on the drive and on the street too. There is a large attractive garden to the rear of the property, which includes a sensory area, developed with input from the residents. Six residents with learning disabilities are accommodated in single bedrooms, one of which is on the ground floor, within the main home. The property benefits from a large lounge and separate dining room. In addition, there is a kitchen with a large attached conservatory. On the day of the visit fee rates ranged from one thousand and forty one pounds and fifty nine pence to two thousand and ninty pounds and seventy nine pence per week. Residents are expected to pay for hairdressing, nail care, major outings and holidays etc in addition to these fees. Information about these costs as well as the day to day operation of the home, including a copy of the last inspection report, are available at the home. Care Homes for Adults (18-65 years) Page 4 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 key inspection was unannounced and took any previous information held by C.S.C.I about the home into account. Throughout this report the terms we and us refers to the Commission for Social Care Inspection (CSCI). Before the the visit the provider had returned an Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans for improvement over the next twelve months. We also sent out surveys to residents and staff, some of which were returned in time to be included in this report. The main method of inspection used was called case tracking. This involved selecting a Care Homes for Adults (18-65 years) Page 5 of 28 proportion of residents and tracking the care they received through the checking of records, discussions with them and the staff who care for them, and observation of care practises. A partial tour of the home was also conducted, which included looking at some bedrooms, communal areas and bathing and toilet facilities. Documentation was sampled and the care records of the three people being tracked were examined. We spoke with all 7 residents, three members of staff and a visiting community psychiatric nurse. They shared their views about how the home operated on a day to day basis and the support and facilities provided. The acting manager was available during the visit and the general outcomes of the visit were discussed with her. On the day of the visit 7 people were living at the home. What the care home does well: What has improved since the last inspection? What they could do better: There are areas of the home that need repairing and redecorating. This includes some residents rooms and the exterior paintwork at the rear of the building. Other areas that would benefit from some attention included the following. Care plans should be developed further so that they reflect peoples individual aims and aspirations in life better. They should also contain information about recent legislation that is designed to protect peoples rights and choices. This is so the home can show that they have looked at the effects the legislation has on the residents lives and planned their care accordingly. Staff should receive appropriate training in these subjects so that they know their role in supporting people. New staff had received an induction to help to prepare them for working at the home. Care Homes for Adults (18-65 years) Page 7 of 28 However clearer recording would be beneficial to show the depth of the guidance and training they had undertaken and the dated they finished it. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have access to the information they need to decide if the home can meet their needs. The home has a comprehensive system in place to assess peoples needs prior to admission. This means that they can make sure that the home can support them appropriately before they move into the home. Evidence: People have access to very clear information about the home, this includes the Service Users Guide which was available in each residents bedroom. A review of all information available prior to this visit, and the content of people care records, showed that the home does not admit people without a comprehensive assessment of their needs being completed. The assessment record of a new resident showed that information had been collected about their needs and what support they required. This included potential risks and their expectations from the home. Assessments were thorough but there were some sections that had minor gaps in the information collated. Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: Trial visits had been arranged to introduce them to the other residents, these included a short visit followed by invitations to lunch and a sleepover if possible. Existing residents had been asked if they were happy with the new person moving into their home. 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. People are empowered to make choices about their lives and feel that they are supported to lead their lives as they prefer. Care plans provide a person centred approach to providing the right level of support while acknowledging that people can take responsible risks. Evidence: We looked at two support plans for people with different needs. They were written in the first person and contained comprehensive information about their needs and preferences, providing staff with a person centred approach to delivering their support. They did not clearly outline peoples individual aims and aspirations for the future, but comments from residents showed that these were being taken into account. Risk assessments were included in peoples files identifying areas of potential risk. They included everyday life experiences such as going into town safely, as well as more critical areas. These included behavioural triggers and told staff how to manage any Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: incidents. Identified areas of potential risk had been incorporated into the care planning process. Care reviews had taken place and staff said that residents were involved in these if they wanted to be. Monthly wellbeing evaluations had also been completed. A Community Psychiatric Nurse was undertaking a review for one of the residents on the day of the visit . He made positive comments about the level of care and support the home provided and the abilities of the staff. He told us, on the whole Im very happy with the home, and staff are very good. The home has not yet included the content of the Mental Capacity Act into the care planning process. This is new legislation that is aimed at protecting peoples rights and choices. Residents told us that they were happy at the home and that staff were meeting their needs. They said that they were able to make decisions and choices about their daily lives. There is a key worker system in place so that each resident has a named person they can relate to. Staff were knowledgeable about the people they supported and the need to encourage independence, giving good examples. They described how they tried to make sure that residents were as involved as possible in making choices about their daily lives. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to follow their chosen lifestyle and have access to a variety of leisure activities. People benefit from being fully involved in the running of the home. Evidence: Each resident had a plan for meeting his or her social needs. They also had a programme of their preferred weekly activities and there was a board in the dining room where they could put a tick against things they wanted to take part in. People said that they had plenty to do at the home, this incuded, games, Nintendo Wii, DVD night and free time where people decide how they want to spend their time. This could be doing things like playing Monopoly or painting. They also told us that they took part in community activities like bowling, swimming, cinema, Club 87, shopping and Dove Dance. There is a 9 seater minibus available for outings. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: Staff are currently working with residents to develop holiday arrangements. In the past people have gone to Bruges on a regular basis, but the manager wants to offer more varied options. An activities meeting is held regularly and the manager said that these would be used to discuss new holiday possibilities on an individual basis. Staff said that some people either had or were due to start voluntary jobs outside the home. One resident told us that they worked at a farm and another said that he was going to work in a charity shop shortly. Staff said that the new manager had opened up this area by sourcing jobs and training opportunities for people Residents are encouraged to carry out their own household tasks to promote their independence. This includes washing and ironing their own laundry, cleaning their rooms and helping in the kitchen. Staff provide support as needed. Two of the residents showed us round the kitchen and explained how menus were developed. They said that each resident takes it in turn to prepare a meals, which they prepare with support from staff. They told us that meetings were held to discuss peoples choices and a folder with pictures of various food options was used for residents to select what they wanted and add it to the magnetic board on the kitchen wall. Staff demonstrated a good knowledge of the support people needed and what they could do themselves. They were seen to include residents in decision making during the day and interacted very positively with them. One resident told us, I do a lot of things, like play on my PS2, watch DVDs and television. Another said, we chose what we do, we just pick what we want to do and tick the board. 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. There are good processes for the provision of personal and health care support, which meet the needs and wishes of the residents. People are able to manage their medications themselves if they can, but if they need help staff are trained to support them with it in a safe way. Evidence: People told us that they were happy with the way staff supported them regarding their daily lives, including their health needs. Health booklets were being completed so that people could take them to appointments with them. However the ones we looked at were not fully completed yet. Records and peoples comments showed that residents had access to outside agencies such as specialist nurses, doctors, chiropodists and opticians. Records and discussions demonstrated that the home has satisfactory policies and procedures concerning the receipt, storage, administration and disposal of medications. No issues were highlighted by the pharmacist following his visit in Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: September 2008. Although there were no residents looking after their own medications when we visited, systems were in place for this to happen. 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 are protected by clear policies and procedures for handling complaints and allegations of abuse. Evidence: The home has a complaints procedure, which tells residents and relatives how to make a complaint and how it will be handled. A copy is given to all new residents as part of the Service User Guide which is available in each room. One person said, if I have any complaints I go to the home manager. Information provided by the manager showed that the home had received 12 complaints since the last inspection, three of which were upheld. Appropriate actions had been taken to address any shortfalls. The people we spoke with, and those who returned surveys, said that that they were happy at the home and had no complaints. However that said that if they did have any concerns they would be comfortable speaking to any of the staff about them. The home has a policy and procedure about safeguarding people from abuse so that staff know what they should do if they have any concerns in this area. When concerns had been raised the home had taken actions to safeguard the people concerned and alert the appropriate people, such as social services. Training records, as well as staff Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: comments, demonstrated that staff had received training in this subject. One senior support worker told us that she had recently completed the alerter trainers course, this will enable her to train other staff. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and comfortable home. They are encouraged to personalise their rooms and take an active part in deciding on the decor of their rooms and communal spaces. Some areas are not adequately maintained and decorated. Evidence: We took a partial tour of the home which included looking at communal areas and some of the bedrooms and bathroom facilities. Bedrooms had been personalised and residents said that they had chosen the colour schemes and were responsible for keeping them clean and tidy. Some bedrooms had been redecorated, but others were in need of attention. For example one of the rooms we looked at had some damage to the painted walls. The manager said that the resident had swapped rooms with someone else and they were arranging to redecorate the room as soon as possible. She told us that other improvements were also planned, this included an activities room on the top floor, which was in the process of being decorated. The corridors and kitchen had been repainted and a new stair carpet had been fitted. In places the work looked unfinished with a corridor wall having a rough line between Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: the different colour paints. Although one of the bathrooms had been refitted and decorated the wallpaper on the ceiling was already peeling off in places. There was also a hole in the dining room radiator cover. On the outside of the home some areas needed some attention. for example the window frames to the rear of the building required attention. The home has a large well maintained garden to the rear with a sensory area for people to enjoy when they want to relax. There is a car park to the side of the building and roadside parking is also available. People told us that they were happy with their rooms and the general facilities at the home. One person told us how he had been involved in choosing the decor and furnishings for his room. 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 are safeguarded by the homes recruitment procedure, which helps to ensure that staff are suitable to work with vulnerable people. Residents receive support from staff who are knowledgeable about their needs and have access to appropriate training. Evidence: The rota and peoples comments showed that 4 staff were on duty during the day with 2 on at night, one of them being awake at all times. Residents and staff told us there was enough staff on duty to meet the needs of the people currently living at the home. One member of staff said that the rota was flexible to fit round residents social activities. Observation showed that staff supported people in a calm and relaxed manner. They included people in decision making and encouraged them to be independent while being available to offer support as needed. Recruitment of new staff was being carried out correctly with essential checks, such as written references and C.R.B. (Criminal Records Bureau) checks, being undertaken. Staff comments showed that new staff received an induction to the home, but as this Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: was done on a computer documentation did not fully evidence what had been included, in what depth each area had been covered and the completion date. The home has a training programme which includes essential subjects such as infection control, protection of vulnerable adults from abuse and basic food hygiene. More specialist areas such as epilepsy, none crisis intervention and the safe administration of medications had also been provided to some staff. Most staff have also completed a Learning Disabilities Qualification. Staff said that they felt well trained and supported and they demonstrated a good knowledge of the people they were caring for. However one person said that the use of the computer training did not always give staff the practical instruction they needed. No training had been provided to staff about new legislation, such as the Mental Capacity Act and The Deprivation of Liberties Act, which are aimed at protecting people rights and choices. The manager said that this training would be provided shortly. The company encourage staff to complete an N.V.Q (National Vocational Qualification) in care. Information provided showed that out of 17 care staff 15 have attained an NVQ and two new staff are waiting to be enrolled on the course. 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. Leadership and guidance is provided to staff to ensure that support to residents is delivered in a consistent manner. The home is managed in the best interest of the of the residents. There are systems in place to make sure that the health, safety and welfare needs of the residents are met. Evidence: The home does not currently have a Registered Manager but an acting manager, Kelly Strouther has been responsible for the day to day operation of the home since August 2008. She has experience in managing a care home and told us that she had begun the process to become the Registered Manager. Residents told us that they were happy with how the home was run and found the manager available and approachable. Staff were also complementary about how she managed the home and included staff and residents in the decision making at the home. One person said, Kelly came in and in 8 months she has turned the home round by working as a team. Another told us, she is very approachable and had made Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: a lot of difference, its a happy home. When asked what they liked about the home staff told us, we get regular training and theres a good team mix, I love my job, its a close knit team, provides consistency for service users, people get proper care, its a home from home, as we are small we always have time for individuals and relate well with families and professionals. Two areas were highlighted by staff as areas that they felt could be improved. These were regarding reducing the corporate paperwork and providing more opportunities for people to work out in the community. The manager has already begun to address the latter. The company have a quality assurance system in place to gain the views of people who use the service and monitor that staff are following company policies. Records and peoples comments also showed that residents had meetings to discuss various topics, such as menus, activities and changes in the home. Staff meetings had also taken place. The home has health and safety polices and procedures to guide and instruct staff. There is also a programme in place to service and maintain equipment in the home on a regular basis. Information provided in the AQAA and sampling on the day of the visit demonstrated that regular checks on equipment, such as fire equipment and portable appliance testing, had taken place. 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 1 24 23 All areas of the home must be decorated, furnished and maintained to a satisfactory standard. This will enable people to live in a suitable environment which is decorated and furnished to suit their needs. 01/09/2009 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 6 Support plans should include reference to the Mental Capacity Act, 2007 and the effects it has on resident lives. This is to help to make sure that their rights and choices are protected. Support plans should fully reflect peoples aims and aspirations so that staff have a clearer picture of the people they are supporting and how they want to live their lives. The home should make sure that staff are aware of the content of new legislation, such as the Mental Capacity Act and Deprivation of Liberties Act, so that they have a better understanding of supporting people appropriately. Page 27 of 28 2 6 3 35 Care Homes for Adults (18-65 years) 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. 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