Care Home: Coveham

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What the care home does well The home provides many opportunities for service users to express themselves, they have freedom of choice and autonomy over their lives. The homes staff treat all service users as individuals and respond to their needs, wishes and preferences the way that has been agreed with them. Through care planning, assessment and development of the routine it is possible to see the input each individual has had. The plans are person centred, holistic and flexible to give the opportunity for individual choice and control over their lives. Health action planning ensures that the individuals personal and healthcare needs are assessed and that support was provided in the way that they preferred and required. Staff enable service users to have opportunities to maintain and develop social, emotional, communication and independent living skills. Life skills are promoted as are goals which are agreed with the service users and encouraged by staff. What has improved since the last inspection? The home has improved the courses now available regarding specialised training which ensures staff have the required skills, experience and knowledge to care for the service users currently living at the home. Seventy five percent of staff now have an NVQ, National Vocational Qualification in care level two or above. Regulation 26 visits are now taking place monthly. These visits are documented and involve the person undertaking the audit speaking to service users and staff, look through documents including any complaints, and touring the building to ensure any problems are identified and dealt with appropriately. The home has now developed survey questionnaires for service users, staff and other health professionals as part of there quality assurance policy. What the care home could do better: No requirements were made during this inspection, it was recommended that service users towels and bath mats be taken to the bathroom by individual service users and returned to their bedroom or the laundry straight after use to avoid possible cross infection. The training matrix could be further improved if it showed the dates when training has been completed along with the dates refresher training etc are due. Key inspection report Care homes for adults (18-65 years) Name: Address: Coveham Anyards Road Cobham Surrey KT11 2LJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sally Hall     Date: 2 4 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Coveham Anyards Road Cobham Surrey KT11 2LJ 01932794600 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Surrey County Council - Adults & Community Care care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accomodated is 10. The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Learning disability (LD) Date of last inspection Brief description of the care home Coveham is a purpose built local authority home providing accommodation for twelve residents. The home is located in a residential road in Cobham and has easy access to shops, public transport and other local services. The accommodation for residents is provided on two floors and all the bedrooms are single. The communal space provided comprises of two bright and comfortably furnished lounges, a large dining room with a computer area sectioned off, a well-fitted kitchen, a communal laundry and suitable bathroom/toilet facilities. The home is able to offer accommodation for 10 residents. The home has a large garden, and has an outdoor patio area with a barbecue for summer entertainment. There are parking facilities in the front drive for up to ten cars and the home has its Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 10 Brief description of the care home own vehicle for use by its residents. The fee is approx 641:82 pounds per week. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Inspector agreed and explained the inspection process with the staff on duty at the start of the inspection. Later the Inspector was joined by the assistant Manager. The focus of the inspection was to assess Coveham in accordance with the Care Home Regulations 2001 and the National Minimum Standards for Younger Adults. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. The Inspector used a varied method of gathering evidence to complete this inspection, pre-inspection information such as the previous report and discussion and correspondence with the registered provider was used in the planning process to support the inspector to explore any issues of concern and verify practice and service provision. The home had completed an annual quality assurance assessment questionnaire, which was received prior the site visit to the home. This provided the Care Homes for Adults (18-65 years) Page 6 of 27 Inspector with information relating to what the home considers it does well, what they could do better, what has improved within the last 12 months and future plans for improvement. Survey questionnaires were sent to the home prior to the inspection for completion by service users, staff and other health professionals. Documentation and records were read. Time was spent reading of written policies and procedures, reviewing care plans and records kept within the home. Other records viewed included risk assessments, pre-admission assessments, menus, rotas, training records and recruitment records. In addition part of the homes environment was viewed this included some service users bedrooms and communal areas. The Inspector identified three people who use the service for case tracking, speaking with one of them whilst assessing the available information held in the home pertaining to the care provision for them. In addition the Inspector met another person who use the service, which gave her a good opportunity to observe the quality of staff interaction within the home and quality of life enjoyed. Care Homes for Adults (18-65 years) Page 7 of 27 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 8 of 27 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 9 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 27 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. Residents can be confident their needs are assessed prior to admission. Evidence: One pre assessment documentation was viewed, all other service users had been at the home for some years and therefore the pre assessments would have been archived. Evidence from this demonstrated that a thorough pre admission assessment is carried out to enable the unit manager to make a judgement as to whether the home will be suitable for and can meet the needs of the individual. The assessment included information gathered from care managers, other health professionals the service user and their family or advocate. A number of multi agency meetings are held before admission to ensure the move to the residential home is the right move for the service user. Evidence of these meetings plus medical reports requested were available on file. Upon admission, a further assessment is undertaken by the unit manager. Information from all the assessments informs care planning and risk assessment. Care Homes for Adults (18-65 years) Page 11 of 27 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. Service users benefit from being competently assessed and supported with regard to their health and personal care needs though comprehensive care plans and risk assessments being documented. Evidence: People who live in the home confirmed that arrangements are made for them to see the optician, doctors and other health care professionals when they need to. Those who need help to manage their medication are supported by trained staff and are protected by the homes policies and procedures for the safe storage and administration of medication. Service users spoken with or surveyed confirmed that their privacy is respected and staff were seen knocking on doors before entering, some service users prefer to lock their doors the service users wishes are respected. Observation of interaction between staff and residents throughout the visit confirmed that privacy and dignity is respected in the home. Confidential information is handled discreetly and sensitively. Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: Care plans were viewed for three service users. All care plans contained evidence of individual needs assessments, and the plans were person centred and holistic. There was evidence of routines that had been led by the service user and were flexible to respond to the service users day to day choices. Goals seen set were achievable and monitored by staff. Further evidence of regular review and updating of care plans was evident. Current risk assessments contain sufficient detail for staff to understand their role in reducing possible risks for service users and others. The home has developed risk management strategies, and these are detailed with all individual risk assessments, being reviewed in a timely way. The service users can take risks with q risk management framework. The service users at the home are going on holiday soon, risk assessments are already in place to go with them with further blank assessment sheets in case new risks are identified re there environment for example. Service users spoken to or surveyed stated how happy they are in the home. They were satisfied with the care they receive and praised staff for the way in which they carry out their duties. When asked about how they felt about the care in the home phrases were used such as: when I am feeling unwell the staff help me and look after me, its my home and I like it here and the staff are so kind and helpful. Care Homes for Adults (18-65 years) Page 13 of 27 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. Service users benefit from being supported to make choices and take part in a range of activities Service users can feel confident that they are offered a well balanced and varied diet. Evidence: People who live in the home are supported to live their lives as they choose. Routines are flexible. Restrictions are kept to a minimum within a risk management framework. There is a variety of activities which service users take part in such as art and crafts, many of which they chose to do at the clubs they go to or in some cases as with arts and crafts they attend classes. They may choose to take part in activities or outing as they wish. Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: It was clear form the surveys and when talking to service users that they do go out and several enjoy going to the pub or out for a meal. One service users said they would like to do that more often. The whole home is going on holiday soon some going to Dorset others to the New Forrest. With just days to go both service users and staff were enthusiastic. The home does organise barbeques in the court yard garden and friends and family are welcome to join service users. The home takes particular care to ensure that food is nutritious and takes account of specialist dietary needs. The range of food available for service users is good as is the flexibility around meal times them. The dining rooms are well laid out with tables attractively set. Each service users has a home day where a member of staff spends the day with them and they do things like clean their rooms , do laundry, go to the hairdressers, go shopping or to the bank etc. Most service users go to clubs or lunch clubs most days of the week, The home now has decorated and fitted out a kitchen dinning area on the first floor, here service users can learn cooking skills and /or invite friends and family for meals. This is a new facility which it hoped will be in use once service users return from their holiday. Although most service users are older people, two are still able to help out at a local centre for which they get paid for doing light work in the gardens for example. Two service users are on a basic computer course, and computers are available in the home for their use. Another three service user are undertaking an arts and craft course locally. Care Homes for Adults (18-65 years) Page 15 of 27 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. Service users can be confident they will receive personal support in accordance with their needs and wishes and can that they are fully supported with their healthcare needs. Service users welfare is protected from harm by the homes policy and procedures with regard to the administration and dispensing of medication. Evidence: Times of getting up / going to bed, having baths, eating meals and other activities are flexible to allow for different service users daily routines. All service users were able to make their own choices with regards to what they wished to wear, and this was evident by their individual appearance. We observed excellent interaction between staff and service users. Care records and specific health care records were sampled for three service users. Records viewed confirmed service users had access to a range of health care input as and when required but not as part of regular health checks. This included access to Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: their chosen G.P (where possible), Dentist and Optician in addition to identified specialist health care input. The Home facilitates service users keeping hospital appointments and seeing their own GP. We viewed the medication storage arrangements and some records including Medication Administration Record (MAR) sheets, MAR sheets were seen to be completed correctly and medication was stored appropriately. Staff spoken to confirmed the arrangements for timely disposal of medication all of which is documented. The home has a medication policy and procedure in place which is followed by staff at the home. The home could demonstrate that as required medication is given following an agreed protocol. The staff spoken with and the training matrix seen confirmed that all staff who dispense medication have received the appropriate training. Care Homes for Adults (18-65 years) Page 17 of 27 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. Service users can feel confident that their rights are protected with regard to making complaints and they are protected from the risks of abuse. Evidence: The complaints procedure was seen prominently displayed in the home and available in different formats appropriate for all service users living within the home. The complaints procedure contained information regarding timescales for responding to a complaint do need to check that the procedure gives the details of the Care Quality Commission now. We the commission has not received any complaints regarding the home in the last year. The homes Policy for safeguarding Service Users and staff Whistle blowing procedure were seen to be available. These include procedures for the reporting of suspicion or evidence of abuse with a format for the recording of any allegations and action to be taken. The training matrix viewed indicated that staff had received the training required to protect service users from abuse. With further refresher training being arranged. It was evidenced that all staff have a current CRB (Criminal Records Bureau) check and the home operates a robust recruitment procedure. Care Homes for Adults (18-65 years) Page 18 of 27 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. Service users benefit from living in a home which is on the whole suitable for their needs, is clean and comfortable. Evidence: The home occupies two floors with individual service users rooms, bathroom/toilet facilities and communal areas. All areas viewed appeared clean and tidy and in keeping with a homely environment. However the bathing areas could be more homely if they not quite so clinical in appearance. Whilst the service users bedrooms are fairly small as rooms are redecorated some permanent furniture and fittings are being removed to give more scope in layout and more usable room. It was very evident room the service users rooms seen that they are encouraged to decorate and personalise there rooms to their own interests and taste. A room due to be decorated while they are holiday has chosen the colour of the paint work before they go away. None of the service users bedrooms has en-suit facilities but toilets are positioned Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: near by bedrooms. There is a wet room on the ground floor and a bathroom on the first floor. Toilets and bathrooms were lockable offering service users privacy, although staff are able to access toilets/bathrooms in an emergency if required. In the bathroom bath mats were seen with a hand towel seen in the down stairs facility, whilst we would not to stop service users using these they could compromise infection control if used communally. Staff were asked to ensure service users used their own personal items and they be returned to there room or be laundered after use. These items were removed by staff straight away. Care Homes for Adults (18-65 years) Page 20 of 27 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. Service users care, social and emotional needs are promoted by the employment of suitably trained experienced care staff in such numbers that meet their needs. Evidence: Following a review of the staffing rota and observations of staff on duty at the time of inspection it appeared that there were sufficient members of staff on duty to meet with service users needs. It was noted that the home does use staff from the staff bank on a regular basis although individually they do not do a large number of hours, it is important they receive training to match the permanent staff. The majority of staff have received training in the following. Fire safety awareness, adult safeguarding, First Aid, Basic food Hygiene, Manual Handling, Health and Safety, Administration of Medication, A wide range of training has been identified for staff over and above core skills courses. They include Managing aggression and violence, Downs and dementia, behavioural management, Autism Spectrum Conditions, Makaton, continence and learning disability awareness. These more specialised courses have been arranged to ensure staff have the skill and knowledge to meet the needs of the service user they care for. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: Seventy five percent of the permanent staff had been trained to NVQ, National Vocational Qualification Level II in Care or above. Care Homes for Adults (18-65 years) Page 22 of 27 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. Service users and staff are supported by the homes policies and procedures and they can feel confident that their health and safety is protected. Service users can feel confident that the home will continue to improve the service through their quality control measures Evidence: The Registered Manager is undertaking the RMA ( registered managers award). The home has now sent out quality assurance questionnaires to health professionals, and families. Questionnaires will also be given out to service users, the information from these will be used to improve the service. The home is visited by an area manager who undertakes a regulation 26 visits monthly. These visits are documented and involve the person undertaking the audit speaking to service users and staff, looking through documents including any complaints, and touring the building to ensure any problems are identified and dealt with appropriately. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: They have regular service user meetings, last year the service users asked for a Wii for Christmas they have enjoyed playing games on this which includes bowling. Policies and procedures were seen and are easily accessible to staff. Records were viewed relating to Health and Safety Procedures, medication and safeguarding. The AQAA Annual Quality Assurance Assessment completed by the manager was used to evidence that checks and servicing of fire safety equipment / emergency lighting had been undertaken at the required frequency. Procedures are available for the reporting of incidents (Regulation 37) occurring within the home. Staff training was evidenced with regard to First Aid, Food Hygiene and other mandatory courses. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 30 service users towels and bath mats be taken to the bathroom by individual service users and returned to their bedroom or the laundry straight after use to avoid possible cross infection. The training matrix could be further improved if it showed the dates when training has been completed along with the dates refresher training etc are due. 2 35 Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - 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!