Care Home: Danemere

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What the care home does well Danemere is a relaxed, comfortable and friendly environment that offers support and care for one resident who has an acquired brain injury with a range of complex needs. The resident is encouraged to make a full range of choices, with reference to agreed risk assessments, in all aspects of daily life. The resident has a good number of leisure and life skill interests, which the home supports. The resident benefits from a stable and skilled staff team and manager all of whom have worked in the home for a number of years. Staff are very positive about their role and are confident when faced with challenges. Advocates for the resident such as family and social services continue to be very pleased with the quality of care and support that the service provides. The manager and staff of the home have an excellent working relationship with the resident`s family and Social Services. communication is an important aspect of the care and there are good systems to ensure this is effective at all levels, allowing the home and other representatives to work as a team improving the best possible care for the resident. Comments received during the inspection process confirmed that the manager has been involved in the residents care for many years and is `trusted to look after the resident to a high standard`. What has improved since the last inspection? The resident has been moved to a ground floor flat that has been upgraded to meet her specific care needs. It is well decorated and provides an attractive homely environment and benefits from an outside patio area. The home continues to include the resident in all aspects of care and has taken some steps for this to be recorded within the care documentation. The home benefits from carefully selected staff who are committed to providing high quality care and quality of life for the resident. What the care home could do better: There were no major areas of improvement identified during this Inspection, which need to be addressed to improve outcomes for the resident. The manager responded positively to some minor areas for improvement during this inspection and so these have been documented within the report. It was however noted that the home still does not have a full range of policies and procedures to underpin the practice in the home, although this was raised at the last key inspection. A requirement has been made with regard to this matter. Key inspection report Care homes for adults (18-65 years) Name: Address: Danemere Dane Road Seaford East Sussex BN25 1DU     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: Melanie Freeman     Date: 1 4 0 9 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 28 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 28 Information about the care home Name of care home: Address: Danemere Dane Road Seaford East Sussex BN25 1DU 01323890696 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Freshford Care Consultants care home 1 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accomodated is 1 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 Danemere is registered to provide residential accommodation and care for one younger adult with an acquired brain injury and associated learning disability. The residents home consists of a flat on the ground floor of a semi-detached building. The home is situated in a residential area of Seaford, within walking distance of the town centre, public transport and the seafront, with GP and dentist surgeries easily accessible. The flat includes a large sitting/dining room, a kitchen, bathroom and a bedroom for the residents use and a separte office/sleeping room for staff. To the rear of the flat is a small patio area. The current fees charged for the one resident accommodated is approximately £1800 per week. A copy of the last inspection report is kept in the home with a copy Care Homes for Adults (18-65 years) Page 4 of 28 1 Over 65 0 Brief description of the care home obtainable via the manager. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an Unannounced key Inspection, which included a visit to the home which took place on Monday 14 September 2009, and lasted approximately 3 hours. The inspection process included a visit to all areas in the home, observation of working practices, examination of the homes records and discussion with the registered manager. The main focus of the inspection was to assess the quality of live that the resident experiences. The inspector met with the current resident, spoke to her mother and social services care manager. The visit also included discussion with the manager and all staff on duty along with observation of care practices and the lifestyle opportunities enjoyed by the resident. The required Annual Quality Assurance Assessment (AQAA) was completed and returned prior to the inspection visit and information from this has been used to inform Care Homes for Adults (18-65 years) Page 6 of 28 this report. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Adults (18-65 years) Page 8 of 28 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 9 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 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Existing and prospective residents can be very confident that their needs will be carefully assessed and met. Evidence: The homes statement of purpose and service users guide was available in the office area, although some of the updated documentation had been mislaid. The manager confirmed that she would review what was available and ensure suitable for the current resident and the provision provided. The availability of this documentation for prospective residents is not so important as the home does not intend to increase numbers, with the current resident having lived in the home for many years. The home however needs to be able to demonstrate what care it provides and how its provision is intended for people with a learning disability and acquired brain injury. The home is very open about the inspection process and tells everyone connected with Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: the resident when an inspection has taken place, sharing the report when received. The services provided at Danemere are designed for one resident. The assessment documentation of this resident was examined at the last key inspection and was found to be very comprehensive, and complemented with a range of information from Social Services. The manager and staff were able to demonstrate their knowledge and understanding of the specific needs of the resident. Observations in the home and discussions with the family and the Social Services care manager, indicated that the home continues to meet the residents needs very well. A contract is in place in the form of an individual placement agreement, and involves the resident, relatives, Social Services and the registered provider, and stipulates a minimum of 1:1 staffing at all times. Care Homes for Adults (18-65 years) Page 12 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The resident clearly benefits from good, skilled and prompt care, based on individual preferences and abilities. Evidence: Records seen confirmed that a comprehensive care plan has been developed. This includes an ongoing assessment of need, risk assessments and guidelines for staff to follow, which enables the staff to provide the support and care needed by the resident. The plan shows evidence of review, and input from the annual Social Services reviews. The plan of care included some individual goals and reflected choices made, it recorded what the resident could do and how this could be promoted to maintain independence and autonomy. The risk assessment process is used to allow choices about all aspects of the day, to be respected within agreed limitations and levels of supervision. The risk assessments are thorough and make it clear that only experienced staff can take the resident out Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: on their own. The risk assessment contains a range of useful guidelines about how to support challenges. The assessment around self administration of an injection however, needs further documentation and the manager said that this would be addressed. Although the care documentation was extensive and was found to be of a high standard by the residents representative, the plans of care were not always signed or dated and the consultation process with either the resident, or their representative was not clearly recorded. These matters were discussed with the manager who confirmed that additional documentation is currently being sampled to improve these areas. Care Homes for Adults (18-65 years) Page 14 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The resident benefits from being supported to access local community facilities and a range of leisure and other preferred activities based on personal interests. The resident benefits from freedoms and routines that are flexible and can be confident that they will be treated as an individual. The resident enjoys food, which is under constant review. Evidence: The resident is supported to make Danemere home where she is encouraged to take some responsibility for keeping it clean and comfortable. The manager confirmed that the resident takes part in a number of activities outside the home including trips to local shops, cafes and the park. The seafront is close by, and walks along the seafront are a regular occurrence when weather permits. The Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: resident is also able to complete a number of activities within the home, including art and craft work which the resident said that she enjoyed. There was also evidence of this activity displayed throughout the home. The resident also writes a diary reflecting her feelings and the activity of the day. The manager explained that college attendance was no longer beneficial to the resident and the provision of computer skills and equipment are being sourced to develop further skills and interests. Contact with relatives and friends is encouraged, the resident is able to spend alternative weekends with her family who play an active role in the multi-disciplinary reviews of the care provided. This provides an important advocacy for the resident, and this family contact is a very important part of her life. A varied menu offers meals specific to the residents assessed needs. Staff confirmed that meals are chosen together with the resident, who often does the shopping and some food preparation. Care Homes for Adults (18-65 years) Page 16 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. The resident benefits from attentive and skilled health care. Evidence: Personal support is provided in such a way that ensures the residents privacy and dignity, with independence and control fully encouraged, although safety of the resident being taken into account at all times. The staff treat the resident as an adult enabling the required support to meet personal and health care needs to be provided, and enabling a quality of life free from unnecessary restriction. Staff were very familiar with the residents needs and observation confirmed that they were both knowledgeable and skilled in providing care and support in a sensitive way. The needs of the resident are regularly reviewed with the involvement of the family, Social Services, health professionals and the homes management. An annual review has recently been completed by Social Services. Medication is secured in a locked cupboard and is regularly reviewed during hospital Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: visits. Records confirmed that medicines are administered safely and the resident also takes some responsibility for recording this process. The medicine charts completed by staff needed slight amendment to record clearly all medicines administered. The manager confirmed following the inspection that this matter had been addressed. Although there is no facility to store controlled drugs in the home the manager confirmed if the need for this was raised, suitable arrangements would be provided. The procedures reviewed relating to medicine administration need to be amended to reflect the practice in the home, and provide clear guidelines to staff. It was evident from the daily routines that there is a focus on successfully supporting health needs in the best interests of the resident, who is encouraged to play a full role. Care Homes for Adults (18-65 years) Page 18 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. An effective complaints procedure is in place. The resident and her representatives feel they can discuss any aspect of their care with the staff, with their opinions listened to and acted upon within recognised and reasonable limitations. Evidence: A complaints procedure is in place along with associated forms to record the process. There have been no formal complaints since the last inspection, and the good communication systems at all levels throughout the home ensures any issues are raised discussed and resolved. The resident was found to be confident in expressing her view on the facilities and able to raise matters with staff, these were listened to and responded to. In addition discussion took place around specific interests and activity for the day. Although the home has a safeguarding vulnerable adult procedure this did not record clearly the appropriate alerting procedures. This was discussed with the manager who was well aware of the correct procedures, and agreed to review the procedure in accordance with the local policies and procedures. She and the senior carer in the home are attending an update training day on adult safeguarding in October 2009. Training in adult protection is provided for all the staff and the manager confirmed that this is to be repeated again this year. All those contacted as part of the inspection Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: process confirmed that they had no concerns about the provision of care, and said that they were able to raise any problems if they had any, with staff or the manager. Care Homes for Adults (18-65 years) Page 20 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The resident benefits from living in a fresh, clean, warm, homely, and comfortable environment, which meets their needs. Evidence: All areas of the home were viewed with the consent of the resident. Since the last inspection the residents accommodation has been moved to a ground floor flat, that has undergone a complete refurbishment. The flat is located in a semi-detached building, close to Seaford town centre and the seafront. All areas of the home are well decorated and maintained and includes a sitting/dining room, kitchen, bathroom and bedroom. It also benefits from an outside patio area. The whole flat has been adapted and designed around the resident individual health and personal care needs. Discussion took place around the fire precautions in the home and the manager confirmed following the inspection visit that she had contacted the Fire Safety Officer for advice arranging a visit to review the facilities and precautions in place. 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. The resident continues to benefit from a well-chosen, skilled and stable staff team. Staff morale is high resulting in an enthusiastic workforce that works positively with the resident to improve their whole quality of life. Evidence: There is always at least one carer in the home with the resident at all times, and extra staff are provided to support some activity and trips for the resident outside of the home. The duty rota examined detailed the number of staff working in the home, however it did not clearly record the on call arrangements or who the Agency staff member working in the home was. The manager confirmed that this matter had been addressed following the inspection visit. There continues to be a low turnover of staff and the Agency staff working in the home has also worked in the home for a long time and is experienced and skilled in her work, and has a nursing qualification. Sufficient staff have achieved the basic National Vocational Qualification in Care at level 2 or equivalent. Staff were seen to be skilled in responding to the residents specific care needs. The staff had been appraised of her health needs and records clearly demonstrated what Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: care was delivered in response to these. Staff training records were not well established and the manager confirmed although her training was all up to date, other staff training needs to be followed up to ensure all relevant training had been maintained for all staff. A training matrix is not used in the home and this was recommended as a good tool to plan and record the training provided in the home. The manager provides much of the training and is a qualified Assessor. Contact with her following the inspection confirmed that she had organised much of the required training for staff, ensuring they are updated on best practice in care, health and safety. Some of this training will include deprivation of liberty guidelines. No new staff have been recruited since the last inspection although a review of finances have now indicated that recruitment of a new member of staff can be progressed. The manager was able to demonstrate robust recruitment practice will be followed, including all the required checks. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The resident benefits from a committed and effective management. Evidence: The registered manager has been managing the home for over nine years and has completed NVQ level 4 in Care and the Registered Manager Award. She works 20 hours exclusively for the home, although she is always available to the resident , staff and relatives on the telephone. Her priority remains Danemere and the level of care it provides. She is highly motivated and committed to providing good care to the resident as evidenced in discussions with staff, the resident and her advocates. An inclusive and open management style is maintained with good communication at all levels. Systems are in place to monitor the support and care provided, discussions with the resident occur daily in addition to the ongoing involvement of the relatives and Social Services who contract for this service. Some personal money is held in a joint account with the manager and full accounts and records are held in the home, reflecting how this is spent. This system has been in place for a number of years and is to be Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: reviewed by Social Services to ensure that the best interest of the resident is still being followed, and that this process is fully recorded. An annual development for the home had clearly been progressed with the environment being improved. The Annual Quality Assurance Assessment, could be completed in further detail to reflect the quality monitoring systems including the auditing processes, the planned improvements and the outcomes for the resident. Although some work has been undertaken to the review the homes policies and procedures it was clear from the examination of a small sample that they need to be completely reviewed to reflect the the practice in the home. For example the medicines procedure was not service specific. The manager confirmed that many of the policies were taken from a nursing home that was under the same ownership and have not been adapted. The homes Annual Quality Assurance Assessment confirmed that all health and safety checks continue to be carried out on schedule as required. A range of complex health issues requires the resident to have constant supervision. Access arrangements to the front door and flat now ensure that the resident is not left alone in the flat at any time. 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 41 12 The registered person will 25/11/2009 ensure that suitable policies and procedures are in place, to ensure that the home makes proper provision for the welfare of residents. The provision of appropriate policies and procedures will ensure suitable guidelines are provided to staff, that underpins best practice in the home. 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 Care Homes for Adults (18-65 years) Page 27 of 28 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 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!