Care Home: Dell Residential Home (Sudbury)

What the care home does well The staff support people well and treat them with respect. People are involved in developing their care plans so they get the right care and support. People are given the right support to participate in the daily routines of the home such as planning and preparing meals. People enjoy getting out and about and taking part in activities. People feel the home is well managed and people are safe and comfortable. What has improved since the last inspection? Medication procedures are more robust. Some of the bungalows have been redecorated and lots of money has been spent on making the home a nice comfortable place to live. What the care home could do better: No requirements have been made at this inspection. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Dell Residential Home (Sudbury) Cats Lane Great Cornard Sudbury Suffolk CO10 2SF     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: Tina Burns     Date: 1 1 0 5 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: Dell Residential Home (Sudbury) Cats Lane Great Cornard Sudbury Suffolk CO10 2SF 01787311297 01787313385 the.dell@craegmoor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Speciality Care (REIT Homes) Ltd care home 48 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 48 The Dell is a permanent care home for adults with a learning disability. It was first registered in 1987 as a core and cluster home where small groups of service users are accommodated in bungalows, each bungalow forming a self-contained unit. Over time, additional bungalows have been built to bring the home to the present capacity of 48. The current registered owners, Speciality Care (Reit) Homes Ltd, purchased the home in 1995 and agreed that the Dell had reached its maximum desired capacity. Speciality Care was acquired by Craegmoor Healthcare Ltd in March 1998. The bungalows accommodate up to six people and have their own communal areas, laundry facilities and some catering facilities. They are grouped around a central administration block that also includes the main kitchen and day care area. Access to the site is by a private drive that is shared with some immediate neighbours. The home is situated within a quiet residential area with good links to Sudbury town centre. The buildings are modern, purpose-built units and offer a good standard of Care Homes for Adults (18-65 years) Page 4 of 28 Brief description of the care home accommodation. All service users have good-sized private bedrooms all have a wash hand basin. At the time of inspection fees started at £698.00 per week but varied according to assessed needs. 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 focused on the care standards relating to care homes for adults. The report has been written using accumulated evidence gathered prior to and during the inspection. We asked people who live at the Dell for their views. We spoke to some of the staff and visitors and looked round the home. We looked at some peoples care plans and other records that are kept in the office. Evidence was also taken from the Annual Quality Assurance Assessment (AQAA) Care Homes for Adults (18-65 years) Page 6 of 28 completed by the management of the home and submitted to the Care Quality Commission (CQC). The AQAA provides an opportunity for the service to tell us what they do well in detail, and areas they are looking to improve or develop. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users can expect to have the information they need to make an informed choice about whether the home will meet their needs. Evidence: The AQAA tells us that before a service user moves into the home a full and comprehensive assessment is undertaken so that they can be sure that the individuals needs can be met. It also tells us that prospective service users are encouraged to visit so that they are able to make an informed choice about where they live. Comments we received and records we looked at during the inspection reflected the information provided in the AQAA. The records we examined included copies of local authority assessments and pre admission assessments undertaken by the home. The assessments covered a wide range of physical, social and emotional needs, such as health, safety, finances, personal care and physical well being, eating and drinking, mobility, elimination, pain, sleep, mental health, communication and social interaction. Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: The detail of the information provided and the style in which the assessments were completed indicated that prospective service users are fully involved in all stages of the admission process. One of the service users we spoke with told us; The home manager came to visit me. She spoke to me about the home and let me look at some brochures. The homes Service User Guide had been designed with the needs of the client group in mind and included pictures, symbols and large print. Further more service user agreements, in appropriate formats were in place and a designated link person, who is introduced during the pre admission process, assists with information, helps the person to settle in and generally acts as a point of contact for the service user and their families. The homes certificate of registration was on display in the reception area with a range of other information. The home is not currently providing full occupancy as Bungalow 7 is not being used. The providers are consulting with social care services about the needs of local people with learning disabilities before making a decision about the use of that bungalow. 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 living at the home are fully consulted about their needs and receive a service that is based on their individual needs and preferences. Evidence: We spoke with three service users and looked at their care plans. Their care plans were highly individual and reflected the information provided in their assessments. They were written in a style that respected the service user and promoted their involvement. Further more, the format had been designed with the needs of the service user group in mind and included appropriate use of pictures and symbols throughout. The care plans seen included information about each persons mental capacity and a statement about whether or not they gave consent for information to be shared with other people. They also included personal profiles and life histories and covered a wide range of areas such as relationships and social contacts, health and keeping safe Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: (including the management of specific risks to self and others), personal care, mental health and behaviour, communication and independence. There was good evidence that each area of need in the care plans were regularly reviewed. Staff we spoke with confirmed that they are a valuable resource that enables them to assist and support people in a person centred and effective way. Observations made, records examined and feedback received confirmed that people living at the Dell are appropriately supported to make individual choices and decisions. Advocacy and befriending services are used by a number of service users and where appropriate multi disciplinary Best Interest meetings take place. In addition chit chat sheets are used to record any thing that the service user specifically wishes to discuss with senior team members and regular residents or your voice meetings take place and are attended by a high percentage of the service users. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home can expect to be involved in meaningful activities of their choice. Furthermore, they can expect to be provided with the support they need to maintain relationships with their friends and families. The home also provides varied and healthy meals. Evidence: The AQAA tells us that people that live at the Dell have access to a wide range of activities and pastimes and this was confirmed by the people we spoke with during the inspection and the observations we made. There was lots of evidence that people had good opportunity to get out and about and activities were wide ranging and varied. Several people attended one of the local day centres and some were undertaking the Asdan course at the local college. Three service users were working towards NVQ Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: qualifications. The home encourages service uses to participate in community events and some are also assisted to attend the local church. There are also opportunities to participate in events organised by the company, for example Artist of the Year. Service users are also given the assistance they need to plan holidays and short breaks, with staff support if needed. Feedback we received confirmed that the home provides good support to enable individuals to maintain personal relationships with their friends and families. Visitors are made welcome at the home and people are given the assistance they need to visit their friends and families too. Information provided in the AQAA, people we spoke with and observations we made confirmed that service users are involved in the daily routines of the bungalows. The extent to which people can fully participate in tasks varies between bungalows and depends on the needs and abilities of individuals. However it was evident that people are encouraged to actively participate in tasks where possible, for example; preparing and cooking food, cleaning the home, doing laundry and welcoming visitors. The main kitchen is situated in the administration block and provides meals for four of the bungalows. The remaining bungalows shop for, prepare and cook their own meals. Since the last inspection the district council has undertaken a food premises inspection and everything was found to be satisfactory. Further more the home has reviewed the way that they transport hot food from the kitchen to the bungalows; they have purchased suitable trolleys with insulated containers that maintain the food at the correct temperature while it is being transported. Menus are provided in picture format and provide meal options that can be chosen by service users on the day. The plastic crockery being used at the last inspection had been replaced. On the day of inspection the meals provided looked healthy and appetising. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home can expect their personal and healthcare needs to be met in a way that reflects there preferences and respects their dignity. Evidence: Care plans were detailed; they included the assistance required with personal care and accounted for the individuals personal preferences. Discussion with the manager and feedback from staff and service users confirmed that routines, such as getting up or going to bed and bathing are flexible and depend on peoples needs and choices. People we spoke with also confirmed that the home is pro-active about promoting service users privacy and dignity and our observations were that personal care was provided discreetly and in private. Observations made and records examined confirmed that the home had appropriate procedures in place for the safe storage, recording and administration of medication. Staff responsible for handling medication had undertaken medication training and two medication errors that had been reported to us by the home since the last inspection had been dealt with appropriately and thoroughly and had not impacted on the well Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: being of the service users concerned. The requirements made following the last inspection about the administration of insulin to one service user had been met. The individuals care plan included a clear protocol for administration, staff responsible for administering the insulin had been suitably trained and there was an appropriate risk assessment in place. Observations made and records examined confirmed that people living at the home are supported to access community healthcare services. Everyone had their own personal healthcare plan and records included information about individuals health care needs, health care instructions and outcomes of health care appointments. 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. People living at the home can expect to have their views listened to and acted upon. Furthermore they can expect to be protected from abuse. Evidence: The home had an appropriate complaints procedure in place; it was available in a suitable format and was displayed in the reception building and individual bungalows. Feedback from service users confirmed that they knew how to make a complaint and raise concerns however evidence indicated that issues are usually dealt with before they become complaints. The AQAA told us that there had been four formal complaints made since the last inspection. We looked at the homes complaints records and they corresponded with the details in the AQAA. They also provided a good record of the complaint made and how they had been addressed. In all cases it was clear that issues were taken seriously and dealt with promptly and thoroughly. Feedback from staff and records examined confirmed that staff had undertaken training in the Protection of Vulnerable Adults. Whistle blowing procedures and procedures for staff or visitors to report concerns were displayed in the entrance to the main building. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: The manager has notified us about events or incidents that have potential to impact on the well being of service users. They have demonstrated that they understand the procedures for reporting safeguarding matters and worked closely with the local authority to investigate concerns and ensure people are safe. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The bungalows are tidy, safe and clean and provide comfortable and homely accommodation. Evidence: At the time of inspection all areas seen were tidy, safe and clean and there were no unpleasant smells. Of the five surveys returned by service users four said that the home was always clean and one said sometimes. The furniture, decor and facilities provided in each of the bungalows were comfortable and pleasant and created a homely and relaxing environment. Observations made, information provided in the AQAA and discussion with the manager confirmed that the home has an ongoing and effective maintenance and refurbishment plan and there had been considerable improvements made since our last visit. The requirement made following the last inspection about addressing water damage in bungalows 1, 2, 3 and 4 had been fully met. Improvements had been made in most bungalows and included redecoration, replacement of carpets and replacement of furniture. Bungalow 3 benefited from replacement windows and a new boiler, bungalow 1 had a new cooker and bungalow 8 had replacement radiator covers. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: At the last inspection we were concerned that laundry areas in some of the bungalows did not have hand wash facilities, consequently the manager had addressed the matter by installing hand gel dispensers. At this visit we talked with the manager about infection control and discussed whether or not the facilities were sufficient. They agreed that they would seek advice from the infection control team and have since advised us that sinks are being installed. 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 receiving a service are safeguarded by robust recruitment procedures. Furthermore, they can expect to be supported by staff that are appropriately trained and competent to do the job. Evidence: Three staff recruitment records were examined and included evidence of ID checks, evidence of Criminal Record Bureau (CRB) checks, copies of application forms, written references and health checks. There was also good evidence that face to face interviews are carried out as part of the staff selection process. Feedback from staff confirmed that new staff initially work under supervision and undertake induction programmes that meet the Skills for Care induction standards and Learning Disability Award Framework. The AQAA tells us that approximately fifty percent of care workers employed hold or are working towards NVQ level two in care or above. Staff spoken with and records seen confirmed that care workers undertake training in the following areas; Safeguarding Adults, Basic Food Hygiene, Equality and Diversity, Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: Fire Safety, First Aid, Health and Safety, COSHH (control of substances hazardous to health), Infection control, Manual Handling (loads), Safer People Handling, Violence and Aggression, Medication, Epilepsy, Diabetes and Makaton Sign Language. Mental Capacity training is also planned. Discussion with the manager, observations on the day of our visit and comments from people we spoke with confirmed that staffing ratios are suitable for the needs of the service users. One member of staff told us that staffing levels enable them to provide a very good service and another told us that since the last inspection staffing has improved, there is better training and more people are doing NVQs. Feedback from care workers confirmed that a programme of regular formal supervision and team meetings is still in place. 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. People benefit from a well run home. Further more, their health, safety and welfare is promoted and protected. Evidence: The registered manager for the home is Ms Kelly Cox. She has been the registered manager since March 2008. Kelly Cox is qualified with NVQ 4 in care and holds the registered manager award and the NVQ assessors award. She was able to evidence to us at this inspection that she regularly undertakes training and keeps her knowledge and skills up to date. Comments received by the Commission indicate that Ms Cox is a competent manager who has led improvements at the home and built positive relationships with staff, service users and relatives. Comments included; Shes always here to listen and we work like one team. Its a nice place to work. One member of staff told us that improvements had been made to the environment, the quality of care, training opportunities and frequency of supervisions. Another told us things are noticeably Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: different and went on to say that induction programmes are more thorough, the bungalows have been redecorated and look more homely, there is a better sense of team spirit and staff and service users are happier. Compliments received by the home from a visiting professional were highly complimentary and included; Since my last visit I have seen great progress and positive steps made to ensure each residents needs are met. Staff working in a person centred approach, encouraging service users to make their choices and decisions. Keep up the good work. Since the last inspection the manager has kept us fully informed about significant events at the home and made notifications required under regular 37 of the Care Home Regulations. The five requirements and two recommendations made at the last inspection were also appropriately addressed. Observations made during our visit were that the manager and deputy manager worked very well together and provided good leadership and a clear sense of direction to the team. They also demonstrated that they work hard to meet national care standards and are highly committed to provide a good quality of service to the people that live at the home. The AQAA submitted in April 2009 was appropriately detailed. It told us what the home does well, how it is evidenced and how they intend to improve. The homes self assessment procedures include a wide range of audits and these cover areas such as financial administration, health and safety, medication and service user involvement. There had also been a thorough Quality Assurance Audit completed by the company in March 2009. There was good evidence that people who live at the Dell are fully consulted through individual reviews and residents meetings. Service User surveys had also been completed by twenty seven people. The manager advised that the surveys will be analysed and action points will be highlighted and addressed. The AQAA tells us that there are appropriate procedures in place for reporting incidents and accidents. Health and safety strategy meetings take place at the home every three months and involve staff and service user representatives and routine maintenance and health and safety tests and checks are carried out. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!