Care Home: Estoril

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What the care home does well Each service user has a care plan which provides staff with lots of information about the likes and dislikes of the people they support. Staff know the service users well and support people to make choices, and choose how they would like to spend their time.The home was comfortable, and domestic in scale and style. Service users have good facilities, and plenty of space which they say they `like.`The home has a car that people can use. This means that people who live there can get out and about easily.Staff look after people`s health and carefor them well. What has improved since the last inspection? Records were available to show that when staff start working in the home that they receive a good induction. This helps them to feel confident about what they are doing. What the care home could do better: The service provides good care and support to the people who live at `Estoril`. But staff say that they would benefit from more supervision to support them with their work, and the manager has agreed to take a look at this. Key inspection report Care homes for adults (18-65 years) Name: Address: Estoril Wonston Road Southminster Essex CM0 7FE 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: June Humphreys Date: 0 5 0 8 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 29 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 29 Information about the care home Name of care home: Address: Estoril Wonston Road Southminster Essex CM0 7FE 01621774776 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) : estoril@zerothreecarehomes.co.uk Zero Three Care Homes LLP care home 5 Number of places (if applicable): Under 65 Over 65 5 0 learning disability Additional conditions: Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 5 persons) Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 29 A bit about the care home Estoril is a fully detached, domestic style, two-storey house, situated in a quiet residential area of Southminster. The property is fully in keeping with other properties around it. The home is registered for five residents, all accommodated in single rooms on the ground and first floors. On the ground floor there is one communal lounge/dining room with adjoining conservatory at the rear on the home. There is easy access to a large rear garden. Visitor car parking is provided at the front of the property and the home is approximately a quarter mile from the village centre, which has local bus services and a railway station. Regular community access is mainly provided to service users by the use of a vehicle based at the home. Fees were reported as ranging from £1829.10 to £1906.73 . CQC inspection reports can be obtained from the home, or via the CQC internet website. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 29 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 2 stars. This means that the people who use this service experience good quality outcomes. One Inspector June Humphreys visited the home unannounced on the 13th July. A further visit was undertaken on the 5th August to gain access to important documents that were not seen at the previous inspection. The Inspector looked around the home, and observed staff and Service Users working together. A sample of records kept in the home was looked at to ensure the health and safety of service users is taken into consideration at all times. This included two care plans, supervision records, and staff rotas, complaints, medication and accident records. The Annual Quality Assurance Assessment (AQAA, is a self audit tool that the home uses to tell us what they do well, and identify any areas for improvement) was good, well laid out and contributed positively to the overall inspection report. At the end of the inspection, feedback was given to the Registered Manager of the home regarding the inspection. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well Each service user has a care plan which provides staff with lots of information about the likes and dislikes of the people they support. Staff know the service users well and support people to make choices, and choose how they would like to spend their time. The home was comfortable, and domestic in scale and style. Service users have good facilities, and plenty of space which they say they like. The home has a car that people can use. This means that people who live there can get out and about easily. Staff look after peoples health and care Care Homes for Adults (18-65 years) Page 8 of 29 for them well. What has got better from the last inspection What the care home could do better The service provides good care and support to the people who live at Estoril. But staff say that they would benefit from more supervision to support them with their work, and the manager has agreed to take a look at this. Care Homes for Adults (18-65 years) Page 9 of 29 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact June Humphreys Care Quality Commission Eastern Region Citygate, Gallowsgate New castle upon Tyne NE1 4PA 03000 616161 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 10 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can expect to look at the homes statement of purpose and service users guide as part of the assessment process, but would benefit from compatibility being part of the assessment, to ensure their social and emotional needs will be met. Evidence: A Statement of Purpose is held within the home and all current and prospective service users are provided with a copy. The Service Users Guide was also available for inspection, and would benefit the current service user group greatly if produced in a pictorial format. Two pre admission assessments were looked as part of the inspection. Peoples needs are fully assessed prior to moving into the home, but evidence was not available to demonstrate that consideration was given to the matching process of the people sharing the house. It was evident from discussions with staff, and observation on the first day of the inspection that there were issues in relation to the compatibility of several of the people who were sharing the house. The manager acknowledged that certain people did not relate to each other well, and stated in the AQQA that we have identified that one service user needs to live in a smaller service and have started to look at them being Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: supported in a single service. The manager confirmed that this was in process. Care Homes for Adults (18-65 years) Page 13 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgment: People using this service experience excellent quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. All service users can expect to have a care plan, and to be supported by staff to maximize their opportunities to be independent. Evidence: The care plans of individual service users were comprehensive and detailed including regular reviews to assess changes in individual care packages. Changes were documented clearly enabling support staff to deliver care appropriately. The company also has a psychologist, who is involved in developing guidelines, to help with peoples challenging behaviour. Service users lead reasonably independent lives according to their varying levels of ability. Staff understands the importance of allowing them to take sensibly evaluated risks in order to enjoy a range of opportunities. Guidelines on managing risk are drawn up with the service users where ever possible, and involving other agencies such as social workers and various health professionals. These are closely monitored as people living in the home have a range of complex needs and need appropriate support to be kept safe. A key worker system is in operation in the home and this enables service users to focus on their individual goals, and ensure that peoples individual needs are met. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: Care plans are set up so that people are doing the things that they like, and choose to do, but it was difficult to confirm this as service users have limited ability to communicate verbally. One service user said that he was happy, out to buy MacDonalds soon. Evidence observed on the first day of inspection was that most service users do require one to one support to complete the tasks written in the care plans, and with three members of staff on duty to five service users this is not always possible. The manager advised that usually there is four members of staff on duty, and this was the case on the 2nd day of inspection. With good shift planning most people are able to do what that have planned for each day. Care Homes for Adults (18-65 years) Page 15 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can expect to be involved in decisions about their lives, and be involved in planning the care and support they receive. Evidence: The provision of regular activities within the home appears to be good. Staff have continually reviewed service users activities as they have developed or changed interests. An activity log is kept which shows what people have done, and where they have been. It is an excellent diary/record that service users can look at with staff. It is pictorial, and has simple written language so that it can be easily understood. Changes are also documented as part of service users reviews. On the first day of inspection it was not possible for all five service users do the activities listed on their programme due to the level of staffing. One person waited most of the day to do the task that they wanted. They did go out, but for only a short time. Despite this, evidence from the activity diary did show that a range of activities were occurring on most days. Throughout this inspection staff were observed to interact with service users in an appropriate and supportive manner. The atmosphere in the home was positive, with the service Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: encouraging involvement from families, who both visited the home, but also invited their relatives to go out and occasionally stay with them. Service users are involved in talking about what they would like to eat with their keyworkers, and also has a group. Peoples likes and dislikes are well recorded within their care plans, and this is taken into consideration when completing the menu. One service user had expressed that they disliked the food on the menu, and was having a take away that evening. The evening meal is usually the main cooked meal of the day and service users can choose to eat where they want and when they want, providing their nutritional needs are met and also taking into account any perceived risks. Care Homes for Adults (18-65 years) Page 17 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Both health care and personal support is provided in a manner preferred by the individual service user. Evidence: Service users have individual health care plans that give a comprehensive overview of their general health, and acts as an indicator to any changing health needs. Service users are supported where necessary with all aspects of their physical and emotional health, and receive adequate and appropriate input from specialists such as community nurses, consultants, GP, dentists, opticians and dieticians. Information and advice provided, was adequately monitored, and recorded in the care plans seen. All service users currently living in the home require full staff support with their medication needs. Written protocols were in place to ensure that all staff follows the same prompting procedure, when administering medication, and that if a person refuses that this is clearly recorded, and medical intervention is sourced if necessary. Sound medication procedures are in place, but were seen not to have been followed at all times when the home was inspected. One service users medication had been signed on the MAR sheet but the medication remained in the packet. The explanation for this was that the oral suspension was administrated instead of the tablets. The staff member advised that this was because the tablets had been recently introduced. When the tablets Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: were introduced the oral medication should have been disposed of immediately. All other checks made were satisfactory. Medication is stored securely in a cabinet in the office. Care Homes for Adults (18-65 years) Page 19 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure at the house is on display; and service users can be assured that concerns and complaints will be listened to and acted on. Evidence: The home had a clear complaints procedure in place; this was referred to in the homes Statement of Purpose and Service users Guide. The document would benefit from being available in pictorial format for ease of use by service users who would not be able to understand the written document. At the time of the inspection visit there had been no complaints made to either the home or the Commission since the last key inspection visit. Service users have regular contact with their allocated key worker, and concerns are usually picked up then, by staff who know them well. Any changes in behaviour are care fully monitored and recorded and the staff member on duty at the inspection stated I feel confident that if something was upsetting someone, that staff would notice and find out, and do there very best to help them raise their concern. Training in the prevention of abuse is included in the induction programme, which was looked at, and discussed with the Manager. Staff spoken to were aware of the safeguarding procedures within the home, and of the Whistle Blowing policy. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can expect to live in an environment that is safe and well-maintained, and in which they can develop their independence Evidence: At the time of the inspection the home was comfortable and domestic in scale and style. The general cleanliness of the home was maintained to a good standard but there were several things which required attention on the first day of the inspection. The downstairs toilet was plain, with no decoration, and wall tiles were seen to be dirty. The paper towel holder was empty. COSHH products such as dishwasher tablets, and various types of cleaner were being stored under the sink in the kitchen, and a suitable lock had not been fitted. The garden looked unkempt. The trampoline was broken, and unusable due to safety, but remained. Pieces of wood, old bottles and a range of different materials that require disposal were left in an open container. No steps were available for service users to access the Jacuzzi, and staff was not able to advise when this would be undertaken. These were raised with the staff member as part of the feedback at the end of the inspection. At the 2nd visit the manager acknowledged that there were a number of repairs outstanding at the previous visit mostly due to the number of breakages by service users at that time. All of the things except for the bathroom had been made tidy and where necessary safe. A maintenance list was available which included a timescale for the refurbishment of the downstairs toilet. Speaking to several relatives they were Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: very positive about how quickly things within the home were replaced. One person said the manager works hard to keep up with repairs, it not easy with the boys. They are heavy handed at times. Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by staff that are trained and safe to care for them. Evidence: The files of two new employees were inspected. They contained all the appropriate security and identity checks including Criminal Records Bureau checks and two up to date references. The company has clear job descriptions and person specifications in place which are used as part of interview, but also provide information to staff on the role they are undertaking. Staff training within the service appears to be good. The manager stated in the AQAA that All staff have a micro-induction when they start in their post and then a more detailed induction at a later date. All staff have to complete LDQ training before completing their probationary period.. The induction training is provided in house by the company. Feedback from staff was that this training was very useful, but that due to the high demands of the service users with which they work, more support on the job was needed when initially working in the home. Supervision was in place but looking at the records, some supervisions were clinical cascade meetings. These are very useful, providing an opportunity for a style of group supervision where individual service users are discussed. But several staff suggested that it was difficult to put forward individual Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: views. This could relate to confidence of staff. The manager states that We are currently looking at revising our recording formats for supervision, so they are not just objective based. This would be helpful, as the service employs a number of young staff working with varied, sometimes challenging people and it is important that the management team ensure staff are supervised on a regular basis. All senior staff had completed a range of NVQ qualifications. If staff have not, then the company are keen to support staff to do so. Staffing rotas seen recorded that the minimum staffing provided, was three support workers on duty during the daytime (up to 2000 hours), however the manager stated that often there was a fourth member of staff on duty Night shifts showed a minimum one awake worker and one asleep on call in the home. The manager is supernumerary Monday to Friday. On the first day of inspection their were three staff on duty, and this impacted on the service users being able to undertake the activities written in their plan of care. Most of the service users in the home require one to one support, some two to one to participate in activities outside of the home. Therefore it of great importance that the manager continues to review staffing levels in the home. This is to ensure service users receive the service agreed, but also for staff to take breaks when necessary. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the best interests of the service users; their health, safety and welfare are promoted and protected. Evidence: The manager demonstrates an active and ongoing commitment to developing the home, and always acts promptly on any requirements made. The service strength is the high level of consistency provided by the quality of care plans and risk assessments. This enables staff to feel confident in the delivery of care, and understand the difficulties that some service users are experiencing. My observation was that staff spoke warmly of the young people and saw their qualities beyond any challenging behavior that they may present. This positive approach from staff appears to promote good relationships between themselves and the people they work with. Relationships appeared easy going’, but respectful and consistent. It was observed that the current service users were all young people, and generally the Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: staff recruited were also young. Staff said that this meant that they could easily relate to service users, and fit in with them. The service target group tends to be people with more complex care needs. It is therefore crucial that training and supervision are given high profile, as many of the staff will not have had previous experience of working with such challenging behaviour. Whilst supervision and induction is provided, as previously stated there is a need for the manager to talk to staff about supervision, and to identify individual needs. Information provided by the home as part of this inspection showed that there is good compliance with Health & Safety matters. Equipment and systems are being serviced at the appropriate intervals. Staff are provided with H & S training, and when spoken to had good knowledge, and understanding of different policies that they had read. Records seen confirmed that regular fire alarm tests and drills are carried out. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes No 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 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 Description 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 Description 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 1 Service User would benefit from the service users guide being produced in a user-friendly format for people with Learning difficulties. Either written form or audio The assessment process should be reviewed, and provide evidence that the assessment has considered the compatibility of the new prospective user with the people already living in the house, this will ensure service users Page 27 of 29 2 2 Care Homes for Adults (18-65 years) 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 social and emotional needs can be met. 3 20 The manager must audit medication to ensure all medication is disposed of on time, and not used when not listed on the Mar sheet. \It is recommended that the registered manager reviews the current supervision processes to ensure that they meet the needs of the staff team, to sustain the level of service provided to service users. 4 36 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 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) 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 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!