Care Home: Fern Lodge Nursing Home

What the care home does well Fern Lodge is very well run and the manager is well regarded by people living in the home, relatives and staff. A visiting health professional commented about a person living in the home, "home keeps him occupied - staff know about him. Care is personcentred. Can always find a staff member." Staff working at the home are also highly thought of, one person living in the home writing, "look after the clients properly." A relative made a similar comment. Another person living in the home said, "staff very good, excellent. Food`s good. Room clean, tidy - own room. Staff very polite, don`t shout or swear, knock on door." A relative told us, "the best place for him - near to me, not a prisoner, well fed, do his laundry, TV in room, can isolate himself if he wants." People in the home have their care needs fully assessed by a suitably qualified person before they move in and are given the opportunity to visit beforehand to see if the home will meet their needs. The standard of catering is good so people living in the home are well nourished and are offered choice. The home receives few complaints and measures are in place to protect people from possible abuse. The home is well maintained so that people live in a safe environment. Staff receive training to carry out their role. Fern Lodge is used by training organisations for placements of students so is acknowledged as a good place for learning to take place. A variety of methods are used to find out if the home provides a good quality service. People living in the home are able to express their views about their daily lives and how the home is run so they feel they are valued. What has improved since the last inspection? Senior staff have done training about the Mental Capacity Act so they know what actions they should take to protect the interests of people who lack capacity. Virtually 50 percent of staff have achieved NVQ2 in care qualification so they are skilled in carrying out their role. Induction standards are linked to the nationally recognised Skills for Care foundation standards so that staff undertake training about adult protection when they start work. What the care home could do better: The individual social care needs of people living in the home should be recorded on the care plan so that staff provide care that is person centred. The home should find independent mental health advocates for people who do not have a family member or close friend who can give them guidance to provide support about important decisions in their life. Care plans need to show that staff are encouraging people living in the home to adopt healthy lifestyles. Key inspection report Care homes for adults (18-65 years) Name: Address: Fern Lodge Nursing Home 5 Eversley Park Chester Cheshire CH2 2AJ     The quality rating for this care home is:   three star excellent 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 Shimmin     Date: 0 6 0 5 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 26 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 26 Information about the care home Name of care home: Address: Fern Lodge Nursing Home 5 Eversley Park Chester Cheshire CH2 2AJ 01244372288 01244374425 marcus@fernlodge.orangehome.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Fairhome Care Group (Fern Lodge) Limited care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD. The maximum number of service users who can be accommodated is: 21. Date of last inspection Brief description of the care home Fern Lodge is a Victorian, three storey semi-detached house near Chester city centre. The home is close to a main bus route and ten minutes walk from the nearest shops. It is also within walking distance of the Countess of Chester Health Park. There are bedrooms on all three floors. As there is no passenger lift, access to all floors is by a staircase. There are thirteen single rooms and four twin rooms; one of the single rooms has en suite facilities. People living in the home are there because they have mental health problems and as Care Homes for Adults (18-65 years) Page 4 of 26 21 Over 65 0 Brief description of the care home it is a nursing home, nurses are on duty at all times. The weekly fees are 521 to 586 pounds. Care Homes for Adults (18-65 years) Page 5 of 26 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection on this service was completed on 8 May, 2007. The overall quality rating for this service is 3 stars. This means that the people who use the service experience excellent quality outcomes. This key unannounced inspection visit took place over neasrly five and a half hours. One regulatory inspector carried out the visit. Care Homes for Adults (18-65 years) Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: The individual social care needs of people living in the home should be recorded on the care plan so that staff provide care that is person centred. The home should find independent mental health advocates for people who do not have a family member or close friend who can give them guidance to provide support Care Homes for Adults (18-65 years) Page 7 of 26 about important decisions in their life. Care plans need to show that staff are encouraging people living in the home to adopt healthy lifestyles. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. 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 26 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 26 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. People have their needs assessed before deciding to move into the home so they know their needs can be met. Evidence: We looked at the information obtained by the manager of Fern Lodge about two people who had moved into the home since our last big inspection. In one case the person had completed a self assessment, which is helpful as the person is able to identify any areas where they feel assistance might be needed and also enables the person to say if they have any strengths. The manager of Fern Lodge went to visit one person before she moved into the home to find out if the home could meet her needs. There was plenty of information provided by mental health care professionals about the care needs of both people so that the home could draw up a care plan describing what actions needed to be taken by staff to meet the needs of people moving into Fern Lodge. The manager said that both people had visited the home before moving in on a permanent basis so that they could decide if the home would be suitable for them. One person commented that he felt quite settled since moving into Fern Lodge. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to make decisions and take risks in their daily lives and this is documented in care plans so that people are able to lead a fairly independent lifestyle. Evidence: Staff at Fern Lodge encourage people moving into the home to take part in drawing up their care plan so they are able to make decisions about their care. One person had declined to do this and this was documented. The manager said that every person living in the home had a keyworker so they would know who to speak to if they wanted to look at their care plan or make any changes. Two care plans were seen and they had been kept under review every one to two months so that changing needs were recorded. Two mental health professionals were visiting the home to review the care needs of a number of people living there. One said, clients fully involved in this process - able to voice their opinions. The manager told us that five people living in the home did not have access to someone who could support them in making decisions but that efforts were being made to put this right. Staff had undertaken training in the Mental Capacity Act so they were aware about how to help people who Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: need assistance. Care plans provided only limited information about the social care needs of people living in the home. Although there was information in the initial assessments about the individual social care needs of people on admission to the home this information was not transferred to the care plan except in a very nonspecific way. This means that the individual social care needs of people living in the home may not be known to all staff and that those needs may not be met. We also looked at risk assessments, which were written for people living in the home. Staff had identified a variety of risks and had documented what actions staff would take to minimise these risks. We saw evidence that people living in the home were given advice about taking risks and were given support to do this. One person said, can come and go as I like - pretty much so. I feel safe. Care Homes for Adults (18-65 years) Page 12 of 26 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 are able to take part in activities that suit their lifestyles and can make choices so they stay as active and independent as possible in their daily lives. Evidence: Staff at Fern Lodge encourage people living in the home to take advantage of any opportunities to undertake education or employment. Several people have expressed the wish to return to work and the home has tried to assist with this. One person works in a sheltered employment capacity for a local organisation that supports this type of employment. People living in the home are also given a small financial sum to carry out household chores at the home so that they are given incentives to increase their income. Three people living in the home attend a training scheme either on a regular or ad hoc basis so that they are able to take part in activities outside the home that they enjoy and can also develop skills. People are supported to go out of the home independently Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: and the home has its own car so that small groups of people can go out into the wider community. For instance, several people had visited a local garden centre the previous week with the manager. We were given evidence that people are supported to maintain family and friendship links and develop friendships within the home so that these essential human needs are met and people do not feel isolated. One relative commented that it was very important that he was able to visit a home that was close to where he lived for ease of access. He also said that his relative had choice in his daily life so that he could stay in his own room if he wished and that he enjoyed a good deal of freedom to come and go as he pleased. The home employs two cooks who provide a choice of homemade and fresh produce so people are well nourished and are given a variety of food. The main meal is served at 5pm so that those people who wish to go out for the day can still enjoy a cooked evening meal. The home has menus which are rotated on a four weekly basis and are adjusted according to the season. People living in the home meet on a regular basis and are able to talk about the menus and make changes if they wish. Care Homes for Adults (18-65 years) Page 14 of 26 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 way in which peoples needs are met means they receive the care they need in a way that respects their dignity. Evidence: The manager told us that every person living in the home has a keyworker who takes the lead in relation to discussing the care needs of people on an individual basis. Care is provided in a manner that respects the privacy and preferences of people living in the home and which is unobtrusive so that people feel that staff provide sensitive care. The outcome of this is that the mental health needs of people are met and improve as a result of the care provided. One CPN said, mental health always stable. Although care plans do not always demonstrate that care is person centred there is evidence that the care provided by staff is person centred so that peoples individual care needs are met. We looked at how the health care needs of people were being met. The home contacts a number of health care professionals to make sure that peoples health care needs are monitored and checked when necessary. However, care plans also indicated that the staff needed to take more action in relation to health promotion in relation to the dietary needs of one person and in relation to supporting another person to reduce Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: their dependency on nicotine. The manager told us that more than half the people in the home smoke, which may be adversely affecting their health. We looked at how medication was being managed at Fern Lodge. Overall this was of a good standard and advice was given about ensuring that the refusal to take medication is recorded so that action can be taken to monitor this. Several people living in the home were administering their own medication and there was documentary evidence that this was being well managed and kept under review so that people were protected. Care Homes for Adults (18-65 years) Page 16 of 26 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. Policies, procedures and training for complaints and safeguarding adults are satisfactory so people living in the home are protected. Evidence: Fern Lodge has a complaints procedure, which is displayed in the hallway of the home. The manager said that this was to be reviewed in the near future. However, it gave people living in the home sufficient information about how to make a complaint if they wished. People said they had no complaints. The home has received only one complaint in the last year and this was investigated and appropriate actions taken to address any issues raised. The home has a policy about safeguarding adults and the content of this policy is detailed and covers all issues that staff need to be aware of. Staff have signed to say that they have read and understood the policy so they know what to do if they suspect someone is being abused. Staff also undertake training in safeguarding adults during the induction process so they are aware of their responsibilities. The manager told us that the home uses a safe system for the protection of the money of people living in the home. Care Homes for Adults (18-65 years) Page 17 of 26 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. Fern Lodge is well maintained, clean and tidy so that people live in safe and comfortable surroundings. Evidence: We looked at several parts of the home. We found the home to be clean, tidy and well maintained. Fern Lodge offers a relaxed, comfortable and homely environment for people living there. A visiting health professional commented, environment always clean. The manager sent us information before the visit, which stated that the homes equipment and installations were serviced and checked on a regular basis. Various improvements are carried out at the home to make sure that it is fit for purpose. For example, during our visit the door to the smoking lounge was being replaced so that staff could observe smokers from the corridor and not have to enter the room, thereby protecting staff from a smoky environment. The manager sent us information before the inspection and told us, we complete a weekly repairs list that details work needed. We conduct a monthly inspection of the premises, both internal and external. Any items that need attention are forwarded to Head Office for approval.We complete an Annual Property Inspection which identifies renewals and work to be completed over the coming year. The manager also told us that although specialist clinical waste bins were not required at present he was making provision to have one bin provided at the home so that any Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: waste could be disposed of safely. Staff at the home have been undertaking a training module in infection control so they know how to manage any outbreak of infection at the home. Care Homes for Adults (18-65 years) Page 19 of 26 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. Staff have had training to make sure they develop their skills and provide safe care. Recruitment procedures are thorough to ensure that people living in the home are protected from possible poor practice and harm. Evidence: We looked at two staff records. These indicated that staff receive training appropriate to their role, including a full induction so they are competent and skilled in carrying out their job. The manager told us that all staff are given job descriptions so they know what is expected of them. Nearly 50 percent of staff have achieved the NVQ2 qualification in care. The manager told us that a number of staff leave to work in another environment having gained valuable experience at Fern Lodge. The home is recognised by training organisations as a good and suitable placement for students to gain knowledge and skills, which means that the home is highly regarded. The home usually has a student on placement at the home. Staff said they were given support to attend training so that they could keep up to date. We looked at the recruitment records of two new staff members. These were of a good standard and indicated that the home had taken steps to ensure that staff recruited were suitable to work in the home. The manager said that new staff members did not start work until a full security check had been received from the Criminal Records Bureau so that people are fully protected. The manager provided us with information Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: before the visit which said, staff have annual appraisals that are linked to their job descriptions and these identify training needs for the year ahead. Job descriptions are reviewed on a regular basis by the Manager and staff at their annual appraisal. All staff have an allocated supervisor and participate in regular supervision sessions. This indicates that staff receive appropriate support and supervision, so they are valued by the homes management. A new staff member said, I like the relaxed atmosphere seem to treat people equally. Care Homes for Adults (18-65 years) Page 21 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Fern Lodge is well run so that the best interests of the people living in the home are promoted. Evidence: We spoke to the manager who has managed Fern Lodge for 19 years. He is qualified as a registered mental health nurse and completed the Registered Managers Award in 2004. A deputy manager supports the manager. Fern Lodge is very well managed, which is demonstrated through feedback we received about the home from people living in the home, relatives, staff and visiting health care professionals. One relative wrote that in relation to what the home does well, looks after their residents. A health professional said about the home, very welcoming, always get information and given allocated time - very structured. She said that the manager was, very knowledgeable about clients. Fern Lodge uses various methods to find out if the home is providing a good service. Staff talk to people living in the home on an informal basis every day. There are also regular residents meetings where people can voice their opinions about how the home is run and suggest improvements. People living in the home are encouraged to set the Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: agenda and take the lead if possible. The home has clear policies and procedures about health and safety. These are made available to staff who are expected to read them so they know what is expected of them. The manager told us that the policies and procedures are reviewed on a six monthly basis and that he meets with the managers of other homes within the organisation to assess what further actions need to be taken to meet the Care Standards in full. A representative of the organisation visits the home on an unannounced basis every month and provides the manager with a written and verbal report about how the home is performing so the manager receives feedback about any improvements that need to be made. The manager told us that staff undertake all the training that they need to carry out their role on a regular basis so they are safe practitioners and so that people living in the home are protected. Care Homes for Adults (18-65 years) Page 23 of 26 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 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Care plans should include sufficient detail about the individual social care needs of people living in the home so that these needs are fully understood and met. Advocates should be provided for those people in the home who have no one to support them so that they receive the advice and guidance they need to make important decisions. Care plans need to reflect that care staff are taking action to promote healthy lifestyles so that peoples health care needs are well managed and people are protected. 2 7 3 19 Care Homes for Adults (18-65 years) Page 25 of 26 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 26 of 26 - 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!