Care Home: Harborough Road

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Key inspection report Care homes for adults (18-65 years) Name: Address: Harborough Road 1a Harborough Road Rushden Northants NN10 0LT     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: Ansuya Chudasama     Date: 1 1 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Harborough Road 1a Harborough Road Rushden Northants NN10 0LT 01933413163 01933413163 JudyPhillips@mencap.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Royal Mencap Society care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Number 1a Harborough Road is part of the Royal Mencap Society and is a care home providing personal care and accommodation for up to four adults with a learning disability. The care home is situated in the residential area of Rushden. The accommodation is over two floors, with access to the first floor via a stairwell. All bedrooms are single, one of which being located on the ground floor; bathroom and toilet facilities are located on both the ground and first floor. There are limited car parking facilities to the front of the property, and a courtyard garden is located to the rear of the garden. Information as to the facilities and services offered is available to prospective service users upon request; and are available in both written and symbol format. Commission of Social Care Inspection Reports are located in the office. The current weekly fee is £313.00 with additional costs for chiropody and hairdressing Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 4 Brief description of the care home services to meet the individual needs of the people who live at the home. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out in accordance with the Care Quality Commission (CQC) policy and methodologies which require review of key standards for the provision of a care home for older people that takes account of the peoples views and information received about the service since the last inspection. Evidence used and judgments made within the main body of the report include information from this visit. We looked at the Annual Quality Assurance Assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment tool that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We sent out care homes surveys for relatives, health professionals and staff and for the people to complete information about how the home was meeting their needs. We received the surveys back when we asked for them. The information from these Care Homes for Adults (18-65 years) Page 6 of 27 documents are used in the report. We also looked at the information from the last key inspection and the records of any other visits that we have made to the home in the last 12 months. Information we have about how the home has managed any complaints and things that have happened in the home, which are reported under notifications and are a legal requirement are also looked at. The report refers to we this is because the report is written on behalf of the Quality Care Commission. We last inspected this service on the 22nd of August 07. This key inspection was carried out on the 11th of August 09. The manager of the home helped out with the inspection process. During this inspection we tracked the care of one person living in the home. This involved reading their care records and also talking to them wherever possible to obtain their views on the service. We also observed the interactions of the people with staff and the other people who live in the home. Documentation relating to staff recruitment, training and supervision, medication administration, complaints and health and safety were also examined. We had the opportunity to talk to some of the staff who were on duty. Care Homes for Adults (18-65 years) Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 27 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 9 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The peoples assessment needs are carried out prior to admission to ensure that the home is able to meet their needs. Evidence: The home has a Statement of Purpose and a Service User Guide, which gives information about the services provided by the home. The people and their families are given this information. We are told in the AQAA that the home is looking at developing and producing the Statement of Purpose and Service User Guide in different formats and this also includes completing a DVD version of the Service Users Guide so that individuals looking for accommodation are able to access information about 1A Harborough Rd and be more in control of their decision in the next 12 months. Information from a family survey said I do think they look after their family member well and have all her needs all sorted out. We were informed by the home that a new person had been admitted to the home following a series of visits, which was said to have gone well. We were also told that the other people in the home had taken to the Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: person well. Talking to the person and staff, and observation of the interactions between the people confirmed this. One of the questionnaires received said that their social worker had asked them if they wanted to come to the home and the person said yes and they had visited the home several times. The peoples files looked at showed that there were assessment admission details of the person being admitted to the home. The home also visited people in their own environment but a record of this visit is not recorded. This was discussed with the manager and it was stated that in the future this would be recorded. All the people in the home have contracts. The weekly charge varies per person because this depends on their individual circumstances. The amount the person pays is stated in their contract of occupancy. Care Homes for Adults (18-65 years) Page 12 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All the people have detailed care plans to ensure the staff have the information to meet their needs. Evidence: We looked at one new persons care plan and discussed their care needs with staff on duty. We were informed that the support plans had been done recently and these were completed using the person centred planning (PCP) process, which explains how the person wanted to be cared by staff. For example there was information recorded for what are my need and what support do I need and what is my routine and what do I like The information in the plans was well written. The staff spoken to had very good understanding of the care needs of all the people living in the home. We were told that the staff review the peoples care plans regularly. We were also told that the people are able to attend their care planning meetings. One person had their plans reviewed more often to ensure their needs were being met. We were told that this person attended their meeting and told the meeting Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: how they wanted their needs to be met. This was confirmed by talking to the person. The care plans seen were detailed and had information about personal and health care, and life style information. We are told by staff that they discuss the care plan with the people and relatives to tell them how their needs are to be met by the home. Annual reviews by Social Services were being undertaken to find out if the peoples needs were being met. A range of risk assessments are in place that enables the people to take risks as part of an independent lifestyle. These risk assessments are crossed reference to the support plans. There were daily notes recorded for each person to say what they had done on the day. The peoples information was kept secure in the office and staff are aware about the homes confidentiality procedures. Care Homes for Adults (18-65 years) Page 14 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Meals served are nutritious with a menu, which changes each week so that the people have a balanced diet with choices to meet their needs. Evidence: Staff spoken to told us that the people choose the menus for the week on Saturdays by using pictures. A menu in picture format was displayed for the day. We were told that the home does not have a cook but the staff do the cooking at the home. The people are encouraged to eat healthy food . Sometimes people in the home helped out with some meal preparation. The AQAA says for our plans for improvement in the next 12 months is to involve the people we support in more cooking and preparation of meals. One person told us that the food at the home was very nice and they had takeaway curry which they like. Reading daily notes of the people showed that they enjoyed eating the meals at the home. Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: We were told by one person that they enjoyed going to the day centre four times a week and they did cooking. On their one to one day with staff once a week, they spend time cleaning their room, doing shopping, and did things that they enjoyed doing. On the day of the inspection the person had visited their family and told us that they enjoyed this. They also told us that they are happy here and go to the garden centre and help with shopping. We were also told that two people in the home went to the theater to watch a show and stayed overnight in London with support from staff. We were told by them that they enjoyed this very much and wanted to go out more often to different shows, and wanted to go on the train and the boat. One person said that they would like to go on a plane with another person in the home. This was also agreed by another person who was not able to tell us verbally but was observed smiling and shaking their head when this was being discussed with the person and staff. Comments from one questionnaire said that more time away from home to do various activities was needed and staff are very keen to support but funding not always available. The AQAA says that the home will continue to look out for new activities and experiences, offer a wide variety of opportunities to the people we support,. We were told that two people were going for a meal with one of the peoples family which they were looking forward to. The people in the home were observed doing what they wanted to do and appeared very relaxed and at home. They were also observed getting on well with staff and each other. We were told that the home takes people on holiday with staff supporting them and they enjoyed this. The staff spoken to tell us that they try their best to meet the peoples needs by trying different things with them. One of the people told us that they liked their bedroom, and each persons bedroom seen was individualised to their taste. One person in the home did not have any family but has a volunteer who also acts as an advocate. The home has one person who has an advocate to help the person with any concerns. Most of the people in the home maintain contact with their families and friends and the home helps the people to maintain contact with their relatives. One family asked for more contact with the home to find out how their family member was doing and this was discussed with the manager who stated that this would be done. Care Homes for Adults (18-65 years) Page 16 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The peoples health and personal care needs are being met. Evidence: We observed staff interaction and noticed that they talked to people in a respectful manner. One of the people we spoke to informed us that the staff knocked on their doors before entering their room. We were told that the staff nice and helpful. Some people bought their own clothes with support from staff and enjoyed this. There was information about how the peoples personal care needs were being met. The evidence in the care plans and staff spoken to showed that the people are offered support for their physical and emotional health needs. There were records kept of health visits and the people have access to the opticians, dentists, chiropodist, and other health care professionals. The AQAA says that the people have detailed health action plans for all individuals and those seen were good. Comments received from the questionnaires said the staff supports the needs of people who use this service and paperwork is always up to date. Another comment Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: from a professional stated that the home is very keen to adopt suggestions to improve lives of residents, particularly if medication can be reduced and very good at following appointments and checking if activity has been done. One of the person spoken to told us that if they did not feel well, they would tell the staff. We were told that those people who were not able to verbally tell staff used body language and sounds to inform them if they were not well. The staff also had good understanding of the peoples behaviours to know when they were not feeling well. We were told that the staff who gave out medication had received the accredited training for administering medication. There were medication profiles for each person. The home did not have any controlled drugs but had the controlled drugs cupboard. The records and medication checked was good. Care Homes for Adults (18-65 years) Page 18 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff have good understanding of the peoples behaviours to ensure they are protected from any abuse Evidence: The home has a complaints policy, and the procedures for making a complaint is recorded in the Statement of Purpose and Service User Guide. We are told that the home gives a copy of this to the people and their representatives. One person in the home is able to verbally tell staff if they have any concerns. This person told us that I am not sad I am ok and nice people. The home has not received any complaints. All the staff had completed the safe guarding of vulnerable adults training and they receive refresher training on this regularly. The staff spoken to had good understanding of this and understood the peoples behaviours to know if they were unhappy or not feeling well. The home has not made any safe guarding referrals to Social Services safe guarding team. The people all have their own safes in their room and keep their money in them. The home has very good monitoring systems in place to monitor the peoples money kept at the home. Two peoples money counted was incorrect by being over a few pence. Care Homes for Adults (18-65 years) Page 19 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and has a homely atmosphere to meet the peoples needs Evidence: A tour of the home showed that the place is clean and homely. The home has single bedrooms. Three bedrooms and an office is located on the first floor. One bedroom is situated on the ground floor. The bedrooms seen were indivualised to the people and they had been involved in choosing the colour and style for their rooms. One person spoken to told us that they like their room and some people enjoyed spending time in them. The ground floor has a toilet and bathroom fitted with a ceiling hoist. There is no smoking in the home. The home had a new carpet in the lounge area and looked very pleasant. The pictures of the people living in the home were displayed in the room and this gave a homely feel to the place. The hall and stairways were being painted. The laundry room and bath were showing signs of looking old and needing attention. We were told in the AQAA that the home had a programme of redecoration. The kitchen was combined with dining area and met the needs of the people. The walls in the kitchen had been painted and looked pleasant. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes recruitment procedures are robust to ensure the people are protected from potential harm. Evidence: The staff recruitment files were looked at in detail. Evidence showed that the relevant information was being obtained to safe guard people from any potential harm. The paper work for staff files was good and there fore it was easy to find information required. New staff undertakes the skills in care induction. Staff spoken to said that they received an induction at the home when they start work. Staff spoken to informed us that they were getting supervision every 4 to 6 weeks. The home did not use agency staff and we were told that there was enough staff on duty but more relief staff were needed when staff went on holiday or were off sick. This was discussed with the manager who stated that they worked on shift when staff went on holiday or went on training. The manager was also looking into having a relief staff to cover shifts when needed. We were told that the home retains a lot of their staff and this provides continuity to the people. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: The staff say that they enjoy working at the home, and it was said that they looked after the peoples needs well. We were told that they do lots of training and have completed all the statutory training. One staff said they enjoyed working at the home and with the people. It was said that they all get on well as a team. We are told that staff meetings are held and the peoples needs, staff training, health and safety and information about the organisation is discussed. A staff training matrix showing all the training carried out by staff was seen. All staff except one person did not have NVQ level 2 training in care. Three staff have NVQ level 3 in care. We were told by staff that the manager is good and I do enjoy working here, I like the people, and staff. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interest of the people. Evidence: The registered manager has experience managing homes for people with learning disabilities and has completed the Registered Managers Award. She has undertaken regular training to meet the needs of the people and to manage her role. When the manager came to the home in November 07, she reviewed alot of the paper work and introduced new care planning documents. The manager says supervision from her manager is good and she is well supported. She enjoys working at the home. It was said what the home did well was to provide individual care and support to the people. The staff tell us that the manager is very supportive. and it was a nice atmosphere to work at the home. The accident and incident records show that these were being recorded appropriately and reported to the appropriate agencies. The home sent out questionnaires and had two returned. We were told that staff Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: questionnaires were sent out last year but not this year. The home has the peoples meeting and discuss activities and things that they would like to do. The home undertakes detailed regulation 26 monthly visits and these were good because it has an action plan when something needs to be done with the persons name recorded for doing this. This was checked at the next visit to see if it was completed. Mencap has a dedicated diversity officer and there is a steering group of staff from across the organisation who meet to share good practice and oversee the implementation of diversity policy. The Fire Officer had visited on the 28th of June 07 and the outcome was satisfactory. The fire alarm system was being tested on a weekly basis. The emergency lighting was done on a 3 monthly basis. The home needs to check with the fire officer to find out if this should be done on a monthly basis. The staff told us that fire drill practice was also happening on a regular basis and the people were involved in this process. We were told by staff that they had received fire and food hygiene training. The Environmental health officer had visited and awarded the home three stars on the 12th of February 08, which is good. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 11 23 Provide the people with more out side activities to increase their skills. Ensure that the peoples money is checked regularly to ensure that the balance is the same as what is recorded on the balance sheet. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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