Care Home: Lancam Nursing Home

What the care home does well There are good care planning and risk assessment systems to ensure that the residents` needs are identified and met. The home`s pre-admission procedure has ensured that only residents` whose needs can be met are admitted. The food is good and the residents` dietary, cultural and religious requirements are met. The residents` are listened to and action is taken to improve the service. The staff are committed and work hard to provide care that meets the needs of the people. What has improved since the last inspection? The manager has worked hard to improve a number of areas as identified in our last inspection reports. For example, a medication auditing system has been introduced to make sure that medicines are stored and administered safely. Restrictors have been fitted to windows on the first floor to reduce or eliminate the chance of accidents and incidents happening and the residents being hurt. The staff without written contracts or letters of employment have been given their contracts and terms and conditions of employment. The manager has complied with the fire officer`s and health and safety officer`s requirements and there is an ongoing maintenance programme. Work has begun to address the way the residents` finances are handled. For example, the home has stopped the practice of buying things in bulk with the residents` money rather than shopping for individual residents. This has ensured that each resident`s money is spent on the type and amount of the item they want. What the care home could do better: Recent building work in the garden has left some holes uncovered. There are also plastic sheets and some pieces of wood that put the residents` health and safety at risk. All these must be addressed so that the residents can enjoy the garden without a risk to their health and safety. Even though the manager has done some work to change the way some of the residents` money is handled, there still remains more work to be done to improve the situation. The residents must not be asked to pay money by direct debit for their personal or additional expenses. There is a need for the manager to ensure that the lift is in good working order. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Lancam Nursing Home 55-57 Netherlands Road New Barnet Hertfordshire EN5 1BP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Teferi Degeneh     Date: 2 2 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Lancam Nursing Home 55-57 Netherlands Road New Barnet Hertfordshire EN5 1BP 02084407904 02084490557 lancam@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Lancam Nursing Care Limited care home 12 Number of places (if applicable): Under 65 Over 65 12 physical disability Additional conditions: 12 The Registered Person may provide the following categories 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: Physical Disability - Code PD and PD(E) The maximum number of service users who can be accommodated is 12 Date of last inspection Brief description of the care home Lancam is a privately owned care home registered to provide nursing care to twelve adults with physical disabilities. The registration category for Lancam allows service users with physical disabilities to continue to receive care at the home when they pass the age of 65 years. There are four single bedrooms and four double bedrooms on the ground floor and first floors of the home. A shaft lift connects the two floors. There are three bathrooms, two of which have assisted baths and one en suite that is used by a service user. There is atwo lounges and a dining room on the ground floor. There is a large attractive garden to the rear of the home. The home is a in a pleasant residential area close to local shops and transport links. Service users vary in age but currently all of them are under 65. The homes registration conditions allow this. The home has been operating for many years but was bought by the current owner two years ago. Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home Mrs Glenda Barker is the registered manager of the home. Fees charged at the home range between £700 and £1350. A copy of this Inspection report can be requested directly from the home or through the CQC website. 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 was a surprise inspection which means that the home had not been informed of our visit. The inspection took approximately six hours beginning at 07:50 am and ending at 15:00 pm. The manager was present throughout the inspection. The inspection activity included a tour of the building, the examination of the residents and staff files and the review of the homes policies, procedures and health and safety records. We were able to observe and talk to and a number of residents and staff individually and in groups. The homes annual quality assurance assessment (AQAA) which we had received before the inspection was considered for this inspection. The AQAA is a self assessment which the home is required to complete and send to the Care Quality Commission (CQC) to tell us what they are doing and how they intend to Care Homes for Adults (18-65 years) Page 6 of 27 improve outcomes for the people who use the service. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 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 9 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. New residents can be confident that a decision about their admission to the home is based on the ability of the home to provide services and facilities that meet their needs. Evidence: The annual quality assurance assessment (AQAA) confirms that the home completes a pre-admission assessment for all new service users. The AQAA states that new residents are given a summary of the homes latest annual audit and a service user guide. We checked five residents files and confirmed that the home has obtained information about the residents. The manager said that the home requests health, social, medical, physical, emotional and other information from health professionals, relatives and the residents in order to complete the assessments and care plans. From discussions with the manager it is evident that new residents are admitted only if their assessed needs can be met by the home. Three residents we spoke to said they are happy with the services and facilities of the home. Care Homes for Adults (18-65 years) Page 10 of 27 Care Homes for Adults (18-65 years) Page 11 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. The residents have benefited from the homes good care planning and risk assessment systems. The systems have ensured that the residents needs are identified and ways of meeting the needs are planned. Evidence: We chose and checked five residents files. All these files have up-to-date assessments and care plans. As mentioned above the assessments include various areas such as health care, medical, social and emotional needs. The care plans are based on the outcome of the needs assessment and are organized in columns clearly stating the needs, the objectives, the care needed and the people responsible for ensuring that the needs are met. The three residents we spoke to told us that they have key workers who meet and discuss their needs with them. It was clear from the files that risk assessments have been completed and up dated for the residents. The risk assessments identify risks to individual residents and how to Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: reduce or manage the risks. The residents or representatives have been consulted regarding the management of risks. Discussions with the manager and an examination of the files showed that the home involves the residents and seeks their agreement before using some specialist equipment, which can be interpreted us restrictive. The manager said that risk assessments and care plans are reviewed regularly. Care Homes for Adults (18-65 years) Page 13 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. The food is good and the residents dietary, cultural and religious requirements are met. The home needs to improve the way it charges the residents for their extra expenses. This is to prevent potential abuse of the residents money. Evidence: A programme of activities, a copy of which was displayed at the home, was examined. The programme gives a list of activities to be provided by care staff everyday at 3 PM. The activities included board games, painting and exercise to music. The residents also spend time watching television either in their bedrooms or in one of the two lounges. One of the residents we spoke to have their own telephone which they use to contact friends and relatives. The manager said staff are designated to provide the activities. The two other residents interviewed said they are happy with the activities provided at the home. A resident was asked by the manager if they would like to be supported to Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: go to a shop and buy clothes but they refused saying that they could not go out. They instead preferred one of the staff to buy the clothes for them. At the last random inspection we asked the manager to improve the way the residents money is managed. The manager informed us that the home has stopped using the residents money to buy items in bulk and sharing them among the residents. The residents personal allowance is now kept and recorded separately as required at the last random inspection. However, the practice of money going to the homes account through a direct debit has not stopped. Four residents are charged certain amount of money on a monthly basis for extra expenses and additional fees. This would mean that the residents continue to be charged even if they already have enough money at the home or even when there is no need for them to spend money. We noticed from the records of a resident that the home did not transfer to the residents account on time the money it had received through the direct debit. From discussions with the residents and the manager, and from the inspection of the files and visitors book it was clear that the residents are visited by families and friends. The manager said the home is open for the relatives and friends of the residents to visit. As mentioned above some residents have telephones. The manager confirmed to us that all of the residents are registered on the electoral roll to vote. She said that some residents vote in person while others use postal voting system. We observed that the residents have access to communal areas. From a conversation with a residents it was confirmed that some residents have advocates or solicitors which help them with their finances. However, the home is yet to find an advocate or a social worker for a resident. Before checking the menus and the meals we asked two residents if they knew what they would have for lunch. Both residents told us the right meal that was planned and offered for the day. The chef has a long experience of working in care homes. All the residents we spoke to said the meals at the home are good. The menu looks balanced with various choices. From the residents files and discussions with the manager it was evident that the peoples cultural, dietary and religious needs are identified and catered for. The home also regularly monitors the residents weights. Care Homes for Adults (18-65 years) Page 15 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 residents health care and medical needs are met by the homes good relationship with health care professionals and the medication auditing system. Evidence: The AQAA states that the home facilitate for the residents to have access to general practitioners (GPs), Chiropodist, Optometrists, Dentists, Physiotherapists and specialist services such as Speech and Language Therapists, Dieticians and Tissue Viability Nurses. The AQAA also confirms that the people who use the service are encouraged, where possible, to arrange medical appointments by themselves. There was written evidence in the residents files that medical appointments have been made for them and they have seen health care professionals. The manager said community psychiatric nurses and psychiatrists visit the home. It was clear from the manager and the staff rota that at least a member of staff on shift is a nurse and a worker who has completed first aid training. The residents daily records showed that the staff were able notice medical symptoms and take appropriate action such as informing the manager and making hospital or GP appointments for the residents. Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: A number of issues in relation to medication storage and administration had been identified and the manager had been asked to make improvements at our last inspection. At this visit we checked the medicines and the medication administration record sheets and found that the manager has introduced a daily auditing system which enabled the home to ensure that medicines are kept safely and administered to the residents as prescribed. From discussions with the manager and from the records it was evident that the handover system at the end of a shift includes the checking of medication. We noticed that the temperature of the room where the medicines are kept is monitored and recorded. It was clear from the inspection of the medication and discussion with the manager that the home records the dates when the bottles with liquid medicines are opened. Records and conversation with the manager confirmed that staff who administer medication are trained. Observations and discussions with care staff indicated that the staff are experienced to support the people who use the service by ensuring respect, dignity and choice. We talked to two care staff who were able to demonstrate their knowledge, skill, and experience of providing good quality of care in a residential home. We also talked to some residents who confirmed to us that they are happy with the staff. On the day of the inspection all the residents we saw appeared presentable and comfortable. Care Homes for Adults (18-65 years) Page 17 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 residents can be confident that they are safe at the home and their concerns are listened to and dealt with effectively by the manager through good complaints procedure and safeguarding policy. Evidence: Two complaints have been recorded since the last inspection. These have been investigated and addressed by the manager. The residents we spoke to informed us that they know who to talk to if they have a concern. The home has a complaints procedure. The two care staff we interviewed were able to explain the different forms of abuse and how to ensure that the people who use the service are safeguarded. It was clear from conversations with the manager that all the staff have attended training on safeguarding and there is a training plan for all staff to attend a refresher course in the same subject in June. The home has its own safeguarding policy and procedure and as well as receiving a copy of the local authoritys new policy presented in pictorial and easy-read format. Care Homes for Adults (18-65 years) Page 18 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. Despite good cleanliness and accessibility of the home, the health and safety of the people who use the service are not guaranteed. Evidence: The home has two large sitting areas with television sets. Window restrictors have been installed as required at the last inspection and all parts of the home were clean, fresh and tidy on the day of the inspection. The residents said they are happy with the facilities of the home. From observations and the AQAA it was evident that the home is accessible to the residents. During the tour of the premises we noticed that the fence on the right side of the building at the back had been removed and some newly dug holes have been left uncovered. We also noticed that the garden was not well looked after and there were pieces of wood and a big sheet of plastic left on the grass in the garden. We discussed with the manager the potential risks arising from these to the people who use the service and asked her to ensure that the fence is re-fixed, the holes covered and the pieces of wood and the plastic sheets removed. Care Homes for Adults (18-65 years) Page 19 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 people who use the service are confident that they are supported by care staff who are vetted, trained and supported by the manager and the owner of the home. Evidence: At the last inspection we asked the owner to ensure that all staff have a letter of employment or a contract. We also asked him to look into the staffing level to ensure that there is an additional member of staff on shift to help with the laundry tasks. From the staff files and discussions with the manager we were able to confirm that all staff have a letter of employment and that there is a person employed to do the laundry. The rota showed that there are two care staff, a registered nurse, the manager, two domestic staff and a laundry person during the day. The night shift is covered by two waking night staff. The manager said at least there is a care staff with a first aid qualification on each shift. We reviewed five staff files. Each of these files has a copy of an application form, evidence of criminal record bureau check, written references and terms and conditions of employment. The manager told us that all jobs are advertised and new staff are recruited through the interviews. Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: The home has a training plan which indicates the days, year and type of training that the staff need to attend. From the AQAA and discussion with the manager it is clear that a number of staff have completed a national vocational qualification (NVQ) at level 2 in care. As mentioned above the staff we interviewed were able to demonstrate their good knowledge, skill and experience of supporting people in a care home. The residents said the staff are good. Care Homes for Adults (18-65 years) Page 21 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 people who use the service and the staff have confidence in the way the home is managed. The arrangements put in place to consult the residents and the other people to comment on the quality of the service and the actions taken by the manager to manage risks to the residents have enabled the people who use the service to live in a better environment. Evidence: The staff and the residents we spoke to told us that the manager is approachable and helpful. During the inspection and at other times of our contact the manager has been willing to work with us and has been positive about improving the service. She has a long experience of managing services and is currently completing NVQ level 4 in leadership and management. The manager has been registered with the Commission since the last inspection. As we mentioned above the home has a medication auditing system. There is also an overall quality assurance system. Through this system the residents, relatives and Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: professionals are invited to complete a survey questionnaire. The outcome of the last such quality assurance exercise was seen. The manager has outlined the actions to be taken as a result of the exercise. There is a regular residents meeting which gives the residents to discuss common concerns to be addressed by the home. There have been ten recorded incidents since the last inspection. Most of these incidents were related to falls. Records and discussions with the manager confirmed that action has been taken to study the pattern of the falls, to review risk assessments and to provide appropriate service and facility to manage the incidents. During the viewing of the premises and from discussions with the manager we confirmed that each room has a call bell. Records and the AQAA showed that health and safety checks are undertaken regularly. For example, the portable electrical appliances were last checked on 16/11/2008 and a pest control officer visited on 01/05/2009 and confirmed that there was no pest activity at the home. An engineer visited the home on 09/04/2009 to service the passenger lift and commented that the lift motor is stalling. As a result of this the manager has started contacting companies to check how much they will charge to change or service the motor. Copies of two prices the manager has so far received were seen. The manager said a decision to employ a company to change or service the lift will be made as soon as a third company gives them the price they will charge. Care Homes for Adults (18-65 years) Page 23 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 24 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 1 13 20 Money for toiletries and 30/05/2010 personal allowance must not be collected from the residents by direct debit when they already have enough amount at the home. Any money collected from the residents must be in their cash tin or in their personal account immediately. This is to ensure that the residents finances are appropriately used for their own benefits only. 2 42 23 The passenger lift must be in good working order. The Care Quality Commission must be notified in writing that the lift is in good working order. This reduces the risk to the and safety of the people who use the service. 15/06/2009 Care Homes for Adults (18-65 years) Page 25 of 27 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - 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!