Care Home: Little Oaks Residential Home

Similar services:

• 2 Perhaver Park
• The Vicarage
• St George`s
• 5 Seafield Road
• Radfords
• Honeybourne House
• 32 Beaumont Way

What the care home does well Little oaks provides smaller group living for up to five people between 18 & 65 years who have a learning disability. The home is situated in a residential area and is not far from the town centre and local facilities. The home is well maintained and each person has their own bedroom which they can personalise. Up to date procedures are in place to ensure the health and safety of persons at the home. Robust procedures are in place to reduce the risk of harm or abuse to people using the service. Quality assurance procedures ensure that the quality of the service provided is regularly monitored and improved. The standard of cleanliness is good and procedures are in place to reduce the risk of the spread of infection. Information for people using the service has been made available in an appropriate and accessible format. What has improved since the last inspection? People using the service have been involved in choosing new furniture, pictures, light fittings etc for the lounge/dining room. This area now appears very comfortable and promotes a more homely feel. It was positive to see that people are now supported to develop and maintain independent living skills including cooking, cleaning and laundry. People spoken with were positive about this. The atmosphere during the inspection was noted to be relaxed and inclusive. Care planning procedures have been reviewed so make them more accessible to people using the service. We found care plans to be reflective of peoples needs and up to date. Risk assessment procedures had also improved. We were able to see that people were able to take informed risks with appropriate levels of staff support. No restrictive practices were observed during this inspection. We found appropriate procedures in place for the management and administration of peoples medication. Training records indicated that staff had received appropriate training to ensure that they were able to meet the assessed needs of people using the service. What the care home could do better: There are no outstanding requirements and no requirements have been raised as a result of this inspection. Key inspection report Care homes for adults (18-65 years) Name: Address: Little Oaks Residential Home 22 Bridgwater Road Taunton Somerset TA1 2DS     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: kathy McCluskey     Date: 2 2 0 4 2 0 1 0 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 28 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Little Oaks Residential Home 22 Bridgwater Road Taunton Somerset TA1 2DS 01823322427 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): pam.degun@tiscali.co.uk Mrs Parminder Kaur Degun Name of registered manager (if applicable) Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 5. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability- Code LD Date of last inspection Brief description of the care home Little Oaks Residential home is a two storey detached bungalow dating back to the 1930s. The home is situated in a residential area of the town and is a short walk from local shops. There is adequate parking and good sized gardens. The home is registered with the Care Quality Commission (CQC) to provide personal care for up to five people with learning disability between the age of 18 and 65 years. Given the size and layout of the home, the home would not be able to accommodate Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 5 2 5 0 6 2 0 0 9 Brief description of the care home people with physical/mobility difficulties. The home is not registered to provide nursing care. The registered provider is Mrs Parminder Degun. The home does not currently have a registered manager. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over half a day by regulation inspector Kathy McCluskey. The home completed its Annual Quality Assurance Assessment (AQAA) and returned this to the Commission within agreed timescales. The AQAA is a self assessment which focuses on how well outcomes are being met for people using the service. It also provides us with some numerical information. At the time of this inspection four people were living at the home. A recent discharge means that the home have one vacancy. We were able to meet with three people during our inspection and we were given unrestricted access to the home. All records required for this inspection were made available to us. The acting manager was available throughout the inspection. Care Homes for Adults (18-65 years) Page 6 of 28 We would like to thank all those involved for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. The term we used throughout this report refers to we the Commission. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: There are no outstanding requirements and no requirements have been raised as a result of this inspection. Care Homes for Adults (18-65 years) Page 8 of 28 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 9 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home and services offered has been produced in an accessible format for people using the service and for those people who are thinking about using the service. Although there have been no admissions to the home for some time, procedures are in place to ensure that people are appropriately assessed before a placement is offered. Procedures are in place to ensure that staff have the skills needed to meet peoples needs. Evidence: The home have produced a Statement of Purpose and service user guide which provide information about the home and services offered. These documents have been produced in an accessible format for people with a learning disability. Apart from one recent planned discharge, the group of people using the service has Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: remained stable and there have been no new admissions for some considerable period. This being the case, not all standards could be assessed. The home has procedures in place to ensure that people are appropriately assessed before a placement at the home is offered. We were informed that assessments from health care professionals would also be obtained where appropriate. A staff training matrix indicated that staff have received a range of training to ensure they have the skills to meet the needs of people using the service. Care Homes for Adults (18-65 years) Page 12 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning procedures have improved. Care plans are up to date and reflective of peoples assessed needs. Steps have been taken to ensure that care plans are more accessible to people using the service. Risk assessment procedures have improved and these now ensure that people are appropriately supported to take informed risks. Evidence: With the permission of people using the service, we examined three care plans. We found that care planning procedures had improved since the last inspection. Information about peoples assessed needs and abilities was easily accessible and the home had started to use some symbols/pictures to make information more accessible to people. The home could further improve care plans to promote a more person centred approach to care by ensuring information about peoples preferences is recorded. This would include, for example, preferences for diet/fluid, preferred times for getting up in the morning or retiring at night. Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: It was positive to see that one individual was involved in recording daily entries in their plan of care. Daily entries made by staff provide information about the outcomes for each individual which is positive. Care plans had been signed by each individual and it has been recommended that, where appropriate, information could be recorded in the first person. This would only be appropriate where the individual could fully contribute to the care planning process. Improvements were noted in the homes risk assessment procedures. Individual risk assessments were in place which would enable individuals to take informed risks with appropriate levels of staff support. People are supported as appropriate to manage their own finances. Records of transactions are maintained along with any receipts. We have recommended that a second staff signature is obtained for any transaction where an individual is unable to sign themselves. Balances and transactions are regularly checked by an external auditor. Confidentiality procedures are in place for staff and this is also covered in the homes induction programme for newly appointed staff. During this inspection we found all records to be appropriately stored. Care Homes for Adults (18-65 years) Page 14 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home have made improvements so that people are supported to develop and maintain independent living skills. People benefit from a relaxed and inclusive environment and no restrictive practices were observed. Evidence: It was apparent that people were benefiting from the positive improvements made since the last inspection with regard to independent living skills. Two people using the service were keen to tell us about the improvements and of how they were more involved in life at the home. People are now supported to develop independent living skills such as cooking, cleaning, doing their own laundry and shopping. One person told us how much they enjoyed cooking the Sunday roast. Information about peoples abilities and the level of support required was seen to be clearly recorded in their plan Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: of care. During this inspection the atmosphere appeared more relaxed and inclusive. One person went to do their washing and people were observed helping themselves to drinks. People are involved in shopping for food and provisions twice weekly. They are also involved in planning meals at the home. We were able to see that people had been able to make a decision as to whether they locked their bedroom door. Two people at the home work at a local supermarket and both told us that they continued to enjoy their work. One person attends a workpower placement. Local day centres are also utilised. People spoken with were positive about leisure opportunities. The home have recruited volunteers who are responsible for supporting people to access a range of social and leisure activities. One person was keen to tell me how much they had enjoyed a trip to Swansea recently to support their team at a football match. We were also shown photographs of other trips out. Care Homes for Adults (18-65 years) Page 16 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensure that peoples personal and health care needs are met. Appropriate procedures are in place for the management and administration of peoples medication. Evidence: We were informed that people using the service only required staff to prompt them to meet their personal hygiene needs. We found care plans to be reflective of individuals personal hygiene needs. We were informed that people are able to make choices about what time they get up or go to bed though, as already mentioned in this report, the home need to ensure that peoples preferences are recorded in their plan of care so that staff can ensure a person centred approach to care. We were able to see that people have access to a range of health care professionals. As required, staff offer assistance for people to attend appointments. Details of each persons contact with health care professionals were seen to be recorded in their plan of care. Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: One person using the service requires assistance and monitoring to meet their nutritional needs. Given the needs of the individual and that they have lost weight, we have recommended that the home maintain records of the amount and type of diet and fluid offered and taken. This should be reflected in the plan of care and regularly reviewed. We examined the homes procedures for the management and administration of medication. We were informed that only two people using the service were currently prescribed medication. This was confirmed by records examined. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). We found all medicines to be securely stored with no excess stocks. We found MAR charts to be appropriately completed. Appropriate procedures are in place for the receipt and return of medicines. Medicines are administered by staff who have received appropriate training. One person is provided with a weeks supply of their medicines to self medicate. Whilst the individual had signed the MAR charts, it has been recommended that the home record the number of tablets given to the individual as this will ensure a clearer audit trail. Care Homes for Adults (18-65 years) Page 18 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes complaints procedure ensures that people know how to raise concerns. Up to date procedures are in place to reduce the risk of harm or abuse to people using the service. Evidence: The home has produced an appropriate and accessible complaints procedure which was seen to be clearly displayed in the home. People told us that they would feel confident in raising concerns if they had any. The homes completed AQAA and records examined during the inspection told us that the home have not received any complaints since the last inspection. No concerns have been raised with the Commission. The home has procedures in place to reduce the risk of harm or abuse to people using the service. Staff have access to a range of up to date procedures and staff have received training in the protection of vulnerable adults. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements made mean that the home provides a more comfortable and homely environment for people. People have their own bedrooms which they can personalise. The home is well maintained and has procedures in place to reduce the risk of the spread of infection. Evidence: On arrival at the home we were met by one individual using the service who was keen to show us the recent improvements. New furniture, pictures, light fittings and dining furniture has been purchased for the lounge/dining area and people using the service were involved in this process. This area appeared welcoming, comfortable and very homely. Four people are currently living at the home and each have their own bedroom on the ground floor. We saw one bedroom and it was apparent that people are supported to personalise their rooms. People have a key to their bedroom. Locks can be overridden by staff in the event of an emergency. The fifth bedroom which is located on the first floor and accessed by a very steep staircase, is not currently occupied. One bedroom Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: has the provision of an en-suite shower and toilet, another bedroom has an en-suite toilet. Other bedrooms have the provision of a wash hand basin. The home has a small kitchen, laundry room bathroom and toilet located on the ground floor. The home does not have any aids or adaptations and does not accommodate people with physical or mobility difficulties. All areas appeared clean and well maintained. Staff hand washing facilities were seen to be appropriated sited. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are met by a staff team who have been appropriately trained. The home follows robust procedures for staff recruitment which reduce the risk of harm or abuse to people using the service. Evidence: We were able to see that staff are issued a job description which clearly sets out their role, responsibilities and lines of accountability. All newly appointed staff complete an in-house induction before completing a more detailed induction programme which follows the recommendation of the common induction standards. Evidence of this was seen in the staff files examined. A staff training matrix confirmed that staff had received mandatory and specialised training. Certificated evidence was also available. The homes completed AQAA told us that of the seven permanent care staff employed, two have achieved a minimum of an NVQ level 2 in care. The AQAA also told us that all staff will be supported to achieve this award. We were informed that given the numbers and needs of people using the service, the number of care staff on duty during the day has reduced from two to one. Nights are Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: covered by one sleep in carer. The acting manager told us that she worked week days in addition to the carer. We were also informed that volunteers have been employed to support people to access leisure/social activities. We examined four staff recruitment files for recently employed staff and volunteers. All recruitment files contained all required information and we were able to see that staff did not commence employment until required information had been received. We were able to see that staff are offered regular supervision sessions where training needs are discussed. Documented evidence of this was seen to be maintained in staff files. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not currently have a registered manager though appropriate interim arrangements are in place to ensure that the home is appropriately managed. Procedures are in place to monitor and improve the quality of the service provided. Up to date procedures are in place to ensure the heath and safety of persons at the home. Evidence: The home does not currently have a registered manager though an acting manager is in post. Management arrangements have remained stable since the last inspection and the acting manager is currently completing the leadership and management award. The acting manager is supported by the provider who visits the home on a regular basis. People appeared relaxed with the acting manager and interactions were noted to be kind and respectful. It was apparent that people were supported to be involved in and Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: kept up to date with all aspects of life at the home. Regular meetings are held for staff and people using the service. The home has procedures in place to monitor and improve the quality of the service delivered. Apart from in-house meetings, quality questionnaires are sent out to people using the service, staff, relatives and health care professionals to seek their views on the quality of the service provided. We were able to see an analysis of a recent survey and responses were noted to be positive. As part of the quality assurance process and in line with the care homes regulations, monthly visits are made by the registered provider with reports maintained at the home. We were able to see that staff have access to a range of up to date policies and procedures. Records examined at this inspection were found to be well maintained, up to date and stored appropriately. We toured the premises and examined records relating to health and safety. All records were found to be up to date and no concerns were noted with the premises. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 To promote a more person centred appropach to care, information about peoples preferences should be included in the plan of care and, where appropriate, care plans could be written in the first person. To further protect people using the service and staff, two signatures should be obtained for financial transactions where an individual using the service is unable to sign for themselves. Details about the amount and type of fluid and diet taken should be recorded on a daily basis for the identified individual. The home should ensure that the plan of care is updated to reflect this and that it is kept under review. To enable a clear audit trail, the number of tablets given to the individual who self medicates should be recorded on the MAR chart. 2 7 3 19 4 20 Care Homes for Adults (18-65 years) Page 27 of 28 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 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!