Care Home: Manor Cheshire Home

What the care home does well People who live in the home are provided with assistance to live as independently as possible. People are encouraged to voice their opinions and are part of the staff recruitment process. People who live in the home attend a variety of interesting functions, concerts and other activities. What has improved since the last inspection? There has been some decoration in the home and new flooring laid so that the home can be kept clean and tidy. What the care home could do better: There must be methods in place so that people who live in the home do not run out of any medication as this may have a detrimental affect on their well being and health. When people have medication administered this must be recorded so that evidence is available to show this. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Manor Cheshire Home Church Road Brampton Cambridgeshire PE28 4PF     The quality rating for this care home is:   one star adequate 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: Alison Hilton     Date: 2 3 0 9 2 0 0 8 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. the things that people have said are important to them: They reflect 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 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Manor Cheshire Home Church Road Brampton Cambridgeshire PE28 4PF 01480412412 01480413737 wendy.carter@lc-uk.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Janet Audrey Larter Type of registration: Number of places registered: Leonard Cheshire Disability care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: Date of last inspection Brief description of the care home The Manor Cheshire care home is situated in the village of Brampton, about three miles from the centre of the busy market town of Huntingdon, which has a range of shops, pubs, restaurants and leisure facilities. The home is purpose built, adjacent to the old Manor House, and offers accommodation in a main building and in three bungalows. The main building has thirteen single bedrooms on the ground floor and four on the first floor. The bedrooms on the ground floor have en-suite facilities. Two of the three bungalows offer single accommodation: the third bungalow has two single bedrooms, sitting room, kitchen and bathroom. Communal areas consist of a lounge/dining room, smoking room, activities area and a physiotherapy room. The home has well maintained grounds. The old Manor House is in a state of disrepair and is only used for staff training. The village of Brampton offers a range of local facilities, such as pubs, take-away restaurants, shops and banks. The cities of Cambridge, Peterborough and Bedford are all within a half hour drive and offer a range of indoor Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 21 Brief description of the care home and outdoor leisure facilities, as well as a large number of shops, restaurants and other amenities. Huntingdon has good road and rail links to London and major cities north. Copies of CSCI reports are made available to service users and their relatives upon request. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate 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: We, the Commission for Social Care Inspection (CSCI) carried out a key unannounced inspection of The Manor on Tuesday 23rd September 2008 at 08:25 hrs using the Commission’s methodology described below. This report makes judgements about the service based on the evidence we have gathered. Staff, people who live at the home and the manager were spoken to. An annual service review (ASR) took place on 13th March 2008 when the annual quality assurance assessment (AQAA) was used. A number of records were seen, together with three staff personnel files and the file of one person living in the home. Care Homes for Adults (18-65 years) Page 6 of 29 Care Homes for Adults (18-65 years) Page 7 of 29 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to decide if the home and staff can meet their needs. Evidence: The Statement of Purpose describes the home and what services are available so a person could see if the home would provide the necessary support to meet thier needs. There have been no new admissions for some time to confirm the document is useful. The manager was aware of the need for pre-admission assessments from placing authorities and from staff in the home to ensure a persons specialist needs could be met. Risk assessments are also completed to ensure the safety of people living in the home. Care Homes for Adults (18-65 years) Page 10 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: 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 plans are completed with people to ensure they remain as independent as possible. Evidence: People spoken to during the inspection said they were involved in all aspects of their care plans and reviews of those plans. The plans are held in the persons room and we were permitted by one person to look at theirs. The plan contained up to date information and there had recently been a review, however a lot of the file was repetitive and some unnecessary and noncompleted forms could be removed. The person made some comments about aspects of the care plan that he did not agree with. With his permission these were discussed with the manager and she agreed that a further review of the information would be made. In discussion with the manager the following week, she stated that all files were being looked at and the file seen during the inspection had been completed. Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: We spoke to the finance administrator in the home who said that most financial areas such as fees are dealt with on a regional basis. He authorises payments and oversees the finances of three people living in the home who cannot sign cheques. All others take care of their own finances or have the help of a parent or solicitor. All are encouraged to go to the Bank or cash machine in the village. On speaking with people who live in the home, they confirmed that they are encouraged to deal with their own finances. There are details of available advocates and some people said they had assistance from them or parents who acted as advocates for them. The manager said that people in the home are on the interviewing panel for staff, and people confirmed this. Leonard Cheshire have a campaign manager who is attending the Tory conference this year and one of the people living in The Manor will also be going to give their view. People in the home said that they do go out and about as and when they want and are assisted when necessary and that risk assessments are completed. These were seen on file. Care Homes for Adults (18-65 years) Page 12 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home make choices about their lives ensuring they maintain their independence and social links. Evidence: Breakfast is cereal, fresh fruit, bagels, toast, and cooked breakfast. People were seen enjoying these up until 11:30am. Lunch on day of inspection was Shepherds pie; poached plaice or mushroom stroganoff with rice, carrots, cabbage, and cauliflower. For dessert was chocolate croissant pudding, water melon or yoghurt. An example of tea menu choices are Butternut and sweet potato soup, crusty bread, cheesy garlic bread or sausage baguette. The home has a minibus, which is used to transport people on trips. The manager said that more staff are going to take the MIDAS driving training, which is required to be Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: able to drive the minibus. This will mean it can be used more frequently. One person said they enjoy the cinema, rock concerts and other activities away from the home. He said that sometimes a taxi is used but there is only one firm with a taxi that takes wheelchairs. Other people in the home said I visited Skylarks (another Cheshire home) for a week and went out a lot; I get on with all the staff; my family visits; I get up and go to bed when I want. I like heavy rock and go to concerts. I also go to the cinema and to football matches; I get out all the time; I don’t let anything hold me back. I have a special phone. I watch a lot of TV and play the organ. They encourage us to be as independent as we can be. I get on well with the carers. There are a lot of new staff. I like it to a certain extent. Hardly anyone to have a sensible conversation with. Cant abide people barging in when Im being hoisted and then start talking about other peoples personal things. This lady had had a review last week and was involved. At weekends theyre short of staff but when there are enough I go to the Garden Centre, into Huntingdon and things like that. ts all right here. The carers dont stay long. The food is all right and theres a choice. I go to the pub and garden centre. The activities co-ordinator is sick at the moment and staff are trying to do things with people when they can. Most people can get into the village unaided and across to the local pub. One person went to the cinema in the afternoon of the inspection. Activities are detailed on a white board (a request from people living in the home), such as Bridge, Drama (one person does this in Papworth), Multple Sclerosis centre, indoor games, bowling, shopping, sailing (one person was due to go the evening of the inspection). One person is on the Service Users Network Association (SUNA) as a rep and he goes to various meetings, the next of which is in Blackpool in October. He is assisted by staff in the home to do this. Another person works at a local animal sanctuary although he commented that transport is an issue. The manager said the minibus is available to transport him when he wants to go. It was discussed that a record could be kept of when transport was requested but not available to ensure people were not put at a disadvantage and to see if there was an issue. The manager said she is hoping to recruit a deputy Activies Co-ordinator and has built this into the budget. Some domiciliary staff are key workers to some of those living here at their request. Care Homes for Adults (18-65 years) Page 14 of 29 Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people are met, however there is a problem with medication management that does not promote the safety and wellbeing of people living in the home. Evidence: The medication administration record (MAR) sheets for one person were not completed in relation to ear drops being administered at 13:00 hrs on 8,9,10,13,15,17 and 19 Sept and 22:00 hrs on 11,13,16,22 and 23 Sept. Other medications are self administered and the correct documentation was available in relation these. A different person ran out of Lactulose on 20,21,22 and 23 September. Staff must ensure that no person runs out of medication and when medicines are prescribed they must be given and accurately recorded to ensure the well being of people living in the home. People are encouraged to self medicate and this was confirmed in discussion with those who live at The Manor. There was no evidence on file however that a risk assessment in relation to self medication had been completed, aklthough there was one on taking medication out of the building. Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: People said they were treated with respect and their care was provided in a way that suited them. Staff were seen to knock on doors and wait for a reply before entering a room. They said that the GP and other health professionals were available when needed. People had specialised wheelchairs and other equipment, some of which was purchased by the individual and some by the home. Where possible the details of what a person wishes to happen on their death is discussed and recorded in the care plan. Where a person has not wished to discuss this has been recorded as well. The District Nurse deals with all pressure area care although staff in the home involve the Tissue Viability Nurse when necessary. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peopleare assured their concerns and complaints are taken seriously and acted on. Evidence: Two complaints were received by the manager from the mother of a former resident. They have been dealt with and he has now moved to a different home that can meet his increased needs. One other complaint about the cleanliness of a persons room had been dealt with according to the policy of the home. People in the home said they knew how to complain and had meetings which were attended by the manager and issues dealt with. The manager said she took all complaints seriously and encouraged open discussion. Staff spoken to were able to talk about safeguarding people in the home. Staff have either been on training, are booked to go on refresher training or are booked to go on initial training (over and above that completed on induction). Care Homes for Adults (18-65 years) Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, clean and homely environment, where their independence is promoted. Evidence: There is new flooring in the entrance hall, corridors and some bedrooms. The domestics said this has made it easier to maintain a clean and fresh home with no odours. People who live there said it was easier to get about and they had noticed that it was fresher. Some door surrounds and other areas had been repainted, but the use of wheelchairs in the building meant the maintenance man was well used. The domestics commented that some rooms have lots of personal items and although they try hard to keep rooms clean it is quite difficult logistically as well as with health and safety issues. People said they had their rooms decorated and had the furnishings they needed. Some are out in self contained flats in the grounds as well as in bedsits within the main building. There is only one communal area available to people and this is both for watching TV, Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: mealtimes and visitors area. There are few other areas that people can sit, other than in their rooms when they have visitors with whom they wish to have private conversations. People have all the equipment necessary for them to lead as independent lives as possible. Care Homes for Adults (18-65 years) Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good recruitment practices mean people are not at risk of harm, and good staff training means they are competent to meet the needs of those living in the home. Evidence: There are two staff vacancies one is a 3 day per week care post and 1 maternity leave post. Staff interviews are completed with one of the people who lives in The Manor on the panel and another who shows people round the home. Their views as well as those of people who meet prospective staff on the tour are listened to. The manager said no agency staff are used, there are 2 bank workers and part time staff do overtime. There are 6 staff on in the morning, 3 or 4 staff on in the afternoon and 3 overnight. There is a chef, kitchen assistant, domestics, maintenance person, training co-ordinator (2 days per week), financial administrator and driver/gardener on duty. Staff rotas must be kept up to date and accurate so that people living in the home can see who is on duty. The rota seen during the inspection had some gaps on some shifts, however these were to be covered by the senior who completes the rota who had not got round to completing it at the time we saw it. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: The training organiser showed us the training matrix on the computer that shows all training delivered and what is needed by each member of staff. The induction for new staff covers all the required areas. New staff have been booked on the one day PoVA course and other staff on a refresher course. Most training is supplied by in house trainers with Fire Marshall training, Deaf Awareness and Minibus driver training being bought in. Other than the statutory courses the staff are offered communication training, behaviour awareness, safer eating, Boots medication training. Eight staff are undertaking the Advanced medication course with Boots. The Chef said she had just finished NVQ Level 3 in Management and has done refreshers on other courses. She cooks the birthday cakes and decorates them as requested by the person whose birthday it is. She is planning a Halloween party this year. She has other roles within the home and risk assesses catering eg COSHH and personal protective equipment. She said that there was no-one on a special diet at the moment. She is the support services supervisor for the catering and domestic teams in the home. She is on a regional committee about food in residential homes and attends meetings. One domestic said she had received an induction and attends courses such as eating problems and challenging behaviour as well as those for the job like infection control and PoVA. She was able to explain what to do if she witnessed abuse. She has access to all necessary cleaning goods. Another domestic had an induction and mentor for 2 weeks. She is doing NVQ Level 2 in Housekeeping. She knew where the COSHH information was. She was aware of what to do in the event of abuse and the different types. Both commented on issues around storage in the individual rooms as some are so full it is very difficult to clean adequately and then only by removing piles of things, which they found difficult in the time alloted. A member of care staff said she has NVQ Level 2 in Care but is unsure if she wants to do NVQ Level 3 although she has the support for it from the manager. Some staff felt there were issues with afternoon shift as if there are 3 on duty and one person living in the home requires two to hoist leaving only one member of staff on the floor. Staff felt they had more time now that one person had left the home as his increasing needs meant more staff input. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: Four staff files were seen during the inspection and they contained the necessary information and where there were open comments by referees, these had been followed up by the manager. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Conduct and management of the home is good and this ensures the home is run in the best interest of those who live there. Evidence: There is an emergency evacuation plan for each person in the home and those in the bungalows in the grounds in the case of a fire. These have been completed and signed by the person or their proxy. Lighting checks are completed monthly. Fire fighting equipment was tested on 18/4/08 with 6 monthly tests. Staff and people living in the home have a fire drill weekly, the last being on 28/8/08 when 13 people were involved. The manager holds staff, heads of department, team leader, maintenance and health and safety meetings. People who live in the home have their own meetings to which the manager or other staff are invited. Copies of the minutes for all these meetings were seen. Care Homes for Adults (18-65 years) Page 24 of 29 Care Homes for Adults (18-65 years) Page 25 of 29 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 29 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 20 13 People who live in the home must have medication administered and recorded as being administered to ensure their well being. Peoples health may deteriorate if they do not have their medication 01/11/2008 2 20 13 People living in the home must not run out of any prescribed medication. Peoples health may deteriorate if they do not have the medications they are prescribed. 01/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 Care plans should reflect where there may be a disagreement about changing needs and how they are met, to ensure the views of people using the service are known. Risk assessments should be part of the process of self medicating so that staff know a person is able to undertake Page 27 of 29 2 20 Care Homes for Adults (18-65 years) this task safely. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 © (2008) 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 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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