Care Home: Orchards

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What the care home does well Assessments of need undertaken prior to any admission to the home are comprehensive, involve necessary agencies and professionals and identify work needed to meet outcomes. Mental Capacity Act assessments confirm a person`s capacity to make their own decisions and other risk assessments identify strengths and abilities. Infection control practices safeguard people well from preventable harm. People are regularly consulted about their care and improvements are made in response if needed. What has improved since the last inspection? The home has effective strategies for safeguarding people from potential harm, which could come from visitors to the home. The boiler has been replaced and this gives greater capacity for hot water and heating, providing people with more comfort. All four requirements from the last key inspection have now been fully met. What the care home could do better: The environment is in need of some attention to maintain a pleasing environment for people living there, and this is planned for later in 2009. The manager should confirm that the induction package provided for newly appointed staff is "Skills for Care" compliant so that staff are provided with the nationally recognised skills and knowledge to provide safe care to people living at the home. The trip hazards in the garden caused by building materials being stored there need to be removed without undue delay. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Orchards 136 Oak Tree Lane Selly Oak Birmingham West Midlands B29 6HU     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: Martin George     Date: 2 1 0 1 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.csci.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: Orchards 136 Oak Tree Lane Selly Oak Birmingham West Midlands B29 6HU 01214724671 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) : Mr M Young,Mrs Young care home 3 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Residents must be aged under 65 years Date of last inspection Brief description of the care home 3 The Orchards is a large, three storey Victorian House in Selly Oak. The home currently provides care and support to one adult who has a learning disability. There is a small garden to the front of the home. The ground floor comprises of a large entrance hallway, dining room and a comfortable sized lounge that has patio doors leading to the garden. There is a large family sized kitchen with a door leading to the back garden, small shower room and WC and a very small laundry room. On the first floor are two single bedrooms with en suite facilities for residents, and further rooms including the owners private bedroom. The son of one of the residents who is currently fostered by the owners occupies a small bedroom at the front of the house. There is a fair sized bathroom used by all the residents and the owners and a staircase leading to the second floor. There is an office and a private room used by the owners family on the second floor. There is a private, secure garden with patio area and lawn to the rear of the property. The Commission for Social Care Inspection report is available in the Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home home for any visitors who wish to read it. The Manager said that the fees charged per week are £403. 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 unannounced key inspection was carried out by a single inspector between 10.20 and 16.40. As part of the inspection all National Minimum Standards defined as key by the Commission for Social Care Inspection were considered. Information about the performance of the home was sought and collated in a number of ways. Information from the last key inspection report and other information submitted to the Commission prior to the visit were analysed to formulate a plan for the inspection and through these sources of information we were able to form an initial judgement about the quality of care provided by the home. On the day of the inspection we spoke to the manager, his wife and the one person Care Homes for Adults (18-65 years) Page 6 of 27 living at the home. We also undertook a tour of the premises and observed practice, which provided evidence in support of the records we also checked on the day. This approach allowed us to assess how well outcomes were being met for those receiving a service. Following the inspection we were provided with written information and data about the home through their annual quality assurance assessment and this provided information that supported our findings. 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 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who come to live at the home have been carefully assessed to ensure their needs can be met. Evidence: Information provided to prospective admissions is contained in a statement of purpose and welcome guide, both of which are up to date and are suited to the needs of people who live there. People are carefully and comprehensively assessed prior to any decision being made about whether the home is able to meet their needs. The pre-admission assessments carried out by the home cover a wide range of needs consistent with, and exceeding, National Minimum Standards to ensure that the home can provide services that will help people achieve to their potential. We looked at the pre-admission assessment of a prospective admission that has been under consideration for several months. The manager liaised with relevant agencies to gain as much information as possible. The person has recently acquired refugee status and the manager says the admission will Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: not progress any further unless funding arrangements can be finalised. The home has not taken any admissions for some time but the pre-admission process in place satisfies us that any future admission would be well managed and would consider potential matching difficulties with the person who has been living at the home for several years to ensure their stability was not disrupted. The Annual Quality Assurance Assessment (AQAA) is the homes own assessment of how well it provides a service, submitted to the Commission for Social Care Inspection (CSCI) prior to inspection. This document states that the pre-admission assessment involves the manager speaking with the prospective admission and their current carers to identify the level of needs and whether Orchards can meet them. The AQAA also states that any prospective admission will be given the chance to visit the home, meet the staff and other people living there and also try out their room. This helps determine whether the person will be happy living at Orchards. The home has a contract for people living there and this contains up to date information about the standard fees and details what items and services are not included, which are dry cleaning, hairdressing and chiropody. The person living at the home said she knew what she had to pay extra for. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The person living at the home is encouraged and supported to make decisions and live as independently as her capability allows. Evidence: The care plan for the one person living at the home covers a wide range of issues relevant to ensuring outcomes for the person are met. The plan includes a comprehensive Mental Capacity Act assessment, which clearly identifies that she is able to make her own decisions. The manager explained to us that he is not always sure her decisions are what he would regard as in her best interests but there are risk assessments that show how the home manages any potential consequences arising out of her decisions. Risk assessments we saw identified the persons abilities and strengths and showed that careful thought and assessment had gone into determining the persons levels of independence and capability in a range of activities she engages in. Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: Involving the person in their own care planning is difficult as she does not see herself as needing care and is therefore resistant to efforts to try and engage her in the review process. A discussion with the person supported this view as she told us that what she really needs is a place of her own and avoided any attempts by us to try and ascertain her current level of ability to do that. The person manages all her own money and financial matters and there is a risk assessment supporting this. The manager told us that she is unwilling to discuss ways of managing her money more effectively and tends to have a boom or bust mentality. When we spoke with the person she told us how she is encouraged to get involved in day to day decision making, from things like what to have for tea, how to furnish her room and choices about activities and holidays. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are encouraged and supported to make and maintain community links and friendships. Evidence: The person living at the home attends a local centre three times per week and on the day of the visit received confirmation that she has been accepted to carry out tasks at the centre that will allow her to earn. The person explained to us that she is very happy going to the centre. She also told us that she likes shopping. The person is encouraged and supported to meet up with her circle of friends to help her maintain social networks outside of the home. On her file we saw a risk assessment covering the issue of a man friend who used to stay on occasional overnights. This situation has since changed and he is now required to vacate the Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: home by 11pm. This change came about following unsubstantiated concerns that he may have been emotionally or financially manipulating the person but she was clear that she wanted no action taking. The manager nonetheless decided that some safeguarding action was required to protect her from any potential harm. The manager explained that where a visitor presents an actual or potential risk to those living at the home or staff this is assessed and a strategy put in place to minimise or eradicate the risk. The AQAA gives an example of this with a friend of the person who lives at the home who visited on one occasion under the influence of alcohol and was threatening to the manager and his wife. A sobriety requirement was made to allow further visits to take place. This evidences the commitment of the home to ensure the person can continue to have visitors of their choice whilst safeguarding everyone from harm. Evidence of meals taken are kept in the daily records so it is easy to monitor that people are having their nutritional needs met. The informal family ethos of the home and the fact that there is only one person placed there means that meals are decided on a daily what does everyone fancy basis, so there is no need to have formal menu planning. The person is reluctant to help with preparation of meals but she is always encouraged to do so. The person has been on holiday to Disneyland, Florida and Spain, as well as several outings in the UK. These destinations and outings were planned following discussions with the person to find out what she wanted to do. She told us that she really enjoyed the holidays and likes being with the manager and his wife. The AQAA states that there is an anti-discriminatory policy covering all aspects of the service that the home offers to ensure equality and diversity is incorprated in service delivery. Because the home runs on family lines and the people living there are effectively assimilated into the family they enjoy equal autonomy, consideration and freedom as every other member of the household and our observation on the day and discussion with the person living there confirmed this to be true. 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. People living at the home have their personal support and healthcare needs risk assessed to ensure help is provided as required. Evidence: The person living at the home is encouraged to live as independent a life as possible but does require monitoring or support with some of her personal and healthcare needs. Her hygiene standards are poor, especially around her foot care. The manager told us that she is unaware of the need to regularly change her footwear and this can lead to problems such as athletes foot. The person does not require any form of physical assistance with personal care needs but does require monitoring and reminding about day to day hygiene, such as washing her hands after using the toilet. Records are kept of all health related appointments which have been attended by the person. The only shortfall noted was that she is slightly overdue for an annual eye test. She is happy to see all health professionals apart from the dentist. We were told that she is banned from all dental practices in the vicinity as a result of aggressive incidents during appointments. The manager told us that in an emergency she would Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: need to be admitted to Accident and Emergency. The person is taking one prescribed medication but it has been risk assessed that she needs to be supervised during administration. The associated risk assessment clearly details why supervision is required, which according to the AQAA is due to her inability to read the instructions, manage colours or differentiate between sizes. Because the person is assessed under the MCA as able to make decisions she has agreed to be supervised during administration of medication and a written consent is on her file. The Medication Administration Records (MAR) sheets are all up to date and fully completed, showing that the person is having her medication needs fully met. The medication storage arrangements meet requirements and ensure that unauthorised access, with potential risk to people living at the home, is prevented. Both the manager and his wife are fully registered mental nurses and are therefore suitably trained to administer medication. 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. People living at the home are protected from harm and abuse by carers who are skilled in providing safe care and deal with concerns quickly. Evidence: There was a notification sent to CSCI on the 9th August 2008 regarding an assault on the person living at the home by one of her female friends. We were told that this was triggered by a three way relationship problem. The person living at the home and the person who assaulted her were spoken to by police and it was agreed that no further action needed to be taken. Records we looked at provided evidence of how this matter was dealt with by the home to ensure the person was adequately safeguarded from similar occurrences. The home has a complaints book but there have been no complaints. The home has comprehensive policies on adult protection and complaints. Both the manager and his wife (the only two carers at present) are fully conversant with these. A discussion with the person living at the home assured us that she knows what to do if she feels unhappy about anything. She told us that she feels very safe living at Orchards. 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. People benefit from a homely environment where potential infection and cross contamination risks are identified and eradicated. Evidence: On the day of the visit we found the home in a state of some untidiness but this was because the kitchen was in the midst of being refurbished. The kitchen itself was having new flooring put in and this was part finished. A new hand basin was waiting to be fitted. Once the fittings are finished the ceiling will also be painted. The manager was confident the work in the kitchen would be finished by the weekend following the inspection. The first thing we noticed on arrival was that the large entrance area is in need of some attention as it is quite dark and needs redecorating, which the manager told us is due to be done by March 2009. Although some areas of the home will benefit from some redecoration there is a homely feel to the place and the person living there told us she likes her room and likes living there. Furnishings in the communal areas of the home are in good order. The AQAA states that carpets and furnishings are professionally cleaned three times per year to ensure people living at the home benefit from a well maintained environment. The boiler has recently been replaced and now has greater capacity Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: providing people with a better controlled environment and hot water on demand. The garden area is untidy as a result of building materials for the kitchen refurbishment cluttering up the area and presenting potential trip hazards to people living at the home. Without the clutter this is a pleasant area to relax. There is a nice patio area and a safe stretch of lawn with flower beds down each side. The home keeps Hazard Analysis and Critical Control Point (HACCP) and safer food, better business records. These show the health and safety measures taken by the home to protect people from preventable harm. There is a seperate infection control file, which details what is done to safeguard people from identifiable risks. The AQAA states that carpets and furnishings are professionally cleaned three times per year and that both the manager and his wife have completed training in the prevention and control of infection. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment and training of staff is given the level of priority to ensure people living at the home receive safe and competent care and have their needs met. Evidence: The home does not currently employ any staff as the manager and his wife run the home on their own. Both have the required qualifications necessary to provide competent care to people living at the home and the AQAA states that the managers wife is in the midst of completing a further qualification to enhance her knowledge and skills, ensuring that people continue to be looked after by carers committed to their own development. The manager told us that if he took another admission he would need to employ at least one member of staff to ensure that peoples needs could continue to be consistently met. Should there be a need to recruit he would use the local job centre. We saw the application form and interview format that would be used and these covered all necessary areas for effective recruitment. In the past when staff have been appointed the person living at the home meets the candidates and offers the manager her view about their suitability. The manager said that if the person gave an absolute thumbs down then the applicant would not be considered for appointment. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: The home has a comprehensive induction package but the manager needs to confirm it is compliant with the Skills for Care induction programme to ensure new staff are given the nationally recognised skills and knowledge required to provide safe care to people living at the home. Staff who have worked at the home previously have been provided with training covering areas necessary to meet the needs of people living at the home and the manager confirmed this will be provided to any staff appointed in the future. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are consulted regularly to ensure managers are kept well informed about how they can improve services for them. Evidence: The home is managed and staffed by the manager and his wife, both Registered Mental Nurses who have kept their registration current. The manager has also completed the Registered Managers Award and both keep their knowledge and skills updated to ensure they maintain the ability to provide effective care to people living at the home. Required health and safety checks are carried out regularly to protect people from a range of potential hazards and risks associated with things such as fire, water contamination and risks associated with equipment. Records accurately detail when health and safety checks have been carried out and any actions needed to safeguard people. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: There is a very comprehensive quality assurance system in place, covering all aspects of service delivery. The views of people using the service are a key element of the quality assurance process used by the home and this indicates high levels of satisfaction. Findings are analysed and presented as a series of graphs to make it easy to identify any areas requiring development to improve outcomes for people living at the home. The manager said that the mother of the person living at the home was approached to offer views about the quality of care provided to her daughter but she declined from getting involved in any form of consultation. The AQAA confirms that all required policies are in place and have been reviewed within the past 6 months to ensure they are consistent with latest legislation and guidance and continue to provide relevant safeguards to people receiving a service. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 24 The clutter in the back garden needs to be removed as soon as possible to remove potential trip hazards and ensure the safety of people is maintained. Care Homes for Adults (18-65 years) Page 26 of 27 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 © (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!