Care Home: Orchid House

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What the care home does well The service supports people to be part of the community and encourages them to maintain links with relatives and friends. People told us that they really enjoyed their holiday to Euro Disney and staff made the holiday fun. A relative said they fully support the home to make informed decisions about holidays and encourage them to jon in activities away from the home. People told us that they really like living at the home and were able to make choices about how they spend their time. They said they had been able to choose the colour scheme for their bedroom and enjoy spending time shopping with the support from staff. What has improved since the last inspection? The service have improved the care plans by making them person centred. People have been involved in the process by using pictures and writing the plan in plain English. The risk assessments are sufficiently detailed to help people maintain their Independence while remaining safe. They have completed health assessments for people who want to follow a healthy eating lifestyle and they have consulted speech therapists to ensure one person is supported to have a diet which reduces the risk of choking. The staff have attended some of the training identified in the previous inspection report, although some training in areas of safeguarding adults, health and safety and infection control remains outstanding. The deputy manager was able to provide dates when the training will take place. One new member of staff had attended a comprehensive induction which meets the `Skills for Care` standards although the home need to improve their own induction programme. They have improved the frequency of supervision provided to staff, although yearly appraisals still need to take place. New policies and procedures have been purchased although they still need to make adjustments to the policies to make them specific to Orchid House. What the care home could do better: The service have improved the medication procedures, by arranging for all medication to be delivered in a monitored dosage system. this has reduced the risk of mistakes, although recording systems remain a concern. Handwritten records were made to record changes to one persons medication using a separate medication administration record (MAR). Procedures need to be improved when people have overnight stays and breaks away from the home, so that staff are clear about the records to be used. The recruitment of staff must be made safer by ensuring all the required employment checks are obtained before the employee commences work at the home. Quality assurance systems must be in place to ensure the views of people who use the service and other stakeholders are gained. Key inspection report Care homes for adults (18-65 years) Name: Address: Orchid House 42 Spring Street Saint Ann`s Road Rotherham South Yorkshire S65 1HD     The quality rating for this care home is:   one star adequate 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: Valerie Hoyle     Date: 1 3 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Orchid House 42 Spring Street Saint Ann`s Road Rotherham South Yorkshire S65 1HD 01709836542 F/P01709836542 NONE Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Jacqueline Ann Marshall,Mr Andrew Marshall care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Orchid House is a four-bedded facility providing a long-term residential service for younger adults with a learning disability. The home is a detached property set in a residential street within walking distance of Rotherham Town Centre. Local pubs, shops, and access to the public transport are close by. Information gained on 13th October 2009 confirmed weekly fees range from £728.63 to £1328.74, additional charges include days out and toiletries. Service Users Guides are available in all bedrooms or on request from the manager. The last published inspection report (dated 14th April 2009) is available on request and a copy is available in dining area for visitors to read. 1 4 0 4 2 0 0 9 4 Over 65 0 Care Homes for Adults (18-65 years) Page 4 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: 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: The quality rating for this service is 1 star. This means that the people who use the service experience adequate quality outcomes. This unannounced inspection took place over 4.5 hours starting 10:30 finishing at 15:00. This visit included a partial inspection of the home. Two people who use the service, the manager and deputy manager and one relative was spoken to during this inspection, their views are included within this report. Four surveys from the previous inspection was received from people who use the service, their comments are included in this report. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous reports may have been deleted or carried forward into this report as recommendations but only when it is considered that the people who use the service are not being put at significant risk of harm. In future, Care Homes for Adults (18-65 years) Page 5 of 27 if a requirement is repeated, it is likely that enforcement action will be taken. Occupancy at the home continues to be 100 , as all four people have lived at the home for a number of years. All four peoples care were looked at. Policies relating to medication, complaints, protection and handling of peoples money were looked at. Two recruitment and training records were looked at to assess how people were protected. Procedures and risk assessments relating to health and safety were looked at and discussed with the manager. The Annual Quality Assurance Assessment (AQAA) was sent to the home for the manager to complete. This was received in a timely manner. An AQAA is a self-assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their services. The AQAA also provides us with statistical information about the individual service and trends and patterns in social care. Care Homes for Adults (18-65 years) Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 7 of 27 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service were assessed before moving into the home and staff are able to meet their needs. Evidence: Rotherham Social Services Department has placed all four people who use the service. The registered manager would assess any new admissions to the home and would use the homes assessment tool. The manager has the necessary competencies to ensure any new assessments are carried out effectively. People have lived at the home for a number of years and they said they were happy at the home and did not want to live anywhere else. Social Services have undertaken annual reviews on all the people and they confirm that Orchid House continues to meet their needs and people are appropriately placed. Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in decisions about their lives, and play an active role in planning the care and support they receive. Evidence: Care plans for all people who use the service were looked at. The plans were person centred and were agreed with the individual. They were written in easy read and used pictures so make them easy for the individual to understand. It was clear that the individual had been involved in their development and the deputy manager said the plans were working well. All care plans had risk assessments which were sufficient to ensure people can maintain their independence while remaining safe. The placing authority had reviewed all the plans and they feel that people are appropriately placed and receiving the care and support they need. People said they liked living at the home, and they feel staff provide the support they need. A relative said staff were very good and they always keep them informed about any changes to their care. The manager said people were supported by staff and relatives to make decisions about their lifestyle. Advocacy services were not currently Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: used although the manager said they had been used in the past, and arrangements would be made if required. Staff support people where needed to manage their money, and they maintain accurate records for people who choose to have their savings held at the home. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their life style, and they are supported to develop new skills. People are supported to follow interests and activities. Evidence: People are able to take part in meaningful activities. They are supported to make decisions about how they spend their time including taking part peer and culturally appropriate activities. One person attends a training centre while another attends a pottery class. People are able to take part in organised leisure groups and they have recently returned from a holiday at Euro Disney. People said they had had a great time going on all the rides and eating out at restaurants in the park. People were encouraged to maintain regular contact with family and friends including overnight stays at parents. One person travels independently to visit friends and Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: family and is aware of the risks when traveling alone. A visiting relative said they were happy with their relatives placement although they would like him/her to have more activities outside of the home. People were encouraged to undertake routine tasks in the home, including keeping their bedroom clean, food shopping and helping with food preparation and preparing snacks. Mealtimes were organised to fit in with the routines of people who use the service. People are involved in choosing the meals served, and they are encouraged to eat a healthy diet. One person is keeping a food diary to assist in following a healthy diet. The person is attending appointments with the community dietician and is making excellent progress. The person said they were happy with the way they receive support, and is pleased with the weight they had lost. Care Homes for Adults (18-65 years) Page 14 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 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 that people receive is based on their individual needs. The principles of respect, dignity and privacy were put into practice. Medication procedures do not fully protect people who use the service. Evidence: People were supported to make decisions about their health and wellbeing. People said they were able to decide when they get up and go to bed, although this was sometimes determined by their daily activities. People said they can choose the clothing they wear and buy. One person said they had bought several new leisure shirts from Euro Disney, and liked shopping in the parks. Another person showed the new clothing they had bought including coats and jumpers for their holiday. People were supported to attend health appointments including dentists, opticians, and their doctor. People also access specialist support including speech therapists and consultants who support peoples mental health. One person is currently having involvement with the speech therapist to reduce the risk of choking. Staff are following specific instruction from the speech therapist to support the person with their diet. Staff continue to develop health action plans although the deputy manager said Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: they were having difficulty gaining cooperation from peoples GP. Medication policies and procedures were looked at. The policies were not sufficiently robust to ensure people receive their medication as prescribed. They have improved how medication is received and have moved to a monitored dosage system for all people. There remains some confusion with regard to how medication is recorded as duplicate sheets had been hand written to reflect changes to a persons dosage. This could be confusing for staff and pose a risk to the person who may not receive medication as prescribed. Original records were not used to record medication administered, while the four people were on holiday, and there appears to be some confusion how records are maintained when people have overnight stays at relatives. The policy should provide clear guidance in the event of holidays and overnight stays. They have developed a system for recording medication received although this did not describe the medication received only that they had received four cassettes. Care Homes for Adults (18-65 years) Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were able to express their concerns and feel safe in the home. Safeguarding procedures were in place although some staff needs training to ensure they are alert to the signs of abuse which will help protect people from harm. Evidence: There is a complaints procedure and the deputy manager has developed a new system for recording complaints. People were aware of how to make complaints and they said they feel safe in the home. The AQAA told us that they had not received any complaints since the last inspection, although there was limited information in the AQAA to confirm how the home promotes complaints. Safeguarding procedures are in place and the AQAA told us that there have been no referrals since the last inspection. A requirment was made for staff to have the skills and knowledge to to recognise the signs of abuse. Records confirm only two staff have attended courses, this means people may not be protected from harm. The deputy manager was able to organise a course for the remaining staff to attend in the near future. Care Homes for Adults (18-65 years) Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people to live safely. It is well maintained and meets health and safety requirements. Evidence: The home has been refurbished recently with new carpets furniture and most areas have been redecorated. People said they had chosen their colour scheme and they had personalised their rooms to their individual taste. People were encouraged to keep their bedrooms clean and tidy and staff have responsibility for maintaining a clean and hygienic environment. Care Homes for Adults (18-65 years) Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff need to complete refresher training to ensure they have the skills and competencies to meet the needs of people. Recruitment procedures were mostly followed although missing reference means people may be at risk from harm. Evidence: Staff were employed in sufficient numbers to ensure peoples needs could be met. People said they like the staff that work at the home, and they support them to maintain links with family and friends. Some of the mandatory training remains outstanding from the last inspection of the service. Staff require training in infection control and health and safety to ensure they have the necessary competencies to keep people safe and prevent the risk of cross infection. The deputy manager told us that they have arranged the training for November. They have developed a training plan to identify gaps in staffs training and they have sourced external trainers to ensure training is up to date and meet the needs of the service. A new member of staff had undertake a comprehensive induction programme which was arranged by a training organisation. The home still needs to develop their own induction programme which meets the Skills for Care standards for any further new staff employed to work at the home. Staff recruitment files were looked at to ensure they employ staff who are suitable to Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: work with vulnerable adults. One new member of staff had been employed since the last inspection and she had the required Criminal Record Bureau (CRB) check, although she had only one reference. The files were still unorganised which makes it difficult to determine if all the documents were in place. Supervision of staff had improved from the last inspection and records were sufficient. Yearly appraisals need to be undertaken to enable staff to discuss work practice and to identify their training and development needs. Care Homes for Adults (18-65 years) Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements needs clarification to ensure the effective running of the home. There remains no effective quality assurance systems to gain the views of people who use the service. Evidence: The manager has the required qualifications and experience to manage the day to day operations at the home. He is supported by a deputy manager, and they have designated roles to ensure they operate in the best interest of people living at the home. There appeared to be some conflict between the manager and deputy which needs clarification to ensure the effective running of the home. They have purchased policies and procedures to improve the existing documents, although they need to be made service specific. The manager returned the Annual Quality Assurance Assessment (AQAA) to us in a timely manner, although it lacked detail and failed to provide a reasonable picture of the current situation within the service. Quality assurance systems were not in place, although the manager said peoples views were listened to and action taken to deal with issues raised. The manager said Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: the local social services department had given the home some quality monitoring systems although they had not commenced using them. Health and safety documents were looked at during the previous inspection in April 2009 and they were all up to date and current to the service delivered. Care Homes for Adults (18-65 years) Page 22 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 20 13 Arrangements must be made 06/07/2009 to ensure that accurate records are kept of all medicines received, administered and leaving the home or disposed of. This helps to confirm that medication is being given as prescribed and facilitates accurate checking of stock levels. This will ensure people receive their medication as prescribed. 2 35 18 Staff must have the required 03/08/2009 skills and competencies to ensure they can meet the needs of people who use the service. This means staff must receive refresher training in all mandatory areas Care Homes for Adults (18-65 years) Page 23 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Arrangements must be made to ensure that accurate records are kept of all medication received, administered and leaving the home or disposed of. This helps to confirm medication is being given as prescribed and facilitates accurate checking of stock levels 30/11/2009 2 23 18 Staff must be alert to the 30/11/2009 signs of abuse and must be familiar with the procedures to follow if they suspect any incidents of abuse has taken place. This will help to protect people who use the service from abuse 3 34 18 Staff must not commence employment at the home until two references are obtained. 30/11/2009 Care Homes for Adults (18-65 years) Page 24 of 27 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 This will ensure people receive care from staff who have been recruited correctly 4 35 18 Staff must attend training in health and safety and infection control. To ensure they have the required skills and competencies to keep people safe 5 39 24 Quality assurance systems must be implemented to ensure people who use the service can give their views on how the service is run. The data must be collated and an action plan must be made available. This will ensure the service is run in the best interests of the people 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 30/11/2009 30/11/2009 1 20 The medication policy should clearly state how medication and records should be managed when people have overnight stays at relatives or when the people are away on holiday. The manager should ensure that the AQAA provides sufficient detail to provide a picture of the progress made 2 37 Care Homes for Adults (18-65 years) Page 25 of 27 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations and demonstrate how the service can be improved. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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