Care Home: Phoenix Lodge

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What the care home does well The overall care is planned in a responsible manner, and takes into account the interests, preferences, needs and abilities of the people living at the home. People`s views and any concerns they have are listened to and effectively managed. There is a clear and robust training, development framework accessed by all of the care staff. The care staff are suitably recruited which protects and benefits people who live at the home. The home has a dedicated staff group, with several members of staff having worked there for a number of years. The care staff demonstrated a god understanding of the people who live at the home their needs and abilities. The home is well managed and run and where areas for improvement emerge the home usually recognises and managers this well. What has improved since the last inspection? Since the last site visit the home has amalgamated the registration of all of its three homes under the Registration of Phoenix Cottages Ltd. For the purpose of this report, Phoenix Cottages has been operating for over ten years and was rated as a 2*care home. Phoenix Lodge was the newly registered service. The homes are now called Phoenix Lodge and the registered provider is Phoenix Cottages Ltd. Information regarding Phoenix Cottages is available from the home. What the care home could do better: There are no major issues for improvement however the home needs to address any points outlined in the report. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Phoenix Lodge Phoenix Lodge 68A Low Leighton Road New Mills High Peak Derbyshire SK22 4PJ     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: Nancy Bradley     Date: 0 3 0 8 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 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Phoenix Lodge Phoenix Lodge 68A Low Leighton Road New Mills High Peak Derbyshire SK22 4PJ 01663749257 01663749257 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Phoenix Cottages Ltd care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 13 The registered person may provide the following category of service only: Care home code PC To service users of the following gender: Both Whose primary care needs on admission to the home are within the following category: Learning disability code LD Date of last inspection Brief description of the care home Phoenix Cottages are two adjoining houses next door to Phoenix Lodge care home. The three houses provide separate living accommodation, although the three homes are all combine under the one registration Phoenix Lodge. The number of people who may be accommodated at Phoenix Lodge care home is thirteen. Phoenix Lodge is siutated in the New Mills which is the Peak Park of Derbyshire. There is good road and rail networks to the cities of Stockport and Manchester. Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 13 0 8 1 2 2 0 0 8 Brief description of the care home Information on fees is available from the home. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection and took place over a total of five hours. We spoke with the registered manager, care staff and people living at the home. The inspection activity during this site visit was to assess the service against the key National Minimum Standards and these are identified through the report. We looked at all the information that we received or asked for, since the last key inspection. This included the following: The Annual Quality Assurance Assessment (AQAA) that was sent to us by the home. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the home. Care Homes for Adults (18-65 years) Page 6 of 28 Two people living at the home were case tracked. Case tracking is a method used to track the care of individuals from the assessments undertaken before they are admitted to a service through to the care and support they receive on a daily basis. This includes looking at care plans and other documents relating to that persons care, talking to staff regarding the care they provide and if possible talking to the person. Additionally, time was spent in preparation for the visit, looking at the service history and any information received since the previous site visit. Records were seen relating to the people living there and the general running of the home. There were seven people living at the home on the day of the visit, the home has several vacancies We sent out Have Your Say questionnaires to people living at the home and at the time of writing this report we have received one completed questionnaire. The completed survey indicated they were very happy there, were supported by the staff on a daily basis and liked living at Phoenix Lodge. Completed questionnaires from relatives were very positive about the home and indicated they were happy with the care their relatives received and the home. We received seven staff questionnaires which indicated they were happy working at the home, the level of communication between team members was excellent and overall it was a good place to work. We received a warm welcome from the home. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place to ensure that peoples needs are fully assessed and met prior to admission. This ensures that peoples holistic needs are appropriately met. Evidence: The majority of the people who are admitted to the home have their needs assessed by social workers or through the care management system. The single assessment then forms part of the planned care people receive. The home undertakes their own individual comprehensive needs assessment. This was in accordance with a recognised care model and provides a comprehensives person centred record of individual needs, including identified strengths and needs, long-term goals, and evaluation. Care management review the care needs on an annual base. Family and carers interests were also recorded. Information in the AQAA indicates the home has developed a system so they can respond to requests for emergency admissions. Information from the registered manager indicates the home as further developed its Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: procedures for planed admissions. This includes visits by the home to see people where they are currently living, visits to the home over a period of time, and clear care plans in place prior to admission. Placing Authorises and families are also part in the admission process. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A consistent care planning and review systems ensures that peoples individual needs are met. People are supported to achieve an independent lifestyle and participation in all aspects of the life at the home and within the wider community is encouraged. Evidence: During the site visit the care plans of two people who live at the home were casetracked. The registered manager in conjunction with the care staff had compiled the care plans for the people and there was evidence of the care plans being reviewed on a regular basis. The people case-tracked had comprehensive care plans, which were in accordance with their assessed needs and formulated within a risk assessment framework. The care records include peoples goals, achievements, aspirations individual lifestyle preferences and choices. Daily records are also maintained on each person. Care plans were personalised and had been signed by the person or their families. The peoples key-workers go through all the care records with them so people are aware of Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: its content. The home has moved into person centred planning and people living at the home were being involved in their planning and work developing their care plans. People are also involved in the daily recording of events and keep a scrapbook of how they spend their days. From the work seen people at the home are very proud of what they have achieved. Everyone living at the home has access to the Advocacy service should this be required. During the visit care staff were observed discussing with people, choices and arrangements for daily living. Detailed risk assessments were in place and these included actions to be taken by staff and interventions prescribed by outside healthcare professionals. Risk assessments are individual to the person and also generic covering general activities The home compiles a three-monthly summary for placing Authorities on each person living at the home, and notifies them of any changes to the agreed care plan. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were arrangements in place to enable people to maintain and develop appropriate relationships and to participate in activities both in the home and outside in the wider community in accordance with their preferences and wishes. Evidence: During the site visit we spoke with people from the home about the activities they were engaged in and the arrangements for these. The care records of all people provided detailed needs assessment and care planning information regarding their social, recreational, educational and occupational activities both within the home and outside in the community. The peoples personal goals, choices and preferences were identified and there were properly recorded risk assessments in place for each person in relation to the activities they were engaged in. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: People at the home have a very active daily life with planned activities and trips out, following discussions at house meetings. Activities are tailored to the individual needs and abilities of the people living at the home. Several of the people go out to college, day centres and access activities in the community where they have developed new relationships outside of Phoenix Lodge. Many of the people have obtained certificates showing what courses and qualifications they have attained during their attendance at the college. At the day centre and at the college people have been able to access computer courses. A record of peoples individual activities is kept and included in their person centred care plan . On the day we visited people were out at the day centre, out visiting family and shopping. One person was involved in life-skills work with their key worker. Information on peoples records indicated that contact with family and friends were appropriate and that were they played an important part in their lives, the home maintains good contact with them. Restrictions on contact were clearly recorded and were with peoples agreement. Families are very much involved in the care of the people at Phoenix Lodge. People at the home are able to make and receive telephone calls. Information in the AQAA indicates the home is looking to further improve the level of communication between people living at the home and their relatives. Examination of the menus showed the home is providing a healthy, well-balanced and nutritious diet with some people on special diets. The home maintains a record of peoples weight. The people are given a choice if they do not like the options on the menu. People living at the home are very involved in planning meals, shopping for food and assisting in meal preparation. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home receive personal and health care support in a way, which promotes their independence and is in accordance with their preferences and beliefs. Evidence: During the visit it was clear that the peoples privacy and dignity is respected, and where people need supervision during personal care this is recorded in their care plan. The home operates a key-worker system and people at the home indicated they knew who their key-worker was and told us how they helped them in the home and out in the wider community. The key-worker is responsible for all aspects of personal support and health care needs of the people at the home. The level of support required is fully recorded in peoples care plans. From records examined and from discussions with staff, people health and personal needs were being met . People were generally healthy and records showed that staff promptly contacted the appropriated medical services. All people attended services within the community including the optician, podiatry, and dentist. We discussed with the home about using the My Health Care Passport booklet. This is a record of all medical appointments and health details. Each person completes this and can take it Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: with them to appointments. This is a scheme supported by the National Health Service and the Co Operative Bank for people with additional needs. People attend Ashgreen for routine medical appointments and check ups; also the Community Nurse carries out general screening on the people living at the home. The home operates and monitors the majority of peoples medication. Only staff who have received the required training administer medication. The home operates to Derbyshire County Council medication procedures. The arrangements for receipt, storage, administration and disposal of all medication were also examined and found to be satisfactory. All medication is recorded on the homes MAR sheets. At the time of this inspection the local Pharmacy has not carried out an audit of the homes medication procedures. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are suitable arrangements in place to safeguard peoples welfare, which enables their concerns and complaints to be listened to and acted upon. Evidence: The home has a complaints procedure, which is included in the service users guide which all of the people living at the home have a copy of. The complaints procedure is also displayed throughout the home. The home has developed a format which is accessible to people and they are made aware of how to make a complaint and who they can complain to. Information in the AQAA indicated that one complaint has been received by the home since the previous site visit. This was investigated within the homes timescales. The Care Quality Commission has not received any concerns about this home. The home maintains a record of all outcomes from any complaints made. People spoken with during the site visit indicated they knew how and who to speak with if they had any concerns or were not happy. The home has regular house meetings where people can voice their concerns and raise issues which are important to them. Information in the AQAA and in discussions with the registered manager confirms there has been one incident reported under the safeguarding of vulnerable adults procedures since the last site visit. This was investigated jointly by Derbyshire Adult Social Services and the home. Training records seen indicated the majority of the staff Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: have received training on the safeguarding of vulnerable adults. The home operates in accordance with Derbyshire County Council Adults Social Services policy on Safeguarding of Vulnerable Adults. The homes policy includes whistle blowing and shows the current contact details for Call Derbyshire. Peoples finances were seen and checked. From records seen the home operates satisfactory procedures for protecting people monies. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate 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, homely and safe environment, which meets their needs, aspirations and prompts their independence. Evidence: For the purposes of the report Phoenix Lodge comprises of three houses. Two of the houses were the original Phoenix Cottages with the third house being the Lodge and the most recent addition. All three now make up the home which is called Phoenix Lodge. We carried out a tour of the home, accompanied by registered manager. All communal areas were viewed together with staff facilities. Peoples bedrooms were viewed with their consent and all rooms had been decorated and furnished to their personal choice and all were highly personalised. The home was clean, maintained, well furnished, equipped and well lit and heated. There are no outstanding maintenance issues with an on going programme of refurbishment and decoration in place in two of the houses. During the tour of the home the areas for improvement where identified by the registered manager. Also we noted the improvements which had been carried out in the two original houses. The third house is currently unoccupied and is of a good standard. Several people have keys to their own rooms.The home was free of any unpleasant odours or smells on the day of the visit. The home has effective infection control procedures in place. People living at the home are encouraged and supported to maintain their own room to a satisfactory standard. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent 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, homely and safe environment, which meets their needs, aspirations and prompts their independence. Evidence: The home operates a key-worker system and the staff spoken with during the visit were aware of the individual needs of the people. From records seen during the visit and from the AQAA the home has a good percentage of staff with a National Vocational Qualification at level 2/3 or above. Phoenix Cottages Ltd has a recruitment policy and procedures in place and from records examined all staff had a current and valid Criminal Records Bureau check, two references and a medical clearance. Several staff records were examined and generally these were well presented. The companies application has been amended to show that a full employment history is required. The application form requests all applicants provide the days date, month and year. All staff comply with the General Social Care Council code of conduct. The home is aware of the new Independent Safeguarding board which comes in to being in October 2009. Discussions with the registered manager and from examination of records the home is providing good training and development opportunities. Details of staff training together with training planned were recorded in the homes training matrix. All staff are having training on Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: the Mental Capacity Act and Deprivation of Liberty Safeguarding (DOLS) depending on their level within the home. Records seen indicated supervision was in line with the National Minimum Standard. Information in the AQAA indicated supervisions were bi-monthly and is seen as good practice. The home conducts annual appraisals and staff job descriptions were in place. A clear staff induction programme is in place with staff completing a six months probationary period. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to ensure that people have a voice and their views are listened to and acted upon.. Evidence: The registered manager has a NVQ level in care and management and is also a NVQ assessor for level 2/3. Discussions with the registered manager confirmed she has a good awareness of her role and responsibilities. Care staff stated the registered manager is supportive and that there is good staff morale and communication within the home. The registered manager has a relevant job description. The home has further developed its system for auditing quality and monitoring its services provided by the home. The home sends out surveys to people living at the home, their relatives, Advocacy Services and Local Authority contacting. The registered manager provided evidence of the most recent audit undertaken by the home. The finding of the quality review or concerns raised is addressed by the home. The home is looking to publicise its findings by producing a newsletter. The home has achieved the Investors in People Award. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: Information in the AQAA dataset indicated that polices are procedures are reviewed on a regular basis. A sample of service/maintenance records was examined (including gas and electricity services) and there was confirmation that all the equipment had been properly maintained. Evidence of checks having been carried out was provided by way of the AQAA. Systems were in place for the monitoring and maintaining the hot water temperatures. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 19 20 24 39 The home should consider using the My Health Care Passport The local Pharmacy should consider undertaking an audit of the homes medication procedures. The home should continue with its refurbishment programme The home should make public its finding following any quality audits undertaken. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!