Care Home: Pinegrove

Similar services:

• Hillside
• Applegarth
• 122 Scorer Street
• Jubilee Villa Care Home
• Thornham Grove
• Beech Lodge
• 8 Thorndale Road (Homefield College)
• Hunter`s Lodge

What the care home does well The home operates a key-worker system, which allows the staff to work on an individual basis with people. The home was well decorated and had the feel of being a real home . The people live in a safe and attractive environment, which is maintained to a good standard and promotes their privacy and independence. The standard of records and record keeping in respect to the people who live at Pinegrove was good with planning taking account of peoples` personal preferences and abilities. The home provides good opportunities` for people who live at Pinegrove to be involved in the local and wider community. What has improved since the last inspection? All the requirements from the previous inspection have been fully complied with by the time of this inspection. The home now keeps all its records on computer. A new acting manger has been appointed. There have been no major service changes. What the care home could do better: There are no major issues for improvement however the home needs to address the requirement shown in this report regarding the registration of the manager. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Pinegrove Main Road Nether Padley Nr Grindleford Derbyshire S32 2HE     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 8 0 7 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.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: Pinegrove Main Road Nether Padley Nr Grindleford Derbyshire S32 2HE (01433)639784 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) : brian.parsons@hft.org.uk Home Farm Trust care home 9 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 9 The home provides care and support for up to nine younger adults with learning disabilities. It is located near the village of Grindleford, in the Peak District National Park, and set in its own large grounds and gardens. The gardens are well maintained and there are lots of parking spaces available. Accommodation is on three floors, with separate dedicated living accommodation for up to three residents on each floor. Individual living accommodation is made up of a single bedroom, kitchenette facilities, and en-suite bathroom with W/C. There is a shared lounge, dining area and kitchen on each floor. A shaft lift provides access between the floors. Information on fees is not available. 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: 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 Care Homes for Adults (18-65 years) Page 5 of 27 outcomes are being met for people using the service. It also gives us some numerical information about the home. One person 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 the previous inspection report. Records were examined relating to the people living there and the general running of the home. There were ten people living at the home on the day of the visit, the home has no vacancies We sent out ten Have Your Say questionnaires to people living at the home and have received nine back. Completed surveys indicated the people living at the home were very happy there, were supported by the staff on a daily basis and liked living at Pinegrove. Majority of the questionnaires had been completed by the people living at the home. Completed questionnaires from relatives were very positive about the home and indicated they were happy with the care their relatives received and rated the home very highly. We received five staff questionnaires which indicated they were happy working at the home. We received a warm, friendly and enthusiastic welcome from the people living at 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 7 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 8 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. 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. Also 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. There has been one person admitted to the home since the previous site vist. New admissions are reviewed within seventy-two hours, monthly and then six Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: monthly. All records are electronic with a hard copy printed up for the people at the home. 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. 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 plan of one person who lives at the home was casetracked. This was the most recent admission to the home. The acting manager in conjunction with the care staff had compiled the care plan for that person and there was evidence of the care plan being reviewed on a regular basis. The person casetracked had a comprehensive care plan, which was 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 Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: peoples key-workers go through all the care records with them so people are aware of its content. People spoken with during the site visit said they were aware of their care plan and knew what was in it, also they knew who their key-worker was. 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. Discussion took place at the site visit as to how the home could develop these further. Everyone living at the home have 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 health care professionals. Risk assessments are individual to the person and also generic covering general activities. 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 excellent 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 and care staff 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 Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: they were engaged in. People at the home have a very active daily life with planned activities and trips out, following discussions at house meetings. How the home wants to develop it outside opportunities for people is recorded in the AQAA. Photographs were on display showing how people have spent their time. Activities are tailored to the individual needs and abilities of the people living at the home. Several of the people go out to work; college and day centres where they have developed new relationships outside of Pinegrove. Many of the people have obtained certificates showing what courses and qualifications they have attained during their attendance at the local college. A record of peoples individual activities is kept and included in their person centred care plan. One person spoken with during the site visit told us about working at MacDonalds and said how they enjoyed it . 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 in contact were clearly recorded and were with peoples agreement. People at the home have access to social networking websites and these have been set up by peoples families prior to them living at the home. Families are very much involved in the care of the people at Pinegrove. 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 cooking their own meals. 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 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. Pinegrove operates a key-worker system and people at the home stated 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, peoples 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 Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: medical appointments and health details. Each person completes this and can take it with them to appointments. This is a scheme supported by the National Health Service and the Co Operative for people with additional needs. The AQAA indicates the home wishes develop peoples confidence when attending medical appointments and with the My Health Passport this is one way in which this may be achieved. The home operates and monitors the majority of peoples medication. Information in the AQAA and in discussion with people at the home confirmed they are able to administer their own medication. All staff have received training on medication administering 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 MAR sheets. The home maintain a tracking system for the people who self administer their medication.One person spoken with during the site visit said they were alright looking after their own medication. The AQAA indicates that medication is provided by Lloyds Chemists, and they regularly undertake medication audits. Information in the AQAA indicates the home would like to support more people at to be responsible for their own medication. 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 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 no complaints had been made about the home since the previous site visit. The Care Quality Commission has not received any concerns about this home. The home also keeps a record of compliments from family and friends. The complaints procedure did not show the up to date contact details for the Care Quality Commission. 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 acting manager confirm 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 Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: Services and the home. Training records seen indicated the majority of the staff 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. People 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 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 live in a comfortable, homely and safe environment, which meets their needs, aspirations and prompts their independence. Evidence: We carried out a tour of the home, accompanied by people who live there. 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. Several of the bedrooms have ensuite facilities and a small kitchenette. People spoken with said they liked their rooms, and were proud of how they had decorated them The home was clean, well maintained, well furnished, equipped and well lit and heated. On the day we visited it was very hot and portable fans had been provided for the bedrooms on the third floor. However people from the third floor indicted it was still very hot and humid. Pinegrove has three floors and each one has a central kitchen and lounge area. There is a separate communal laundry. There are no outstanding maintenance issues with an on going programme of refurbishment and decoration in place. Several people have keys to their own rooms and to the front door of the home if they wish. The home was free of any unpleasant odours or smells on the day of the visit. Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: The home has effective infection control procedures in place. People living at the home are encouraged and supported to maintain the health and safety checks on the home and to maintain their own room to a satisfactory standard. 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. The home has robust recruitment procedures and practices in place which ensure the safety and protect the service users. People living at he home are well supported by an effective staff team who are appropriately trained. 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. The Home Farm Trust has a recruitment policy and procedures in place and from records examined all staff have 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. However the companys application form does not indicate that a full employment history is required. The form is not requesting the days date, month and year. This was discussed with the acting manager. Copies of staff qualifications were on file. All staff comply with the General Social Care Council code of conduct. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: Discussions with the acting 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. However records seen indicated that several staff have yet to receive training on the Mental Capacity Act and Deprivation of Liberty Safeguarding (DOLS). Records seen indicated supervision was in line with the National Minimum Standard. Information in the AQAA indicated supervisions were 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. All staff have a Professional Passport which indicates clear lines of accountability, expectations and targets for personnel development. 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. Systems are in place to ensure that people have a voice and their views are listened to and acted upon. Evidence: A new acting manager has been appointed and is in the process of submitting her application for registered manager to the Care Quality Commission. The acting manager is a registered nurse for people with a learning disability. Records seen confirmed that the regulation 26 visits are carried out and issues raised in these report are addressed. The Home Farm Trust has established a Peoples involvement group, which meets every few months and looks at specific topics, which affects their lives. This then fits in with quality assurance systems, which operates within the home. People spoken with confirmed that they talk about things they like and dislike about living at the home. Information in the AQAA dataset indicated that polices are procedures are reviewed on a regular basis. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: The home has achieved the Investors in People Award. 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. People spoken with confirmed that they assist the care staff to undertake all the health and safety checks. Systems were in place for the monitoring and maintaining the hot water temperatures. 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 1 37 8 The home must have a registered manager in place This is to ensure the home is run in the best interest of the people who live there. 31/08/2009 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 22 34 34 The home to consider using the My Health Care Passport. The complaints policy should show the contact details for the Care Quality Commission. All applicants must provide a full employment history. The homes application form should be amended to indicate that applicants need to provide the days date month and year when supplying a full employment history. All staff should receive training on the Mental Capacity Act and Depravation of Liberty Safeguarding (DOLS). The acting manager should complete a recognised managers award. 5 6 35 37 Care Homes for Adults (18-65 years) Page 26 of 27 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 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!