Care Home: Robin`s Nest

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What the care home does well Robin`s Nest has only been open a short time, and the operating systems are still in the process of being introduced and refined. Being a very small care home, with just two beds, the care on offer is very person centred, and the one person who currently lives at the care home spoke positively about their life and the support that they receive from the staff. What has improved since the last inspection? This is a new service, which has only been open for four months, so this was the first key inspection. What the care home could do better: No statutory requirements have been made as a result of this key inspection visit. Two good practice recommendations relating to developing the Service User Guide and the Statement of Purpose and producing the documents in alternative formats, and updating the Commission`s contact details in the complaints procedure has been made. Key inspection report Care homes for adults (18-65 years) Name: Address: Robin`s Nest 11 Saddletree View Mastin Moor Chesterfield S43 3FB The quality rating for this care home is: two star good 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: Rob Cooper Date: 1 8 0 1 2 0 1 0 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 28 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Robin`s Nest 11 Saddletree View Mastin Moor Chesterfield S43 3FB 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) : Number of places (if applicable): Under 65 Over 65 2 0 Mrs Ann Gibbins,Dr Edward Marcion Ranjit De Saram care home 2 learning disability Additional conditions: The maximum number of service users who may be accommodated is 2 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection 0 4 0 6 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 28 A bit about the care home Robins Nest is a small two bedded care home for people who have a learning disability. The care home is situated in a small house in a quiet residential culde-sac, and provides ordinary domestic, residential care. The bedrooms are situated on the first floor, and are accessed via a staircase. There is a small car parking area to the front of the property, and a small enclosed garden to the rear. The home is situated close to shops and leisure facilities which are situated in the centre of Staveley, which is a five minute car ride from the home. In addition there is a bus route into Chesterfield and Staveley a short walk from the care 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 Care Homes for Adults (18-65 years) Page 6 of 28 How we did our inspection: This is what the inspector did when they were at the care home 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 visit as part of the key inspection process, so that no one at Robins Nest knew that the inspection visit was going to take place. The visit took approximately five hours through the middle of the day, with one inspector present. In preparing for this inspection, the information that the Commission holds about this care home was reviewed, this included looking at the inspection record, considering any complaints or concerns that have been made about the service, and reviewing any notifications made relating to incidents that affect the well being of people living at Robins Nest. The methods used during this key inspection were to visit the care home, where a tool called case tracking was used; currently only one person lives at the care home, and their individual file was seen, with a judgement about the quality of care they are receiving, and if their needs are being met made. This was followed by a partial tour of the building, looking at the activities on offer, and talking to the individual, and one member Care Homes for Adults (18-65 years) Page 7 of 28 of staff about the quality of the service, and their experiences of living and working at Robins Nest. We also sent out an Annual Quality Assurance Assessment (known as an AQAA), which allowed the care home to carry out a self-assessment; and provide a range of information relating to their service. Information provided by them helped to form the judgements in this report. We also gave out one survey asking for views and information from the person who lives at the home, and five to staff. Of these we received the survey from person living at the home, and one from a member of staff, which also helped with the judgements that we made. The manager Julie Bailey provided much of the information during this key inspection visit. People who might want to live at the care home can obtain information about it direct from them, and this would include seeing a copy of this inspection report prepared by the Care Quality Commission. Care Homes for Adults (18-65 years) Page 8 of 28 What the care home does well What has got better from the last inspection What the care home could do better No statutory requirements have been made as a result of this key inspection visit. Two good practice recommendations relating to developing the Service User Guide and the Statement of Purpose and producing the documents in alternative formats, and updating the Commissions contact details in the complaints procedure has been made. Care Homes for Adults (18-65 years) Page 9 of 28 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Rob Cooper Care Quality Commission Citygate Gallowgate Newcastle-upon-Tyne NE1 4PA 03000 616161 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 10 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 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who would want to live at the home have the information they would need to make an informed choice about where to live, they would also have their individual aspirations and needs assessed before they moved in. Evidence: The Statement of Purpose and Service User Guide were both seen. this is a new service, and both documents are still being developed. They both contain all of the basic information that Care Homes Regulations say that they should. However as yet neither documents are in a particularly user friendly format, with no pictures, signs or symbols to help people who may have difficulty with written English to understand. The manager said that there are plans to review both documents to make them easier for people to understand. Robins Nest is a two bedded care home, although currently there is only one person in residence. The care files for this individual were seen as part of the case tracking process. The file contained detailed assessments by a range of professionals, including an NHS Continuing Healthcare Assessment, an out of city placement assessment and an in-house assessment covering areas such as communication, mobility, and social skills. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: Copies of contracts and terms and conditions which outlined the funding arrangements were seen on file, these are currently stored off site, although arrangements to have copies kept in individuals care files were in hand. Care Homes for Adults (18-65 years) Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know their assessed and changing needs and personal goals are reflected in their individual plan of care. People are also supported to make decisions about their lives with assistance if needed. Evidence: The care file contained a clear plan of care, based on the individuals assessment. As this is a very small care home, and currently only one person lives there, they are getting a very personalised and person centred care package. The documentation within the file was clear, and identified the individuals needs and how they should be met. Discussions with the person showed that they were aware of what was in their file, and had clear ideas about what they wanted to do. There was evidence that care plans are being reviewed regularly in line with the National Minimum Standards. In their AQAA the home said: The service users have individual care plans which have been implemented by the staff, the service users and a multi-disciplinary team. The care plans contain the service users needs, choices and wishes. The person who lives at the care home, said that they are fully involved in decisions Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: affecting their life. Within their care file was a programme of activities, and they talked about each one, and how much they enjoyed them. Decisions around the time of going to bed and getting up in the morning are only affected by the activities that the individual is involved in the following day. The discussions clearly demonstrated that this person felt in control of their life, and fully involved in all decision making processes. The person living at Robins Nest also completed a Care Quality Commission questionnaire, in which they said in answer to the question; Do you make decisions about what you do each day?: Always. The care file that was seen contained risk assessments covering both individual needs and risks, and more general risks related to everyday living. The risk assessments were clear and easy to understand, and followed a logical approach to the management of the risks. The manager explained that it was still early days, and more risks will be identified as time goes by, with the necessary risk assessments developed as necessary. In their AQAA they said: The service users have individual risk assessments that are evaluated on a regular basis and updated when required. Care Homes for Adults (18-65 years) Page 15 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. People are able to take part in appropriate activities, and are part of the local community, with their rights and responsibilities being respected by the staff. Evidence: Discussions identified that on a Sunday evening the person living at the home draws up a programme of activities for the following week, with help from the staff. Activities include shopping in Morrison’s, lunch out, going to the pub, going swimming, going to the library, the cinema and bingo. Staff offer as much assistance as is needed, and sometimes it is possible to get the use of a car to make trips wider a field. During the discussion the person involved became quite excited when talking about the activities, and said that they definitely met their needs. In their care file there was a care plan and activity programme to support the range of activities discussed. It was clear through discussions that local facilities in the community are used. This ranges from travelling on the local bus service, shopping at Morrison’s , going to the local shops and pubs, and everything else that relates to every day ordinary living. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: Discussions also showed that family contact is very important. Staff have arranged visits to the family home, and in the past family members have visited Robins Nest, although advancing years have limited these visits recently. In their AQAA the home said: We maintain links with family and friends through contact, letter and phone. We organise activities that the service users choose. Observations of the staff working in the house, showed a situation where the person who lives in the house takes responsibility for cleaning their bedroom, sorting their washing, and a number of other domestic tasks, with support from the staff. Discussions showed that everyone was quite happy with the way household tasks were carried out, and documentation seen during the inspection supported the different roles. On Sunday evenings the menu for the following week is planned, with plenty of input from the people who live at the home. On a Monday there is a shopping trip to Morrison’s to buy the food to meet the requirements of the weeks menu. The home has a well equipped modern kitchen, and in their AQAA they said: The service users plan menus, shopping lists and any activities they would like to participate in that week, this works very well. Care Homes for Adults (18-65 years) Page 17 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 this care home receive personal support in the way that they prefer, and they are protected by the policies and procedures in place for dealing with medication. Evidence: Discussions showed that people make decisions and choices about their own personal care. A regular hair appointment at a hairdressers in Staveley, being a particular highlight. Personal care choices were seen recorded within the care plans. The care files showed that there were care plans in place for health needs, and visits with healthcare professionals such as the doctor or hospital visits were also recorded. A falls and a smoking risk assessment are in place (even though no one living at the home currently smokes). I was told that the local GP surgery provides healthcare support, and that everyone is happy with the arrangements. The medication systems were seen, and the medication administration records showed no obvious errors or omissions and the records relating to ordering and returning medication to the pharmacy was also seen, and all found to be complete and correct. Medication was seen to be stored securely. No one living at Robins Nest currently self-medicates. Care Homes for Adults (18-65 years) Page 18 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. The people who live at the care home feel their complaints are listened to and acted upon. The policies and procedures in place ensure people are protected from abuse, neglect and self harm. Evidence: So far Robins Nest have not received any complaints in the four months since they opened. The homes complaints procedure is on display in the hall, and also forms part of the service user guide, it was noted that the contact details for the Commission were out of date. Discussions with the person who lives at the home indicated that they knew who to complain to, and how to complain, although they said they had never needed to. In their AQAA the home said: We display the complaints procedure near the front door, this states who to contact and how to make a complaint. we have a service users complaints book should they wish to make a complaint. In their AQAA the care home said that 70 of the staff had attended safeguarding adults training within the last twelve months, which was supported by the staff training records. Dates have been arranged for the remaining staff to attend this training in the coming weeks. The training is aimed at raising staff awareness of abuse, and issues around abuse and through raising those issues, offering people greater protection against abusive practice, while also making sure that the staff understand the correct policy and procedure to follow if abusive practice is found. Two members of staff were asked about safeguarding adults training and both said they were aware of the issues, and had undertaken this training. Robins Nest have not had made any safeguarding adults Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: referrals since the home opened. Care Homes for Adults (18-65 years) Page 20 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 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 safe, homely and comfortable environment. Bedrooms suit peoples needs and lifestyle, and promote their independence. The care home is clean and hygienic. Evidence: The care home is situated in a quiet cul-de-sac. The house provides domestic accommodation, with evidence of a well personalised and comfortable home. The upper floor is accessed via a staircase, there are no adaptations for physically disabled people to reach the upper floor. Discussions with the person who lives there showed that they liked the house, and they said that they had everything that they needed. The house is decorated to a good standard, and there is evidence of good quality fixtures and fittings. With the house being newly opened there is little in the way of wear and tear. The house was found to be clean and tidy, with no odour or signs of stained carpets or damage. Staff were seen hoovering during the inspection visit, and the person who lives at the home talked about cleaning routines, particularly cleaning their own bedroom, and doing their washing, and they said that they liked the house the way it was. 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 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 care home have their needs met by appropriately trained and well supported and supervised staff. Evidence: The staff training files were seen, and these showed that there was a training programme in place for all staff, covering training issues relevant to the work being undertaken, and covering the mandatory training areas such as: moving & handling, health & safety and food hygiene. Discussions with one member of staff around training issues identified that this member of staff thought they had been well trained and had good access to training. In their AQAA they said: We provide on going staff training and ensure that all staff work towards National Vocational Qualification (NVQ) level two or three. The files of six members of staff were seen, to check that they contained all of the information that would show that staff at Robins Nest had been recruited in a safe manner, namely that applicants had filled out an application form, provided two written references and had had a Criminal Records Bureau check. The documentation showed that the homes recruitment policy and procedure had worked to protect the people living there. Discussions with one member of staff about their recruitment showed that they had gone through all of the pre-employment checks, and had not started working until those checks had been completed. In their AQAA the home said: We ensure staff supply two references and have a CRB check, prior to commencing position. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: The care industry considers National Vocational Qualifications (NVQ) to level II in care to be the basic qualification for staff working in residential care. A review of the staff training records showed that currently there are six staff working at this care home, of whom there are two staff with NVQ level III qualifications, and three more are currently studying for their NVQ level III. There is a formal staff supervision system in place, in which staff members receive supervision with the manager. This is usually in a one to one meeting. Formal supervision offers staff support and guidance in carrying out their work, and is seen as an essential management tool in residential care. One member of staff was asked about formal supervision, and they said they felt well supported, and they were receiving regular supervision sessions. This was supported by the staff supervision records that were seen. In their AQAA they said: We provide staff supervision every 2-3 months or more often if required. We ensure we hold regular staff meetings to enable consistency to be delivered. 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. This is a well run care home. The health, safety and welfare of the people who live and work there are promoted and protected. Evidence: Robins Nest has a registered manager in place, who is suitably qualified and experienced to be running the home, and has successfully been through the Care Quality Commissions own screening process. The Annual Quality Assurance Assessment (AQAA) for the home was completed within the time frame asked for, and provided sufficient information and detail to enable judgements to be made. The home is developing their quality assurance systems, with similar documentation and systems to those used elsewhere within the organisation being introduced. With only one person currently living at the home, formal meetings are not being held, however evidence was seen that care staff have one to one discussions with the individual about many different aspects of their care. Regulation 26 visits (these are monthly audits by a representative of the owners management team) are taking place, with copies of reports seen; these form part of the homes quality assurance system. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: A range of health & safety records were seen including those relating to fire and the Control of Substances Hazardous to Health (COSHH) these were all found to be correct and complete. One member of staff was asked about health & safety training, and they said that some of the training they had received was around health & safety issues, which was confirmed by the staff training records. Within their AQAA the home provided details of tests and dates of health & safety checks on electrical and fire equipment. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes  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 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 Description 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 Description 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 1 The Statement of Purpose and Service User Guide should be developed, and produced in formats appropriate to the people who live at the home. The contact details for CQC in the complaints procedure should be updated with the address and telephone number of the National Contact Centre in Newcastle. 2 22 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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. 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