Care Home: Seventrees

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What the care home does well People who live in the home tell us they like living there. They said they were happy in the home and would not want to change anything.People who live in Seventrees think they are able to make a choice about how they live their lives. One person said `I can walk to the shop if I want or just sit in my bedroom to watch T.V.`They have regular meetings to talk about what they wanted to happen. They are involved in choosing meals, trips out and holidays.They are able to choose the furniture for their rooms and the colours the room is painted.They liked the staff and thought they treated them well. What has improved since the last inspection? This was the first time we had visited since the providers became a limited company. When thishappens it means we treat Seventrees as a new service, so do not look to see what has got better. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Seventrees Blackfield Road Fawley Hampshire SO45 1EH two star good service The quality rating for this care home is: 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: Patricia Trim Date: 0 5 0 3 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. 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 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (20092008) 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 Information about the care home Name of care home: Address: Seventrees Blackfield Road Fawley Hampshire SO45 1EH 02380892671 02380891339 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) : Auckland Care Ltd care home 8 Number of places (if applicable): Under 65 Over 65 8 0 learning disability Additional conditions: The maximum number of service users to be accommodated is 8. The registered person may provide the following category/ies of service only: Care home only - (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 (LD). Date of last inspection A bit about the care home Seventrees is a large family home that has been adapted to provide 8 single rooms with en suite facilities on ground and first floors for people who have a learning disability. There is a lounge, dining room and conservatory on the ground floor and a quiet room on the first floor. The home has a large garden at the rear of the property. The home is owned by Auckland Care Limited, who own several other homes in Hampshire. The weekly fees are from 900.00 pounds to 1400.00 pounds per week. 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 How we did our inspection: This is what the inspector did when they were at the care home Before writing this report we looked at lots of different things. We got the people who run Seventrees to fill out a big form to tell us lots about the home, the people living there and the staff. We asked people who live in the home to fill out a form telling us what they think about living in Seventrees. We asked someone who has a personal experience of a learning disability to come with us to visit the home so he could talk to the people who live there. This person is called an expert by experience. We visited the home for six hours. Whilst we were there we spoke with the people who live in Seventrees and some of the staff. We also spoke with Steve Thompson, one of the owners, as he was managing the home until a new manager started working there. What the care home does well People who live in the home tell us they like living there. They said they were happy in the home and would not want to change anything. People who live in Seventrees think they are able to make a choice about how they live their lives. One person said I can walk to the shop if I want or just sit in my bedroom to watch T.V. They have regular meetings to talk about what they wanted to happen. They are involved in choosing meals, trips out and holidays. They are able to choose the furniture for their rooms and the colours the room is painted. They liked the staff and thought they treated them well. What has got better from the last inspection This was the first time we had visited since the providers became a limited company. When this happens it means we treat Seventrees as a new service, so do not look to see what has got better. What the care home could do better . Some of the people who live at Seventrees have said they want to lose some weight. Staff are helping them, but need to make sure people still have a choice about what they eat. At the moment it is not easy for people who use the service to go out during the evening. People who use the service are going to be asked if they would like to go out sometimes. If they do, the manager promised to look at how this can be done If you want to speak to the inspector please contact Patricia Trim Fourth Floor Overline House Southampton SO15 1GW 020 7448 9299 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 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 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are actively involved in deciding to move into the home. They have the opportunity to try it out before they move in and these visits, together with detailed assessments and good information ensure they are only offered a place if the home can meet their needs. Evidence: The AQAA stated that people wishing to move into the home had to have an in depth pre admission assessment. They were also encouraged to visit the home and to stay overnight to test drive the service. Assessments seen were detailed and included information from other involved health care professionals such as care managers. Any potential risks were identified and plans put into place to minimise them. There was also evidence that assessments were kept under review and amended to reflect changing needs. For example, one persons dietary needs had changed. Following guidance from a health care professional, the care plan had been amended to reflect the change in the way support was required. Six people who use the service returned survey forms. They all said they felt they had been involved in choosing to move into Seventrees and had the opportunity to visit several times before moving in. 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. There is a clear and consistent care planning system in place, which ensures the needs of people who use the service are met within a risk management policy. People who use the service are involved in making decisions that affect them. Evidence: Care plans are simple, easy to follow and identify what someone can do, what they need help with and how staff are to offer support. For example, one plan showed staff what someone might be trying to express through their behaviour and gave staff clear guidance on how to respond. Risk assessments are used to enable people to do the things they wish whilst minimising any possible risks. For example, one person likes to go out but the risk assessment identified they need help with crossing the road, as they may stop halfway across or panic. Staff are told to walk with the person, giving clear information about what is happening. They are also used to help staff manage behaviours consistently, whilst respecting the persons rights. For example, by recording each stage staff need to go through before using medication prescribed as required only as a last resort and with the on call managers approval. There was evidence plans are reviewed with the key worker on a monthly basis. Records kept showed why changes had been made or why they were not required. In addition to in house reviews, the manager said formal reviews with adult services were being arranged so that care needs could be discussed and reviewed. Two had been Evidence: arranged so far and other adult services managers were being contacted. The AQAA recorded that All s/users have PCP (person centred plans) as well so they can include what they feel is important to them. It helps them to reflect on their own dreams and wishes as well as looking back on past events. People who use the service confirmed they each had a person centred plan, which was normally kept in their rooms. The manager said as reviews were being arranged, these were being updated and were currently held in the office, but that they would be returned to the people who use the service as soon as this was completed. One person said at a recent residents meeting it had been suggested they follow a healthy eating plan. He was very keen to lose some weight. A summary of the meeting was pinned up in the kitchen. This told staff they were no longer to offer bread and biscuits to people who use the service between meals. One person also spoke to the expert by experience about the healthy eating plan. He said that staff chose for him what to eat as he has put on a lot of weight. The fact this could be seen as a limitation of peoples rights to choose what they eat was discussed with the manager. It was agreed he would review the current methods of supporting people to eat healthily to make sure they could still choose not to. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported to join in a wide range of activities that enable them to develop their skills and that they enjoy. They receive the social and emotional support they need to enable them to develop and maintain relationships. Evidence: Care plans identify what activities people who use the service like to join in. This information is used to plan their weekly activities. For example, one person likes to go to the day centre they went to before they moved in. Transport is provided by the home so they can continue to go there. Other people are able to go to various classes such as dance and art. They said they really enjoyed this. The care plan for another person showed they loved supporting the local football team. Daily records showed this person visiting the club shop, watching a match on television and attending a home game. The expert by experience was told by one person that he goes dancing and also goes to football matches. The person said a member of staff is available to take me to the football match whenever I want to go. Another person liked to spend 1 to 1 time with staff and they were seen being given this support. Regular outings are planned to local car boot sales, the beach, cafes and shops. People often choose to go for a run in the house car to collect other people from their various activities. Evidence: Daily records showed people choose when they get up and go to bed. They also choose where they spend their time in the home, some choosing to spend part of the day in their rooms, which are personalised with their own belongings. People who use the service told the expert by experience they thought they were able to make choices about how they spent their time. One person said I can walk to the shop if I want or just sit in my bedroom to watch t.v. Those who spoke to the expert by experience told him they could have friends and family to visit if they wanted. They also told the expert they had regular meetings to plan menus and were involved in preparing meals. A relative, calling to take the person who used the service home for the weekend, commented his family felt part of the persons support network. He felt communication was good and said the family were invited to join in social events. One person who used the service said they felt one member of staff had been particularly good at helping them manage their emotional needs at a difficult time. They commented Shes been there for me from the beginning. Comments from 6 surveys completed by people who used the service showed they thought they could choose what they did during the day, evenings and weekends, although one person felt they could only sometimes make decisions about what they did each day. The manager said staffing levels had been increased to support the additional needs of one person using the service and this gave more flexibility to the support offered to people who use the service. However, it was noted there did not seem to be any outside activities offered at night. The manager said he was aware of this and was reviewing current practice. He would be talking to people who use the service to see if there was anything they wished to do. People who use the service are involved in all aspects of menu planning. They choose the meals, go shopping with staff and help prepare the food. Lunch on the day of the visit was a buffet as all the staff were in having training. Mealtime was very relaxed with the meal being shared between people who use the service and staff. Everyone sat together, chatting. The weekly lunch plan showed people were being encouraged to follow a healthy eating programme, but as stated in the previous section of this report, they must also be offered the opportunity not to follow this plan by having alternatives to yoghurt and fruit available. Some people who use the service required a specialist diet. Specific plans relating to this have been completed following advice from health care specialists and staff were seen following the guidance. 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. The health and personal care that people receive is based on their individual needs and given in a way that respects their rights to privacy and dignity. Staff receive guidance and training that enables them to manage medication safely and, if identified as a personal goal, people who use the service would be supported to manage their own medication. Evidence: Feedback from the 6 survey forms showed people who use the service felt staff listened to them and acted on their wishes. Care plans gave detailed guidance about what support each person needed with their personal care. Plans showed that some people are able to manage independently, or with prompting, whilst others need staff to help them with personal care. Staff were told to offer support sensitively, in a way that gave people who use the service, dignity and respect. There was evidence that plans were regularly reviewed and clearly documented when and why a change had been made. Staff were observed offering support to people who use the service in a sensitive way. For example, one person was assisted with eating their meal quietly in one corner. The member of staff sat beside the person, helped them at their own pace, and chatted quietly to them throughout. However, during the visit, the expert by experience noticed a member of staff going into someones room without knocking or asking permission to enter. This was the only observation of this happening, but staff should be reminded of the rights of people who use the service. Records showed that people who use the service had good access to health care. Several people had needs that required imput from health care professionals and regular visits from them were recorded. Staff had guidance from several health care Evidence: professionals about how to manage various aspects of health care needs. The AQAA recorded that no-one currently living in the home was able to manage their own medication, but anyone coming in who wished to would be suported through a risk management strategy. A member of staff was observed giving out medication after lunch. She followed Royal Pharmaceutical guidelines, by giving the medication to one person at a time, with a drink and then recording it had been taken. The policy of the home is that only staff who have had training are able to give out medication. The member of staff confirmed she had completed training and it was noted that refresher training had been arranged for 23/3/09. There was a system for checking medication into the home and for returning unused medication. It is supplied in a monitored dosage system (mds) by the pharmacist and kept securely locked in a suitable cubboard. 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. Peopl who use the service have the information they need to be able to make complaints and are confident their concerns will be listened to. Staff have the guidance and training they need to be able to minimise the risk of abuse. Evidence: Feedback from 6 survey forms showed people who use the service know how to make complaints, using the complaint procedure. They also have an opportunity to express their views through the residents meetings. The service had a system for recording and responding to complaints, but had not received any since the last inspection. The commission had not received any either. People who use the service told the expert by experience they were aware of the complaints procedure and felt they would use it if they needed to. One person commented if I am not happy about something I would tell staff, my key-worker or the manager. The service had a policy and procedure in respect of safeguarding adults. Two staff spoken with were able to show they had a good understanding of the action they would need to take if any allegation of abuse was made to them. The providers have also demonstrated they are aware of their responsibility to report safeguarding issues to adult services. Staff said they had received training in respect of safeguarding and training records confirmed this. Refresher training had been arranged for all staff for later in the month. 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 who use the service are able to live in a clean, comfortable environment that meets their needs and that they like. Evidence: People who use the service told the expert by experience they were happy in the home and would not want to change anything. They said they had been involved in choosing their own furniture and the decor of their rooms. Since the last inspection an eighth bedroom has been added. This has been adapted to meet the specific needs of the person using it and the registered persons worked with an occupational therapist to identify what was needed. The home has a new laundry. People who use the service are able to do their own laundry if they wish, supported through a risk management strategy. Individual care plans record what the person wishes to do and how staff should support them. Some people like to be involved in cleaning their rooms and this is recorded. The home has a large lounge, dining room and conservatory on the ground floor, which is accessible to everyone. There is also another quiet lounge on the first floor, which can only be accessed by those with full mobility. There is a large garden, which people said they liked to spend time in when the weather was good. There is plenty of space for people to spend time with each other or on their own if they wish. The new laundry has a washing machine that is able to clean soiled linen effectively. Staff have guidance in managing soiled linen and have regular training in infection control. Evidence: 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. Well trained staff are provided in sufficient numbers to meet the needs of the people who use the service. A robust employment procedure is consistently used so risks to people who use the service are minimised. Evidence: Feedback from people who use the service showed they thought staff were good and treated them well. Feedback from staff showed they thought they catered for the needs and well being of the clients, but one felt they needed more staff to give a lot more one to one like take them to the pictures or day trips out. The staff rota showed the normal staff ratio was three staff on duty from 8 a.m. to 8 p.m. plus the manager. The manager said this was an increase, made to reflect the changing needs of one of the people who used the service. The current staffing arrangements do not make it easy for trips out to be planned during the evenings and the manager stated he would be reviewing this and talking to people who use the service about their needs. The home has a policy and procedure for the recruitment of staff. Two staff files were viewed to evaluate how well the recruitment process was followed. Each file contained proof of identity, two references and a Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) check, as well as an application form giving information about qualifications and previous experience. Feedback from three staff surveys and from two staff spoken with during the inspection, showed they felt their recruitment was thorough and fair. Feedback from staff showed they felt they received a good induction and induction records seen confirmed this. Staff were expected to shadow experienced staff, attend training and complete an induction work book so their understanding of training could be assessed. Staff also received regular supervision. Evidence: The AQAA recorded that five staff out of twelve had completed National Vocational Qualification (NVQ) 2 and a further two were completing it. The manager said he had arranged a meeting with a training company to review the current training and to look at introducing the Learning Disability Qualification (LDQ) as this might be better at meeting the needs of people who use the service. Staff thought they received good training and records showed they were able to access courses relevant to the individual needs of people who used the service as well as mandatory training. For example, bereavement training had been arranged so staff could support one person who used the service through personal loss. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from a well-managed home where the management actively seeks their views and opinions. The health and safety of people who use the service is promoted through the implementation of safe working practices. Evidence: The registered person said a new manager had been appointed and would be starting work on 31st March 2009. In the meantime the home was being managed on a day to day basis by one of the providers who has been a registered manager for one of the groups other homes and has the skills and qualifications to manage the service. The service has a number of systems in place to monitor the day to day running of the home. People who use the service felt they were supported to comment on service provision. They have regular service user meetings where they are able to say what they want to happen. For example, at the last meeting, this years holiday was discussed and people were able to put forward their suggestions. The manager said the organisation wants to set up a clients committee by May 2009, comprising representatives from each home. This has been identified as an objective for this year in the annual plan. The manager said he was contacting the local advocacy service to ask for their help in supporting people to join the committee. Practice in the home is monitored by Regulation 26 visits, carried out by one of the providers. Copies of the reports generated by the visits were seen. These showed the visit encompasses all aspects of the service. Recommendations from the reports, such as replacing the kitchen and dining room floors, are actioned. Monthly manager meetings are also held so practice can be shared and decisions relating to all the Evidence: homes made. Records showed that staff training needs are monitored and refresher training arranged as it is needed. Recent training for all staff included food hygiene, infection control and moving and handling. The AQAA contained information about the servicing of equipment. A range of certificates and contracts were viewed at the visit, which showed equipment is regularly serviced to prevent accidental injury to people who use the service. Records showed that the home notifies us as they are required to, of any serious injury or incident involving people who use the service. 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 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 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. - 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. 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