Care Home: Tanglewood

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What the care home does well The home provides care and support for three residents by a stable, well-managed supported, motivated staff team who work in a manner that recognizes residents desire and need for personal privacy, dignity. What has improved since the last inspection? All of the previous six requirements have been complied with which has contributed to our overall rating for the service changing to good. What the care home could do better: Whilst no requirements have been made the following areas need to be addressed. Menus need to be displayed in a fore mat all residents understand, the cleaning needs to improve, the garden needs to be attended to and a manager needs to be registered. Key inspection report Care homes for adults (18-65 years) Name: Address: Tanglewood Larch Avenue Holbury Southampton Hampshire SO45 2PB     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: Peter McNeillie     Date: 2 7 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Tanglewood Larch Avenue Holbury Southampton Hampshire SO45 2PB 02380243091 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.new-support.org.uk Dimension (NSO) Ltd care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 5. 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 Brief description of the care home Tanglewood is a care home registered to provide support care and accommodation for up to five adults with a learning disabilities. The service is managed by Dimension (NSO) Ltd (formerly known as New Support Options) and is is situated in a residential area of Holbury in Southampton, close to local amenities such as shops, pubs and transport services the New Forest and local beaches. Residents are accomodated in their own single bedroom have access to the rest of the Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 5 Brief description of the care home building and large garden to the rear of the property. On site parking is available Care Homes for Adults (18-65 years) Page 5 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: This report was written after taking into consideration a number of sources of evidence and information, including a site visit to the premises. In the course of out visit, we viewed a sample of residents and staff records; we talked with residents, staff and management on the telephone and received a response by an external senior manager to a pre inspection Annual Quality Assurance Assessment. (AQAA). Responses were also received from staff and residents to a pre inspection satisfaction survey. During this inspection which took place on 27/05/09 between the hours of 9.00 am and 12.PM and 22/06/09 for thirty minuted to check staff recruitment records minutes to all of the key standards for younger adults and any previous requirements were Care Homes for Adults (18-65 years) Page 6 of 27 inspected. The results and findings contained in this report will determine the frequency and type of future inspections. The fees at the time of our visit for each resident were one thousand and sixteen pounds per week. Care Homes for Adults (18-65 years) Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a well-developed system of assessing and identifying residents needs which ensures residents safety and assessed needs can be met. Evidence: There have been no admissions since the last inspection. We were informed in the AQAA that all admissions are carried out in accordance with a corporate admissions policy and procedure that requires that no resident is admitted without a full assessment of needs and attendant risks being carried out. This might involve the prospective resident visiting the home on a number of occasions including overnight and weekend stays. If the all parties agree that the assessed needs can be met in a safe manner, the prospective resident would then be invited to be live in the home initially on a trial basis following which a multidisciplinary review of the placement would take place prior to a permanent bed being offered. Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: As part of the final review existing residents views would also be canvassed. Previous inspections had established that all of the current residents had been admitted in accordance with the corporate policy and procedure which included an acknowledgment that the resident or their representatives had been consulted and were involved in the assessment. All assessments had been produced in both a written and alternative format such as pictures or signs to ensure the resident can understand them. Care Homes for Adults (18-65 years) Page 11 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. There is a clear and consistent care planning system in place which ensures residents needs are met within a risk management policy that involves residents in decisions that affect them. Evidence: Following the last inspection a requirement was made that: Care plans and associated risk assessments must be kept under regular review. To ensure compliance with the previous requirement we viewed all of the residents care plans. All plans viewed had been reviewed and updated on a regular basis and had been produced in a written and alternative format such as pictures and symbols to assist residents in understanding them The care plans which indicated how assessed needs are to be met include a personal Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: profiles detailing residents likes, dislikes, wishes and aspirations and a dictionary of signs/sounds used by residents ( known as a communication passport). All of the residents currently being accommodated have high care needs and require a lot of support and supervision by staff. We were informed that the right of residents to take risks is seen as fundamental, however it was clear from records, observations some residents would have difficulty in totally understanding the concept of risk and risk taking. Consequently should restrictions be indicated, following a written risk assessment theses are also recorded in the care plan. In the light of our findings we were satisfied the previous requirement had been complied with. The provider and the home take issues of diversity and equal opportunities very seriously.In their AQAA they told us: People we support are given the opportunity to attend the church of their choice if they wish to go. The staff have attended training on Equal opportunities and anti discriminatory practice. Where people we support have demonstrated discriminating ideas the team support him to understand the differences and individuality of people. The service follows the organizations policies and procedures. Staff have been recruited from different nationalities in the past although there are currently none from a BME background at present. The people we support access public transport and use the local community facilities to ensure that they are included in the community. Where peoples needs have changed through age or increased health problems they have been supported to go through the changes and in one case to move on to more suitable accommodation. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The social activities family, contacts and the provision of varied and nutritious meals reflected residents interests and choices. Evidence: Following the last inspection a requirement was made that: People must be allowed access to all parts of the home unless there is a specific and identified reason why that individual may not do so and this is recorded and supported by a risk assessment. As previously mentioned in the preceding section of this report any restrictions in place within the home are in place following a risk assessment and details being recorded in care plans. In the light of our previous observations and comments we are satisfied this requirement has been complied with. Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: Records seen confirmed personalized individual programs of activities both community and in house based we available to residents. Community activities included attendance at day centres (two residents), weekly food shopping, dancing, gym, pub, car boot sales, the beach, shops, cafe, libraries and health care resources.etc. In house activities tended to be more sedentary and included television, music coloring, puzzles etc. We were informed that no resident is forced to participate in any activity.All agreed choices are recorded in the individual personal plan. We were told all residents have regular contact with family and friends who are encouraged to participate in the residents review if agreed by the resident. We were informed to ensure family contact is maintained if required, the home would assist with transportation. We were informed that residents who assist with food shopping are consulted about what food they wish to eat. At the time of our visit we did not see a menu displayed however we are aware that a corporate color-coded pictorial menu planning system is available that ensures balanced and nutritional meals that reflects residents choices and personal preferences, are served. Care Homes for Adults (18-65 years) Page 15 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. Arrangements are in place, ensuring the personal emotional, health care and medication needs of residents are met. Evidence: Details of the personal care, support and health care needs of residents need were clearly recorded in individual care plans with which staff demonstrated a clear understanding and familiarity with. Guidelines seen and comments by staff indicated that residents who were able exercised choice in all aspects of their lives including bedtimes, clothes, the gender of their carer, key worker, GP,dentist optician,and how and on what to spend their money. Where the resident was unable to fully understand the concept of choice and staff had to make a choice for them on day to day issues this would be recorded. On major issues the residents representative,a care manager or an independent advocate would be consulted Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: Records viewed indicated that any special medical, health or social care needs would be provided following consultation with the appropriate professional. Records are kept of all appointments and details of any advice and treatment given. Professional consulted, might include the local doctors, district nurses, physiotherapists, occupational therapists, speech language therapists, care managers and any other specialist required including the local community learning disability team or care managers. Following the last inspection a requirement was made that: The manager must ascertain whether the medication cabinet meets with the legal requirements for the storage of controlled drugs. Controlled Drugs, including Temazepam, must be stored in a Controlled Drugs cupboard complying with the Misuse of Drugs (Safe Custody) Regulations 1973. We were shown secure cabinet designed specifically for the storage of medication that in compliance with the above requirement. Medication records confirmed that all prescribed medication, (which was seen to be securely stored) was administered in accordance with a medication policy and procedure by trained staff. The record of medication administered to residents and unwanted drugs disposed of were complete and accurate. A procedure that ensures residents can assume responsibility for their own medication was in place. Records viewed confirmed,following a risk assessment no resident was responsible for their own medication. Care Homes for Adults (18-65 years) Page 17 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. The home has clear policies and procedures in place which ensures residents are able to complain and are protected from abuse. Evidence: Due to the problems of communication we were unable to ascertain how residents felt about discussing any concerns they had with the homes manager. Staff told us, should they feel any resident who could not communicate for themselves was unhappy or dissatisfied with the service they were receiving,they would raise this with management and were confident any issued raised would be dealt with promptly and fairly. A whistle blowing and Adult Protection Policy and Procedure based on the No Secrets publication had been implemented to work in tandem with the multi agency procedure produced by Hampshire County Council. All staff spoken with confirmed they had received training in recognizing various types of abuse and were aware of and were able to demonstrate the procedure to follow should they witness or suspect the abuse of a resident. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A safe, well maintained, clean and suitably furnished home is provided for residents which meets their needs. Evidence: Following the last inspection two requirements were made that: People must be allowed access to all parts of the home unless there is a specific and identified reason why that individual may not do so and this is recorded and supported by a risk assessment. And People must be able to have access to bathrooms at all times unless there is a specific and identified reason why that individual may not do so and this is recorded and supported by a risk assessment. These matters has been referred to earlier in this report. We are therefore satisfied this requirement has been complied with. The home with its own on site parking is a converted two storey building situated in a quiet residential area close to shops, community facilities, The New Forest and beaches. From the outside there is nothing to distinguish the home from its neighbors, there Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: are no discriminatory signs and nothing to indicate it is a care home. All areas of the home were free from unpleasant odors and obvious hazards furniture was comfortable and met residents individual and collective needs. We did however highlight to the manager by phone that there were areas within the home that required cleaning. She gave a verbal undertaking the home would cleaned from top to bottom as a matter of urgency to improve the living conditions of the residents. All communal areas were accessible by residents including the large enclosed garden which was in a poor state and required the grass to be cut. We were concerned to note that a recent visit undertaken on behalf of the provider under regulation 26 had failed to highlight this matter. A verbal undertaking was given by the member of staff assisting us and the manager the grass would be cut within a day or so of our visit to enable residents if they wished to use this area. During our second visit on 22/06/09, we noted the home was cleaner than on our first visit and the grass had been cut. An infection control policy and procedure was in place as were disposal aprons, gloves, antiseptic hand soap and a washing machine fitted with a high temperature programme and sluicing mode. 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. Residents needs are met by sufficient numbers of well trained and supported staff who are recruited and selected using a procedure designed to protect all residents. Evidence: Following the last inspection a requirement was made that: Recruitment records must be held at the home for all staff to include evidence that Criminal Records Bureau and Protection of Vulnerable Adults checks have been undertaken. In the absence of the manager on our first visit the staff recruitment records were unavailable however; the dates and numbers of criminal bureau checks and staff employment staff dates were viewed. In a subsequent visit on 22/06/09, after viewing three staff recruitment records, we were able to confirm t that all staff are employed in accordance with a robust equal opportunities recruitment, and selection procedure, which is designed to protect residents. This involves the completion of an application form, the signing of a rehabilitation of Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: offenders declaration, an interview, and satisfactory Criminal Record Bureau (CRB) disclosure, Protection of Vulnerable Adults (POVA) and reference checks. In the light of the evidence seen we are satisfied the requirement has been complied with. On commencing employment, records seen also confirmed that all staff are subject to an in house induction and corporate induction and training programme that include first aid, handling medication, food handling, moving and handling, safeguarding and infection control followed by inclusion in an NVQ training programme. We were informed by an external senior manager in the AQAA that following their induction 70 were currently on training courses leading to an NVQ qualification. In our last report we questioned whether staffing levels were sufficient. Since this visit residents numbers have been reduced by two to three persons. In our view, at the time of our visit staff numbers and the deployment of staff was sufficient to meet the residents needs. We were informed that there is always a minimum of two staff on duty during the day and this is sometimes three, dependent on the residents appointments or program. Sleeping in staff plus on call telephone back up is available at night. 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. The management of the home ensures the health, safety and welfare of residents and staff are promoted and the home is run in the best interests of the residents whose views about living in the home are formally sought through their representatives. Evidence: At the time of our visit the registered managers post had been vacant since February 2009. The home was being managed by the registered manager of a similar nearby home. The manager with whom we spoke on the phone was unsure when the post would be filled. During or visit we spoke with The Regional Director responsible for the home who gave us a verbal assurance and undertaking the matter of a registered manager for the home would be resolved within the next month. In the light of these assurances we are not making a requirement at this time. In talking with staff we were satisfied that the home despite the absence of a registered manager has a clearly defined management structure. Staff were aware all Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: of their responsibilities and the limits of their authority. Staff described the management both internal and external as supportive, approachable, accessible and encouraged them come up with ideas and suggestions for improvement. As part of the homes quality monitoring system, residents and residents relatives/representatives and health /social care professionals are invited to participate in satisfaction surveys. The views expressed in the surveys are seen as key in highlighting areas that may require improvement or attention and the future development of this service. All of the previous regulators have been provided with regular results of these surveys and the actions being taken in response to the results. An in house health and safety policy was in place to ensure the day-to-day safety of staff and residents. In their AQAA we were told , procedures include, weekly health/ safety checks, the regular servicing of equipment, staff training in the techniques of moving and handling, infection control, control of substances hazardous to health (C.O.S.H.H.) first aid, health and safety, reporting accidents, and procedures to follow in the event of fire (including evacuation). 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 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 Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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