Care Home: The Chestnuts

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Chestnuts The Chestnuts Byfleet Surrey KT14 7AN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jo Griffiths     Date: 1 6 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: The Chestnuts The Chestnuts Byfleet Surrey KT14 7AN 01932336200 01932347092 sue@downingcarehomes.co.uk 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) : Downing (Chertsey Road) Limited care home 20 Number of places (if applicable): Under 65 Over 65 0 0 0 learning disability physical disability sensory impairment Additional conditions: 20 20 20 The maximum number of service users to be accommodated is 20. 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) Physical disability -(PD) Sensory impairment - (SI) Date of last inspection Brief description of the care home The home is owned and managed by Downing (Chertsey Road) Limited. The home is registered to accommodate twenty adults with learning disabilities,it also caters for those with physical disabilities It is located in a residential area of Byfleet in Surrey. There is access to public transport and the home also has dedicated transport available to service users. The home has three separate units. Each of the units has their own living, dining and kitchen areas. Service users are provided with single bedroom accommodation and all the rooms are fitted with overhead hoist equipment. A good range of bathroom, toilet Care Homes for Adults (18-65 years) Page 4 of 29 Brief description of the care home and washing facilities is available in each unit. The home has a patio area and a wellmaintained garden which are accessible to service users.There is a newly built activities centre in the grounds. Weekly fees for the service range from one thousand three hundred to one thousand five hundred pounds. Care Homes for Adults (18-65 years) Page 5 of 29 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 unnanounced key inspection of The Chestnuts took place over six hours,during the visit time was spent with service users,the registered manager,unit managers,care and administrative staff.The home was toured and a range of records and other documents were inspected including some care plans,staff records,medication records and policies and procedures.Service users were joined over part of the lunchtime. Throughout the visit staff were very helpful in providing information and assisting with the inspection. Information provided in the AQAA(Annual Quality Assurance Document) that the registered manager completed has also been used as evidence to inform this inspection. Care Homes for Adults (18-65 years) Page 6 of 29 Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 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 29 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. Information is available for prospective service users and their representatives to enable them to make an informed decision about the home before a place is accepted. Pre admission assessments take place and service users have opportunities to visit the home and spend time there before moving in. Evidence: Information about the home is available for prospective service users and their representatives,it is made available for service users in an easy read format and there is also a colour A4 sized leaflet with information and colour photographs.Each service user has a copy of the service users guide.The statement of purpose needed some updating to reflect staff changes and to add details of the new Commission. The information is on display in the entrance alongside the last inspection report,information on how to raise concerns or complaints and a colourful newsletter. A new service user moved in in August 2008,a full needs assessment was undertaken Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: before they were offered a place and there was a planned transition period in which the registered manager and care staff visited the service user, and the service user visited the home.A place at the home is only offered if needs can be met as fully as possible. When overnight or weekend stays take place the manager stays at the home as well to provide continuity and familiarity for the person.Staff including night staff are introduced prior to someone moving in.The recent admission had been successful and an initial review had taken place. Care Homes for Adults (18-65 years) Page 11 of 29 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. Service users each have an individual person centred plan that is kept up to date and reflects their needs in detail. Service users have opportunities to take part in the daily running of the home and are supported to take acceptable and assessed risks. Evidence: The home has made progress on developing person centred care plans and this work is nearing completion.Each service user has an individual plan,three were sampled and all were completed to a good standard.Information is being transferred into new folders that includes clear details on personal and healthcare needs,interests,reviews and activities,goals,risk assessments and there is a comprehensive range of picture symbols to aid communication.The new format is more user friendly and where possible service users contribute to the plans or relatives are invited to do so. Service users are of a wide range of needs,abilities and ages,they are supported with decision Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: making by staff who understand their communication methods and needs and are offered choices such as of activity,meal and wherever possible of which staff support them. Service users are supported to take risks and to be as independent as possible,they each have a home day when they spend time with their key workers and are supported with keeping their room clean and tidy,shopping and cooking at a level that suits individual needs. Confidential information is kept safely in the main office or on each house and records seen were up to date. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has made considerable improvements to allow service users access to more activities at home and in the community. Contact with friends and relatives is supported and promoted. Meals are healthy,varied and nutritious and service users take part in menu planning. Evidence: There has been an increase in activities available for service users since the last inspection,this has been brought about by the rearrangement of the rota so there are enough staff on duty to facilitate activities,previously staff were reduced during the main part of the day. There are also now two members of staff who along with undertaking the maintenance of the home are dedicated drivers and available at Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: weekends and the organisation has built an activities centre in the grounds.This allows for service users from each unit to take part in activities with friends from other units and take part in more activities at home as well as in the community.The centre can also accommodate social events such as the Christmas party. Service users each have an individual activity programme and activities are recorded on a daily basis then collated each week and month.Recording seen showed that a range of activities take place and contact from relatives is also well recorded. The manager is hoping to recruit an activities coordinator and the post is being advertised. Activities available include bowling,swimming,Us on a Bus- a provider who visits the home with activities,aromatherapy,outings,shopping,gardening,seeability for those sight difficulties and there are two local day centres used.The manager rotas in extra staff on some days to accommodate activities and trips out and the staffing of the home has increased to an extent to allow for this.Staff can also volunteer to do extra hours in agreement with the manager. The activity centre is well equipped and airy,during the visit it was used by all the service users present during the day as areas of one unit were not accessible due to improvements being made to the floor and as the annual fire alarm testing in the main building took place.The disruption and noise could have seriously affected some people with autism or epilepsy.Some other service users had gone out to Brighton for the day. The manager said that as some facilities usually attended were closed for Easter holidays outings had also taken place earlier in the week.The home has a dedicated car and minibus. Staff said that there are a lot of outings on offer and each service user is offered an annual holiday,venues have included Blackpool and Eurodisney,if service users prefer days out this is accommodated,holidays are taken in small groups.Service users are supported to attend the church of their choice if they wish to practice their faith. Contact with relatives and friends is supported and a record of visits and telephone calls is kept,the manager and a staff spoke of three service users very regularly spending weekends with relatives and had good knowledge of the relationships service users had with relatives and frequency of visits.One service user with no relatives has a friend who visits and supports them by attending special events at the home. Meals are varied,healthy and nutritious,each unit has a menu and a book with laminated pictures of foods,service users have opportunities to contribute to menu planning and there is always choice of meal.The main meal is taken in the evening,lunch during the visit was baked potato cheese and baked beans,with fresh fruit or a choice of yoghourt or other puddings.Those needing help with their meal were supported appropriately.The AQAA states that in the summer some service users like to have their meals in the garden,there is a patio area and chairs and table to allow for this.Two service users are on special diets and meals are tailored to their needs. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: The routines of the house are flexible and service users can now move around more freely due to alterations that have taken place making the home more open plan. Care Homes for Adults (18-65 years) Page 16 of 29 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 needs of service users are well met and preferences are respected. Good health is promoted and medication procedures are thorough. Evidence: Service users have a range of health,communication,personal support and mobility needs.The majority have epilepsy and there are a number of wheelchair users.Each person has a health action plan booklet and care plans include easy read medical information, some service users have communication passports.Equipment is supplied to aid mobility and independence. Service users are supported to attend medical appointments in the community,these include specialist and routine visits.Some service users have regular blood tests and an e mail from a hospital deputy charge nurse was read praising staff for the way they supported a service user with their blood test. Any health changes are promptly responded to and referred to health colleagues. Two staff members and the manager spoke of the support that they and other staff had given to a terminally ill service user who had passed away at the home Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: recently,they had clearly been very committed to providing the best possible care and support to the person and support to relatives.The service user had chosen to end their life in the home and staff were well supported by district nurses.The GP and relatives had both written letters praising staff for their dedication and care.The manager also spoke of support given to other service users after the death. Staff spoken with were knowledgeable about personal needs,gender preference is respected when personal care is given and during the visit staff were respectful towards service users and maintained their dignity. Medication is securely stored in a medication room and there is storage in the rooms of more independent service users who are supported to take medication under supervision. Medication procedures are in place and all staff who administer medication have undertaken the required training,staff do not attend medication training until they are familiar with the home and service users.An error in medication recording was brought to the attention of the manager and unit manager who undertook to address it as soon as possible. Care Homes for Adults (18-65 years) Page 18 of 29 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 a complaints procedure that is made accessible for service users. Service users and others can be sure that any concerns or complaints will be taken seriously and addressed. Service users are protected from harm by the policies and procedures in place and staff are trained to recognise signs of abuse. Evidence: The home has a complaints procedure that is on display and available for service users in a pictorial format,speaking up forms are also available for them.Most of the service users would need support to raise a concern or complaint and the easy read form is a tool that is available for this purpose.Service users also have opportunities to raise concerns on a one to one basis with key workers and other staff. One formal complaint had been received in the last twelve months that had been responded to fully by the organisation. The homes safeguarding vulnerable adults procedure was updated last year and has been made more compatible with procedures for raising safeguarding referrals, this was a requirement from the last inspection.One safeguarding matter has been looked into by the local authority since the last visit and the outcome was that the allegation was unfounded. Staff receive safeguarding training and regular updates and recruitment procedures are thorough ensuring that staff are fully vetted before Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: they start work. The safety of service users and staff is promoted by the use of risk assessments and behavioural guidelines. There are thorough procedures in place for supporting service users with their finances,personal spending money and financial information are kept securely and the petty cash of two service users that was checked tallied with records. Care Homes for Adults (18-65 years) Page 20 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The building is clean,well decorated and furnished and has a very homely feel. Individual rooms are personalised to reflect individual tastes and interests. Shared areas are comfortable and have been made more spacious and accessible. Evidence: The home is bright,airy and has a welcoming feeling,since the last inspection substantial changes have been made to the property to make it feel more homely and in response to service users needs. There are now three units,Beeches,Willows and Cherries,each has its own attractive front door within the main building so service users can enter their own small home area within the larger building.Beeches and Willows each provide accommodation for those needing a higher level of support,Cherries accommodates four more able service users and has had its own laundry added to enable service users to develop independence skills with their laundry. Each unit was very nicely decorated and furnished,bedrooms are very comfortable and well presented,the majority of bedrooms were seen and they each reflect the Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: personality of the individual.One service user has lots of Disney items and pictures,another who is very fond of snowmen has a snowman mural on the walls,another items related to trains and one service user has a pet fish.Other personal touches include TVs,music systems,family photos and pictures,one person has items relating to and a photo of themselves when in the services. Two bedrooms needed new carpets,the manager said these were due to be measured up for the next day. There had been a lot of redecoration and some parts of the layout had been changed to make areas more accessible and open plan.The bedroom of a service user who passed away is being redecorated sensitively in stages. Each unit has sufficient bath and shower rooms and toilets,bedrooms all have a wash hand basins.Units also each have an open plan living/dining area leading onto a kitchen.These areas were homely and one unit was in the process of having new flooring in part of the living area. There is equipment throughout the home for shared or personal use to help promote or maintain the independence and safety of service users and staff, such as bathing equipment,hoists,specialist seating,wheelchairs and air beds. The garden is accessible,attractive,safe and well maintained,service users can help with gardening if they wish to. An activities centre has been built in the grounds with an area of decking outside it,it is large enough to accommodate a number of service users for activities and is well equipped. All areas of the home were very clean and hygienic. Overall the organisation is demonstrating that it is investing in the property in response to service users needs and further investment is planned. Care Homes for Adults (18-65 years) Page 22 of 29 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. Service users are supported by a well trained and competent staff team. Recruitment procedures are thorough and protect service users. Staff have a good rapport with service users and understand their individual needs. Evidence: The staff team consists of the registered manager,three unit managers,senior care staff,care staff and cleaning,administration and maintenance staff,the two maintenance workers are also drivers.There is a current vacancy for an activities coordinator.Since the last inspection there has been an increase in staff on duty during the main part of the day to allow for support with outings and activities and the home is running overstaffed to allow for extra hours to be put on the rota when needed.There is one waking night staff on each unit at night and one sleeping for the whole building to provide additional support if needed.The staff team has become more stable and there is minimal turnover.No agency staff have been used for nearly a year.Staff are well supported and have regular recorded supervision,senior staff supervise some of the junior staff. Staff meetings are held and the times can vary to accommodate night carers. The team is diverse and there are staff from a range of cultures and of differing ages and experience.Each service user has a key worker and Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: co key worker for continuity of care and they choose their key worker. Recruitment procedures are thorough,three staff files were read and they all contained the documents necessary,staff do not start work until they have been successfully vetted and they receive induction.Core and specialist training is given and core training is regularly updated,evidence was seen from a training provider of courses booked and undertaken this year.Specialist training includes epilepsy and diabetes awareness and two staff members are on a six month autism course,NVQ training is promoted. Staff observed and spoken with were cheerful and attentive towards service users,they had a good rapport with them and presented as genuinely interested in the lives of those they support. The manager has enabled and supported the staff group to develop and become a stable team for the benefit of service users. Care Homes for Adults (18-65 years) Page 24 of 29 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 home is well run in the best interests of service users and staff and investment has improved the quality of life of service users. The organisation undertakes internal quality assurance including gaining the views of service users. Evidence: The home has a friendly,open and welcoming feeling.The registered manager is experienced and has worked there for approximately two years,during that time significant changes have been made to the service to improve the quality of life of the people who live there.Staffing,the environment,record keeping,safeguarding processes and the provision of more activities are among the areas of improvement made. The organisation undertakes quality assurance, Regulation 26 visits take place monthly and are recorded,internal audits take place and the views of relatives are sought.The views of service users are sought via individual keyworker meetings,the manager said that service user meetings had been tried but due to the communication needs of service Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: users individual meetings had been considered more effective. All the organisations policies and procedures had been updated in 2008 by the managers within the organisation,they are available for staff in their key working room. Staff were observed to be using safe working practices and equipment is serviced,during the visit the fire alarms were subject to their annual test by an outside contractor. All records and other documents seen were well completed and presented and the manager has identified areas where she wishes to improve further. The four requirements made at the last inspection had been fully met,none have been made as a result of this visit. The organisation, registered manager and staff have demonstrated that they have a commitment to improving and providing a service that adapts to service users needs in a planned manner. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 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 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!