Care Home: Three Gates

Similar services:

• Polesworth Group Friary Road
• Polesworth Group Pooley Heights
• Polesworth Group 32 Station Road
• Polesworth Group 70 Long Street
• Breme
• Polesworth Group 64 Long Street
• Polesworth Group 68 Long Street
• 10 Whitfield Avenue

What the care home does well People are given information about the home, before they move in so that they can decide whether they want to live there. Records that explain how people like and need to be cared for are well written and understood by the staff team so that people`s needs are met. Medicines are well managed so that people receive their medication safely. People have lots of opportunities to make choices and decisions about their lives. The home is good at helping people stay in touch with friends and relatives so that people do not lose contact with those who are important to them. Staff have training to help them understand how to offer care to people and meet their needs. The staff team have made a lot of effort to make sure that the way people communicate is understood and respected. There is a good system of employing new staff so that people who live in the home do not have unsuitable staff working with them. People who live in the home said good things about the staff team and enjoy their company. We were told that staff are good and friendly. The home is being well managed so that people`s health and safety is protected. What has improved since the last inspection? This was the home`s first inspection since becoming newly registered with the commission in 2008, however the service remains the same. What the care home could do better: The home does not have a photocopier. This means that staff have to travel to another place to copy people`s prescriptions, which takes up a lot of time and makes following a good medicines policy more difficult. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Three Gates Three Gates 59 Grove Road Knowle Solihull B93 0PJ     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: Julie Preston     Date: 1 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Three Gates Three Gates 59 Grove Road Knowle Solihull B93 0PJ 01564770352 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) : Solihull Care Trust care home 4 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 4 The maximum number of service users to be accommodated is 4. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disabilities (LD) 4 Date of last inspection Brief description of the care home Three Gates offers care, support and accomodation to up to four adults with a learning disability. The home is situated in the Knowle area of Solihull, close to local amenities such as shops, parks, places of worship and public transport routes. Each person has their own bedroom. Shared space consists of a kitchen, lounge and separate dining room. There is space for parking several cars at the front of the home and private gardens at the rear. Fees range from 870.24 to 1220.90 each week and people pay a contribution toward this from their welfare benefit. Care Homes for Adults (18-65 years) Page 4 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The visit to this home took place over half a day. People who live there and the staff team did not know that we were coming. During our visit we case tracked two people. Case tracking means that we meet and talk to people and the staff that support them, look at records about their care, the way their medicines are looked after and look at the home they live in to make sure that it meets their needs. Case tracking helps us understand the experiences of people who live in the home. We also talked to the manager, the house leader and other staff about the support they give to people and looked at records that explain how to help people stay safe and Care Homes for Adults (18-65 years) Page 5 of 27 well. We were not able to gather the views of all of the people who live in the home as they have complex communication needs. However, other people did make comments about the staff team, the way activities are planned for and arranged and the opportunities they have to make choices and decisions. We looked around the home to make sure that it was clean, warm and a pleasant place for people to live. Notifications that the home send us about events that may affect the well being of people who live there were also looked at as well as information about complaints. This helps us understand how people are being listened to and how their health and safety is protected. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Accessible information is made available to people before they move in to the home so that they can make an informed choice about whether to live there. Peoples needs are assessed before they move into the home so that they can be confident their needs will be met. Evidence: The home has a statement of purpose and service user guide which is made available to people who live there and to their relatives. The service user guide contains pictures and photographs which describe the home and the services provided, which meets the communication needs of the people who live there. The same group of people have lived in the home for many years and there are currently no vacancies. At our last visit in July 2007 each person had had an assessment made of their needs before moving in to ensure that the home was suitable for them. The procedure for assessment remains the same as at our last visit. Care Homes for Adults (18-65 years) Page 9 of 27 Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems of care planning and risk assessment in place to ensure that peoples needs are understood and met. People who live in the home receive good support to make choices and decisions about their day to day lives. Evidence: We looked at care plans and risk assessments for two of the people who live in the home. These documents describe how people like and need to be supported to manage their day to day lives and the safeguards in place to minimise risk of harm to them. Each care plan had been reviewed within the last six months to make sure that it was relevant to peoples current needs. Areas of risk had been assessed and actions taken to minimise potential hazards so that people could take responsible risks as part of their regular routines. For example, one person was able to spend time without staff Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: support at his college course, which he commented was very important to him. The care plans that we looked at clearly described peoples needs and the two members of staff we spoke to demonstrated effective knowledge of their roles in supporting people who live in the home. This indicates that staff have read and understood care plans and should ensure that peoples needs continue to be met. Some people who live in the home need assistance to manage their money. We looked at two peoples financial records which showed that income and expenditure had been recorded, with receipts on file for each transaction. There were records which showed that a monthly audit takes place which should make sure that any errors can be promptly responded to. One person said he was very pleased to be able to manage some of his own money. Records showed that this had been assessed to make sure that the person was not exposed to unreasonable risks which may impact upon his safety. Some people who live in the home were not able to tell us about their experiences of making choices and decisions due to their complex communication needs. However, it was evident that peoples non verbal communication was quickly acted upon by the staff team. For example, a person who bought his coat to a staff member was offered a trip out and another who picked up a cup was given a hot drink. This shows that the staff team are responsive to peoples methods of communication so that they can make choices and decisions about their lifestyles. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People take part in a range of activities that they enjoy and are supported to keep in touch with their friends and relatives. People are offered a varied and nutritious diet and enjoy their meals and mealtimes. Evidence: The home employs designated day staff who work alongside the residential team so that people have more support to go out and do things that they enjoy. From looking at two care plans it was evident that peoples social and leisure preferences had been recorded. We looked at daily records which showed that their preferences were being respected. The records showed that people had access to a wide range of community based activities such as attendance at college courses, shopping trips, lunch in cafes, pubs and restaurants, local walks and drives to places of interest. Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: Each person has an activity plan which is drawn up on a weekly basis. One person told us that he was fully included in this process and liked knowing what he was doing each day. The activity plans contained photographs so that people could see what was on offer for the day. Activities had been evaluated so that staff had information about whether each person had enjoyed the experience. Staff commented that the evaluations helped them with future planning where people were not able to express their choices due to their complex communication needs. The home supports people to keep in touch with their friends and relatives. The records that we looked at described the level of support each person needed to maintain this contact. People told us that they were able to make and receive telephone calls in private and to visit their friends and families as often as they wanted to. A relative of one of the people who lives at Three Gates had made a written comment that staff were always friendly and welcoming when they visited. Staff continue to promote healthy eating within the home. There is a menu book, with photographs of food that is used to plan meals for the week. Healthy choices are identified in the menu book and staff confirmed that care is taken to ensure a balanced diet for the ongoing benefit of people who live in the home. People told us that they were fully included in planning their meals and enjoyed the food that was provided. One person said that he particularly liked roast dinners which were available every Sunday. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are effective systems in place to meet peoples personal and health care needs. Medicines are well managed so that people receive their medication in a planned and safe manner. Evidence: We looked at personal and health care records for two people. They contained clear information about peoples needs and had been recently reviewed to make sure that they were accurate and up to date. The two members of staff that we spoke to were able to describe how they supported people with their personal and health care, which indicates that they had read and understood individuals care plans. We saw comments from a visiting healthcare professional, who stated that they had observed good practice from the staff team and that the home provides a total communication environment for the people who live there. Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: The records we looked at showed that people had regular appointments with healthcare staff and that the outcome of the contact had been recorded so that staff had up to date information about peoples health. The home have devised hospital plans so that in the event a person needs to be admitted in an emergency there is up to date information about their health needs and prescribed medicines which can be shared with hospital staff. We looked at the way medicines are managed in the home to check that this was being done safely. Medicines had been securely stored and we were told that all medicines were checked by staff each week. This should ensure that errors are spotted quickly and investigated promptly. A senior member of staff told us that there had been no mistakes in handling medicines within the last twelve months. Staff records showed that they had received accredited training in the safe handling of medicines and had a competence based assessment every six months from a registered nurse. This should ensure that people receive their medication in a planned and safe manner. From looking at the medication records of two people it was evident that medicines had been given as prescribed. The home does not have a photocopier for copying prescriptions so that there are robust procedures for receiving medicines onto the premises. Staff said that they have to travel to another home to photocopy peoples prescriptions, which is necessary to comply with their own medicines policies and procedures. Care Homes for Adults (18-65 years) Page 16 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are effective procedures in place to listen to peoples complaints and safeguard them from possible harm. Evidence: There have been no complaints, either to the home or to the commission since our last visit in 2007. The home has a complaints procedure which is made available to the people who live there and to their families. Two of the people told us that they were confident that staff would listen to them if they were not happy. One person said that the staff were good at listening. We looked at training records for three members of staff, which showed that they had taken part in safeguarding training earlier this year. The staff that we spoke to told us that they understood the importance of the training so that people could be protected from potential harm. There have been no safeguarding issues raised within the home since our last visit. Some people who live at Three Gates demonstrate behaviour that may harm themselves or others. The staff team continue to work closely with psychology services to support people who may present challenges and it was noted that there had been a Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: major reduction of notifications to the commission regarding incidents when people had been harmed. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and comfortable home which is furnished and equipped to meet their needs and promote their Independence. Evidence: Three Gates is situated in the Knowle area of Solihull and is a traditional detached house which looks no different to others in the area. There is space at the front of the home for parking several vehicles and private gardens to the rear. We looked around the shared areas of the home, which include a kitchen, dining room and lounge. All of the rooms were clean, warm and well decorated. The kitchen had been refitted and a new cooker installed making it look more pleasant for the people who live there. We saw that locks had been fitted to kitchen cupboards and were told that this had been agreed to reduce the risk of harm to some people who may eat items that would be damaging to their health. Two people who are not considered to be at risk in this area showed us how to override the locks so that they could help themselves to food and drink and therefore maintain their independence. The manager told us that the office is being relocated from the ground floor laundry room to a spare room on the first floor. It is anticipated that this will create a more Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: useful and secure office space as well as free up the laundry area so that people can be more involved in doing their washing. The bedrooms that we looked at were clean and comfortably furnished according to each persons taste. People told us that they were happy with their bedrooms and that they chose how their rooms looked. The first floor bathroom has assisted bathing facilities which meet the needs of the people who live in the home. There is a separate ground floor toilet, which has recently been fitted with a call bell so that people can summon assistance from staff if they need to. 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. People are supported by a trained team of well established staff who have good understanding of their needs. The home operates a robust system of recruiting staff for the ongoing protection of the people who live there. Evidence: We asked people about the qualities of the staff who work with and were told that the team are good and friendly. Some people who live in the home were not able to express how they felt about the staff team due to their complex communication needs. We saw that people spent a lot of time with staff, choosing to sit next to them and stand with them. This indicates that people are comfortable with the staff who work with them. The staff that we spoke to at this visit were knowledgeable about peoples needs and clearly know them well. The staff rota showed that up to five staff members are on duty each day to support the people who live in the home. A waking night staff is employed and there are on Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: call systems in place so that lone workers have access to senior staff for advice in the event that this is needed. The staff that we spoke to felt that current levels met the needs of people living at Three Gates. There have been no new staff appointed since our last visit in 2007 when we looked at the homes procedures for checking that new staff were suitable to work with vulnerable adults. Solihull Care Trust has a policy for the recruitment and selection of staff which is unchanged since our last visit and was judged as good at that time. One member of staff had transferred from another Care Trust home and it was evident in their records that they had worked a number of shifts at Three Gates before beginning full time employment there. Solihull Care Trust operates a rolling programme of staff training so that the staff team have regular training updates to assist them to meet the needs of people who live in the home more effectively. We spoke to one member of staff about their recent training sessions and were told that the training had helped him consider his practice and the way that it impacted on others. Another staff member said that training opportunities were good and frequently offered. This should contribute to the deployment of a well trained team of staff for the benefit of people who live in the home. 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 home is being well managed and peoples health and safety is promoted and protected. People are confident that their views and opinions are listened to and respected by the staff team. Evidence: The home has a new manager who is due to submit an application for registration to the commission. This person has eleven years experience in social care and is a registered learning disabilities nurse. In the managers absence the home is run by a house leader, who is also a registered learning disabilities nurse. Both the manager and house leader were present at this visit and were able to answer our questions confidently, demonstrating a commitment to continuing to improve outcomes for people who live at Three Gates. There are systems in place to review the quality of care and service provided within Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: the home. We saw that care plans and risk assessments had been reviewed on a regular basis, financial audits had taken place and health and safety checks had been made. One person who lives in the home showed us a photograph of the resident and staff team at an awards ceremony organised by Solihull Care Trust. The home had won a highly commended award for addressing inequality. The person told us that they had been nominated by a Speech and Language Therapist in recognition of the work done by all to create a total communication environment within the home. The person said he was very proud of everyones achievement. We were shown copies of reports made by a representative of the Care Trust (called Regulation 26 reports) that commented on the standard of care provided in the home. The most recent report, concerning the administration of peoples medicines, stated that there were no issues that needed to be addressed for the well being of people living at Three Gates. People told us that they were confident that they would be listened to by the staff team. This indicates that the home are taking quality issues seriously for the benefit of people who live there. A number of checks are made to make sure that peoples health and well being is protected. We looked at some records that show this has happened. The fire alarm system had been tested and serviced on a regular basis to make sure that it was working properly. People had taken part in fire drills so that they had opportunities to practise leaving the building in the event of an emergency. A report from West Midlands Fire Service in 2009 stated that there was nothing that the home needed to do to improve fire safety precautions for the people who live there. We saw evidence that regular health and safety checks are completed, which are reported to the registered provider should concerns arise. Training records showed that all staff have taken part in health and safety training. This should contribute towards promoting peoples health and safety. 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 1 20 Consideration should be given to providing accessible photocopying facilities so that prescriptions can be copied as part of the homes medication policies and procedures. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!