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Inspection on 12/03/09 for Bishops Corner

Also see our care home review for Bishops Corner for more information

This is the latest available inspection report for this service, carried out on 12th March 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Bishops Corner 23 Boscobel Road St Leonards-on-sea East Sussex TN38 0LX     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: Caroline Johnson     Date: 1 2 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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.csci.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: Bishops Corner 23 Boscobel Road St Leonards-on-sea East Sussex TN38 0LX 01424201643 01424421684 admin@newdirections.gb.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): New Directions (Bexhill) Limited Name of registered manager (if applicable) Miss Sanchia Lowe Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of services users to be accommodated is 8. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disabilities (LD) Date of last inspection Brief description of the care home Bishops Corner is a care home providing social and residential care for eight young adults with learning disabilities, in particular those with Prader-Willi syndrome. The home is owned by New Directions (Bexhill) Limited who also have another three similar homes in East Sussex. It is situated in a quiet residential part of St. Leonards-on-Sea, being a short walk from the towns shopping centre and railway station. The house is a large three-storey property. There is a garden with patio terrace for use by residents at the rear of the house. Accommodation is provided on two floors. There are two communal lounges, one designated for smokers, and a separate dining room. The Care Homes for Adults (18-65 years) Page 4 of 29 care home 8 Over 65 0 8 Brief description of the care home domestic-style kitchen and laundry are suitably equipped. There is a large arts and crafts room, which is in daily use by service users, supervised by day centre staff. A variety of off-site activities are arranged, including attendance at the local college and sports centre. A people carrier vehicle is available for trips and leisure outings. Details of the fees can be seen in the summary section of this report. Inspection reports can be read at the home and reference to how to obtain a copy is also made in the homes statement of purpose. 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: For the purpose of this report the people living at Bishops Corner will be referred to as residents. As part of the inspection process a site visit was carried out on 12 March 2009 and it lasted from 09:45am until 5:00pm. The registered manager facilitated the inspection. Over the course of the inspection there was an opportunity to meet with and to spend time in the dining room with five of the residents. In addition time was spent with two members of staff in private. All communal areas were seen along with three of the bedrooms. Two care plans were examined in detail. In addition records seen included; staff recruitment, training, medication, menus, health and safety, quality assurance and leisure activities. Care Homes for Adults (18-65 years) Page 6 of 29 At the time of this inspection the fee for the service was 1,272 pounds each week. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.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. Prospective residents are provided with detailed information about the home and the services on offer. Evidence: There is a detailed statement of purpose in place. The service user guide is also detailed and includes information about the views of the residents accommodated. In addition there is reference to a video that can be viewed to obtain further information about the home and the services on offer. The complaints procedure is available in a symbol format. It was acknowledged that the format is not that easy to understand and that the majority of the residents would understand a simplified written version of the complaint procedure. Each of the residents has a copy of the terms and conditions of residence. The document is comprehensive covering a wide range of issues. Details of individual fee contributions are included but the room to be occupied is not stated. Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: There have been no new admissions to the home within the past two years. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans clearly demonstrate the abilities and needs of the residents. Further work in the area of goal identification and planning to assist residents to achieve their goals would improve care plans further. Evidence: Two care plans were examined in detail at this inspection. Since the last inspection extensive work has been carried out to use a more person centred approach to care planning. Residents have been much more involved in this process and in many cases they have written sections of their own person centred plans. It was noted that within the PCP folders there are details of residents dreams, hopes and aspirations. In addition there are a number of short, medium and long term goals identified. In relation to one resident it was noted that only one area that they had identified in their hopes and aspirations was included as a goal. The manager advised that work has been undertaken to ensure that goals are clearer Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: and whilst this was found to be the case what remains unclear is how progress with the goals are to be documented. In addition the staff spoken with, whilst very knowledgeable of the needs of the residents, they were not clear about the goals that were being worked on. The appropriateness of some goals was discussed. For example a goal for one resident is to go on a 1:1 with key worker. How this was to be achieved stated needs to stay awake 3/5 mornings a week and not sleep in day room. Will be set tasks. It was noted that this resident has had their medication reviewed. However, they generally find it hard to stay awake in the mornings and this can be the case whether they are offered activities they really enjoy or activities they only sometimes enjoy. It was not clear from record keeping what action was taken by staff if the resident chose not to participate in an activity or if they fell asleep. A staff member stated that they offer alternatives but this is not always recorded. For another resident the goal was in relation to stopping smoking. Records stated that an appointment would be booked via the gp for attendance at a smoke clinic and that progress would be reviewed weekly. There was no evidence that the appointment had been made. No agreement with the resident about how to go about reducing smoking or no advice to staff about how to support the resident. What was noted was that a number of residents have increased their independence in a number of areas, examples include walking to college, walking to a shop or posting a letter. A resident spoken with was particularly proud of their achievements and their plans to build upon this success. Risk assessments are in place where there is a perceived risk and details included the level of the risk and the action to be taken to reduce the risk of an accident/incident occurring. Residents meetings are held regularly and some of the residents take it in turn to share the chairing of the meeting. Records show that a wide range of areas are discussed and that each of the residents are encouraged to participate in the meeting. It was also noted that a number of residents requested that they attend particular clubs. In one case the request was repeated at each meeting over a few months. The manager advised that they have been able to meet some of these requests but this is not documented. It was evident whilst speaking with residents that they are kept informed of changes that are to be made both in terms of staffing and in relation to maintenance and redecoration. Care Homes for Adults (18-65 years) Page 13 of 29 Care Homes for Adults (18-65 years) Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are offered a wide range of interesting and stimulating activities to meet their individual wishes and interests. Evidence: Each of the residents has an individual programme of activities in place. There is a full time and a part time activity co-ordinator in post and a range of day services are run either in the day centre within the home, at a day centre based at one of the sister homes or in the community. Activities in the community include swimming, basketball, trampoline, gym, occasional horse riding, cricket, music gym and pottery. Activities in the day centres include literacy and numeracy and a wide range of art and crafts. In addition the residents have a Wii fit programme that they enjoy participating in on a weekly basis. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: One of the residents joined the tour around part of the home and she was able to provide information about the redecoration plans for parts of the building. It was also evident that she and other residents were very much aware of the contribution they each make in relation to keeping their home clean and homely. Residents have a responsibility to keep their individual bedrooms clean and tidy and where necessary they are given support to achieve this. In addition they also share the responsibility for hoovering and dusting the lounge and hallway. There are regular opportunities for residents to visit their friends and to invite their friends to visit them. Some of the residents attend clubs and there is a pub visit at least once a week. It was noted that four residents attend church on a regular basis. A staff member advised that some of the residents have recently started attending a football club at the weekends. At the time of inspection three of the residents were away on their annual holiday at Centre Parcs in Holland and there were plans for another three residents to go on their holiday in Norfolk the following week. There is a four week menu in place that is varied and well balanced. A choice of two meals is served and the second choice is generally a vegetarian option. The four week menu is generally the same as the menus for all the homes within the organisation but changes can be made by the residents as long as the overall calorie count for meals remains the same. A pasta dish was served for lunch on the day of inspection. The meal was nutritious, well balanced and ample in terms of portion size. 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 home ensures that the healthcare needs of the residents are met. Evidence: Record keeping shows that residents attend a wide range of healthcare appointments such as dental, opticians, chiropody and where appropriate diabetic clinics. Where necessary the home also seeks support and guidance from professionals. All of the residents have a health action plan in place. Each of the residents are weighed on a weekly basis and a record is kept of the outcome. Residents are supported to achieve their target weight and in relation to the residents case tracked this had been achieved in one case and in relation to the second resident it was noted that they had gone well below their target weight and were receiving support to get back up to their target weight. The procedures in place for the storage and handling of medication were in order. It was noted that the local pharmacist had visited the home in recent months to monitor the storage of medication. There is clear advice for the use of medication prescribed Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: on an as required basis. However, it was noted that rather than initial administration of as required medication staff sign O. The code designated for O means other. However on the rear of the MAR chart they then do not record why the medication was given. It was noted that one resident has an agreement in place in relation to self administering their inhaler. However, it did not state self-admin on the MAR chart. In addition the agreement was written in 2007 and there was no evidence that it had been reviewed since. 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 procedures in place ensure that anyone wishing to make a complaint can do so. Evidence: There is a detailed complaint procedure in place and as stated previously there is also a simplified version which incorporates the use of symbols. In addition there is a complaints/suggestions box where residents can post any concerns or suggestions that they might have. Records showed that there had been two complaints received from residents and in both cases the residents had signed to say that they were happy with the outcome of the investigation . There were eight compliments recorded many of which were thank you cards from relatives for the support provided to them and to the residents. It was reported that staff were to attend training on the protection of vulnerable adults the day following the inspection. There are good procedures in place for the reporting of alerts for consideration under adult protection. Care Homes for Adults (18-65 years) Page 19 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 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 maintained and decorated to a good standard. Additional cleaning in some areas would enhance this further. Evidence: The building is well maintained and decorated to a good standard. Communal areas consist of a large lounge which has recently been redecorated. In addition there is a large dining room and a second room that is designated as a smoking area. The smoking area has recently been repainted and a new carpet is due to be fitted. There is a large garden to the rear of the property and residents advised that they have a compost bin for recycling their waste vegetables. One of the residents has a rabbit and this is kept in the garden area. A new kitchen has recently been fitted and the kitchen was being painted on the day of inspection. The kitchen area is kept locked but residents are supported to use the kitchen to assist with meal preparation and with making drinks. The larder is also kept locked. Each of the residents is supported to purchase items for their supper basket which is kept in the larder. This will include drinks, crackers and fruit and residents are supported to have access to their baskets in the evenings. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: There is a detailed maintenance schedule which shows the planned priorities for redecoration for the coming year. Included within this are plans to convert one of the downstairs bathroom to a shower room as currently there is no shower facility in the home. Residents spoken with were keen for this to happen. A requirement was made at the last inspection to draw up a risk assessment detailing the action to be taken by staff should a resident refuse to leave the building. This had been achieved. All of the residents attend to their own laundry with support provided as needed. Some of the residents also do their own ironing. Three of the bedrooms were seen and in each case the rooms had been personalised to reflect the tastes and personalities of the residents. In each bedroom there were areas that were very dusty. The manager advised that residents are responsible for cleaning their own bedrooms with support provided as needed. There is a cleaning rota in place for staff to ensure that all other areas of the home are kept clean. In addition at Easter and Christmas there is a thorough cleaning of all areas of the home. Care Homes for Adults (18-65 years) Page 21 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. Staff are provided with regular opportunities to update their knowledge and skills to equip them to meet the needs of the residents accommodated. Evidence: The majority of the staff team were up to date with mandatory training and where there were some shortfalls it was noted that training had been planned. Eight of the staff team have completed NVQ (national vocational qualification) level two, five have completed level three and three staff are currently studying for this qualification. Recruitment procedures were seen in relation to two staff employed since the last inspection of the home. Procedures were thorough showing that a range of checks were carried out prior to appointing staff. New staff initially complete the homes induction which can take up to two weeks to complete. Following this they then go on to complete the Common Induction Standards. A staff member spoken with stated that their induction to the service was excellent. They advised that they shadowed staff for two months. They also stated that they received formal supervision every month and that they have found the manager to be very approachable. Care Homes for Adults (18-65 years) Page 22 of 29 Care Homes for Adults (18-65 years) Page 23 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 and the systems in place ensure the health, safety and welfare of the residents and staff team. Evidence: The registered manager has completed NVQ at level three and four and in addition she has completed the Registered Managers Award. Staff described her as supportive and approachable. Staff meetings are held regularly and as is company policy a resident joins the first part of the meeting to represent the residents views. Staff spoken with stated that they find the staff meetings very helpful and they also stated that everyone is encouraged to share their views. There is an annual development plan, which is revised in January each year. This details the planned redecoration for the home in the coming year. There is a now a computer in the office making it easier for the manager to keep up to date with administration and managerial tasks. However, it was noted that changes to the care plans or new risk assessments are still typed by the administrator for the home. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: The home receives an unannounced visit each month from a member of the senior management team who then reports to the director on the running of the home. A number of reports were seen and it was evident that a wide range of areas are monitored. It was reported that the policies and procedures are reviewed by the company in March of every year. Any new documents are discussed in team meetings and in the managers meetings. Generally they are generic documents but occasionally they need adapting for individual homes. As part of the homes quality assurance systems satisfaction questionnaires are sent to residents, their relatives, staff and visiting professionals. Questionnaires have recently been completed by residents and the manager advised that she has yet to collate the responses and to speak individually with the residents who raised particular issues. Staff questionnaires were also completed recently and it was noted that generally staff used the tick system and no comments were provided. The manager advised that she and another manager within the group have been looking to adapt the questionnaire to try to encourage staff to share their views. The management of residents finances were examined in relation to two residents and in each case the records seen were in order. Detailed health and safety checks are carried out. Records are in place to show that equipment is tested and serviced at regular intervals. Portable appliance tests are carried out annually and water samples are also sent for analysis in relation to Legionella. Care Homes for Adults (18-65 years) Page 25 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 26 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 1 20 13 The registered person must ensure that the the arrangements in place for a service user to self administer their medication are reviewed on a regular basis. Regulation 13(2). Service users must be encouraged to retain and self administer their own medication where appropriate, and be protected by the homes policies and procedures for dealing with medicines. 15/05/2009 2 30 16 The registered person must ensure that all areas of the home are kept clean. Regulation 16 (2)(j). The home must be clean and hygienic. 15/05/2009 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 Care Homes for Adults (18-65 years) Page 27 of 29 improving their service. No. Refer to Standard Good Practice Recommendations 1 6 The home should continue to work on identifying the steps to be taken by staff in assisting residents to achieve goals that have been identified as appropriate for them to achieve. Records should clearly demonstrate whether the issues raised by residents as part of the residents meetings have been met. The rear of the MAR chart should be used to state why medicine administered on an as required basis has been given. 2 7 3 20 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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). 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