Inspection on 01/04/08 for Budlake

This is the latest available inspection report for this service, carried out on 1st April 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Similar services:

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St George`s

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Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Budlake 64 Chudleigh Road Alphington Exeter Devon EX2 8TZ Lead Inspector Teresa Anderson Unannounced Inspection 2nd April 2008 12:00 Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Budlake Address 64 Chudleigh Road Alphington Exeter Devon EX2 8TZ 01392 439321 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Guinness Care and Support Ltd Mr Neville John Phillips Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 4. Date of last inspection New service Brief Description of the Service: Budlake is a care home offering care and accommodation to up to four people who have a learning disability. Guinness Care and Support Ltd operate the home. Some of the staff are employed by this organisation and others are employed by the Health Authority. The home is situated in the residential area of Alphington. It is a large detached house that is within walking distance of shops, church, health centre, pubs and other local facilities. There is easy access to other local amenities, local beauty spots and places of interest. The home does not have its own transport. Staff use their cars to take people out. The home blends well into the community and is not easily recognisable as a residential home. It has four bedrooms, one on the ground floor, and three on the first. The home stands in a large garden and has ample parking facilities. The current fees for the home are £600 to £1,000 The home makes the inspection reports available to people by displaying them on a table in the hall. Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place as part of the normal programme of inspection. It began at 12.00pm and finished at approximately 4.30pm. As the people living here have limited verbal communication we (the commission) could not speak with them directly about their experiences. We therefore observed them going about their normal business and their interactions with staff. We also looked at care records, spoke with staff and the manager and looked around the building. We looked at other records relating to the operation of this home and also at the information the manager supplied relating to the management of this home. Prior to the visit, and in order to get a more rounded view of the quality of the service offered here, we sent surveys to six relatives of the people living here and four were returned; to staff working here and four were returned; to some health and social care staff and none were returned. People who live here could not complete surveys due to their limited communication. What the service does well: This home has a good procedure in place for assessing people to ensure that their needs can be met and that they will fit in with the other people living here. From this assessment a person centred plan of care, individual to each person, is drawn up. This is reviewed regularly and where appropriate involves other people such as advocates, relatives and health and social care professionals. Because the people living here have limited communication, staff work really hard to get to know their likes, dislikes and preferences so that their needs can be met in a way each person prefers. People have good and easy access to appropriate health care, both for treatment and to promote well being and prevent ill health. People live full and active lives. They go out frequently for walks and to local beauty spots and places of interest. Inside the home people are supported to follow their interests, for example in cooking, knitting and art and craftwork. They are supported to meet with their friends, both old and new, and with their relatives. Relatives say they are kept up to date with developments and any changes, and are always made welcome in the home. Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 6 People living here enjoy home cooking, prepared by care staff, and can be as involved as they wish and/or as they are able. Fresh fruit and vegetables are encouraged. Although staff are aware of peoples preferences for less healthy food, they try to help people to strike the balance between these and eating healthily. People living at Budlake, or who support people living here, have made no complaints to the home or to the commission. However, people are encouraged to let their views known and staff have a relaxed manner that encourages open feedback. Staff receive training in safeguarding vulnerable people, demonstrate a good understanding of this and a zero tolerance to it. People who live here are relaxed in the company of staff. Their money is well managed and kept safe. Staff are described by supporters of people who live here as ‘excellent’. They say they know people well and work really hard to meet their needs. There is a stable and committed workforce who are supported to develop the skills needed. Four of the five staff hold a National Vocational Qualification (NVQ) in care, and the fifth person is working towards this. They are recruited using robust methods to help ensure that only suitable staff work with these vulnerable people. This is a well managed home which ensures that the people living here are at the heart of its operation. The manager is trained and experienced. He understands the client group, the needs of whom this home seeks to meet and has a strongly developed understanding of equality and diversity. Good systems are in place to ensure the home runs efficiently and is safe. What has improved since the last inspection? What they could do better: During this inspection it was noted that some improvements are needed in the way some medicines received and administered in the home are recorded. We found that the central heating system had not been working properly for some time although the manager has reported this and is confident this will be fixed shortly. We found that one person has not been able to leave the home or access the garden since January because the ramps (for wheelchair users) requested from head office have yet to be installed. Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. Any new person who came to live here would have their needs assessed to ensure this home could meet them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The people living at this home have lived here for a very long time. Because of this we did not look at needs assessments that had been carried out before they had been admitted many years ago. However, staff and the manager described the process to us. What they describe will help to make sure that the home can meet each persons needs, that each person living here wants to live here and that the right people live together and get on with one another. Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. People living here benefit from a system of assessment and care planning that ensures that their needs are met in a way that suits them. People living here are helped to make choices in their daily lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the care plans of the people who live here. We found that they are written in a way that ensures they (and where appropriate their relatives) are involved in the planning of their care. They are easy to read, understand and follow and give all staff the level of detail needed to ensure that people’s needs are met in a consistent way. Care plans are reviewed regularly. That is at least monthly by staff and annually with each person’s relative or advocate. Although we saw one care plan that needed reviewing due to changed needs, the manager explained that this was due to happen in the short term and Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 11 involved meeting with other health professionals. After the inspection the manager confirmed this had happened. We saw that care plans contain information about people’s preferences and when we spoke with staff we found they know the people living here very well and know even more about what they like and don’t like. We saw staff involving people in making decisions about for example what food to buy and what to eat. We saw people helping themselves to some things they wanted and we saw staff supporting other people to get things they wanted. All this indicates that routines are not rigid and that people are helped to make choices and decisions about what they do. Risk assessments are in place that help people to live fulfilling lives whilst trying to minimise risks to their safety. One care plan showed that risk assessments need updating, and the manager explained this was in hand and was due to someone’s changing needs. This took place as part of the care plan review. Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. People living here benefit from good links with the community and family and friends, and are generally supported to take part in a variety of activities. The food and meals served meet people’s needs and preferences and help to ensure that people have a healthy diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at Budlake normally have lots of opportunities for activities both in and outside of the home. There are arts and crafts sessions, people help with cooking and one person is helped to knit as much as they want to. In addition the home has a TV with a good size screen that is easy to see. All around the home are examples of people’s artwork and boxes with activities that people like to do. Approximately three days per week there is an extra member of staff who helps with meeting peoples leisure and social needs. Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 13 One person living at the home has recently developed more physical needs. Although the manager has requested that ramps be provided by the parent organisation, this has yet to happen. This means that this person cannot leave the home at all. In addition, this person cannot go into the garden because again this is inaccessible to people who use wheelchairs. The manager reports that he is confident ramps will be in place in the short term. Other people are supported to use local amenities such as the local shops, swimming facilities local walks and are supported to go for trips out. Outings have not been as frequent as they usually are because a member of staff has to be available to remain in the home with one person who cannot leave the home due to access problems. However, the manager has made arrangements to help overcome this and is confident this will not be an issue when the home provides wheelchair access. Friends and/or relatives of people living here say they can visit easily and that staff support people to visit with them in their own homes. The manager also reports that staff are working towards widening people’s circle of friends by meeting up with groups from other homes. He also reports that the ‘Parachute Club’ is starting at the end of March, which people will go out to and join in with activities. People, who wish to be, are supported to help with shopping for and with preparation of meals. Staff know people’s preferences very well and ensure that these are met. They also work hard to help ensure that people have a healthy balanced diet. On the day of this inspection one member of staff was cooking a chicken based meal with one person who lives here. This person was extremely happy to be involved in this. Bowls of fruit are available in the dining room and records show that people choose what they would like to eat for breakfast. Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. Peoples care needs are well met and ensure and promote people’s well-being. The procedures relating to the management of people’s medicines need some minor improvements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person who lives here is registered with a local GP and records show that visits to them are made when needed. Records also show that people regularly visit the dentist and optician to help keep them well. One person recently had an episode in hospital and staff have responded well to their additional needs. Records and discussions with staff show that if people need additional support that they can receive this easily. This has included input from for example the physiotherapist. We talked to staff about how they recognise that someone without verbal communication might have medical or health needs. Staff demonstrate an excellent understanding of each person and their behaviours and what these Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 15 might mean. They clearly work very hard to interpret people’s communication and to help meet their needs. Staff report that people choose when they get up and go to bed and that although each person has a recorded ‘daily routine’ this is very flexible depending on what each person wants. We saw staff responding very flexibly to people’s wishes and requests. The home uses a monitored dosage system issued by a local pharmacy to manage medications. None of the service users are able to manage their own medicines so staff do this for them. We looked at the system in use and found it to be safe and secure. We looked at records and found them to be generally up to date. We tried to check that records relating to medicines only used very occasionally tallied with the number of these medicines in the home. However, we could not because records were incomplete. We also found that staff are not signing to say they have applied a prescribed cream as they should. Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. People living here are safe and staff have the skills to ensure they can interpret and act upon behaviours which might be a form of complaint. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Budlake has developed a complaints procedure that is available in many different formats to suit the communication needs of the people who live here. For example it is available in picture form and in symbol form. No complaints have been received by the home or by the commission. We spent some time in the home and saw that people are comfortable in the presence of staff. We saw staff supporting people to make their wishes and preferences known. Where someone indicated they did not wish to do something, staff took this seriously. We spoke to staff about ‘Safeguarding’. They demonstrate a good understanding of what abuse is and what to do if they suspect or see this. The manager reports that all staff received training in safeguarding and that this is repeated on a yearly basis. We looked at how peoples monies are managed. We found they are kept safe and securely. We looked at two accounts and found that staff record all monies received and all monies spent. Receipts, records and monies all tallied. Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29, 30. Quality in this outcome area is adequate. The home is clean and homely, however it is not meeting the needs of all the people who live here. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Budlake is a large residential home that has been converted to be used as a care home. The majority of interior decoration is carried out by the manager and staff and in general, it is well maintained. It is clean and odour free throughout. Staff report they have received training in infection control. Although the laundry is situated in an area off the kitchen, staff describe that the procedures in place overcome the risk of the spread of infection. All laundry is contained within sealed containers and taken into the laundry via the back door and not through the kitchen. Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 18 One person living at the home has developed more physical needs. However, they are unable to leave the home or access the garden because there are no ramps to outside areas. The manager reports that these were requested from the head office as long ago as January. In addition to this the heating at the home has not been working consistently. This fault has been reported and engineers have visited. However, at the time of the site visit this had not been remedied. The manager has since contacted the commission to say that he is confident this will be fixed in the short term. Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is excellent. People living here are cared for by staff who have excellent skills and who are employed in sufficient numbers. People are protected from harm by good recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In surveys some people said that they would like more staff on duty to ‘relieve the pressure’ and so that people could go out more often. We spoke to the manager and staff about this. They report that because one person has increased physical needs, that this has had an effect on the number of staff needed. The manager says that having recognised this, staffing numbers have recently been increased and that he is recruiting two more members of staff. He reports that in there are usually two members of staff on duty, and that this has been increased to three on the middle shift (on most days) to help better meet people’s social needs. Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 20 People (in surveys) were very complimentary about the staff working at this home. They say they know the people living here well and respond well to their needs. They say staff create a homely and caring atmosphere. They also say that the key worker system, where each person has a named member of staff to co-ordinate their care, works very well. One person said ‘I am delighted to have the opportunity to say that the staff and management of Budlake cannot be improved’. All staff receive appropriate training and four of the five staff have completed National Vocational Qualification (NVQ) training and one person is undertaking this. We looked at two staff files. We found that all the checks needed to help ensure that only suitable staff work with these vulnerable people are undertaken. These include written references and police checks. In surveys some staff said they would like additional training and we saw that the manager had responded to this. He has provided a list of available training which staff have signed up to. Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This is a well managed home which promotes the interests, welfare and safety of the people who live here. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prior to this inspection the manager completed a pre inspection questionnaire. This gave us all the information we asked for and was clear and comprehensive. It demonstrates that the manager has an understanding of the needs of the client group who use this service and that he knows what is good practice in relation to meeting their needs. Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 22 The manager has worked here for several years. Although he spends about half of his time at another home, staff say this does not cause a problem. They describe the manager as supportive and easy to approach. The manager reports that he has recently successfully completed the Registered Manager’s Award. In order to ensure that people are involved in the running of the home frequent meetings are held with the people who live and work here. In addition an annual quality assurance survey is undertaken which involves relatives and other care providers. We looked at fire records and found that all the necessary checks are undertaken. This includes ensuring that fire alarms work and emergency lighting works. In addition records show that staff have training in what to do if the fire alarm sounds. We looked at the fire escape and saw that it had some moss growing on it that might make it slippy. The manager reports he had already noted this, but due to recent heavy rains had been unable to deal with it. Staff report that the fire escape has usually been given its post winter clean by now, and confirmed that the rains had prevented this. The manager has since reported that this has now been dealt with. Staff and the information provided by the manager shows that mandatory training is supplied and up to date. This has included moving and handling training. Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 5 CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 2 30 3 STAFFING Standard No Score 31 x 32 4 33 x 34 3 35 4 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000071072.V358571.R01.S.doc x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Budlake Score 3 3 2 x 3 x 3 x x 3 x Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP20 Regulation 13 (2) Requirement So that medicines are managed safely records of any medicines kept in the home must be up to date and accurate. This includes auditing regularly those medicines only used occasionally and ensuring that staff sign to say they have applied a prescribed cream. The central heating must be kept in good working order to ensure that people are warm enough. Timescale for action 31/05/08 2. YA24 23 (2) (p) 31/05/08 3. YA24 12 (4) (b) Arrangements must be made to 31/05/08 ensure that people with physical disabilities have their health and welfare needs, which must include access in and out of the home and garden, met in a way that is equal to those people who do not have physical disabilities. Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Budlake DS0000071072.V358571.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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