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Inspection on 28/04/09 for The Melanie Ann Trust

Also see our care home review for The Melanie Ann Trust for more information

This is the latest available inspection report for this service, carried out on 28th April 2009.

CQC 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.

What the care home does well

There is a friendly atmosphere in 99 Saltings Road, which offers a homely and comfortable place in which to live. Staff working at the home have positive relationships with residents and try to improve their quality of life. The staff recognize the importance of meeting individuals` differing religious, racial, physical and cultural needs. Residents` personal health care needs are well supported and choice, privacy and dignity are seen as important. Residents present as being relaxed and comfortable with staff indicating they feel safe and secure with them. They enjoy a range of activities and are supported to be a part of their local community. People living at the home are supported to maintain contact with their family and friends. Residents enjoy the meals that are cooked using fresh ingredients and choice is offered.

What has improved since the last inspection?

The home`s Statement of Purpose and complaints procedure are now available to residents in an audio format so they can more easily understand them. A new, more person centered, care planning system is being introduced to make important information readily available to staff to help them meet residents` needs and assist them in supporting people to make their own decisions. The quality of daily records is generally improved. Risk assessments are being made more comprehensive and include activities and the environment to better protect residents. Parts of the home have been redecorated and refurbished. Increased training is being made available to staff.

What the care home could do better:

Whilst the new person centered care plans are being introduced, the Manager should be diligent in ensuring all parts of the existing care plans are reviewed within their given timescales to ensure they are reflective of the residents` current needs. Acknowledging there is better recording of daily events, some daily records should be improved to include information about the residents` emotional welfare and their responses to the days activities.When it is judged the administration of PRN medication is not required, this should be recorded on the MAR sheet to show there has been an assessment of need. Residents` comfort would be enhanced if the garden was more regularly maintained. Acknowledging there have been recent unexpected staff shortages, staff should not work long consecutive shift patterns that may compromise their competency through fatigue. The home would find it easier to provide evidence of compliance with Regulations if the staff application form and reference request forms are updated. Residents enjoy the outings and consideration should be given to increasing the frequency of these. The Manager should proceed with her stated intention to include health care professionals and Care Managers in future surveys as soon as possible.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Melanie Ann Trust 99 Saltings Road Snodland Kent ME6 5HA     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: Gary Bartlett     Date: 2 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 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: The Melanie Ann Trust 99 Saltings Road Snodland Kent ME6 5HA 01634243430 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) : de006c7582@blueyonder.co.uk The Melanie Ann Trust care home 2 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 2 The maximum number of service users who can be accommodated is: 2 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home The Melanie Ann Trust is registered with the Charities Commission and currently has two properties in Snodland. 99 Saltings Road is an end of terrace property close to Snodland town centre, with a small external garden. The home is registered to provide residential care and accommodation for 2 younger adults who have learning disabilities and a sensory impairment. The people living at the home are supported to participate in a variety of activities, both in the home and within the local community. The sister home is close by and provides care for 3 young adults with learning disabilities and sensory impairments. The care staff currently work across both homes. The fees charged are dependant on individuals assessed needs. Full details can be Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home obtained from the provider. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection was conducted by Gary Bartlett, Regulatory Inspector, who was at The Melanie Ann Trust from 9.00 a.m. until 4.00 pm. The inspection of 99 Saltings Road was conducted in conjunction with that of its sister home, 251 Saltings Road. Both homes are managed by Mrs Jennifer Edwards and run in the same way, therefore having similar outcomes for people living in them. Judgments about quality of life and choices were taken from direct observation and by discussion with the residents and staff. Some records and parts of the building and grounds were inspected. The Manager had completed an Annual Quality Assurance Assessment, from which Care Homes for Adults (18-65 years) Page 6 of 27 information was used to inform the inspection process. Surveys had been distributed but none had been returned to the Commission by the time of the site visit. The Care Homes Regulations 2001 and the National Minimum Standards for Care Homes for Younger Adults refer to people who use the service as service users. People living at The Melanie Ann Trust prefer to be referred to as residents. Accordingly this shall be done in the text of this report. The Inspector would like to thank everyone involved for their contribution to the inspection. What the care home does well: What has improved since the last inspection? What they could do better: Whilst the new person centered care plans are being introduced, the Manager should be diligent in ensuring all parts of the existing care plans are reviewed within their given timescales to ensure they are reflective of the residents current needs. Acknowledging there is better recording of daily events, some daily records should be improved to include information about the residents emotional welfare and their responses to the days activities. Care Homes for Adults (18-65 years) Page 8 of 27 When it is judged the administration of PRN medication is not required, this should be recorded on the MAR sheet to show there has been an assessment of need. Residents comfort would be enhanced if the garden was more regularly maintained. Acknowledging there have been recent unexpected staff shortages, staff should not work long consecutive shift patterns that may compromise their competency through fatigue. The home would find it easier to provide evidence of compliance with Regulations if the staff application form and reference request forms are updated. Residents enjoy the outings and consideration should be given to increasing the frequency of these. The Manager should proceed with her stated intention to include health care professionals and Care Managers in future surveys as soon as possible. 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 9 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 10 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. Residents can be confident they will have an assessment of their needs before they move in to the Melanie Ann Trust. Evidence: The Statement of Purpose and the Service User Guide are presented as one document and some photographs are used to make it easier for people moving to the home to understand. The Manager states an audio version is now available to better meet the needs of the people living at the home. The Manager described how a comprehensive assessment would be carried out for all prospective residents. This is necessary to be sure their needs are likely to be met by the home. Assessment forms are available for the recording of the information which would be the starting point for the persons care plan. The procedure remains untested as no new residents have been admitted recently. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to care plan records will better show how residents personal and health needs are to be met and how they are supported in making decisions. Evidence: The judgment for this outcome group has taken into account the quality of life for the residents. The judgment also includes assessment of the level of knowledge and understanding displayed by staff when providing both personal and health care. Observation during the day of the site visit and the last inspection report indicates the home considers individuals health and dietary needs. Each person has a care plan to provide staff with information on the support they need to ensure their needs are met. The plans of both residents were inspected in detail. They include pictures that demonstrate the persons likes and dislikes and things and people that are important to them. This is a good example of keeping the person at the centre of the plan. Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: The home has recently recruited Mulberry House to assist in the introduction of a new care plan system which will make it easier for staff to access important information about how to provide care. The daily records seen are detailed and mostly of a good quality. Some are repetitive and just descriptive of the days activities and do not convey how the resident has responded during the day or how they feel emotionally. This would give a fuller picture of the persons lifestyle and help staff when it comes to reviewing care plans. Until the new documentation is introduced, the home must be more diligent in ensuring all parts of the existing care plans are reviewed within required timescales and up to date information is available. For example, medical guidelines on one residents plan had expired. There was discussion about the need for the new care plans to be specific about what support is given, when and by whom. Due to the disabilities of the people living at the home it is difficult for them to make everyday choices. To help with this, the Manager has consulted with a Speech and Language Therapist to develop communication plans for each person. Staff members spoken with have a good knowledge of the communication methods of each resident and they offer choices in a way that the person can understand. Individuals risk assessments are included as part of the care plan and are being developed to include daily activities and outings such as trips to the nightclub and horse riding. This is necessary to promote residents safety. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy the activities that are available to them. They are supported to be a part of their local community and to maintain contact with family and friends. The routines of the home are relaxed and support each persons preferences and abilities. Evidence: The people living at the home have a timetable of activities that they can choose to take part in. Activities recorded as being occassionally undertaken include the use of the local health suite, trampolining, horse riding, shopping, bowling, swimming and meals out. Consideration should be given to offering residents more outings. The home has a local allotment plot, although the daily records seen did not indicate recent activity there. The staff and Manager stated that the people living at the home enjoy the activities and have been attending some activities for many years. Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: The new care plan system that is about to be implemented has improved facilities for recording individuals religious and cultural preferences. Whilst at home, people can relax in their bedrooms, the lounge or use the sensory room. There is a small rear garden for use in the summer. There are photographs included in the care plans of previous holidays and staff help them to choose based on their knowledge of what type of holiday they enjoy. Vistors are welcome to visit at any reasonable time and each person is supported to maintain contact with their family, advocates and friends. The Manager has recently identified training in supporting people with learning disabilities with their sexuality and relationships and said she is in the process of arranging for staff to attend this. This may benefit the people living at the home. During the visit the atmosphere was relaxed and each person was seen to be supported with daily living activities. Staff carry out most of the domestic duties in the home and the people living there are enabled to be involved as far as they are able. Objects of reference are used to support people to understand what activities are available for that day. There is not a set menu in the home. Each person is offered a choice of their meal and staff members are responsible for ensuring that a balanced and healthy diet is maintained. Individuals special dietary needs are taken account of. Observation of lunchtime showed that people enjoy their meals and are able to express their likes and dislikes. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from sensitive and flexible support that meets their individual needs and preferences. Evidence: Discussion with staff clearly shows they are aware of the type and nature of the support required for individuals care needs. They have a very good understanding of the preferred routines and varying requirements of each person. They provide flexible support to residents based on individual choice and personal care is provided in private to promote the dignity of residents. Personal care is provided by female staff members on a one to one basis. Through discussion with the staff and assessing the two care plans, it is evident residents have ready access to health and social care professionals. Residents are supported with any routine and specialist appointments. The Manager said she is reviewing the current facilities for the storage of medicines to ensure they fully comply with the latest guidelines from the Royal Pharmaceutical Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: Society. The Medication Record Administration Record (MAR) sheets seen were completed appropriately. It is recommended that when it is judged the administration of PRN medication is not required, this should be recorded on the MAR sheet using an appropriate symbol to show there has been an assessment of need. Medications are only administered by staff authorized to do so. No residents currently staying at the Melanie Ann Trust manages their own medicines. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are protected by clear policies and procedures. They are enabled to offer comments or complaints. Evidence: The complaints procedure is readily available to people who use the service. Since the last inspection, this has been made available in an audio format. The Home keeps a record of all complaints received by them, the result of the investigation and how the complaint has been resolved. The AQAA indicates the home has not received any complaints in the last twelve months and the Commission has not directly received any information regarding complaints about the home since the last inspection. There are procedures for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. The staff spoken with have a sound understanding of safeguarding vulnerable adults procedures and of the need to be mindful of individuals needs. A senior staff member stated any allegation of abuse would be referred to the concerned agencies without delay. There have not been any safeguarding alerts in the last twelve months. 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. Residents live in a comfortable and generally well maintained home. Evidence: 99 Saltings Road offers a clean and comfortable environment for people to stay in. The Manager described an ongoing programme of redecoration and refurbishment. Since the last inspection, the sensory room has been redecorated and the bathroom carpet replaced. She said the stained sofas in the lounge are due to be replaced in the near future. Each person living at the home has their own bedroom that has been furnished and decorated to reflect their tastes. There is a bathroom, with shower, on the first floor and a toilet on the ground floor. Staff say the toilet and bathroom facilities are suitable for residents needs. The Manager agreed to tidy the garden which has been allowed to become overgrown. This will make it more pleasant for residents to use and improve the outlook from the house. Those parts of the home seen were clean and free from offensive odours. Care Homes for Adults (18-65 years) Page 19 of 27 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. Robust recruitment processes are followed to ensure only properly vetted people work at the home. People living in the home benefit from the support of caring staff, who demonstrate a good understanding of residents needs and preferences. Evidence: Robust recruitment processes are followed to ensure only properly checked people work at the home. People applying to work at the home have to complete an application form, provide two references and have a POVA and Criminal Records Bureau (CRB) check and attend an interview. There was discussion about the of updating of the staff application and reference request forms. Residents indicate they like the staff and find them approachable and kind. Throughout the site visit there was evidence of good relationships between staff and residents. Staff obviously know the residents well and how best to put them at ease. The staff roster was inspected and showed that one staff member had worked long and consecutive shifts during April. The Manager explained this was done voluntarily Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: and to help cover unexpected staff shortages. She acknowledged that long consecutive shift patterns could compromise staff competency through fatigue and thereby put residents at risk. There is an induction programme in place for new staff and staff say there is regular training. This was confirmed by records seen. The Deputy Manager stated he is preparing a new training matrix to give a clearer management overview of courses attended and those booked. Staff spoke of regular supervision and appraisals. 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 benefits from a management and senior staff team that is experienced, accessible and supportive. Evidence: The Manager is a registered nurse and has completed the Registered Managers Award (RMA). The Manager works across the two homes owned by the Trust and is supernumerary to the care hours provided. The Manager attends the providers forum and the Trust are members of the National Care Homes Association and Kent Care Homes Association. The Deputy Manager has recently completed the Registered Managers Award. In response to previous inspection reports, more effective management systems are being implemented to safeguard residents interests. The Manager is aware of changing legislation and is updating policies and practices accordingly. Examples being the Mental Capacity Act and the restriction of liberty. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: The Manager said a quality assurance assessment is carried out regularly and involves sending surveys to people using the service and their relatives. She is intending this to be expanded to include health care professionals such as Care Managers and GPs. The Kent Care Homes Association conduct an annual quality visit to the home and produce a report of their findings. A member of the board of trustees of the Melanie Ann Trust visits the home monthly to assess the quality of the service under Regulation 26 of the Care Homes Regulations 2001. Staff spoken with have a sound understanding of emergency procedures. The AQAA records all records of maintenance and safety checks are up to date and that all policies and procedures are reviewed. The Manager confirmed this. These were not inspected on this occasion. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 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. 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