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Inspection on 12/07/05 for Glyn Residential Care Home

Also see our care home review for Glyn Residential Care Home for more information

This inspection was carried out on 12th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

The home provides a safe environment for residents where they are looked after by dedicated and caring staff, who are suitably trained. There is a commitment to staff training with Glyn. The manager leads by example. The inspector received three comment cards from service users, prior to the inspection and three comment cards from relatives/visitors. One relative stated, "I cannot express enough how happy I am with the level of care [the resident] receives at Glyn. I feel any questions I have are freely answered". The home enables residents to participate in appropriate activities and meals are varied, plentiful and well managed to meet residents` needs and preferences. There is continuity of care with staff having worked in the home a long time. Residents support needs are met within Glyn.

What has improved since the last inspection?

The home has a full compliment of care staff. Since the last inspection the home has introduced a keyworker system. Glyn has further developed their newsletter, which not only keeps relatives and friends of Glyn informed but aids communication.

What the care home could do better:

Although the home has comprehensive care plans the individual resident`s files would benefit from being developed in a modular format. Such a system would ensure that all the relevant information about an individual is held in one place. It would also promote confidentiality and access on a needs-toknow basis. It was agreed that this would be implemented. The care plans would also benefit from more sub-headings provided.

CARE HOME ADULTS 18-65 Glyn Residential Care Home 6 Dudley Avenue Hordle Lymington SO41 0HY Lead Inspector Rodney Martin Unannounced 12th July 2005 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 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 Stationary 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. Glyn Residential Care Home H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Glyn Residential Care Home Address 6 Dudley Avenue Hordle Lymington SO41 0HY 01425 614595 01425 614595 info@glyn-residential.co.uk Glyn Residential Ltd Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Suzanne Bull CRH 7 Category(ies) of LD Learning disability - 7 registration, with number PD Physical disability - 7 of places Glyn Residential Care Home H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Dispensation has been given to one named service user in the MD category to remain accommodated in the home. Date of last inspection 1st November 2004 Brief Description of the Service: 6 Dudley Avenue [Glyn]is one of three homes owned by Mr & Mrs Hayward and currently provides personal care and accommodation for six service users with learning and physical disabilities. An additional three service users, from 2 Dudley Avenue, go daily to Glyn for day care. The home is located in a quiet rural area of the New Forest but is within reach of local shops. Glyn has a mini-bus to access wider community networks. The home is a large chalet style bungalow with all the service users accommodated on the ground floor. Although Glyn is registered for seven, the home currently is only accommodating six service users. All six bedrooms are single, provided with en suite facilities, and are situated on the ground floor. There are two large single bedrooms, upstairs. The sleep-in night staff uses one bedroom and the other is not in use. There is a lounge/dining room, conservatory as well as an accessible garden. Glyn Residential Care Home H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There were no requirements in the previous inspection report, dated 1 November 2004 and none again on this occasion. The unannounced inspection took place between 9.45am and 2pm. Suzanne Bull, registered manager was available to assist the inspector in the inspection process. On the day of the visit the home was accommodating six service users, whose ages ranged from 25 to 64 years old. Glyn has four male and two female service users. One service user has been in the home fifteen years and there have been no new admissions since April 2001. The inspector was able to tour the building as well as speak to the staff members on duty and also met a resident’s parents who were visiting. They confirmed that they had no complaints about the home and were more than satisfied with the care given in Glyn. The inspector had a meal with residents at lunchtime. The inspector spoke to four residents as well as all the staff on duty. Staff are actively encouraged to help residents make decisions in promoting independence. From discussion with the staff and an inspection of residents’ plans the inspector was able to confirm that, as far as is practicable, the home supports the residents to make all the important decisions in their lives. There was evidence available on the day of the inspection to indicate that the core values are being upheld in Glyn. Care and staffing records were inspected. These were relevant and up to date. What the service does well: The home provides a safe environment for residents where they are looked after by dedicated and caring staff, who are suitably trained. There is a commitment to staff training with Glyn. The manager leads by example. The inspector received three comment cards from service users, prior to the inspection and three comment cards from relatives/visitors. One relative stated, “I cannot express enough how happy I am with the level of care [the resident] receives at Glyn. I feel any questions I have are freely answered”. Glyn Residential Care Home H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 6 The home enables residents to participate in appropriate activities and meals are varied, plentiful and well managed to meet residents’ needs and preferences. There is continuity of care with staff having worked in the home a long time. Residents support needs are met within Glyn. What has improved since the last inspection? What they could do better: 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. Glyn Residential Care Home H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Glyn Residential Care Home H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 and 4 The home’s admission procedure ensures that prospective residents have opportunities to visit the home and that assessed needs and aspirations are met within Glyn. EVIDENCE: Although there have been no new admissions since April 2001 all new prospective service users would be subject to a comprehensive assessment procedure, undertaken by the manager. Once a placement has been made this would be reviewed to ensure the home is suitable and the care needs would be revised, where appropriate. Residents are encouraged and supported to use the home’s facilities and there was evidence that the physical, intellectual, emotional, social and spiritual needs of the residents are adequately met within Glyn. Glyn Residential Care Home H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8 and 9 There is a clear care planning system in place, with evidence of consultation with residents about decision making, which ensures that their needs are met. EVIDENCE: All service users have an individual care plan. These are based on the initial assessment and care plan review, which are updated regularly. Any potential restriction of choice, freedom, services or facilities is decided, where applicable, with the involvement of the multi-disciplinary team, including care managers, parents and members of the primary health care team. Any change would be discussed with the resident, prior to any alteration to the service user plan. The inspector viewed the files of two residents. These were up to date, very comprehensive and detailed in some depth all aspects of the resident’s life within the home. Since the last inspection a keyworker system was introduced in March 2005. It was reported that the keyworker system is to discussed at the next staff meeting on 21 July, where staff have been asked to write their views on how Glyn Residential Care Home H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 10 the system is working or not, with ways of improving if necessary. The inspector discussed with the manager having individual resident’s files developed in a modular format, with key information, care plan reviews, contacts relevant to the individual resident, medical information, financial information and confidential information et cetera. Such a system would ensure that all the relevant information about an individual is held in one place. It would also promote confidentiality and access on a needs-to-know basis. It was agreed that this would be implemented. The manager told the inspector that to further develop the care plan that they would be computerised with more sub-headings. Residents are able to voice their opinion at the regular residents’ meetings and are involved in their reviews. Each service user has an activities’ plan. The residents have a say in where they have their holiday. Glyn has been raising money for the residents to go to Disney World, Florida for Christmas 2005. Although a large sum has been raised it is not going to be enough and so the trip to Disney World has been shelved for this year. However, it was reported that more individual holidays would be pursued. Service users are able to take risks and each resident has a comprehensive risk assessment completed in their file. Action is taken to minimise any identified risks and service users are given training about their personal safety. Glyn Residential Care Home H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16 and 17 Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the home. EVIDENCE: Each service user has a timetable of activities, with a full programme for each one. Service users attend various clubs and activity centres, as well as have activities in-house, including games and computer literacy. Day services/activities and the service users social life is part of the care plan and service users supported to develop and maintain their skills, relevant to their age and capabilities. It was evident that each service user has different needs and interests but these are catered for in the home. Glyn has its own transport to provide access to the local community, for service users. There is support for the service users to pursue entertainment, outings and holidays of their choice, as well as eat out and enjoy visits to local pubs. There are joint residents’ meetings with the other two homes. Service users have their own radios, televisions, video, books and hi-fi systems in their Glyn Residential Care Home H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 12 rooms. The home has Sky television installed and is connected to each bedroom. Glyn has a beach hut at Milford-on-Sea, where service users can enjoy a break by the seaside. All service users have family and friends involved. The home actively encourages and supports the service users to maintain family links. Service users spend time with their families in the home and also go to stay with their families. Service users are able to use their own rooms, the dining room or the lounge to entertain guests. Friendships, both in the home and out in the community, are also supported under the same conditions. The home has further developed its newsletter. A copy of the May 2005 newsletter was available, on the day of the inspection. This included a diary of forthcoming events, news items about the residents, articles, quizzes, photographs and visits from local events. All the service users can express a view about meals and some service users help to choose the menu. The weather was very warm on the day of the inspection and residents wanted to eat outside. The meal was relaxed and residents enjoyed sitting under the large patio umbrellas. Residents were given a choice of the main course and were able to choose from a selection for desserts. Residents, spoken to, were very complimentary about the quality and quantity of food provided in the home. One service user has a PEG feed [a system of direct liquid food into the stomach] which a dietician monitors. They were last seen in clinic a month ago. Glyn Residential Care Home H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) assessed 18, 19 and 21 The residents’ physical and emotional health needs are being met, with evidence of good support from health care professionals. EVIDENCE: There are risk assessments and manual handling assessments on file for each resident. Residents can choose what time they get up, or go to bed et cetera. Health professionals such as dentists, community nurses, opticians, speech therapists and physiotherapists are involved with residents, as appropriate. The home is able to offer same sex care to a degree and has a policy on this. Female service users will always have female carers and male service users sometimes have the choice, depending on whether there is a male staff member on duty. Service users are supported and encouraged in all aspects of individual health care and personal care needs. Each service user is registered with the Barton surgery and the home liaises with the surgery on a regular basis. Medication is reviewed annually by the GP. The resident’s wishes concerning terminal care and death have been discussed and recorded in their files. Glyn Residential Care Home H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not inspected on this occasion. EVIDENCE: Glyn Residential Care Home H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29 and 30 A very good standard of accommodation is provided ensuring residents live in a homely, comfortable and safe environment. EVIDENCE: Glyn is a large chalet bungalow and is a well laid out home. Glyn is registered for seven service users, although currently is accommodating six service users, in the six bedrooms on the ground floor. Each bedroom has the minimum of an en suite toilet and five of the six bedrooms also have a bath, shower or both. Residents have personalised their bedrooms with their own possessions and equipment. The seventh bedroom is upstairs and is suitable for an ambulant service user. It was reported that since the last inspection Social Services are aware of the vacancy but to date there have been no referrals for the room. The home has an attractive conservatory overlooking the garden. The garden is accessible for service users to enjoy. The home has created and designed a sensory garden for service users. There is a summerhouse, patio area and Glyn Residential Care Home H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 16 furniture with three large patio umbrellas for service users to sit under in the summer months. As noted in Standards 11 to 17, service users enjoyed having lunch in the garden, as the weather was very warm, on the day of the inspection. Since the last inspection a new carpet has been laid in the lounge area. Glyn provides sufficient communal space, for both the six permanent service users and the three service users from 2 Dudley Avenue and is a non-smoking home. Staff are provided with adequate facilities, including a safe place to store personal belongings and facilities when sleeping in. Residents have been assessed and the relevant equipment has been provided, where appropriate, including tracking hoists, specialist baths, computers et cetera. The home was found to be clean and free from unpleasant odours. The laundry room is situated outside the home and is away from the kitchen and food preparation. Control of Substances Hazardous to Health assessments [COSHH] policies and procedures are in place, to ensure that staff and residents’ health and safety is promoted. Glyn Residential Care Home H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35 and 36 Residents are well supported by a sufficient, well-trained and consistent supervised staff team, who offer continuity of care. EVIDENCE: Glyn employs a manager and twenty-one staff members, which includes two bank carers. Glyn employs staff in sufficient numbers with the complementary skills to support service users’ assessed needs. The home does not use agency staff, but fills last minute gaps in the rota with existing staff. Glyn is one of three homes, in the vicinity, owned by Mr & Mrs Hayward. The majority of staff have worked in Glyn was for some time, providing continuity of care. There is a large pool of staff that work interchangeably at all the homes. Since the last inspection two new carers have been recruited. The inspector was able to view the files of both staff members and meet one, who was on duty, on the day of the inspection. Both files contained the relevant required documentation, including a photograph of the staff member. One had a returned Criminal Records Bureau [CRB] check and the other the home was waiting for its return. The latter was in respect of a school child, employed on a Saturday only and who is not involved in any personal care tasks. They had completed an application form, signed the Rehabilitation of Offenders declaration. There were satisfactory references on file and an employment Glyn Residential Care Home H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 18 permit from Hampshire County Council, which is required by law. They had received a staff contract and had started an induction programme. A job description was available clearly stating their duties and role within Glyn. On the day of the inspection, eleven staff members for all three homes were participating in a deaf awareness course at Little Orchard. Six staff members are currently on a medication course with Brockenhurst College, which is to National Vocational Qualification [NVQ] standard. The inspector met a carer who started last month an NVQ level 3 course. They said that they were benefiting from attending the course. Staff confirmed that there is a commitment to training within Glyn and one staff member said, “they are very good here about training”. The inspector discussed with the manager LDAF training [learning disability award framework, which is a qualifications framework aiming to provide a clear pathway for a worker’s training and development from the day they begin to work in the learning disability sector. It was agreed that this would be pursued. A system of supervision is in place, which is linked to staff appraisals. There was evidence that staff had received supervision, both individual on a one-toone basis as well as in group sessions. Glyn Residential Care Home H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 40, 41 and 43 Glyn is a well run home by a qualified and experienced manager, who provides effective leadership. Service users rights and interests are safeguarded and protected by the home’s policies and procedures and health and safety measures. EVIDENCE: The manager has three years experience in managing the home and is currently undertaking the Registered Managers Award, as well as the assessor’s award for NVQ training. She reported that the registered managers award for NVQ level 4 in both management and care should be completed by December 2005. The manager is a qualified Registered General Nurse having a diploma in nursing and comes across as a competent manager. The inspector spent time speaking to staff during the four hours in the home. They confirmed that they felt supported by the manager and enjoyed working in Glyn. The manager communicates a clear sense of direction and leadership Glyn Residential Care Home H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 20 through regular informal meeting with the staff, staff meetings, staff supervision and education. The inspector also spoke to two visiting parents, on the day of the inspection. They also were very positive about the standard of care and management within the home. The home has written policies and procedures, which staff have access to as part of their induction and ongoing work within Glyn. They are encouraged to familiarise themselves with these. It was confirmed, on the day of the inspection, that staff were aware of the relevant policies and procedures within Glyn. The policies and procedures are reviewed and monitored by the manager. Glyn Residential Care Home H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 3 x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Glyn Residential Care Home Score 3 3 x 3 Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 3 x 3 H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 22 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Glyn Residential Care Home H54 S11739 Glyn Residential V238236 120705 Stage 2.doc Version 1.40 Page 23 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 National Enquiry Line: 0845 015 0120 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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