CARE HOME ADULTS 18-65
Mundania Road 2 Mundania Road London SE22 0NG Lead Inspector
Lisa Wilde Unannounced 14 July 2005, 10:00am
th 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. Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Mundania Road Address 2 Mundania Road, London, SE22 0NG 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) 0208 693 1983 0208 693 9279 Saffronland Homes Ms Teresa Carter CRH Care Home PC Care Home Only 6 Category(ies) of LD Learning Disability registration, with number PD Physical Disability of places Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1st February 2005 Brief Description of the Service: Mundania Road is registered to provide accommodation and care to 6 service users with learning disabilities. At the time of this inspection there were 4 male service users living at the home. The house is a large Victorian style 3 storeydetached building located in a side street close to many local shops, community services and transport links. There is a large communal dining area and lounge with a communal kitchen on the lower ground floor. There is a garden with patio at the back of the house. There is no lift and the house is not wheelchair accessible. The homes mission statement is that it aims to assist its residents with appropriate support to achieve greater independence and living skills with a view to moving back into the community. Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day in July 2005. The inspector spoke with all four service users, staff and the service manager. In addition the inspector made contact with parents and family of the service users and three of the four social workers of the people currently living at the home. One service user said that he was very happy at the home and very happy with his life. One other service user didn’t wish to comment and the other two service users have limited communication abilities which meant that the inspector was not able to find out their views. There is a difference in opinion about the home from some of the family members involved with the service users; some being happy with the service provided and others not. This issue is discussed within this report. Social workers who support service users at this home in general are very satisfied with the individual support their clients are offered, one describing the home as the best placement they have experienced for their client who has been to a number of different services. Given the differing views held by family members and other stakeholders the focus of this home over the next period needs to be one of consultation and review to make sure that everyone involved feels that they are being listened to, understands where other parties are coming from and knows that problems are being resolved clearly together, holding in mind the best interests of this vulnerable service user group. What the service does well:
Service users’ needs and wishes are assessed by suitable staff prior to them coming to the home and staff and management discuss whether they can meet the needs of someone before they are offered a place at the home. This means that prospective service users and their families can know that their needs and wishes are going to be met by the home before they move there. Care plans are in place and reviewed often enough for service users to know that as their needs change they will continue to be met by the staff at the home. Generally service users are consulted about all aspects of their life at the home. Service users are supported to take reasonable risks and make choices as part of their independent lifestyles at the home. Service users are offered an individual programmes of activities that allows them to access the local community as they choose. The spacious shared areas in the home are clean, attractive and comfortable providing a space that supports the service users lifestyles.
Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 Page 6 Staff understand their role at the home which means that service users benefit from clarity and staff who are certain about what they need to do while at work. The home is well run as the manager has the experience and skills necessary to show that she understands the needs of the service users and how staff, practice and procedures at the home should meet those needs. What has improved since the last inspection? What they could do better:
Given the limited communication of some of the service users, the home is not doing enough to consult formally with families and other stakeholders which means that they cannot be sure that they are running the service in the best interests of the people who use it. The home is not doing enough to ensure that there is a varied programme of activities within the home for those service users who, for whatever reason, cannot access the community at any particular time which means that service users may not be stimulated enough on a day-to-day basis. Although service users are supported on a one-to-one basis to shop, cook and eat as they choose the practice of locking away the food in the home means that individual choice and independence is being limited for most of the service users, based on the assessed risk for one service user of having the food freely available. Although as far as possible the home is doing what it can to make sure that the views of service users are listened to and acted on, the home is not doing enough to show that it is consulting and working with the families of service users to ease concerns and find ways of working together to support service users. This means that support may be inconsistent from all people involved in the care of the service users and some families may be unhappy with or unclear about the agreed action plans in place. Because of the lack of a deputy manager service users are not being supported by an effective staff team as there is not enough management input at the home. Service users are not benefiting from an appropriately trained staff team as some staff are not comfortable working with the more challenging behaviour that some service users can show. The Registered Manager must ensure that training appropriate to the individual needs of the service users is offered to staff to enable them to feel secure in working with the service users more challenging behaviours. Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 Page 7 The home is not currently showing that service users (and their families’ and other stakeholders’) views are being taken into account and are being used to develop the home in ways that are in the best interests of the service users. 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. Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 & 3 Service users needs and wishes are assessed by suitable staff prior to them coming to the home and staff and management discuss whether they can meet the needs of someone before they are offered a place at the home. This means that prospective service users and their families can know that their needs are wishes are going to be met by the home before they move there. EVIDENCE: The inspector saw thorough needs and risk assessments of all service users on file that had been carried out prior to them moving to the home. The manager stated that she would attend and conduct the assessments of potential service users with her manager. The inspector saw care plans in place that outline different areas of need and how staff were to meet those needs. Behaviour is monitored at the home to assess when certain environmental triggers may be impacting on service users. Service users are linked into external services such as speech and language, counselling and occupational therapy. Staff were able to discuss individual service user’s needs and how they aim to meet them and the needs of the wider service user group in general. Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 9 Care plans are in place and reviewed often enough for service users to know that as their needs change they will continue to be met by the staff at the home. Generally service users are consulted about all aspects of their life at the home but given the limited communication of some of the service users the home is not doing enough to consult formally with families and other stakeholders which means that they cannot be sure that they are running the service in the best interests of the people who use it. Service users are supported to take reasonable risks and make choices as part of their independent lifestyles at the home. EVIDENCE: The care plans in place were reviewed at six monthly intervals as required. There was evidence in the files that families are consulted and kept informed of ongoing issues at the home. Some of the family members who spoke with the inspector were very happy with the home and felt that they were able to sort out any difficulties with the staff and manager. Some of the family members did not feel this was the case. Given the nature of this service user group and the limited communication of some of the people at the home, consultation with the family members is very important and a requirement is made under this standard and Standards 22 & 39. (See Requirement 1)
Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 Page 11 On the day of the inspection all service users apart from one were out in the community with staff. One was at work and two were going for walks or to the park. One service user chose to change his plans and not attend his college placement and was supported in his choice and then offered another activity outside of the home. Daily and weekly plans showed that service users are accessing the community as they choose and being supported to take risks as part of a risk assessment framework within the home. Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 &17 Service users are offered an individual programmes of activities that allows them to access the local community as they choose. The home is not doing enough to ensure that there is a varied programme of activities within the home for those service users who, for whatever reason, cannot access the community at any particular time which means that service users may not be stimulated enough on a day-to-day basis. Although service users are supported on a one-to-one basis to shop, cook and eat as they choose the practice of locking away the food in the home means that individual choice and independence is being limited for most of the service users, based on the assessed risk for one service user of having the food freely available. EVIDENCE: The inspector spoke with one service user who said he had a very full week and was very happy with the things that he did in the house and in the local area. Service users have different activity plans in place dependent on their levels of ability. The inspector was concerned that one service user had not been able or had not chosen, to attend their activities for a long period of time and spent considerable time in the house. Although on the day of the inspection staff did keep going to this service user and asking if he wanted to
Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 Page 13 do things, there was a plan in place on their file from other professionals and recent reviews that said that this was not the way to work with that service user. The inspector spoke to the service user’s keyworker who was not fully aware of the latest action plan to work with this service user and as such requirements are made (See Requirements 2 & 3) Service users are supported to shop, cook and eat on an individual basis with shared meals being encouraged where possible. The inspector was concerned that all the food in the home is locked away because one service user had recently eaten some frozen food and become ill. This meant that some service users who are able to make their own snacks and small meals have to ask staff to unlock the cupboards and fridges in order to make a snack, impacting on their levels if independence and choice. (See Requirement 4) Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) X All these standards were met at the last inspection. EVIDENCE: Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 Page 15 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) 22 Although as far as possible the home is doing what it can to make sure that the views of service users are listened to and acted on, the home is not doing enough to show that it is consulting and working with the families of service users to ease concerns and find ways of working together to support service users. This means that support may be inconsistent from all people involved in the care of the service users and some families may be unhappy with or unclear about the agreed action plans in place. EVIDENCE: There is a complaint policy and procedure and there was evidence in the complaints book that complaints from family members are taken seriously by the manager, investigated and any action taken recorded and fedback to the complainant. Vulnerable adults meetings involving other professionals are arranged when an issue of potential abuse arises although the Commission had not been formally notified nor invited to two recent vulnerable adults meetings. This is not the responsibility of the home but of social services but as a matter of good practice the home should prompt the social worker to ensure all relevant parties are at the meetings. The inspector had spoken with two current service users’ families who were not happy with the way certain issues were being managed at the home, although they had said that they did not want to make formal complaints to the Commission. They felt that nothing they had to say was anything that they had not already talked with the manager about and when issues were fedback to the manager she confirmed that she was aware of the concerns but had a different view as to how to manage the issues. The inspector spoke with the social workers of three of the four service users two of whom were very happy with the service and the support that was being offered to the service users, one of whom was new to the service and couldn’t comment in any detail. The inspector was concerned that ongoing issues were not being resolved at the home between some of the
Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 Page 16 families and the staff/management and that this would have an impact on the consistency of support offered to service users by all the people involved in their lives. A requirement about consultation has been made under Standard 8 that applies to this Standard also. Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 27, 28, 29 & 30 The spacious shared areas in the home are clean, attractive and comfortable providing a space that supports the service users lifestyles. EVIDENCE: The shared space in the home is spacious, comfortable and clean. On this inspection the inspector did not see any of the service users’ rooms but previous inspections have confirmed that all bedrooms meet the required size standards. The home has six toilets and three bathrooms which meets the requirements of the standards. The current service users do not need any specialist equipment to assist with their mobility. Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 Page 18 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, 33 & 35 Staff understand their role at the home which means that service users benefit from clarity and staff who are certain about what they need to do while at work. Because of the lack of a deputy manager, service users are not being supported by an effective staff team as there is not enough management input at the home. Service users are not benefiting from an appropriately trained staff team as some staff are not comfortable working with the more challenging behaviour that some service users can show. EVIDENCE: The inspector spoke with several staff who showed awareness of their role and what they were expected to do while at work. Staff showed awareness of individual service users’ needs and the needs of the service user group in general. Some staff stated that they were concerned about some behaviours of certain service users and this evidenced a training need. The inspector spoke with the manager who felt that training adapted to the service by external professionals would be most appropriate (See Requirement 5) Between 8am and 8pm there are a minimum of 4 staff on duty and at night there is one waking night staff plus one staff member who sleeps on the premises and is on call should service users require assistance during the night. There is currently no deputy manager in post and has not been for some considerable time which is impacting on the level of management support that the current manager has to offer. (See Requirement 6).
Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 Page 19 Currently the manager is on-call for this service every day whereas it would be more appropriate to allow her to have a break and make other managers within the organisation on-call on a rota basis (See Recommendation 1) Training records showed that staff are offered an induction and foundation programme when they start employment but the manager was not certain whether this programme was based on the Learning Disability Award Framework or the Skills for Care requirements as required by the standards (See Requirement 7) Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 Page 20 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) 39 & 42 The home is well run as the manager has the experience and skills necessary to show that she understands the needs of the service users and how staff, practice and procedures at the home should meet those needs. The home is not currently showing that service users (and their families’ and other stakeholders’) views are being taken into account and are being used to develop the home in ways that are in the best interests of the service users. EVIDENCE: The current manager has now been registered with the Commission and is working on the NVQ Level 4 Registered Managers Award. She has a social work qualification and has been at this home since June 2004. She has worked in the social care field since 1976. The quality assurance standard was not fully assessed but the issue of consultation with service users’ families has been discussed earlier. Given the limited communication abilities of the service users at this home there is more of a need to formally consult with families, social workers, and other stakeholders as to their views of the service. The home does not currently use a formal, externally recognised professional quality assurance tool. (See
Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 Page 21 Requirement 8 and Recommendation 2). The home does not currently produce an annual development plan for the home that is based on the views of service users and other stakeholders (See Requirement 9). On the tour of the building the inspector found no cause for concern with regard to health and safety. All the fire records were in place and maintained appropriately as were the gas and other maintenance records. Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 Page 22 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 x x Standard No 22 23
ENVIRONMENT Score 2 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x 3 3 3 3 Standard No 11 12 13 14 15 16 17 x 3 2 3 3 x 2 Standard No 31 32 33 34 35 36 Score 3 x 2 x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Mundania Road Score x x x x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 3 x G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 Page 23 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 YA6 YA22 YA39 Regulation 12 (3) 22 (2) 24 (3) Requirement The Registered Manager must ensure that service users, their families and other stakeholders are formally consulted about their views of the service. The outcomes of these consultations must be recorded and action plans to address concerns drawn up. The Registered Manager must ensure that all staff are aware of and follow the latest action or support plans devised in the most recent reviews or by external professionals. The Registered Manager must ensure that additional activities take place in the home so that the service user who is currently not able to engage with his external activities has the option to take part should he wish. It is not enough in this instance for staff to merely ask him if he wants to do something, further effort must go into providing a varied and stimulating environment around him. The Registered Manager must ensuer that the practice of locking away all the food in the Timescale for action 30/11/05 2. YA6 YA13 18 (1) (c) (i) 31/08/05 3. YA13 16 (2) (m) & (n) 31/08/05 4. YA17 YA 16 (2) (h) 31/08/05 Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 Page 24 5. YA33 18 (1) (a) 6. YA35 18 (1) (c) (i) 7. YA35 18 (1) (c) (i) 8. YA39 24 (1) (2) & (3) 9. YA39 24 (1) (2) & (3) home stops and that alternative methods are found to ensure that the one service user who is at risk of eating inappropriate food is supported not to do this. The Registered Individuals must ensure that a suitably experienced and skilled individual is recruited to the deputy post at the home. The Registered Manager must ensure that training appropriate to the individual needs of the service users is offered to staff to enable them to feel secure in working with the service users more challenging behaviours. The Registered Manager must ensure that she checks whether the current induction and foundation programme for staff is based on the Learning Disabilities Award Framework and Skills for Care requirements and if it is not ensures that the progarmme is redevised so that it is in line with those requirement. The Registered Individuals must ensure that a comprehensive quality assurance system is in operation in the home that is based on the views of service users and other stakeholders. The Registered Individuals must ensure that an annual development plan is drawn up for the home that is based on the views of service users and other stakeholders and which is published and made available to service users, stakeholders and the Commission. 31/10/05 30/09/05 30/09/05 31/12/05 31/12/05 Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 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. 1. Refer to Standard YA33 Good Practice Recommendations The Registered Individuals should consider changing the on-call rota so that other service managers are on-call for this home on certain weeks to allow the registered manager to have time off from being on-call for the home. The Registered Individuals should consider using an externally recognised, professional quality assurance tool within the home. 2. YA39 Mundania Road G52-G02 S7091 Mundania Rd V239578 140705 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection 46 Loman Street Southwark London SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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