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Inspection on 23/02/09 for 72 Doods Road

Also see our care home review for 72 Doods Road for more information

This inspection was carried out on 23rd February 2009.

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

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

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

What the care home does well

The home is well managed and provides a homely and comfortable environment in which service users are supported to reach their potential and gain in confidence and independence. Care plans are completed to a high standard and reflect the current needs of service users,they are reviewed regularly as are health needs and risk assessments. The health needs of service users are well met and any changes or concerns promptly addressed. Medication procedures are robust and protect service users. Service users are provided with information on activities available and if necessary given support to attend them. Staff are well established and genuinely interested in the lives of the people they support,they receive a good standard of training and are well supported by the management team.

What has improved since the last inspection?

The results of the most recently completed quality assurance survey are now held on the premises. A system has been put into place to record concerns as well as complaints.

What the care home could do better:

The flooring in the downstairs toilet must be replaced as it has an odour and is not pleasant for service users to use.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 72 Doods Road 72 Doods Road Reigate Surrey RH2 0NW     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: Deborah Sullivan     Date: 2 3 0 2 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 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: 72 Doods Road 72 Doods Road Reigate Surrey RH2 0NW 01737224505 Telephone number: Fax number: Email address: Provider web address: doods@prospectha.org.uk Name of registered provider(s): Prospect Housing and Support Services care home 8 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 8. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home The home is a large semi-detached house located in a residential area of Reigate in Surrey. The home is served by public transport and all major routes to motorways are easily accessible. The local amenities are within walking distance from the premises. There is limited visitors parking although the nearby streets can also be used for additional parking. The home has a large rear garden and offers single occupancy to 8 Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 8 Brief description of the care home service users. The home is run by Prospect Housing Association Limited who are the registered providers. Care Homes for Adults (18-65 years) Page 5 of 28 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 inspection of Doods Road was undertaken in the company of the Registered manager,support staff,service users and the assistant director for residential and domiciliary services who was present for some of the time. The inspection took place over nearly five and a half hours and time was spent speaking with service users,the manager,assistant director and support staff.The house was toured and and a range of documents and records were inspected including care plans,staff records and medication records and procedures. Information provided in the AQAA(Annual Quality Assurance Assessment)document completed by the registered manager and other information about the service that the Commission has received since the last inspection has also been used as evidence for this inspection. Throughout the visit staff and service users were helpful in providing information. The current weekly fee range for the service is nine hundred and forty nine pounds Care Homes for Adults (18-65 years) Page 6 of 28 twenty three pence per week to nine hundred and fourteen pounds sixty two pence. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 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. Information about the service is available to potential service users and their advocates and a robust assessment procedure is in place. Each service user has a tenancy agreement on their care plan. Evidence: The home has a statement of purpose and service users guide, both are clear, up to date and each service user has a copy. There has been no change to the service user group since the last key inspection and all the service users are well established at the home. The manager said that the admissions procedure used when new people had been admitted in the past would be used should new admissions be considered. The procedure involves assessment by the manager and careful introduction to the service that would involve visits to the home. The organisation is currently in the process of considering becoming a supported living service rather than a registered care home and service users are being supported to air their views about this possible change. Each service user has a tenancy agreement; these are signed and kept on the care Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: plans. Care Homes for Adults (18-65 years) Page 11 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each service user has a care plan that is maintained to a high standard, is accessible to them and reflects current needs. Service users are empowered to make decisions about their lives and to be involved in the running of the home. Evidence: The care plans of three service users were read, each person has a copy of the care plan in their own room. Service users had been involved in drawing up the plans and the information on each reflects the personal, domestic, social, leisure, health and spiritual needs of service users. Risk assessments that were relevant to each person such as regarding smoking, self-harming or taking part in daily activities had been drawn up and were reviewed. The quality of the information was of a good standard, current and easy to access. A temporary plan of care was in place for a service user who had a shoulder injury. Care plans are reviewed every three months, this is Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: recorded, there are full annual reviews and records of CPA meetings. Care plan folders also include daily recording, which is of a good standard and thorough and pen portraits. Service users are encouraged to make choices about their daily lives with support appropriate to individual needs, during the visit service users were making choices about what to do, when to get up and what to have for lunch. One service user chose to get up mid morning. Service users are consulted about the running of the home via regular recorded service user meetings and individual discussion. Service users currently have weekly access to an advocate should they wish to talk with them about the homes future and a keyworker system is in place. Service users have the opportunity to change keyworker if they wish, a staff member said that usually they decline and are happy with current keyworkers Each service user has their own building society account and is responsible for their own finances; one person needs some additional support to make sure they manage their money sensibly. During the visit one service user had gone to draw out their money independently and another was out shopping in the morning. There is lockable space on bedrooms for safe storage. All confidential information is securely stored. Care Homes for Adults (18-65 years) Page 13 of 28 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. Service users are supported to take part in activities of their choice at home and in the community. Independence is promoted and the rights of service users are respected. Meals are healthy and varied and service users contribute to meal planning. Evidence: The home supports service users to be involved in leisure, social and educational activities of interest to them appropriate to their age and abilities. A service user who is over sixty five has it recorded on their care plan that they are retired and like to watch TV and listen to music, they do not wish to attend a drop in centre. Two service users attend an art group. The home maintains information on activities for service Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: users to choose from. A service user said they liked to go shopping with staff and especially liked going to bookshops. Visits to the cinema, garden centre, meals out and other community activities take place and there is a dedicated vehicle for the homes use. A section of the garden has been made into a vegetable patch for a service user and the manager said they successfully grew produce last year. Holidays are arranged each year, the manager said that last year two service users preferred to have days out and others went away in groups of three with staff support. At home service users are encouraged and supported to take part in the daily domestic tasks around the home and to keep their rooms clean and tidy. Service users do their own laundry and during the visit were observed to be hoovering, tidying up and making their lunches. Contact with friends and relatives is supported, one service user is regularly accompanied by staff to visit their relative who lives in a nursing home and daily records showed that another had recently been visited by relatives and kept in touch with them. One service user spoke of enjoying going out for walks with a friend from another service. The daily routines were observed to be relaxed and flexible with comings and goings throughout the day. Service users accessed shared areas of the home freely, went out or spent time in their rooms. Menus are compiled on a weekly basis; each service user chooses a main meal they would like in turn and cooks this meal for themselves alongside staff preparing it for others. The main meal is taken in the evening. The menu was varied and healthy and there is choice available. At lunchtime service users prepared sandwiches or toast for themselves, or with some staff support. The kitchen is equipped with two cookers so service users and staff can cook simultaneously. Service users help in turn with the twice weekly shop. If they wish to eat at a different time to others or away from the dining room this is supported. The home monitors the diet of three service users who are diabetic and one person who is on a reducing diet. It is recorded on their care plan that service user who chooses not to follow their particular faith is not restricted as to what to eat due to this decision. Care Homes for Adults (18-65 years) Page 15 of 28 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. Healthcare needs are well met and service users are encouraged to take responsibility for their own personal and healthcare needs with staff support as necessary. Medication practices are robust and serve to protect service users, whilst supporting independence with administering medication. Evidence: Most of the service users are independent as regards their personal care; others need a little support or prompting. Privacy and dignity is respected and a service user with a temporary injury restricting use of an arm had been supported to buy trousers that did not need undoing to maintain their dignity. Health needs are well recorded on care plans and any changes in need, input from external professionals or medical appointments are documented. Service users have a range of mental and physical health needs, they receive support from health professionals such as dieticians, chiropodists, the GP and psychiatrist. One service user spoke of a chiropody appointment the next day. Regular health checks take place such as with the dentist or optician. Where necessary weights are monitored, the manager said one service Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: user had lost a lot of weight through anxiety over a family situation last year, the care plan evidenced that they were now gaining weight again. Staff spoken with said they knew how to manage any challenging behaviours and as they knew the service user group well were able to deflect it when they recognised signs of escalating behaviour. Medication policies and procedures remain very robust, the manager has put into place clear procedures for staff to follow, all the staff employed by the service are trained to administer medication with regular updates and annual in-house assessments of their practice. The majority of the service users self medicate and individual risk assessments are in place for this. Staff supervise service users filling up their dosett boxes that are then stored in individual lockable space. Service users sign agreements that staff can enter their rooms if they are not there so that medication newly delivered can be safely stored. Medication record sheets seen had been correctly completed. Care Homes for Adults (18-65 years) Page 17 of 28 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. Service users and others have access to the homes complaints procedure and can feel confident that any concerns will be taken seriously. Service users are protected from harm by the procedures in place and staff are aware of their responsibilities in keeping service users safe. Evidence: There is a complaints procedure that is accessible for service users and they each have a copy. No complaints have been recorded in the last year and the home also has a niggles book, again there were no recent entries. Two service users were asked who they would feel they could voice concerns to, they responded they would speak with staff. Staff spoken with were aware of the procedure and the homes safeguarding vulnerable adults procedure. The procedure is clear and there is also a whistleblowing procedure for staff and an up to date copy of the Surrey multi agency safeguarding procedure. Since the last key inspection there has been one fairly recent safeguarding alert that the home referred to the social service department, the home had managed the information well and acted according to the procedure. The alert does not implicate staff and is currently still under investigation. Staff spoken with were aware of the safeguarding procedure and confirmed they had been on POVA training. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: Care Homes for Adults (18-65 years) Page 19 of 28 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. Service users live in a clean, comfortable and well-maintained environment and bedrooms are decorated and personalised to the taste of the occupant. The downstairs toilet floor needs replacing as it has an odour and is unpleasant for service users to use. Evidence: The home is situated in a residential street near to local amenities. It is clean, nicely decorated and well maintained; some areas were looking a little shabby and in need of redecoration such as hallways and stairways. Individual rooms seen were well presented, clean and personalised with items such as pictures and photos, books and ornaments. All the bedrooms have a wash-hand basin. There is one downstairs bedroom, others are on the first and second floors reached by stairs, there are handrails. There is a toilet and bathroom on the first floor with the shower on the second floor, service users have choice of a bath or shower. There is a downstairs toilet that was in need of new flooring as it had a strong odour, the manager said this was due to the needs of one service user and a request for new flooring had been presented to the organisation. Shared areas are the large lounge, dining room, kitchen and conservatory, which is the designated smoking room. Most service users smoke Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: and there is a sign stating the rooms purpose. There is an attractive garden that service users and staff maintain, the manager said there is patio furniture that is used in good weather. During the visit service users accessed shared areas freely and some spent time in the lounge watching TV before and after lunch. Service users spoken with stated they were happy with their rooms. The home does not employ any domestic staff; care staff and service users are responsible for all domestic duties. The maintenance worker undertakes minor repairs, the maintenance book showed that they are recorded and dealt with promptly. The laundry is well equipped as is the large kitchen. The kitchen has plenty of space for staff and service users to cook together and there are two cookers for this purpose. Care Homes for Adults (18-65 years) Page 21 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A well trained, well supported and competent staff team who are knowledgeable about their individual needs supports service users. Staff are respectful towards service users and have good relationships with them. Evidence: The home has a small diverse staff team comprising of the Registered manager, deputy manager, senior support workers and support worker. Most support workers have worked there for a number of years and there is very little staff turnover. As staff and service users are well established staff know the needs of service users very well and are confident in supporting them. Three staff members were spoken with; all liked working at the home, felt well supported by the manager and organisation and said that training opportunities were good. Comments included The training Prospect provide could not be better and The home is like a little family. Core and specialist training is provided and core topics are regularly updated. The manager maintains a training schedule clearly showing when courses were attended or are due, and has a record of training for bank staff. Where bank staff are used they are those well known to the home. Staff have attended equality and diversity and Mental Capacity Act training and said that if they request a particular course it will be made available. New Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: staff receive induction training and are subject to a probation period, all have an annual appraisal. One staff member was waiting for their NVQ 2 to be verified and looking forward to then starting NVQ 3 all other staff have gained an NVQ in care at level 2 or above. Three staff files were read, staff recruitment documentation is kept at head office and a pro forma is held at the home, the manager signs that documents such as CRB disclosures and references have been received. Supervision recording was in place and through and minuted staff meetings are held monthly. Staff had a good rapport with service users who were clearly comfortable with them; they spoke warmly of service users and of being committed to providing a good service. They also spoke of supporting each other and working well as a team. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run in the best interests of service users and staff; the atmosphere is open, inclusive and enabling. The organisation undertakes internal quality assurance and all records are maintained to a high standard. Evidence: The registered manager is well qualified and experienced in the running of the home. The deputy manager supports the manager and staff spoken with felt that the management of the service and organisation as a whole was approachable and supportive. The home has a friendly and inclusive atmosphere, service users were observed to be comfortable in approaching the manager and staff and in going about their daily tasks and activities freely with staff giving direction or advice when needed. The service has internal quality assurance processes; the quality assurance manager undertakes monthly regulation 26 visits that were thoroughly recorded. One requirement was made at the last inspection that the results of the quality audit of the Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: service be held on the premises, this has been met and another audit took place in 2008.Service users are provided with opportunities to air their views individually and in service user meetings. Policies and procedures are kept in the office and are accessible for staff, the organisation and maintenance of all records, procedures and documentation is of a high standard allowing for easy access to information needed and tracking of information for and relating to service users and staff.Policies and procedures are in place to make sure that service users and staff are kept safe,whilst the downstairs toilet floor must be replaced as the manager has stated is requested in the interests of infection control. Clear fire procedures are in place and regular fire practices involving service users are held. A valid insurance certificate is on display and a business plan that runs to this year is in place. The organisation is keeping the Commission updated on progress towards becoming supported living and is aware of action it needs to take should it apply for voluntary deregistration. The home notifies us of any matters that we need to know about and the AQAA (Annual Quality Assurance Assessment) document that each registered service is required to submit annually was received in the given timescale completed by the manager No requirements have been made as a result of this inspection. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 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 1 42 It is recommended that the downstairs toilet floor be replaced as has been requestec by the registered manager. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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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