Inspection on 01/10/08 for 8 Blunt Street

This inspection was carried out on 1st October 2008.

CSCI found this care home to be providing an Adequate 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.

Other inspections for this house

8 Blunt Street 09/10/06

8 Blunt Street 05/01/06

8 Blunt Street 08/08/05

8 Blunt Street 14/02/05

8 Blunt Street 02/06/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) 8 Blunt Street Name: Address: Stanley Common Ilkeston Derbyshire DE7 6FZ One Star Adequate The quality rating for this care home is: 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: Anthony Barker Date: 0 1 1 0 2 0 0 8 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: 8 Blunt Street Stanley Common Ilkeston Derbyshire DE7 6FZ 01159323494 F/P01159323494 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): United Response Name of registered manager (if applicable) Christine Coates Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 3 0 care home 3 learning disability Additional conditions: Date of last inspection A bit about the care home 8 Blunt Street is a semi-detached house in a small village development. Service users are provided with adequate accommodation and single rooms. There is a rear garden. The Home offers personal and social care to people with a severe learning disability with associated conditions that include autism and sensory disability. Activities are planned to meet individual needs. 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: One Star Adequate Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home The date of the last inspection was 9th October 2006. The time spent on this inspection was 8.25 hours and was a key unannounced inspection. Survey forms were posted to service users relatives, staff and external professionals before this inspection. Four completed surveys were returned. The service users all had high levels of dependency and therefore were not able to contribute directly to the inspection process, though they were observed working with and being cared for by staff. The United Response Area Manager, the Services Acting Manager and one senior support worker were spoken to and records were inspected. There was also a tour of the premises. One service user was case tracked so as to determine the quality of service from their perspective. This inspection focussed on all the key standards and on the progress made towards achieving the requirements and recommendations made at the last inspection. The pre-inspection, Annual Quality Assurance Assessment, questionnaire was reviewed prior to this inspection. The fees for the Service are from 1429 pounds to 1652 pounds per week. A copy of the last inspection report, from the Commission for Social Care Inspection (CSCI), was not available to service users and visitors at the time of this inspection. What the care home does well What has got better from the last inspection What the care home could do better All service user related documents must be kept up to date to ensure that service users current needs are being addressed. Service users personal monies must not used to subsidise the Services budgets or for other service users use. All staff must attend regular fire safety training to ensure that the safety of service users is not compromised in the event of a fire. A copy of the Services current five-year Electrical Wiring Certificate must be sent to the Commission to confirm that service users are being kept safe from hazards that may be associated with poor electrical wiring. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Tony Barker CSCI CPC1, Capital Business Park Fulbourn Cambridge CB21 5XE Tel: 01223 771300 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 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 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Full information about the Service was not available in order for prospective service users and their families to make an informed choice about where to live. Evidence: The Services Statement of Purpose was not available at the time of this inspection. It was therefore not possible to assess whether it had been personalised to the Service or amended to address environmental standards. The two service users had lived at this Service for several years. A full assessment of both service users needs was made prior to their admission, as confirmed by detailed examination of care records at a previous inspection. An Individual Charter, between United Response and each service user, was in place. However, these had still not been fully completed, or updated. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users had individual plans of care but these did not fully reflect their current needs and risks to which they were exposed. Evidence: The case tracked service users care file was examined. A Personal Planning Book had been developed in a format that was holistic and person centred: it reflected the individuals personal needs, aspirations and preferences. However, there were no dates recorded within it and no goals. It had not been fully completed and the Acting Manager explained that this was a task in progress. Periodic care plan review meetings had been held and an independent person had been involved in the last review meeting. The AQAA stated that, We have involved external people in the person centred reviews to ensure that the needs of the service do not impact on the choices which individuals may make. Monthly summary sheets were in place. Daily notes were very brief and did not fully reflect the experiences of service users. The senior support worker spoken to described ways in which he encourages service users to make decisions. He said, for example, that the case tracked service user is able to choose between two or three sets of clothes when staff present these. Recorded risk assessments were in place to address the particular risks that individual service users were exposed to. However, these had last been reviewed in September 2006 and so did not reflect current needs and risks. The Acting Manager said that person centred risk assessments were being developed. The senior support worker spoken to described how the case tracked service user is enabled to take responsible risks such as walking in the community with staff. The risk involved is walking along and crossing roads. Evidence: 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. The Service provided activities and services that were age-appropriate and valued by service users and promoted their independence. Evidence: There was evidence of service users being involved in activities that they valued and found fulfilling. One service user attends college three days a week. However, there was some lack of structure to service users days and the Daily Activities Board in the lounge was not in use. The Acting Manager described his thoughts on pursuing voluntary work for the case tracked service user who likes walking. A trampoline in the rear garden provided enjoyment to the case tracked service user, the Acting Manager said. The senior support worker spoken to described a good degree of involvement that service users have in the local community. They regularly take walks in the local park and go to the pub, restaurants and cafes, go to bowling and to swimming. The AQAA referred to plans to, Carry out community mapping to make sure we are aware of all the opportunities available to people. The Acting Manager explained that this would be looking at non-specialist resources in the local community. The AQAA indicated that All service users have family contact. The efforts made to maintain and encourage this contact had been clear at the last inspection. There was a record on the case tracked service users file that showed how positive a trip to a close relative had been two months ago. Staff had recorded how the service users body language had confirmed this. Another service user had regular telephone contact with Evidence: a relative. This relative responded to our postal survey and referred to being, always in contact every Sunday...if anything happens they get in touch with you straight away. It was clear from discussion with the senior support worker that daily routines were being used by staff to promote service users independence. For example, they used the washing machine and dryer in the laundry, and the dishwasher and vacuum cleaner with staff supervision. Both service users were involved in food shopping, preparation and clearing up after meals the senior support worker said. A concern about proposed food budget cuts had been raised by staff who completed our postal survey six weeks before this inspection. The senior support workers view was that the food budget had improved since the present Acting Manager very recently came into post. The Services rolling menu indicated a nutritious diet being provided. However, it did not fully reflect current meal provision and the Acting Manager confirmed that it was not accurate due to there not always being food in the Home to enable the menu to be followed. It was also noted that two cooked meals a day were often provided. The Acting Manager confirmed that improvements to the menu were planned following advice from a dietician and a person centred review in late August 2008. The kitchen and larder were well stocked. 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. The Service was providing service users with personal support in the way they preferred and required and was meeting their physical and emotional health needs. Evidence: The Communications Chart in the lounge had photographs of places that service users visit so that their views on where they would like to go could be sought by enabling them to point at these. One service user was seen to be using this facility at the inspection. The Acting Manager felt that staff should be using Makaton sign language more in order to improve one service users expressive abilities. Service users likes and dislikes were recorded. The senior support worker spoken to gave examples that showed that service users dignity and privacy needs were being met - at times of dressing and bathing, for example. One staff member who completed our postal survey stated that the Service, respects (service users) dignity. The senior support worker gave examples showing that daily routines were flexible and reflected service users expressed opinions. There were no technical aids or equipment in the Home and the Acting Manager confirmed that this reflected service users needs. There was diversity of cultural background within the staff group and this benefited service users, particularly one from a minority ethnic group. Service users also benefited from designated key workers within the staff group and from co-key workers who worked other shifts. The AQAA referred to, looking at accessing an advocate as part of (service users) personal development. The Acting Manager said that a visit to the Service had been made by South Derbyshire Advocacy Service. The case tracked service users My Health File was examined. This was an appropriate person centred document but had no record of health appointments since March 2007. However, there was evidence of one health appointment recorded in November 2007 on another sheet in the file. The senior support worker was able to provide details of the case tracked service user seeing a range of health professionals during 2008. Evidence: A monitored dosage system of medication was in use and medicines were being stored securely. Medication records were read and found to be satisfactory. A record of staff signatures and initials was recommended at the last inspection in order to be clear whether an entry on the medication records was staff initials or a code. This could not be found at this inspection. No controlled drugs were prescribed. Staff training records showed that most staff had received recent training in the safe use of medicines. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Unsafe practices for handling personal money means that service users were not being fully protected. Evidence: The Services complaints procedure was displayed but it was not up to date. The Acting Manager explained that service users were unable to understand text and symbols and it was not realistic to provide this procedure in a suitable format for them. There had been one anonymous complaint about the Service, received in April 2008, when concerns were raised about planned staff reductions. The Service had made a good initial response to this complaint and there are currently ongoing discussions between the Service and ourselves on this matter. A form on which to record complaints was available on United Responses intranet. Safeguarding Adults Procedures and a Whistle Blowing Policy were in place to ensure that service users are kept safe from being abused. Staff training records showed that most staff had received recent training in Safeguarding Adults (Adult Protection) in order to ensure their understanding of adult abuse and its risk management. A concern had been raised by a member of staff, who completed our postal survey, about money being borrowed from service users when there was inadequate money for food for service users. This concern was supported, at this inspection, by evidence from the Services housekeeping records and those of service users personal monies. On two occasions in September there had been insufficient housekeeping money for food. Records indicated that one service user had loaned money to the housekeeping budget and, on another occasion, loaned money to the other service user. This was most concerning as the service users at this Service are not able to give informed consent to these actions. The Acting Manager and Area Manager were investigating and pledged to take action on these issues. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment was clean and hygienic but poor maintenance made it less homely for service users. Evidence: Since the last inspection, the hall, stairway and bathroom had been redecorated. Bedrooms seen were personalised and reflected service users interests. There was, however, evidence of poor maintenance. The bath had no side panel and the top and sides of boxing in the first floor toilet were missing. There was no curtain or blind in the ground floor toilet. The bathroom and staff toilet wash hand basin cold water taps were missing tap heads. These had been removed due to the behaviour of a previous service user. The Housing Association that owns the premises had been requested to replace windows. The rear garden was untidy. During a tour of the premises the Home was found to be clean and hygienic with no unpleasant odours. The senior support worker spoken to described good practice regarding the transportation of soiled materials such as wet bedding. The AQAA indicated that ten staff had completed Infection Control training. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Service had a group of generally well trained and well recruited staff to ensure that service users were safe and their needs were met. Evidence: Five of the nine care staff had achieved a National Vocational Qualification (NVQ) to level 2. This met the requirement to maintain a staff group with at least 50 qualified staff. One staff member who completed our postal survey commented that, there is a perfect match of needs of the people we support and staff qualities and attributes. Surveys completed by staff, before this inspection, indicated that there were times when staff were working long hours to cover staff absences and reduced one to one time with service users. The staffing rotas were examined and these confirmed that several 16-hour shifts were being worked. This could lead to staff becoming tired and create risks for service users. It was not possible to confirm rotas were accurate as it was not clear whether some times referred to morning or evening times. However, overall, there was no evidence that service users assessed needs were not able to be met by the staff team. Following this inspection, and in relation to the anonymous complaint received, the Service has provided us with a recorded risk assessment that addresses the risks associated with staff working on their own. The file of a member of care staff appointed in October 2007 was examined. It was found to contain all elements, required by current Regulations, regarding recruitment practices except that absence of a recent photograph made proving the persons identity less easy. There was no evidence from this persons file that they had completed a structured induction training to required Common Induction Standards. Also, there was no evidence of this from the staff training matrix provided to us by the Service following this inspection - although, according to this record, this was an exception. No staff were being put forward for the specialist induction training award, Learning Disability Evidence: Qualification, that is recommended in National Minimum Standard 35. The training matrix showed that most staff had completed mandatory training except for fire training. This record did not reflect some recent staff changes but indicated that several staff had not been provided with recent training in fire safety. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Service had, until recently, not been well managed and service users best interests had not been promoted by the systems in place. Evidence: The Acting Manager of the Service had 17 years experience of working with people with learning disabilities and had an NVQ in Care and Management at level 4. He had been in post for only a short while before this inspection and was not responsible for most of the shortfalls found. He planned to make application to us to become the Registered Manager. Monthly independent audit visits to the Service on behalf of the Registered Provider, as required by Regulation 26, were taking place and being recorded. The Services annual plan was not available and the Acting Manager was not aware of one. Staff were periodically sent Whats working, whats not working quality assurance questionnaires, in order to assess opinions on the quality of service provided. However, such opinions were not being sought from any other groups such as relatives and external professionals, as recommended at the last inspection. One relative, who responded to our postal questionnaire, said that the Service does, everything to make life as comfortable as possible to the people in their care. The Acting Manager is aware of the matters that require attention to improve this Service, reduce risks to service users and provide them with a quality of life that fully reflects their needs. He has shown, through his management of other United Response services, that he is capable of achieving this task. The AQAA indicated that equipment in the Home was being maintained, and good Health and Safety practices followed, except that the Homes five-year Electrical Wiring Certificate was dated November 2000 and was therefore out of date. One staff Evidence: member recalled that the electrical wiring of the premises was checked in early 2008 but a certificate to support this was not available. Food hygiene practices were satisfactory. Environmental risk assessments were examined and were satisfactory, although they were not being consistently recorded. Fire evacuation practices were occurring monthly and recorded. Fire alarm equipment was being checked monthly and fire alarm break-glass points checked weekly. 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 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 Description 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 1 Standard 6 Regulation 17 Description 17(3)(a) All care planning and other service user related documents must be kept up to date. Timescale for action 01/12/2008 This will ensure that service users current needs are being addressed. 2 23 13 13(6) Service users personal 01/12/2008 monies must not used to subsidise the Services budgets or for other service users use. This will ensure that service users are kept safe and not being financially abused. 3 35 23 23(4)(d) All staff must attend regular fire safety training - twice yearly for those who work at night. 01/02/2009 This will ensure that the safety of service users is not compromised in the event of a fire. 4 42 13 13(4)(a) A copy of the Services current five-year Electrical Wiring Certificate must be sent to the Commission. 01/12/2008 This will confirm that service users are being kept safe from hazards that may be associated with poor electrical wiring. 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 1 Refer to Standard 1 Good Practice Recommendations The Statement of Purpose should be amended to reflect the revised environmental standards and should be personalised to 8 Blunt Street. Each service users Individual Charter should be fully completed. All care planning and risk assessment documents should be person centred. Daily notes should reflect the experiences of service users. Plans to introduce more structure to service users days should be pursued. The Acting Managers planned improvements to the menu should be carried out. A record of health appointments should be carried out consistently. A record of staff signatures and initials should be provided for use with medicine records. The bathroom and staff toilet wash hand basin cold water taps heads should be replaced. The rear garden should be tidied. The bath side panel and the top and sides of boxing in the 2 3 4 5 6 7 8 9 10 11 5 6 6 12 17 19 20 24 24 24 first floor toilet should be replaced. 12 13 14 15 16 17 24 33 33 34 35 35 Curtains or a blind should be provided in the ground floor toilet. Staff should not work excessively long shifts. Staffing rotas should use the 24 hour clock. Staff records should include a recent photograph. Staff should be put forward for the specialist induction training award, Learning Disability Qualification. All staff should complete structured induction training to required Common Induction Standards and records should be maintained that support this. The Acting Manager should make application to the Commission to become the Registered Manager of this Service. The Service should develop an annual plan which should include target dates. Quality assurance questionnaires to relatives and to external professionals should be developed and sent out. 18 37 19 20 39 39 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 © (2008) 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. 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