Inspection on 02/11/06 for 8 Yealand Drive

This inspection was carried out on 2nd November 2006.

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

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

Other inspections for this house

8 Yealand Drive 15/02/06

8 Yealand Drive 06/10/05

8 Yealand Drive 27/01/05

8 Yealand Drive 10/05/04

8 Yealand Drive 25/02/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 8 Yealand Drive Ulverston Cumbria LA12 9JB Lead Inspector Ray Mowat Unannounced Inspection 2 November 2006 08:45 nd 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 Page 1 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 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 Page 2 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 Stationery 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. 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 8 Yealand Drive Address Ulverston Cumbria LA12 9JB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01229 582764 The Oaklea Trust Mrs Susan Millington Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (5) of places 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 5 service users to include: up to 5 service users in the category of LD (Learning Disabilities) up to 5 service users in the category of LD (E) (Learning Disabilities over 65 years of age) Date of last inspection 15th February 2006 Brief Description of the Service: Yealand Drive is situated on a residential housing estate on the outskirts of the town of Ulverston in Cumbria. It is on a bus route and is within walking distance of local amenities and approximately two miles from the town centre. The home is owned by Fairoak housing association but managed and staffed by the Oaklea Trust, a not for profit charitable organisation, specialising in providing services to people with learning disabilities. The home is registered to provide a service to five people with learning disabilities, some of whom may be over sixty-five. The front garden has been made into off road parking for two vehicles. There is ramped access to the front door and the downstairs of the home and rear garden are fully accessible. The ground floor consists of a large lounge, an open plan dining room and kitchen. There is also a laundry/utility room a walk-in shower room with toilet and a single bedroom. Upstairs there are five bedrooms, one being a staff sleep-in room the other four being residents bedrooms, there is also a bathroom with a traditional bath, overhead shower and a toilet. There is a good size rear garden that is accessible from the patio by a paved path. The home has access to a people carrier style vehicle. The home provides suitable information to residents in the statement of purpose and service user guide, with some information provided in alternative formats such as symbols and audio versions. The range of fees is from £527.50 to £712.27 with additional charges for personal sundry expenses. 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was part of an unannounced inspection and took place at 8.45 am on 2/11/06. I met with all the residents during the day spending time with them on their own or in small groups. I met with the manager and the three care staff who were on duty during the day. I also had feedback from other professionals and some of the residents relatives. What the service does well: The manager has responded positively to feedback and is monitoring all parts of the service to make sure residents needs are met. Clear plans have been agreed with residents and their family or representative about how the home is run, future plans and what residents like and do not like. There are regular meetings with residents and staff to make sure everyone knows what they are doing and why. Information is given to residents in different formats that make it easier to Understand. 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 Page 6 All the residents enjoy an annual holiday with support from staff, which is important to them and something they value. What has improved since the last inspection? All the residents have been given an agreement that explains to them the rules about living in the home. The number of staff has increased so there are regular staff that know and understand the resident’s needs. The home has started to record information that makes sure staff know how residents want to live their lives. Staff meet regularly to discuss how they do things and give support to the residents. The home has regular contact with other agencies and services to make sure residents get the right support. 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 Page 7 What they could do better: The home should involve some resident’s representatives when agreeing things with them. The type of activities for residents who cannot make their needs known should be looked at. Medicines bought ‘over the counter’ should be checked and recorded. The sealant around the bath should be replaced and hot water pipes in the laundry should be covered. Risk assessments for dangerous chemicals should be looked at to make sure they are up to date. 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. 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 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 the following standard(s): 1, 2, 5. Quality in this outcome area is good. This judgement has been made using all available evidence including a site visit. Through the ongoing review of assessments and care plans the home ensures they are able to meet the individual needs of residents and respond appropriately to changing needs. Residents are supplied with appropriate information to enable them to make informed decisions. EVIDENCE: There have been no new admissions to the home since the last inspection. Information supplied to residents and prospective residents in the statement of purpose and service user guide had been recently reviewed and updated. Existing resident’s needs had been monitored through the care plan review process, with evidence that the home was liaising with other professionals and specialist services when needs arise. Review meeting minutes were sampled and included relevant information relating to the individual needs of residents and actions that needed to be taken to maintain an effective service. Since the last inspection the home has issued new customer agreements to all the residents with a copy also held on personal files. These had been agreed and signed by some residents but it was evident they did not fully understand the content of the contract. It is recommended resident’s representatives/advocates are involved when agreeing and signing contracts to ensure their best interests are safeguarded. 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 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 the following standard(s): 6, 7, 8, 9, 10. Quality in this outcome area is good. This judgement has been made using all available evidence including a site visit. The home is developing more person centred care plans, which is challenging the current care practices and values of staff but encouraging the personal growth and development of residents. EVIDENCE: The home is continuing to move toward person centred care planning although progress has been slow. One person’s plan was well developed with staff keeping an audio record of each aspect of the plan making it accessible to them, which is good practice. The other care plans in place are comprehensive and provide staff with valuable information to enable them to respond consistently to people’s needs. The home has made appropriate referrals for specialist support and advice from other agencies and is working with some agencies on an ongoing basis with regular reviews taking place. I examined review meeting minutes, which recorded actions to be taken. The reviews involved the resident, family or other representatives, staff and social workers. Care plans were agreed and signed by residents or their representatives. 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 Page 11 The home was working closely with speech therapists to develop “communication passports”, which help staff to understand the meaning of different words and gestures for the individual, therefore helping to maintain a consistent response and improve communication. It was evident from records of resident’s meetings, staff meetings and diary recordings that residents are consulted and involved in the decision making process. From my own observations throughout the day staff were naturally offering choices to residents, this included the time they got up, what they had for breakfast and how they spent their day. These choices are not always straightforward due to people’s communication difficulties and varying level of need. The manager is reviewing and assessing how they are meeting individual needs and enabling people, therefore promoting their independence. This is challenging established practice and routines, which is good practice. She has involved a community nurse with one resident and is using the staff meeting to explore opportunities and discuss issues with the care staff. The home has developed a good range of both individual and general risk assessments that promote independence whilst safeguarding residents and staff. On the whole these had been reviewed and updated however it was evident for some new activities a review of assessments was needed. Personal and confidential information was securely stored with staff being aware of the need to maintain confidentiality at all times. 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 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 the following standard(s): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is adequate. This judgement has been made using all available evidence including a site visit. Although some people are enjoying a fulfilling lifestyle in the community, the home needs to review how they support and encourage mental and physical stimulation for residents who cannot easily make their needs and preferences known. EVIDENCE: Through the ongoing review of care plans, individual needs assessments and the development of communication passports”, the staff are able to gain a better understanding of what people benefit from and enjoy. As described previously current practice is being challenged and the home is involving other professionals to develop strategies and guidance for staff in how to enable residents to grow and develop. Although some of the residents enjoy a busy lifestyle accessing community activities such as day services, college, day trips or other local amenities, there are others who have a more sedentary lifestyle with limited opportunities for mental and physical stimulation. It is therefore recommended the home develop a range of activities for each resident that will provide both mental and physical stimulation appropriate to their abilities and preferences. 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 Page 13 All the residents have had the opportunity for a holiday with support from staff and further holidays or trips are planned relevant to the needs and preferences of the individuals, including one resident who has chosen to go abroad. Some of the holidays are on a one to one basis, with others being in small groups where people were compatible. This level of choice is good and something the residents I met with valued highly. Staff support and encourage residents to maintain contact with friends and family. There was evidence of residents attending social clubs on a regular basis and visiting or being visited by family and friends. I was present during breakfast, which was served at the dining room table. Residents came down separately and were offered a choice of breakfast food, with various options being chosen. There was a friendly and relaxed atmosphere with a healthy “banter” between residents and staff, with staff providing unobtrusive support as required. The menus I examined were varied and reflected individual tastes and choices. They are agreed and planned on a weekly basis with residents, who are also involved in shopping for the food. 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 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 the following standard(s): 18, 19, 20. Quality in this outcome area is good. This judgement has been made using all available evidence including a site visit. The home has good systems in place to ensure individual health care needs are recorded and responded to in a consistent manner. EVIDENCE: Since the last inspection the home has recruited to all the vacant posts giving them a full compliment of staff and enabling them to provide more consistent personal support to residents. Individual’s daily routines are well documented and staff meetings and supervision are being used to monitor and review practice. The home maintains clear records of all health interventions and their outcome within the care plan, with changes of need incorporated to ensure all staff are kept up to date. Daily diary notes are also used to prompt staff that changes have occurred and to refer to the relevant document. The manager and staff have recently attended training in relation to completing individual Health Action Plans for all residents, which is good practice. The Health Action Plan is used to document a resident’s medical history and record all appointments and check ups, to ensure they are receiving an appropriate service. 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 Page 15 On the whole medication was appropriately managed by the home, with a clear recording system and policies and procedures in place. However there was some over the counter medication that was not recorded or checked for suitability with a prescribing pharmacist, in case of any adverse reaction to current medication. 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 22, 23. Quality in this outcome area is good. This judgement has been made using all available evidence including a site visit. The staff receive appropriate training and guidance to ensure they are aware of their responsibilities in responding to concerns or complaints and protecting residents from mistreatment or abuse. Suitable policies and procedures are in place to support good practice. EVIDENCE: There were no recorded complaints since the last inspection, however the home had received a compliment from a relative. A letter had been forwarded to the organisation from the relative stating how “happy and content” they were with the service being provided. This had been shared with the staff team, which is good practice. Some staff have recently completed adult protection training and those spoken to were aware of their responsibilities with regard to identifying and reporting incidents or suspicions. The home has detailed care plans including behaviour management guidelines that support and guide good practice. 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 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 the following standard(s): 24, 25, 26, 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using all available evidence including a site visit. The home is safe, comfortable and well maintained. It is appropriate for the individual needs of the residents and provides a homely living environment. EVIDENCE: Recent improvements have been made to the home environment including decoration of rooms and new laminate flooring. The manager has produced a comprehensive business plan/development plan for the home that ensures the environment is safe and suitable for the needs of residents. There is a planned programme of repairs and renewals to maintain the environment. I inspected all areas of the home and grounds and on the whole it was maintained to a good standard throughout. All the bedrooms were nicely decorated and reflected individual needs and tastes with appropriate furniture and fittings in place. However it is recommended the following issues are addressed. The grouting around the bath is mouldy and should be replaced. There are exposed pipes coming from the boiler in the laundry, although not presenting a significant risk, it is recommended they should be covered. The manager is considering altering the layout of the home to try and create more private space in the communal areas. 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 Page 18 The laundry was well ordered with a colour coding scheme in place to ensure resident’s laundry is separated and not lost. The grounds and gardens are well maintained and provide good space for the residents to relax. 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 Page 19 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36. Quality in this outcome area is good. This judgement has been made using all available evidence including a site visit. The home has a well trained staff team who receive good support and guidance to provide a consistent service to individual residents. EVIDENCE: Since the last inspection the home has recruited new staff to all the vacant posts and is now operating with a full compliment of staff. Some recruitment records are held in the central personnel office so were not examined on this occasion, although the manager confirmed these were up to date. The manager maintains a personnel file for all staff, which I examined during the inspection. These included a job description, a record of training and induction and a record of supervision and appraisal. It was evident staff were getting regular supervision and an annual appraisal, with records up to date and signed by both parties. Based on discussions with staff they said they got “excellent support and could discuss any issues and always get an answer”. Recent training included autism awareness, medication training, assertiveness and adult protection. Training needs and requests were recorded in supervision notes and then passed onto the central training unit. The manager maintains an overall training record for all staff that records training completed. The training unit send out a training programme every three 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 Page 20 months based on feedback from the homes, with reminders sent out to managers when refresher training is required. Through the regular supervision and staff meetings the manager is able to clarify staff roles and responsibilities and address any practice issues and ensure a consistent approach that is meeting residents individual needs and preferences. Other professionals also attend the staff meeting periodically to review practice and for training. 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 Page 21 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42, 43. Quality in this outcome area is good. This judgement has been made using all available evidence including a site visit. The manager and staff team in liaison with other agencies ensure the service is effective and efficient, in supporting residents to lead an independent and fulfilling lifestyle. EVIDENCE: The manager is suitably qualified and experienced recently completing the NVQ 4 Registered Manager award and has a good knowledge of the individual needs of residents. She provides regular support and supervision to the care staff through both formal and informal supervision and annual appraisals. The manager has produced an informative business/development plan for the home, which includes information produced in an accessible format, using pictures and symbols, making it easier for residents to understand. The records examined during the inspection were on the whole up to date and accurate and were securely stored. The home has good systems in place to ensure a safe environment is maintained, with a safety checklist completed on a monthly basis and other 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 Page 22 checks and records completed on a weekly basis relating to water temperatures, food temperatures, fire checks etc. All COSHH substances were safely stored in a locked cabinet, however risk assessments were in need of review and updating. The manager monitors the home’s budget with monthly statements produced to record all income and expenditure. In addition to the home completing regular consultation through house and staff meetings, the organisation completes an annual survey with residents, staff and family/representatives. Two residents are also involved in a “customer forum”, which meets every two months to share information and get feedback. The manager completes a ‘quality improvement plan’ on an annual basis, which is a self-assessment against the National Minimum Standards. In addition Trustees and senior management visit the home on a regular basis to monitor practice and get feedback from residents or their family/representative. 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 Page 23 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 Standard No Score 1 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X 3 2 3 Version 5.2 Page 24 8 Yealand Drive DS0000022684.V296310.R01.S.doc Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA5 YA11 Good Practice Recommendations It is recommended resident’s representatives/advocates are involved when agreeing and signing contracts to ensure their best interests are safeguarded. It is recommended the home develop a range of activities for each resident that will provide both mental and physical stimulation appropriate to their abilities and preferences. It is recommended all over the counter medication is recorded on the MAR chart and checks completed to ensure there will be no adverse reaction with current medication. The grouting around the bath is mouldy and should be replaced. There are exposed pipes from the boiler in the laundry, although not presenting a significant risk, it is recommended they should be covered. It is recommended COSHH risk assessments are reviewed and updated. 3 YA20 4 5 6 YA24 YA24 YA42 8 Yealand Drive DS0000022684.V296310.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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