Inspection on 28/11/07 for ABI Homes

This inspection was carried out on 28th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

ABI Homes 18/11/08

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 ABI Homes 34 Dyers Mews Neath Hill Milton Keynes Buckinghamshire MK14 6ER Lead Inspector Chris Schwarz 28 th Unannounced Inspection November 2007 10:00 DS0000070191.V353022.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 DS0000070191.V353022.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. DS0000070191.V353022.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service ABI Homes Address 34 Dyers Mews Neath Hill Milton Keynes Buckinghamshire MK14 6ER 01908 605066 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) info@abihomesuk.co.uk Resuscitate Care Ltd Mrs Lynda Jayne Wenner Care Home 5 Category(ies) of Learning disability (0) registration, with number of places DS0000070191.V353022.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Learning disability (LD). The maximum number of service users to be accommodated is 5. Date of last inspection Not applicable – new service registered in 2007. Brief Description of the Service: 34 Dyers Mews is as detached property located in a residential area of Milton Keynes and has capacity to accommodate up to five people in single room accommodation. The service was registered earlier in the year and had not yet admitted any service users. The location of the home would mean that people coming to live at 34 Dyers Mews had good access to public transport networks and the facilities of the nearby city centre where there are good shopping, leisure and recreational resources available. No fee structure had been decided at the time of this visit. DS0000070191.V353022.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was conducted over the course of a day and covered all of the key National Minimum Standards for younger adults. Prior to the visit, a detailed self-assessment questionnaire was sent to the provider for completion. As no one was living at the home, surveys could not be sent out to people to gain their views and provide additional information about how the service is meeting needs. Information received by the Commission since the home became registered was taken into account. The inspection focused on the systems and practices that have been put in place and how the manager and provider intend to meet people’s needs. Because practice and the views of service users and other interested parties could not be taken into account, the maximum quality rating that can be awarded under any of the report sections is “adequate” and standards cannot be scored as fully met without sufficient information to assess performance. The visit consisted of discussion with the responsible individual for the company, examination of some of the home’s required records and a tour of the premises. It concluded that a good start has been made to ensuring that the service will be able to meet the needs of people with learning disabilities and some recommendations have been made to improve the measures that are already in place. What the service does well: Procedures are in place to ensure that people coming to live at the home are thoroughly assessed prior to admission and are given opportunity to visit the home beforehand to ensure it meets their needs. Systems are in place to make sure that care requirements and how these are to be met are adequately documented, within a risk assessment framework, to ensure that people’s needs can be safely met. There is indication that people’s needs arising from equality and diversity are likely to be assessed prior to admission and translated into their plan of care. People using the service will have varied and active lifestyles which reflect their interests, provides them with nourishing meals and offers them opportunity to try new experiences and have contact with family, friends and the community. There are systems and procedures in place to ensure that the health and personal care needs of people living at the home will be met, promoting health and well-being and ensuring that they receive medication in a safe and consistent manner. DS0000070191.V353022.R01.S.doc Version 5.2 Page 6 Adult protection procedures are in place and staff training is being organised to ensure that people who will be living at the service are safeguarded against the risk of harm. The home is clean, spacious and well decorated, promoting a positive environment for the people who will be living there. Arrangements are being made to provide staff cover to meet needs and thorough recruitment procedures are being undertaken to ensure staff have the right skills and competencies to support the people who will be living at the home. Management arrangements are in place to promote continuity, safe practice and good quality of care for the people who will be living at the home, to ensure that their needs are met. What has improved since the last inspection? What they could do better: Revision is needed to the admissions policies to make sure that the home does not consider or admit people whose needs it cannot accommodate. The service users guide needs to be produced in formats which are accessible to people with learning disabilities, to make sure they can be involved as much as possible in the admissions process. The missing person procedure is to reflect that staff need to notify the Commission for Social Care Inspection within 24 hours of anyone being missing from the service, to comply with the regulations. The complaints procedure needs to be made available in formats that people living at the service will be able to make use of, in order that their views are listened to. A risk assessment is to be prepared to ensure the safety of staff using the laundry at night and during bad weather, as infection control measures require that people do not walk through the kitchen with washing but walk around the outside of the home to get to the laundry. A risk assessment needs to be undertaken once people are living at the home regarding accessibility to a short amount of exposed pipe work at skirting level in the downstairs toilet. DS0000070191.V353022.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. DS0000070191.V353022.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 DS0000070191.V353022.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 Quality in this outcome area is adequate. Procedures are in place to ensure that people coming to live at the home are thoroughly assessed prior to admission and are given opportunity to visit the home beforehand to ensure it meets their needs. Revision is needed to the admissions policies to make sure that the home does not consider or admit people whose needs it cannot accommodate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A statement of purpose and service users guide were in place covering required areas of information. The copy of the service users guide that was seen had been written over to highlight spelling errors and areas needing amendment; the responsible individual for the provider said that a revised version had been written but was unable to produce a copy for the inspection. The service is intended for people with moderate learning disabilities and the responsible individual said that he has been in contact with local authorities and would be in a position to start considering referrals in the coming weeks. It is recommended that the service users guide be produced in formats that are accessible to people with learning disabilities to make sure that they can be involved as much as possible in the decision to move in. DS0000070191.V353022.R01.S.doc Version 5.2 Page 10 An admissions policy and emergency admissions policy were in place. The admissions policy had been written to reflect the needs of people with mental health problems, such as a statement that service users should have “experienced a diagnosed serious mental health problem, such as a long term illness resulting in either psychiatric in-patient treatment or day hospital attendance.” This is not appropriate to the service’s registration and the policy needs to be re-written to reflect the needs of people with learning disabilities. The emergency admissions policy also reflected mental health practice, referring to procedures under The Mental Health Act and again was not relevant to the service user group for whom registration has been granted. In discussion with the responsible individual it was suggested that emergency admissions should not be considered as a general rule due to the impact this could have on anyone living in a small service. Recommendations have been made to improve this area of intended practice. A needs assessment tool was seen which covered a comprehensive range of areas of care requirements and prompts for finding out needs arising from lifestyle choices, disability and cultural backgrounds. DS0000070191.V353022.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. Systems are in place to make sure that care requirements and how these are to be met are adequately documented, within a risk assessment framework, to ensure that needs can be safely met. There is indication that people’s needs arising from equality and diversity are likely to be assessed prior to admission and translated into their plan of care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A suggested care plan format was read which covered areas such as physical and health care needs, communication, expressing sexuality, behavioural issues, leisure interests and what carers needed to do to support the person. The initial care needs assessment, carried out before admission, covers a broad range of needs such as religious and cultural factors and lifestyle preferences, which would be incorporated into the care plan. An example of a risk assessment was also read which covered all necessary areas like highlighting the level of risk and how to promote safe practice. DS0000070191.V353022.R01.S.doc Version 5.2 Page 12 A policy on decision making was in place and overall the procedures and policies that were seen as part of the inspection reflected involving people who will be using the service as much as possible in their care and how it is delivered, subject to risk assessment, such as cooking, cleaning and shopping. People will be encouraged to manage their own medication and finances where they are able to and subject to risk assessment. House meetings are intended on a regular basis to listen to the views of people at the home and to consult with them about developments. A missing person procedure was in place in the event of anyone being absent. It is recommended that an additional note be added to reflect that staff would need to notify the Commission about anyone being missing, within 24 hours of occurrence. DS0000070191.V353022.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is adequate. People using the service will have varied and active lifestyles which reflect their interests, provides them with nourishing meals and offers them opportunity to try new experiences and have contact with family, friends and the community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People’s interests, preferences and hobbies are to be noted during the initial needs assessment and then their care plan. The responsible individual said that there is intention to convert the two garages into a day service facility rather than people going out to local authority day service provision. A specimen weekly programme of activities was seen which included using in house and community resources to provide people with variety and stimulation although activities would be geared toward individual interests. A visitors policy was in place and people living at the service will be encouraged to keep in contact with family and friends. People’s communication DS0000070191.V353022.R01.S.doc Version 5.2 Page 14 needs are to be recorded in care plans so that staff can provide support if required. The responsible individual said that planning of menus and food preparation will involve service users. There is provision within the care needs assessment to note people’s likes and dislikes and preferences so that these can be taken into account. DS0000070191.V353022.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. The are systems and procedures in place to ensure that the health and personal care needs of people living at the home will be met, promoting health and well-being and ensuring that they receive medication in a safe and consistent manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The needs assessment and care plan formats that were seen provide scope for finding out people’s individual personal care and health care needs and how staff are to support service users. There are doctors, dentists, a pharmacy and the community team for people with learning disabilities close by and the responsible individual had already made links with the community team where a number of health care professionals could provide additional support to people living at the service. The responsible individual said that there is intention to set up a contract with a behavioural specialist and clinical psychologist, to provide support to the home. A medication policy was in place, reflecting use of a monitored dose system of medication administration, and it was envisaged that the supplying pharmacy would provide training for staff. The policy reflected that people living at the DS0000070191.V353022.R01.S.doc Version 5.2 Page 16 home would be supported to manage their own medication if they were safely able to do so and subject to regular assessment. The responsible individual was waiting for a medication cabinet to be supplied. A policy was in place on the use of physical restraint, promoting use only as a last resort and to be avoided wherever possible. The policy stated that where it was needed, it should be part of the person’s care plan or only in emergency situations to prevent serious physical harm. It stipulated that training will be offered to staff. DS0000070191.V353022.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. Complaints and adult protection procedures are in place to guard against risk of harm, although the complaints procedure needs to be in formats that people can make use of. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints procedure was in place which included the contact details of the Commission for Social Care Inspection. Accessible formats of the procedure will be needed so that people living at the service are able to share their concerns about practice and to make sure they are listened to. A recommendation is made to address this. The service had a protection of vulnerable adults/safeguarding policy in place and had obtained a copy of the local authority multi-agency guidance. Contact had been made with the local authority about staff training on safeguarding vulnerable adults. As no one was living at the service, the Commission has not received any complaints about the home and there have not been any adult protection referrals. DS0000070191.V353022.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is adequate. The home is clean, spacious and well decorated, promoting a positive environment for the people who will be living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is a large detached property at the end of a mews in Milton Keynes, close to local and city centre facilities. There is a good size enclosed garden with a covered patio area and parking for three to four vehicles. The ground floor accommodation consists of a kitchen/dining area, a utility/laundry room, toilet, small staff office, two lounges and a third lounge/conservatory. Upstairs there are five bedrooms for single use. Three bedrooms have en-suite bathrooms and the other two have sinks and the occupants would share a main bathroom across the landing. Bedrooms have a lockable storage area, all windows have been fitted with restrictors and radiators have been covered to prevent accidental injury. No adaptations have been made to bath, shower or toilet facilities; it is envisaged that people being referred for consideration of a placement would have good mobility. All parts of the building were clean, well decorated and had been attractively arranged. As part of the home’s DS0000070191.V353022.R01.S.doc Version 5.2 Page 19 registration, recommendations were made for a risk assessment to be prepared to ensure the safety of staff using the laundry at night and during bad weather, as infection control measures require that people do not walk through the kitchen with washing but walk around the outside of the home to get to the laundry. This had not been done and is added to this report. Additionally, it was recommended that a risk assessment needs to be undertaken once people are living at the home regarding accessibility to a short amount of exposed pipe work at skirting level in the downstairs toilet. This is added to the report as a reminder. DS0000070191.V353022.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is adequate. Arrangements are being made to provide staff cover to meet needs and thorough recruitment procedures are being followed to ensure staff have the right skills and competencies to support the people who will be living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A staffing structure has been established, consisting of registered manager, deputy manager, senior support worker and support workers. At the time of this visit, only the registered manager had started employment although there has been activity to fill the other posts and staff are lined up to be offered firm offers of employment. A look at recruitment records showed that the provider has been carrying out thorough checks of prospective staff and shortfalls in the files, such as obtaining photographs and evidence of identification had already been noted and are to be obtained before people start working. The files showed that people who are being considered for posts have experience of providing care and some already had relevant qualifications. The responsible individual had made links with Milton Keynes college and the community team for appropriate staff training and a staff induction had been DS0000070191.V353022.R01.S.doc Version 5.2 Page 21 booked for seven staff over a three day block the week after this inspection. It is compatible with the Learning Disability Award Framework. The manager and deputy manager are being considered for specialist training on autism spectrum disorder. Other sources of training, such as DVD packages, had also been looked into to provide the necessary mandatory training, and as mentioned in other parts of the report, resources for providing medication training and adult protection input have been found. DS0000070191.V353022.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate. Management arrangements are in place to promote continuity, safe practice and good quality of care for the people who will be living at the home, to ensure that their needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has worked in a management position prior to joining the service and has already achieved the Registered Managers Award and National Vocational Qualification level 4. The proposed deputy manager comes from a nursing background with experience of care of people with learning disabilities and older people. The responsible individual was aware of the need to undertake monitoring visits of the service once people have started to live at the home. DS0000070191.V353022.R01.S.doc Version 5.2 Page 23 A number of policies and procedures were in place to promote a safe environment. Policies relating to infection control, first aid, hand washing, risk management and manual handling, as well as the main health and safety policy, were looked at and will provide staff with the necessary guidance. The responsible individual said that health and safety consultants had been booked to undertake a risk assessment of the premises the week after this inspection. DS0000070191.V353022.R01.S.doc Version 5.2 Page 24 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 2 2 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 2 26 2 27 2 28 2 29 2 30 2 STAFFING Standard No Score 31 x 32 2 33 x 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 x 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 2 x 2 x x 2 x DS0000070191.V353022.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? N/a 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 Refer to Standard YA1 Good Practice Recommendations The service users guide is to be made available in formats suitable to the needs of prospective service users, to make sure that they can be involved as much as possible in the admissions process. The admissions policy is to be re-written to reflect the needs of the service user group on the registration certificate (learning disabilities). Consideration is to be given to removing the emergency admissions policy to ensure that only people who have been thoroughly assessed are offered a placement. If emergency admissions are to be considered, the policy needs to be re-written to reflect the service user group on the registration certificate (learning disabilities). The missing person procedure is to reflect that staff need to notify the Commission for Social Care Inspection within 24 hours of anyone being missing from the service, to comply with the regulations. The complaints procedure is to made available in formats DS0000070191.V353022.R01.S.doc Version 5.2 Page 26 2 3 YA2 YA2 4 YA9 5 YA22 6 YA24 7 YA24 that people living at the service will be able to make use of, in order that their views are listened to. A risk assessment is to be prepared to ensure the safety of staff using the laundry at night and during bad weather, as infection control measures require that people do not walk through the kitchen with washing but walk around the outside of the home to get to the laundry. A risk assessment is to be undertaken once people are living at the home regarding accessibility to a short amount of exposed pipe work at skirting level in the downstairs toilet. DS0000070191.V353022.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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