CARE HOMES FOR OLDER PEOPLE
Adelaide Nursing And Residential Care Home 35 West Street Bexleyheath Kent DA7 4RE Lead Inspector
Maria Kinson Unannounced Inspection 18th November 2005 12:15 X10015.doc Version 1.40 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 Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 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 Older People. 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. Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Adelaide Nursing And Residential Care Home Address 35 West Street Bexleyheath Kent DA7 4RE 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) 020 8304 3303 020 8301 0133 Southern Cross Healthcare Services Limited Mr Muhammad Iqbal Gurib Care Home 76 Category(ies) of Dementia (42), Dementia - over 65 years of age registration, with number (1), Old age, not falling within any other of places category (34) Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 1 place registered for nursing care for a service user with dementia under 65, as agreed with CSCI. 1 place registered for service user category DE(E) in the general residential unt for named service user only. 22nd April 2005 Date of last inspection Brief Description of the Service: The Adelaide Care Centre is a purpose built nursing and residential care home. It was first registered in July 1997 and was then purchased by Southern Cross Healthcare in September 1998. The home is situated in a side road off Bexleyheath Broadway near the railway station, bus services and the shopping centre. There is car parking space on the site. The home is registered for a total of 76 places, with different categories of registration. The home has two floors divided into four separate units providing care for the different categories of service users. On the ground floor, there are 20 general nursing beds and 14 beds for conventional residential care. On the first floor, there are 25 nursing beds and 17 beds for residential care, all for older people with dementia. All of the bedrooms in the home have en-suite facilities. The laundry is sited in a separate building to the side of the home. At the rear of the building there is an enclosed garden. Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspectors carried out this inspection on Friday 18th November 2005, between 12.15 and 18.50pm. The inspectors spent two hours on each of the units and examined care, health and safety and recruitment records. The inspectors observed staff communicating with residents and relatives, serving meals and assisting residents to eat and move. Eight members of staff, nine residents and four visitors were spoken with during the inspection and comment cards were distributed to residents, relatives and health and social care professionals. Nine questionnaires were returned to the commission. What the service does well:
Five out of six relatives were satisfied with the overall standard of care provided in the home. Residents and relatives made the following comments about the service. “The home manager holds regular meetings, which are well publicised and at which any issues of concern can be raised”, “ Care plans are always available for me to read and I am kept well informed about health issues”. I am always happy with the care provided”, “ The Manager is approachable and knows what he is doing”, “It’s nice here, I like it”, “The food is good”, “Sometimes there is so much to eat we cannot eat it all”. Staff had established good working relationships with other health and social care professionals. The food provided in the home was varied and well balanced. Residents had access to a varied programme of activities and entertainment. The home was maintained to a satisfactory standard and all areas were clean, tidy and odour free. Some of the bedrooms had been personalised with the resident’s own possessions, which made the rooms feel homely and welcoming. The garden was well maintained and had many features to promote relaxation and interest. The number of care staff that had attained a vocational qualification in care was high. This home has exceeded the recommendation made by the Department of Health about vocational training for care staff. Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 6 This home was well managed. Health and safety issues were addressed promptly and action was taken to safeguard resident’s personal money. Complaints and concerns were dealt with according to the homes procedure and appropriate action was taken to protect residents from abuse. The home had good systems in place for assessing and reviewing the quality of care provided in the home. What has improved since the last inspection?
Since the last inspection a considerable amount of work had been undertaken in the home to make the environment more comfortable and attractive for residents. This included fitting new flooring, redecorating some of the dining rooms, lounges and bedrooms and replacing one of the boilers serving the home. The first floor nursing unit lounge appeared more homely and welcoming and additional features had been fitted to provide interest for residents. Staff on the first floor nursing unit had received in house training about caring for people with dementia. Some improvements were noted as a result of this input. Staff spent more time talking with residents, mealtimes were less rushed and appropriate tableware and condiments were provided. Residents were encouraged where possible to make choice at mealtimes. The manager was monitoring pressure sores closely and provided information to head office about the progress of wounds. Staff were expected to maintain accurate records, including photographs of all sores that developed in the home or the community. The progress of sores was tracked and where progress was slow advice was sought from the Tissue Viability Nurse. Robust procedures for recruiting new staff were followed and action had been taken to try to provide adequate documentation in the files for staff employed prior to the introduction of the Care Standards Act. The manager visited all units regularly and spent time talking with residents, staff and visitors. This approach provided an opportunity for residents and visitors to raise issues of concern and may account in part for the reduction in complaints that the commission is receiving about this service. Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 7 What they could do better: 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. Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4 The standard of care provided on the first floor nursing unit for people with dementia had improved but specialist training is required to enhance resident’s quality of life. EVIDENCE: The previous requirement to provide specialist dementia training for staff that work on the first floor nursing unit had been addressed in part. The manager had arranged for staff to watch two videos about caring for people with dementia and managing challenging behaviour and had made contact with the Alzheimer’s Society about training sessions. The manager was due to attend a certified dementia workshop in November. The inspectors noted several improvements on the first floor nursing unit. Residents were offered a choice of food, staff interacted more frequently with residents and mealtimes were more relaxed. Despite the improvements some members of staff did not provide adequate reassurance or information for residents.
Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 10 The inspectors strongly recommend that all staff that work on the first floor nursing unit attend training that is recommended by the Alzheimer’s Society such as “Today, Tomorrow and Yesterday” or a similar course. See requirement 1. The first floor unit had signs to assist residents to locate the toilets and bathrooms but the name plates and pictures that were fixed to bedroom doors were positioned out of view. Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8. Records indicated that resident’s health and personal needs were met. EVIDENCE: Staff were starting to implement new care documentation. The new format includes a specialist dementia assessment. Staff had attended training about using the new paperwork and good progress had been made with transferring the previous records onto the new system on the residential units. Further work was required on the nursing units where staff vacancies had slowed this process down. Ten sets of care records were examined. All of the residents had a variety of assessments and a care plan, which was agreed and signed by the resident or relative. On the residential unit the life history and social activity profiles were detailed and included specific information about residents interests. This part of the assessment was often blank or not completed in full on the nursing units. Files included a variety of assessments about potential risks to staff and residents from smoking, the use of bedrails, falling and developing pressure sores. Overall the standard of record keeping was good and provided clear evidence of the action that staff had taken to address health and personal issues. Care plans were reviewed and updated regularly.
Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 12 Access to community health care services was good. Records of medical visits indicated that some of the residents had seen General Practitioners, District Nurses, Dentists and Opticians since the last inspection. Feedback from one health care professional that had visited the home was positive. The respondent said that staff communicated clearly and worked in partnership with their team. Body charts and photographs were used to record the position and progress of bruises and wounds and the manager was closely monitoring pressure sores. Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 15. Residents were supported to participate in appropriate activities enabling them to lead fulfilling and varied lives within the home environment. Relatives were encouraged to play a supportive role in their family member’s care. A good variety and choice of food was provided to meet resident’s tastes and preferences. EVIDENCE: The home employs a full time Activities Coordinator. The weekly activities programme was displayed on each of the units. The programme includes a variety of activities and entertainment. During the two weeks prior to this inspection some of the residents had taken part in gentle exercise classes, quizzes, arts and crafts sessions and reminiscence. In the weeks leading up to Christmas a Christmas fair, party, karaoke party, musical entertainment and a winter wonderland show were planned. Resident’s friends and family were invited to attend social functions and to support the home with fundraising. The Activities Coordinator spent time with individual residents who were not able to attend group activities due to poor health. The home had established links with a local school that were making two tapestries, based on subjects chosen by residents, to be displayed in the dining room.
Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 14 The home did not have access to specialist transport and had not been able to arrange any outings other than local shopping trips. The manager was obtaining quotes and information from coach companies to address this issue. Discussions were taking place about changing one of the communal areas into a sensory/ reminiscence room for residents with dementia. This would be an excellent resource. Feedback from relatives and residents was mostly good. Five out of six relatives were satisfied with the overall standard of care provided in the home. Relatives and residents made the following comments “The home manager holds regular meetings, which are well publicised and at which any issues of concern can be raised”, “ Care plans are always available for me to read and I am kept well informed about health issues”. I am always happy with the care provided”, “ The Manager is approachable and knows what he is doing”, “It’s nice here, I like it”, “The food is good”, “Sometimes there is so much to eat we cannot eat it all”. The inspector observed staff serving the lunchtime meal on first floor nursing unit. The dining room looked more welcoming with tablecloths, a floral display, condiments and juice on all of the tables. The meal was served efficiently and residents were assisted to eat and prompted by care and activity staff. Staff encouraged residents to choose their preferred meal from the two options displayed. Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The home has a simple and accessible complaints procedure. The manager took prompt action to protect residents where appropriate. EVIDENCE: The homes complaints procedure was prominently displayed. The procedure includes a timescale for responding to concerns and contact details for the commission. The commission had not received any complaints about this service since the last inspection. The manager reported significant issues and accidents to the commission and Social Services. Two incidents that had occurred in the home since the last inspection were referred to Bexley Social Services for investigation under their adult protection procedure. One of these issues did not relate to staff. The manager dealt with the remaining issue effectively. Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26. The home was maintained to a satisfactory standard but some areas would benefit from redecoration and refurbishment. This would create a more welcoming and homely environment for residents living on the ground floor residential and first floor nursing units. EVIDENCE: A considerable amount of work had been undertaken since the last inspection. This included new flooring in the main kitchen, ground floor dining room and nursing satellite kitchens and redecoration of the dining room on the ground floor and lounges on the nursing units. The worktop in the first floor nursing unit had been renewed, one of the boilers serving the home was replaced and several bedrooms were redecorated as they become vacant. The lounge on the first floor nursing unit had been redecorated and new features such as rope lights and sensory equipment had been purchased to provide interest for residents.
Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 17 The lounge on the general residential unit and the dining room and corridors on the first floor nursing unit looked rather bare. Some of the paintwork on these units was chipped. These areas appeared less homely and welcoming than other parts of the building. See recommendation 1. Plans were being made for the dining room on the first floor residential unit and the corridors on the first floor nursing unit to be redecorated. The previous requirement to replace the damp work surface in the ground floor satellite kitchen had not been addressed. The manager had arranged for this work to be undertaken but had experienced difficulty with the contractors. See requirement 2. The previous requirement to extend call bell leads so that residents could access call bells when they were in bed had been addressed. The main kitchen had been deep cleaned. The building was clean, tidy and odour free throughout. Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Staffing levels were mostly satisfactory however additional staff were not provided on the general residential unit when dependency levels increased. Failure to address this issue could compromise resident’s health and safety. The homes recruitment procedure provides adequate protection for residents. Access to vocational training was excellent but specialist training must be provided for staff that work with people with dementia. This training will assist staff to communicate more effectively with residents. EVIDENCE: Following the investigation of a adult protection issue the commission were asked by the local authority to review the night time staffing levels for the general residential unit. During the night there were two care staff on the residential unit for people with dementia (17 beds) and one carer on the general residential unit (14 beds). The inspectors were told that staff from the residential unit for people with dementia provide assistance and support for the carer on the residential unit. There was little evidence that this arrangement was used other than to cover meal breaks. All of the night staff working on the residential units had a one-hour break during their shift, leaving two staff to support 31 residents for three hours each night. The dependency scores for six residents from the general residential unit were examined and were found to range from 7 to 22. At least three of these residents had scores of 14 or over which indicated they were in need of medium to high levels of support.
Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 19 The inspectors asked the manager about the night time staffing arrangements when it was assessed that resident’s needs had changed and they required nursing care. Extra staff were not provided during these periods and sometimes residents spent several months on the residential unit awaiting transfer to a more suitable environment. See requirement 3. 75 of the care staff working in the home had attained a vocational qualification in care at level two or above. This exceeds the Department of Health’s recommendation for 50 of care staff to achieve this type of qualification by December 2005. The manager and staff are commended for exceeding this standard. Five staff recruitment files were examined. All of the files included the information and documentation listed in Schedule 2 of the Care Homes Regulations. The previous requirement and recommendations relating to this standard were assessed as met. The unit leader posts on the two nursing units were vacant but interviews were planned. Individual training files were maintained for each member of staff and training needs were identified during supervision and appraisal meetings. Since the last inspection some staff had attended mandatory health and safety training updates and other relevant sessions such as care planning, dementia, MRSA, and challenging behaviour. The Activities Coordinator had received some training but had not attended specific training about providing appropriate activities for people with dementia. See recommendation 2. The company had a TOPSS style induction-training programme for new staff. There was no evidence that staff had completed this training. See recommendation 2. Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35, 36 and 38. This home is managed by a competent and experienced manager who has worked hard to improve standards of care and to support staff. EVIDENCE: The manager has been in post for just over one year and has made significant improvements throughout the home in this time. The numbers of complaints raised about the service are decreasing and relatives said they were able to approach the manager at anytime. Residents were familiar with the manager and told the inspectors that he visited their unit each weekday and often spoke with them. Staff felt supported by the manager and said they hoped he would stay. Since the last inspection staff had received additional training about the risks associated with the use of bedrails.
Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 21 The home had a good system in place for monitoring the quality of care provided in the home. The manager completes daily and weekly reports to head office about issues such as accidents, complaints and pressure sores and regular unannounced visits and audits were undertaken. The inspector examined the report from the audit that was carried out on 27.09.05. The overall score indicated that the home was performing well. All audits were checked and validated by the Operations Manager. The home had a robust system for safeguarding resident’s finances. The system is computerised and was regularly audited by the manager and Operations Manager. Five residents money records were checked and were found to be correct. This standard was met in full. It was evident through discussions with staff that supervision was taking place but due to vacant management positions on both of the nursing units this was not taking place as frequently as recommended. See recommendation 3. A random selection of health and safety records were examined. All of the records seen complied with health and safety requirements and recommendations. Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 3 X X X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 X 3 2 X 3 Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP4OP30 Regulation 12 &18 Requirement The Registered Person must provide specialist dementia training for staff that work on the first floor nursing unit. This training must include communication skills. (Previous timescales of 01.02.05 and 01.08.05 were not met ) The Registered Person must replace the worn kitchen worktop in the kitchen on the ground floor nursing unit. (Previous timescale of 01.09.05 was not met ) The Registered Person must carry out a regular risk assessment for the general residential unit taking into account the special needs of residents that may affect the levels of night cover. Based on the findings from this assessment the registered person must make sure that adequate staff are provided on the general residential unit during the night. Timescale for action 01/04/06 2 OP19 23 01/03/06 3 OP27 18 01/02/06 Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 24 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 OP19 OP30 Good Practice Recommendations The Registered Person should endeavour to make the first floor nursing unit dining room and ground floor residential lounge more homely and welcoming. The Registered Person should ensure that new staff undertake the TOPSS induction-training programme. The Activities Coordinator should attend specialist dementia training. The Registered Person should ensure that care staff receive formal supervision at least six times a year. 3 OP36 Adelaide Nursing And Residential Care Home DS0000006752.V262631.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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