Inspection on 25/11/08 for Amherst Court

This inspection was carried out on 25th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Amherst Court 06/12/07

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Amherst Court 39 Amherst Road Bexhill-on-Sea East Sussex TN40 1QN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alexis Reilly     Date: 2 5 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Amherst Court 39 Amherst Road Bexhill-on-Sea East Sussex TN40 1QN 01424217622 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Pages Homes Limited Type of registration: Number of places registered: care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 15. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home Amherst Court is a home for up to 15 people with enduring mental health issues. The house is located on a residential street near to Bexhill town centre. There is street parking available outside the home. The accommodation is over 4 floors. The basement contains all of the communal space, which consists of a large lounge/diner, kitchen, laundry and an office. There is a small garden to the rear, which has a summerhouse used as a smoking room. The upper floors in the home consist of 15 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 28 Brief description of the care home bedrooms and bathrooms/toilets. The current fees range from £450.00 to £750.00 per week. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection began at 9.30am and finished at 3pm. The inspector case tracked three residents as part of the inspection, spending time individually with two of these and seeing other residents in the home. As part of the case tracking the inspector examined the care plans and associated documents such as risk assessments and the activity plans for these individuals. Other documents examined were copies of notifications, accidents and appointments, evidence of external reviews, the record of complaints and the complaints procedure. The service user guide and statement of purpose and a sample of policies and procedures were also examined. Staff recruitment files and staff induction training sheets were also examined as were copies of residents meetings and staff meetings. A partial environmental tour was carried out, and the residents rooms that were part of the case tracking were viewed. The Care Homes for Adults (18-65 years) Page 6 of 28 inspector spent time with the Appointed Manager and the Registered Provider. The views of residents were gained by the inspector and their comments are included in the report. Information was also taken from the AQAA which was filled in and returned by the due date. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Appointed Manager carries out a comprehensive assessment gaining all the relevant information which allows them to make a informed assessment about a persons suitability for the service. Evidence was supporting to suggest that the Appointed Manager has in the past always obtained assessment documents such as mental health assessments from the community and also CPA documentation. Evidence: As part of the inspection the inspector case tracked three residents in the home and spent time with them. As part of the case tracking the inspector examined the care plans and the associated documents such as risk assessments and activity plans for these individuals, also evidenced were the external reviews from the community mental health team to ascertain if the needs identified in the assessment are used as a basis for a comprehensive care plan. Amherst Court has had two recent admissions and the inspector case tracked and met one of these new residents. The Appointed Manager has insured that relevant background information, up to date CPA documentation and copies of mental health assessments are obtain prior to offering Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: prospective residents a place in the service. People are invited to visit the service as part of the introductory process and the home offers a free 7 night stay which can be used by the individual to create their own personal induction into the home. The service user guide and statement of purpose have been updated to include the new details of the registered provider and the appointed manager. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have care plans in place which are person centred and are clear documents to work from. Residents are involved in the development of their care plan. Risk assessments are detailed and clear. Residents are able to make their own choices and decisions, and are treated as individuals. Evidence: As part of the inspection the inspector case tracked three residents in the home and spent time with them. As part of the case tracking the inspector examined the care plans and the associated documents such as risk assessments and activity plans for these individuals, also evidenced were the external reviews from the community mental health team. This helped the inspector to ascertain if the needs identified in the assessment are used by the Appointed Manager as the basis for a comprehensive care plan. Other documents examined were copies of notifications, and accidents and appointments. The inspector spent time with the Appointed Manager and the Registered Provider. Comments from service users are included in the report. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: Following the last inspection the Appointed Manager has changed the style of the care plans to a briefer format. On their own these provide basic details to follow in the provision of care for the residents placed. However the Appointed Manager has included sections of the original care plans used in the home and these have made the document more person centred and relevant to the client group that live at Amherst Court. Risk assessments are comprehensive and detailed. The service has a recommendation to document specific ways of distracting service users from situations, and writing this as guidance for staff to follow in more detail. An immediate requirement was left for the Appointed Manager to contact a residents placing social worker and ask for written guidance in relation to a particular issue with regard to this person. During the inspection the inspector discussed with the Appointed Manager any restrictions which were in place with regard to the residents living at Amherst Court. The Appointed Manager helps five of the residents manage their finances in the home; this varies from staff going with the resident to collect money, as in the past there has been issues with regard to their vulnerability, through to managing a weekly allowance for a resident. This has been agreed verbally with the care manager and resident on admission, however the Appointed Manager has been advised to get this consent in writing. The Appointed Manager has successfully helped resident with their finances and now two residents deal completely independently with all their finances in the home. The Appointed Manager has been advised she may maintain her role as the appointee for the service users in the home. Motivational agreements are in place these are signed by individual residents in the home, as part of this residents are asked if they would like to be involved in chores, cleaning their room, laundry, cleaning the lounge, afternoon baking, collecting the papers or recycling. Residents who smoke take turns in cleaning the smoking chalet. Each resident then chooses which jobs they would like to be involved in. This was discussed with the residents on the day of the inspection and they felt it had been beneficial for them; however they did state If I dont want to do it I dont, some times I feel like not doing the baking I dont do it. Demonstrating the service does give residents choice. The home also had the practice of locking the lounge door at 10pm, and then residents retired to their rooms. This was discussed on the day of the inspection and it was agreed that this is an unacceptable practice, and the residents now have access to the downstairs lounge throughout the night. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents do have some regular and planned activities. However these are insufficient to meet the needs of the residents placed at Amherst Court. Residents benefit from freedoms and flexible routines, and generally enjoy the food. Residents are consulted and listened to regarding the choice of daily activity. However continued work needs to be done on providing activities of substance both within the home and the community. These should be both leisure, educational, and where appropriate, employment opportunities. Evidence: As part of the inspection the inspector case tracked three residents in the home and spent time with them. As part of the case tracking the inspector examined the care plans and the associated documents such as risk assessments and activity plans for these individuals, also evidenced were the external reviews from the community Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: mental health team. Other documents examined were copies of notifications, and accidents and appointments, the record of complaints and the complaints procedure. The inspector spent time with the Appointed Manager and the Registered Provider. Comments from residents are also included in the report. Personal relationships and family relationships are encouraged if these are helpful and appropriate. Two residents now have contact with their relations which had not happened prior to living at Amherst Court. Menus in the home are varied. One complaint had been received with regard to the food on the day of the inspection which was the person wanted the beans served separately from their toast and not on top of the toast. The home has baking sessions each afternoon where a resident will choose and bake the pudding for the evening meal. Residents talked to enjoy this activity. The inspector found evidence of staff going with residents for coffee in the afternoon, and also playing a variety of board games with them in the evening or painting. This is not sufficient for the residents in the home. The Appointed Manager and Registered provider must ensure that a comprehensive range of activities is available for the residents and that these are engaging and ensure that people are reaching their full potential both inside and outside the home. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a comprehensive plan of care and input from the community mental health team. The Appointed Manager has a good relationship with the CMHT and residents health care needs are reviewed and referrals made were appropriate. The procedure for administering medication was found to be in good order. Evidence: As part of the inspection the inspector case tracked three residents in the home and spent time with them. As part of the case tracking the inspector examined the care plans and the associated documents such as risk assessments and activity plans for these individuals, also evidenced were the external reviews from the community mental health team. Other documents examined were copies of notifications, and accidents and appointments, evidence of external reviews, the record of complaints and the complaints procedure. The inspector examined a sample of MAR sheets and the report from the visiting pharmacist. The Appointed Manager has a productive relationship with the CMHT and this ensures that residents in the home are well supported. Residents maintain their own personal care needs, and are supported by staff prompting and encouraging them. Care Homes for Adults (18-65 years) Page 16 of 28 Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service records complaints and deals with these effectively. The Appointed Manager notifies the CSCI and social services of all significant incidents in the home. Residents are protected by the homes policy on Adult Protection. Evidence: As part of the inspection the inspector examined copies of notifications, and accidents and the record of complaints and the complaints procedure. The home has a complaints procedure, which has been updated to include the new details of the Registered Provider and Appointed Manager. Residents have a good relationship with the Appointed Manager and feel comfortable in raising issues with her. Regular resident meetings are also held providing an opportunity for residents to influence issues in the home. The home has policies and procedures in place regarding adult protection. All staff have completed Safe Guarding Vulnerable Adults training. Care Homes for Adults (18-65 years) Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a well maintained home, they are able to personalise their rooms and have access to a small garden area. Evidence: As part of the inspection the inspector carried out a partial environmental tour of the home this included all communal areas, the new laundry area and the bedrooms of the three residents case tracked. Communal accommodation is all located on the basement floor of the house with a large lounge/dining room being the main room. There is a summer house in the garden which is used as a smoking room. The office is sited off the lounge as is the domestic style kitchen. The laundry area, has been relocated to an outbuilding and the previous laundry room has been used as a cloak room, as residents had highlighted they didnt want to keep going into their rooms to put their coats away. There are toilets on each floor and showers or bathrooms on the top 3 floors. The shower on the ground floor has had the showerhead replaced. The majority of bedrooms are single occupancy, although there are two double rooms. Residents sharing these rooms are happy to do so at the present time, this situation must be kept under review. The service stores care plans in a cupboard in the lounge and although a new lock has been brought for this, it is insufficient. This was discussed with the Appointed Manager on the day of the inspection and they have agreed to Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: move this information into the office in a suitable locked filing system. On the day of the site visit the home was clean, hygienic and free from offensive odours. However during the environmental tour an immediate requirement was made in relation to a flue pipe in the dining area, which was very hot and therefore residents would be at risk of burns if they fell or brushed against it. The Registered Provider did arrange for this to be completed during the inspection. There were also uncovered pipes in the downstairs cloakroom which require covering. Care Homes for Adults (18-65 years) Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff interact well with residents and have a understanding of their needs. Staff are working within a person centred approach to the delivery of care, and attend monthly team meetings. However staff supervision must be increased to 6 times each year. Evidence: As part of the inspection the inspector examined the recruitment files of staff recruited to the service since the last inspection these were found to be in good order. Also completed skills for care induction booklets were viewed for the staff in the service, and the list of training, the minutes of staff meetings were also examined. Members of staff were seen on the day of the inspection interacting positively with residents in an encouraging manner. Full staff names are now recorded on the duty rota and this is available to view at all times. There is a recommendation that the hours the Appointed Manager works in administration are clearly recorded on the rota. Applications for employment are accompanied by a completed application form and there is now a time scale attached to the return of applications. Staff supervision is carried out in the service however this is not completed with staff 6 times a year. The Appointed Manager must ensure that staff supervision is in line with the National Minimum Standards. Care Homes for Adults (18-65 years) Page 21 of 28 Care Homes for Adults (18-65 years) Page 22 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Appointed Manager is experienced and has a good understanding of the needs of the residents placed in the home. Quality assurance systems are in place, and the views of residents influence the running of the home. However the Appointed Manager must ensure they submit an application for registration with the CSCI as a matter of priority. Evidence: As part of the inspection the inspector case tracked three residents in the home and spent time with them. As part of the case tracking the inspector examined the care plans and the associated documents such as risk assessments and activity plans for these individuals, also evidenced were the external reviews from the community mental health team. Other documents examined were copies of notifications, and accidents and appointments, the record of complaints and the complaints procedure. The staff recruitment files of new staff within the service were examined and the completed induction training. Minutes of residents meetings and staff meetings were also examined. The inspector spent time with the Appointed Manager and the Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: Registered Provider. Comments from service users were sought and have been included in the report. The Appointed Manager has been in post for approximately 1 year and has still not submitted an application to the CSCI for registration. The Appointed Manager had previously worked in the home as a care assistant, senior carer and then deputy manager and possesses the knowledge and experience of the home necessary to fulfil her role. The Registered Provider visits the home at least on a weekly basis and conducts monthly monitoring visits. The quality monitoring systems in the home are good and ensure views of professional and families or friends are always sought. Policies and procedures have been updated to include the new ownership and management arrangements. Information from the AQAA suggests all documents relating to the health, safety and welfare of service users are up to date. Care Homes for Adults (18-65 years) Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 12 The Registered Person must make proper provision for the health and welfare of service users; to ensure they are protected at all times 13/12/2008 2 24 23 The Registered Provider must 14/12/2008 ensure the surface of the flue is to be made safe to ensure residents are not at risk of burns. To ensure service users are protected at all times. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 16 The Registered Provider 01/02/2009 must ensure residents are consulted on and are offered meaningful activities both inside and outside the service To ensure residents are meeting their full potential 2 24 23 The Registered Provider must ensure all parts of the home are well maintained and in good order. 01/01/2009 Care Homes for Adults (18-65 years) Page 26 of 28 To ensure service users live in a well maintained home. 3 37 8 The Registered Provider must appoint a person to manage the home. 01/02/2009 To ensure the home is managed effectively Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 That the Appointed Manager contact individual social workers and get their signature to agree to any restrictions in the residents finances. That the Appointed Manager ensure that further guidelines are put in writing with regard to distracting residents and defusing a situation. That the Appointed Manager update risk assessments for service users in relation to accessing the kitchen and the practice of the kitchen remaining unlocked. That the Appointed Manager Update the risk assessment of one service user in relation to a historical event and to the consumption of hazardous substances. The Appointed Manager must separate the hours used for care and management and show these clearly on the on the rota. The Appointed Manager must ensure staff are supervised in line with the national minimum standards. 2 8 3 9 4 9 5 33 6 33 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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