Inspection on 07/08/08 for Appletrees

This inspection was carried out on 7th August 2008.

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

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

Other inspections for this house

Appletrees 14/08/06

Appletrees 07/11/05

Appletrees 28/06/05

Appletrees 06/01/05

Appletrees 28/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Appletrees Chapel Row Bucklebury Berkshire RG7 6PB     The quality rating for this care home is:   three star excellent 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: Kerry Kingston     Date: 0 7 0 8 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 30 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 30 Information about the care home Name of care home: Address: Appletrees Chapel Row Bucklebury Berkshire RG7 6PB 0118 971 3769 Telephone number: Fax number: Email address: Provider web address: paulthwaite@choiceltd.co.uk Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Choice Ltd Mr Paul Robert Thwaite care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category 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: Learning disability - LD 0 Over 65 0 Date of last inspection Brief description of the care home Appletrees is a care home for eight adults with learning disabilies, some people have behavioural difficulties. It is situated in a rural location but close to the local shop and public house. All service users have their own bedrooms that are appropriately individualised. The needs of the current service users are complex and comprehensive assessments are undertaken on an individual basis and are updated and reviewed regularly. The fees are approximately two thousand pounds per week, dependant on the assesed needs of individuals. Care Homes for Adults (18-65 years) Page 4 of 30 Care Homes for Adults (18-65 years) Page 5 of 30 Care Homes for Adults (18-65 years) Page 6 of 30 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support peterchart Concerns, complaints and protection Environment Staffing Conduct and management of the home Poor Adequate Good Excellent How we did our inspection: This is a report for the key inspection, which included a routine unannounced site visit to the service. This took place between 10.00 and and 4.30 pm on the the 7th August 2008. The information was collected from an Annual Quality Assurance Assessment, a document sent to the service from the Commission for Social Care Inspection and completed by the manager. Surveys were sent to the people who are supported by the service. Discussions with the manager, the service manager , one staff member and one person, who was able and willing to verbally communicate took place. Observation of other people and their interactions with staff took place during the visit to the home. Care Homes for Adults (18-65 years) Page 7 of 30 Reviewing records of the people who use the service and other records and procedures was also used to collect information on the day of the visit. All information received by the Commission since the last inspection, about this service was also taken into account when producing this inspection report. The current fees are approximately £2000 per week , but this is dependant on the assessed needs of individuals. 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 9 of 30 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 10 of 30 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 home has had no new admissions but it has an admissions policy and procedure that would ensure people are admitted to the home in the best way possible. The home continually assesses people needs to make sure that it can continue to meet them. Evidence: The home has had no new admissions since 2004. A revised Statement of purpose, which was up-dated in 2008, describes how people will be respected, dignity preserved, their rights respected, how they will be helped with Independence, choice and inclusion and all other information on which they can make a decision about whether it would be a suitable home for them. The Admissions policy and procedure is detailed and advises staff how to help people to experience as easy an admission to their new home, as possible. The four care plans seen showed that peoples needs are regularly reviewed reassessed, as necessary, to ensure the home continues to meet their needs. Care Homes for Adults (18-65 years) Page 11 of 30 Care Homes for Adults (18-65 years) Page 12 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home makes sure that people know their assessed needs and what goals they are working towards. The residents are helped to make as many decisions for themselves as possible, but the staff work hard to ensure that they remain motivated and behave in a positive way. People are supported to be as independent, as possible. Evidence: Care plans for four people were seen, all had comprehensive individual care plans, which recognise and identify any equality and diversity issues. Two had the new Person Centred Plan completed others have the Essential Lifestyle Plan, both plans contain detailed information to make them robust working documents. They include Care Homes for Adults (18-65 years) Page 13 of 30 daily living, history (if relevant), what people prefer and enjoy, How I tell you things, peoples cultural religious needs,any gender or sexuality issues, what is important to them and health plans. The communication plans are excellent and staff were observed using communication techniques as described in the care plans. Staff were also observed working to the care plans throughout the day of the visit. Monthly key worker meetings are held, these monitor the action plans drawn up at the six monthly reviews. The action plans are revised and achievements noted or things that dont work out are also noted. They are good records of peoples achievements and choices about what they want to do. One person has a befriender/advocate who could represent their views if necessary. There was evidence of people making decisions on a day -to- day basis with regard to activities, food and holidays. A discussion about someones choice of time to get up, was observed and the hard work being done by the staff team was observed. The work in the respect of balancing the choice of the individual to motivating them and encouraging appropriate behaviour, was excellent. Residents meetings are held and people are encouraged to participate in them, discussing all areas of the running of the home, the home are trying to use methods to ensure peoples inclusion such as mood and communication boards, these are being tried with varying degrees of success. One person said that she can choose things for herself and others were observed making decisions fro themselves. Risk assessments are detailed and support people to maintain and develop independence in areas such as community presence and inclusion for example some people have 2:1 staffing to enable them to go into the community. There are Risk Assessments with regard to behaviour so that peoples equality and diversity needs are not compromised because of some difficult behaviours.There are also comprehensive and up-o-date risk assessments with regard to peoples involvement in household chores and personal care. Any limitations of choice or freedoms such as there being some locked areas in the home are risk assessed and people are asked , as far as possible, to agree to them. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home create varied opportunities so that people can have an interesting and enjoyable lifestyle. The home work hard to make sure that people are respected as individuals and participate in the community. The people who use the service are offered a varied and healthy menu and are encouraged to participate in choosing and preparing food. Evidence: Each person has an activity programme for the week, represented pictorially on a board.There is a mixture of in house activities, such as cooking and there is a day care Care Homes for Adults (18-65 years) Page 15 of 30 building (on site) for mainly craft projects. This also includes a sensory room plus a kitchen for meal cooking. People were observed doing other activities that they enjoy such as word search and reading newspapers with staff help. The home has a daycare organisor who is particularly involved in leading the project work. People are also able to access external activities where staff accompany individuals to activities run by other providers. There is plenty of opportunity for community presence, with people using local recreation facilities to participate in activities such as trampolining and swimming, meals in pubs and church attendance. Activities goals and plans are included on the monthly reviews to see if any areas need adjustment. On the day of the inspection visit, staff were observed assisting people with activities,such as, writing a shopping list in preparation for cookery in the afternoon, helping people with wordsearch (a favourite past time), going through a newspaper with someone who likes to know what is going on in the world, one staff member was baking with a person and one person was supposed to be on external activities but had chosen not to go as they were not comfortable with the activity being offered . Residents said that they had plenty to do and one described day trips and holidays they had participated in. Care plans included activities that people like doing and how they can be supported to do them (including 2:1 staffing ratios when necessary.) There was evidence of peoples art work on display in the home.People are involved in a gardening project, growing their own tomato plants and flowers. People also have opportunity plans which are developed by residents to note the special activities they would like to do throughout the year such as seaside trips. These have to be planned well in advance because of the additional staffing that may be required. leads the projects particularly. The eight people who use the service have contact with families to varying degrees and the home work sensitively with families to try to improve things for people and improve the quality of the contact with their friends and families. Peoples sexuality is clearly recorded in care plans along with any necessary guidelines with regard to behaviour or privacy and dignity. Peoples rights are respected and detailed in the Statement of Purpose. Staff were observed on the day of the visit treating residents with great respect, sensitivity and were always aware of their rights and responsibilities . Menus are presented pictorially, residents were seen choosing some meals. People cook some of their own meals on a 1:1 basis with staff and were seen preparing and shopping for this cookery session. Menus seen were well balanced and nutritious, people can choose to have alternatives if they wish. The home are aware of issues with regard to peoples nutritional needs and take professional advice if they identify Care Homes for Adults (18-65 years) Page 16 of 30 any issues. Care Homes for Adults (18-65 years) Page 17 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples physical, emotional and health care needs are well met. People are supported to meet these needs in the way that they prefer and/or which enhances their development. The home safely administer medication and encourage people to self-medicate where possible and appropriate. Evidence: Care plans for four people, were seen, all had comprehensive individual plans that include what people prefer and enjoy, how I tell you things, peoples cultural and religious needs, any gender or sexuality issues and what is important to them and how they express it. The communication plans are excellent and staff were observed using communication techniques described in the care plans. The staff use various forms of communication to try to ensure that they are giving people care in the way that they prefer and are comfortable with. Care Homes for Adults (18-65 years) Page 18 of 30 The care plans include Health care plans and records which include significant health events and how people like and deal with treatment such as How I tolerate medical intervention and how I show pain. There was evidence on health records of dentist and G.P. appointments. There are very comprehensive behavioural plans and guidelines (where necessary), developed with the help of the psychology team provided by the organisation. There are regular weekly, psychology assistant and monthly psychologists visits to review any behavioural programmes and guidelines. Some people also have input from psychiatrists, as is necessary. The issue of consent to any treatment is detailed in individual files and guidelines, with particular regard to restraint techniques and behavioural programmes. The home use a monitored dosage system to administer medication, there were no recording errors noted when a sample of records were reviewed. The home does not use any controlled drugs. Staff are trained and judged as competent by a senior staff member before they are allowed to administer medication, two people administer medication at all times. One person has embarked on a self medication programme to try to motivate them towards more independence. The pharmacist makes regular visits to the home and does not have any concerns about medication administration practices and procedures (as advised by the manager.) The home use some medication prescribed for use as necessary and have individual guidelines in place, for their use. The as necessary medication is not always written on the administration sheets unless it has been used, it was discussed that it may be safer to write all medication on the administration sheet and ask the G.P to review the prescriptions for people who have not used these medications for long periods of time. Care Homes for Adults (18-65 years) Page 19 of 30 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 home has a robust complaints procedure and listens to people, by various methods, if they have complaints or concerns. Staff protect people from all forms of abuse. Evidence: There is a robust complaints policy and procedure in place, the home has recorded one complaint since last inspection. This was a complaint from a care manager, the Commission were informed of it and it was dealt with appropriately. The complaints procedure is being developed ,with the help of the speech and language therapy team into a meaningful format for people who use the service. Some people are able to articulate any concerns or problems and others show their unhappiness by behaviour. One resident confirmed they knew who to talk to if they were not happy and surveys noted that people knew how to make a complaint. Monthly key worker meetings discuss if individuals have any issues or concerns. The manager confirmed that there have been no safeguarding issues since the last inspection. All staff have protection of vulnerable adults training(safeguarding), as soon as possible after appointment. The staff member spoken to was very clear about what to do if there were any concerns about the well being of the people in her care. Care Homes for Adults (18-65 years) Page 20 of 30 The Commission has recieved no information with regard to safeguarding issues about this service. The home has detailed behavioural programmes and detailed guidelines about the use of restraint. All staff are trained in the use of restraint, Strategies for Crisis Intervention and Prevention. Any restraint used is carefully recorded and signed off by the manager and the psychologist. Restraint is not used often and there are clear methods of de-escalation for staff to use before they have to restrain, as a last resort for the safety of all involved. Two peoples financial records were seen, they were accurate and receipts are held for all expenditure. Staff at the home do no act as appointees, the organisation transfer monies directly into peoples accounts. People have no knowledge of their overall financial status that is what benefits they receive, how much they pay out and their savings totals. Residents pay for staffs out of pocket expenses (meals and drinks when on social trips) but this was seen to be minimal amounts. The manager now pays these out of petty cash and reclaims it from residents, this ensures that the expenditure is clear. The organization is currently reviewing the policy of residents paying for staffs out of pocket expenses. Care Homes for Adults (18-65 years) Page 21 of 30 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. The home offers a spacious and pleasant environment that meets the needs of the people who live there. Evidence: The house is kept to a good standard of cleanliness and is well maintained. There is a large dining area which doubles as living and activities area and a small sitting room, well used by residents. The bathrooms are clean and bathroom floors have been replaced. The garden is well kept and includes a non-slip decking area, the dining area doors open on to it. The home had an environmental health inspection, recently, which resulted in a very good rating. Some areas of the home are locked with number pads to effect entry, risk assessments support this. Care Homes for Adults (18-65 years) Page 22 of 30 Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a trained, competent and skilled staff team who are able to properly meet the complex needs of the people who live there. They have a positive attitude to people and are respectful and sensitive to them. Evidence: The home has a minimum of four members of staff per shift, these are augmented by the manager, who is supernumerary and a day care organisor , who generally works 9-5. The home uses as few agency staff as possible, when used they are from a specialist agency staff that have experience with people with behaviours that may present difficulties. The home has some difficulty recruiting staff because of its rural location and the necessary skills that staff have to have to meet the complex needs of the people who live there. The organisation are providing a taxi service to encourage staff to work in the home. Recruitment records for two staff were seen and they contained all the necessary information to ensure their safety and good character. Care Homes for Adults (18-65 years) Page 24 of 30 The staff were observed on the day of the visit to be working very effectively with the people who live there. They were motivating people, very respectful and had excellent interactions. People were responding to them very positively. Training records showed that staff have received core and additional training which the home considers as core such as anti-discriminatory practice, MAKATON, medication, P.O.V.A and SCIP (Strategies for Crisis Intervention and Prevention). The manager advised that approximately 50 of the current staff team are doing or have completed N.V.Q. training. One staff member was spoken to they said that there are good training opportunities, inductions are always completed before people are part of the rota and there are regular supervisions. Staff described the management as supportive and open. Minutes of staff meetings were seen, they included good discussion, information and instructiion, as appropriate. Care Homes for Adults (18-65 years) Page 25 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well managed in the best interests of the people who live there. The home has a formal Quality Assurance system that encourages development to enhance the quality of the care provided. People are kept as safe as possible. Evidence: The manager completed his Registered Managers Award qualification in June 2008, he has been in post for several years. The home is very well managed and it was evident that the interests of the residents are the priority of the home. The home is visited every month by a senior manager who completes regulation 26 reports, to a good standard. There is a formal Quality Assurance process that is completed in June and July of every year. This consists of questionnaires being Care Homes for Adults (18-65 years) Page 26 of 30 completed by families, people who use the service, staff and other interested parties. The home is attempting to develop ways of ensuring that the people who use the service are heard, these include monthly keyworker meetings and continual review of care plans and behaviours. An annual development plan is completed after all the information from the questionnaires has been received. The manager reported that better communication with residents and more activity opportunities were noted as areas for development from last year. All staff have now received MAKATON training and there are several other developments in communication such as the development of communication boards. The appointment of a day care organisor has enhanced peoples activity opportunities. The manager confirmed that all Health and Safety maintenance checks had been completed and were up-to-date, as noted in the A.Q.A.A. Incidents and accidents are properly recorded and sent to Head Office for analysis and monitoring. Care Homes for Adults (18-65 years) Page 27 of 30 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 28 of 30 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 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 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 16 23 To ensure that people know their overall financial status, so that the manager can support them to make appropriate choices when purchasing goods. Care Homes for Adults (18-65 years) Page 29 of 30 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). 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