CARE HOMES FOR OLDER PEOPLE
Ashleigh House Care Home 18-20 Devon Drive Sherwood Nottingham NG5 2EN Lead Inspector
Andrew Sales Key Unannounced Inspection 11th April 2007 10:00 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 Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Ashleigh House Care Home Address 18-20 Devon Drive Sherwood Nottingham NG5 2EN 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) 0115 969 1165 Mr William Scott N/A. Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th December 2006 Brief Description of the Service: Ashleigh House is a care home providing personal care and accommodation for 19 older people. The home provides short and long term care. The home is owned by William Scott, which is run as a family business. The home is located in a residential area of Sherwood close to shops, pubs, the post office and other amenities. The home was opened in 1987 and consists of 2 converted terraced houses with a purpose built extension. Fifteen of the homes bedrooms are single, and none of the bedrooms have en-suite facilities. Bedrooms are located on 3 floors and there is a passenger lift. The home has a small, enclosed garden and a small car park. The home has recently appointed a new acting manager. The weekly charges as at 1st April 2007 range from £298.21 per week to £323.36 per week. Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and started on Wednesday 11 April and the site visit being conducted on 12 April 2007 at 10.00am. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting residents and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. Discussions were also held with the new manager and some records, documents and policies were inspected. We did not receive the documentation, which should be completed by the provider prior to inspection. We were therefore unable to include any evidence from resident’s surveys. The inspection process also involves collating information throughout the year. This may involve notifications from the provider, complaints or concerns received from the users of the service or from members of the public and information shared with us from other professional bodies such as social services personnel and health visitors. All of the key standards were inspected on this occasion. What the service does well: What has improved since the last inspection?
The previous acting manager has addressed some of the issues raised at previous inspections. The files for residents have been developed and now include details of what actions staff need to undertake to support residents with personal, health and
Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 6 social needs. Detailed reviews have been undertaken for most residents, to establish the right care and support is being made available. Issues raised by the last two pharmacy inspections have been addressed, which means this should help reduce the risk of errors being made. Nearly all of the care staff are now registered to undertake the National Vocational Qualification (NVQ). Three of the staff team have completed this qualification. What they could do better:
Not all resident’s files have been reviewed. This may result in residents being place at risk and not having all their personal and health care needs met. There are no medication risk assessments on files for residents who take medication. This could place them at risk from staff not understanding the effects of medicines or the effects from not taking prescribed medicines. The proprietor must ensure that risk assessments are conducted for individuals on medication. Resident’s dignity is not always promoted. The manager needs to address issues raised in National Minimum Standards (NMS) 10 of this report relating to the dignity of residents. Complaints records were not available for inspection. The proprietor must ensure that the manager is aware of all the documents and procedures within the home. Staff are not trained or guided in the safeguarding of adults. This could also place residents at risk. This issue is outstanding from previous inspections and the proprietor must ensure this is done immediately. Staff are not trained in all of the health and safety subjects required by legislation, this may put residents at risk. The proprietor must ensure this is done to ensure the safety of residents. There is no suitable space for residents to go outside and relax in the fresh air. The proprietor must ensure there are suitable grounds for residents to relax. Not all residents are aware of what is happening with their finances. The proprietor must ensure that the named individual is provided with full details of her account. There is a new manager at the home. This is the fourth manager to come to the home in fourteen months. This is seriously affecting the consistency and quality of management at the home. This does not promote a positive culture to work in or a stable environment to live in. Standards and services are
Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 7 compromised and residents may be put at risk from the lack of attention paid to health and safety monitoring. The proprietor needs to address this urgently to ensure standards of care and safety are raised and maintained. There is no structure for reviewing standards of the service or seeking residents views. There is no regular meaningful consultation with residents. This results in a service that is not run in the best interests of the residents. The proprietor must ensure proper consultation over social and recreational interests does takes place and is acted upon There is no Fire Risk Assessment present. The proprietor must ensure that this is completed to promote the safety of residents and staff. . Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 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 Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive an appropriate assessment prior to moving into the home. EVIDENCE: We looked at the records of three resident’s files. The files contained assessments conducted by the previous acting manager. Where appropriate local authority extended social care assessments were present. All of the assessments contained satisfactory information to enable staff to understand the residents assessed needs. We spoke with four residents, two of which were able to describe discussions they had with the previous manager, about the care they needed.
Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 10 We spoke with one member of staff, who confirmed that they understood these assessments and how they identified the care needs of the residents. The service does not provide intermediate care. Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have been appropriately assessed, but the high turnover of managers may affect this. The staff strive to make sure the people using this service are comfortable and safe. EVIDENCE: We looked at three files, which were generally well set out and detail each area of need, with a basic action plan for care staff. Resident’s assessment plans contain details of each person’s health care needs, including tissue viability and continence risk assessments. There is evidence that people have been appropriately referred to health care professionals. Files viewed, contained records of visits by district nurses, General Practitioners and other professionals.
Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 12 We saw some risk assessments in each of the resident’s assessment plans. But evidence indicates that some of these are out of date, not reviewed frequently and are not in place for all areas of risk. This may result in residents receiving a poor service or being place at risk. Two residents told us what additional help they receive, either from their doctor or district nurse team. Staff described training they had attended for peg feeding, which enable them to support a resident with this need. We also saw training certificates on staff files. We looked at a policy and procedures for receiving, recording, storing, handling, administering and disposing of medicines. The home is registered with the local pharmacist and support and advice obtained as and when needed. The pharmacist visits twice a year and conducts and audit of the homes medicines. We looked at the last report, which did not raise any concerns. We looked at one resident’s record and storage, which are managed appropriately. We noted that none of the residents had risk assessments for the medications they were taking. Where residents are self medicating a risk assessment needs to be conducted to promote the safety of residents. The residents we spoke with did say that the staff are “kind and caring” and do their best for them. They all said they retained their privacy in the home and their wishes were generally respected. We noticed that in the entrance lobby, pictures of resident’s faces had been stuck on the panelled wall, in a random pattern, with the name of a key member of staff written next to them. Whilst we recognise this may have been done with the best of intentions, this undermines the dignity of residents and is institutional. These should be removed. Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The daily routine is flexible to meet the preferences of most residents, though residents find their experiences do not always match their social expectations. Residents are generally happy with the food and choices provided. EVIDENCE: Some of the residents spoken with felt they were happy with the level of activities within the home and outside. Other residents said they could not always get out when they wanted to. We looked at files which record how personal choices were now being balanced with the risks involved to enable residents to make more choices as to how and what they would like to do. Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 14 All residents spoken with said they were pleased with the flexible routines within the home and that it was a relaxing place to be. Staff described flexibility over the daily routine and all four of the residents spoken with said that they are sometimes able to decide when they want to do things. We observed a large number of residents sitting around the lounge wall for long periods of time. Residents commented that they spent much of their time sitting watching the television. Whilst social preferences are recorded on files there is no specific structure to assess residents wishes and allocate resources to meet these needs. This problem has been evident for some years and has been neglected due to the absence of a long-term manager. We discussed this with the new manager who has only has been in post for one month. She was not aware of historical issues that needed attention or of the issues raised from the last inspection report. Two residents told us that they had little to do and felt there was insufficient help to either do things within the home or go out and do basic things like going to the shops or just taking in fresh air. Residents stated that they enjoyed the food at Ashleigh House. We were shown a varied selection of meals, which are available throughout the day. It was established that an effective system is in place to provide any resident with a specific diet. The cook described the catering arrangements. From observations it was clear they ensure that the kitchen and food preparation areas are hygienic and maintained to a safe standard. She also showed how food is now labelled and dated. Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has policies and procedures but these do not ensure residents are consistently safeguarded. EVIDENCE: We observed the policies and procedures relating complaints and the protection of vulnerable adults. They is no evidence of how the safeguarding adults procedure is reviewed or updated to reflect developments in Nottinghamshire County Councils policy on the Protection Of Vulnerable Adults. (P.O.V.A). Combined with the lack of training for staff in this area, this may not adequately protect residents at risk from abuse. The acting manager has only been in post for about one month. The acting manager could not locate the complaints log, as she had not been introduced to the policies and procedures of the service. Though she described fully how she would respond to complaints and how she would record them. We spoke with one member of staff. They were clear about their commitment to provide a safe place in which residents could live and they described how they would intervene if they suspected bad practice. They could not confirm they had attended training in safeguarding adults and we could not find any evidence on staff files.
Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 16 We spoke with four residents, three of these residents told us they felt safe at the home and had no concerns over the conduct of the staff. Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents would benefit if improvements were carried out to internal and external areas of the home. EVIDENCE: We looked at communal areas and one bedroom. Generally the home is kept clean and reasonably well maintained. Residents said they felt it was homely and they felt comfortable with the surroundings. We looked at the kitchen, where some improvements have been made. New sinks and wash-hand basins have been installed and windows made safe.
Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 18 We used the lift, which needs cleaning. Some parts of the outside of the home are used to store rubbish and building materials, which can be seen from inside the home. We looked at the gardens, which are only accessible by steep steps from the rear of the home, or a long walk from the front of the building. The gardens have no seating and contain rubbish and building materials. Two residents told us that they never go anywhere. When asked if they would use a garden if available, they said they would like to even if it was just a place to sit in the summer. Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The procedures for the recruitment and training of staff are more robust and now offer increased protection to people living in the home. EVIDENCE: We looked at four staff files. They contained relevant recruitment documents. All of the personnel files that were examined showed that pre-employment checks were carried out. We spoke with a member of staff who confirmed all the recruitment procedures had taken place. We spoke with four residents, who felt there were adequate care workers and senior staff available on duty and that they did not have to wait long for assistance. We were told that all staff are now registered on the National Vocational Qualification (NVQ) and three had already completed this. Staff told us that they have received training in some health and safety subjects. We found some evidence on staff files. We saw a training list, which identified many staff with gaps in their training needs.
Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 20 Some staff have not received training updates in the mandatory health and safety subjects. The consistency of training is hampered by the high turnover of managers. Staff told us that in the past they had some training needs identified but were not booked to go on courses as managers had since left. This may place residents at risk from staff using poor handling techniques for example. Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s proprietor has not responded appropriately to concerns raised from previous inspections. The service is not managed appropriately due to the high turnover of managers. Resident’s views are not fully taken into consideration. EVIDENCE: Since the previous inspection in December of 2006, we received an action plan from the provider, which sets out how they going to put things right. Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 22 However a number of issues have not been put right, which are highlighted in the requirements table at the end of this report. Since the last inspection another manager has left. The new manager, in post for about one month, is the fourth manager in approximately fourteen months. This raises serious questions as to the reasons for such a high turnover of managers and we are concerned over the proprietor’s ability to ensure appropriate management of the service. We believe that this is the main reason for deteriorations in this service and the main barrier to improvements. Residents said they are consulted over their care during the initial assessment and review process, but felt they were not consulted over general issues in relation to the running of the home. We could not find evidence of developments in quality assurance. At previous inspections we were told that surveys were issued annually. We could find no evidence of this. We discovered that there are inconsistencies in the review of residents care. Evidence suggests that regular consultation is not considered a priority within the home. We could find no evidence of quality monitoring reports from the proprietor who is required to conduct visits to the home and record their findings as required in Regulation 26. We looked at staff files, which showed that some staff have now undertaken training in some mandatory health and safety subjects. This is some improvement since the last inspection, though the whole staff group are required to have received training in all of the mandatory health and safety subjects, including the protection of vulnerable adults. We spoke with two members of staff, who were generally aware of health and safety procedures and commented that some training had been provided. We observed a satisfactory policy with regards to the safe keeping of resident’s personal allowances. The resident’s accounts were observed and one was randomly sampled and checked as part of this inspection. One resident told us that they were concerned about their post office account and where it had gone. The acting manager informed us that accounts were dealt with at the main office at Ascot House, which is another home owned by the same proprietor. We advised this person in the manager’s presence, that they would look into this. We observed some health and safety monitoring activity, which is regularly carried out. This includes regular checks of fire alarms and emergency lighting
Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 23 tests. We could not find evidence of a fire risk assessment being conducted for this service. The manager could not locate the last report from the Environmental Health Department which identified areas of concern and we were not provided with any evidence to suggest these issues had been addressed. Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 1 X X X X x 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 2 X x 2 Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 25 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 2 Standard OP7 OP9 Regulation 15 (2,b) 12(2) Requirement Ensure all parts of the assessment and care plans are reviewed appropriately. Ensure risk assessments are conducted for all residents who are self medicating. Ensure the social needs of residents are planned for and met. This is outstanding from previous inspections. 4 5 OP16 OP18 22 13(6) Ensure the complaints procedure 30/05/07 and records are made available for inspection. Ensure all remaining staff receive 11/04/07 training in the Safeguarding of Adults This is outstanding from previous inspections. 6 OP20 23.(2.o) Ensure that external grounds are suitable for, and safe for use by, service users are provided and appropriately maintained. 11/04/07 Timescale for action 11/04/07 30/06/07 3. OP12 16.(2,m) 11/04/07 Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 26 7 OP30 18.1.c.i. This is outstanding from previous inspections. Ensure all the remaining staff 11/04/07 receive Health and Safety training updates each year. This is outstanding from previous inspections. Ensure the manager is registered with the Commission. Utilise effective quality assurance systems that seek the views of residents, act on their wishes and preferences and ensure the provision of a quality service Ensure provider appropriate monitoring visits are conducted and recorded at the required frequency. Ensure the identified resident is kept informed of her account details or appropriate alternative arrangements are put into place for her finances to be managed. Ensure a Fire Risk Assessment is developed for the home. 8 9 OP31 OP33 8 24 11/04/07 30/06/07 10 OP33 26 30/04/07 13 OP35 20 18/04/07 14. OP38 23.4 11/04/07 15 OP38 13(3)(4) (a)(c) This is outstanding from previous inspections. Ensure the issues raised in the 11/04/07 Environmental Health Department report are addressed urgently. This is outstanding from previous inspections. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations
DS0000002188.V334995.R01.S.doc Version 5.2 Page 27 Ashleigh House Care Home Standard Ashleigh House Care Home DS0000002188.V334995.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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