Inspection on 14/11/05 for Attwoods Residential Care Home

This inspection was carried out on 14th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Attwoods Residential Care Home 25/11/09

Attwoods Residential Care Home 09/02/09

Attwoods Residential Care Home 19/08/08

Attwoods Residential Care Home 18/04/08

Attwoods Residential Care Home 19/11/07

Attwoods Residential Care Home 26/02/07

Attwoods Residential Care Home 12/09/06

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Larchfield Manor

Hawkhills

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Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Attwoods Residential Care Home 46 Northgate Cottingham East Yorkshire HU16 4EZ Lead Inspector Pam Dimishky Unannounced Inspection 14th November 2005 09:30 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 Attwoods Residential Care Home DS0000064183.V263010.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Attwoods Residential Care Home DS0000064183.V263010.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Attwoods Residential Care Home Address 46 Northgate Cottingham East Yorkshire HU16 4EZ 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) 01482 841133 Mr Ateeq Rehman *** Post Vacant *** Care Home 19 Category(ies) of Dementia - over 65 years of age (19), Old age, registration, with number not falling within any other category (19) of places Attwoods Residential Care Home DS0000064183.V263010.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31/05/05 Brief Description of the Service: Attwoods is a care home providing personal care and accommodation. It is registered for older people and also for older people with dementia. The home is situated in Cottingham within easy reach of the village centre and local amenities; a bus stop is outside the door and the railway station is nearby. The home is a large detached house arranged on two floors. Three bedrooms are on the ground floor and other bedrooms can be accessed by the stairs or stair lift. There are six double and seven single bedrooms, however, some of the double rooms are also used as singles. There are two lounges and a dining room on the ground floor; one of the lounges is used by residents who smoke. The kitchen is located directly off the dining room. A paved courtyard and flower-beds are situated to the rear of the building which has full access for wheelchair users and all other residents. There is also limited car parking in this area. Attwoods Residential Care Home DS0000064183.V263010.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over eight hours (including preparation). The inspector looked around all areas of the home and a number of records were inspected. Eight of the thirteen residents, two visitors and two members of staff were spoken to. Some requirements made at the previous inspection remain outstanding but the new proprietor has only recently taken ownership of the home, therefore some timescales have been extended. What the service does well: What has improved since the last inspection? The provider has only recently taken ownership of the home and it is clear an investment is being made in making improvements to the environment eg two bedrooms have been redecorated and looked very attractive with matching bed linen; new furniture has been installed in the hall and dining room and the central heating boiler and one of the stair-lifts have been replaced. Staff training is improving although there is still some way to go in this respect. Attwoods Residential Care Home DS0000064183.V263010.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Attwoods Residential Care Home DS0000064183.V263010.R01.S.doc Version 5.0 Page 7 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 Attwoods Residential Care Home DS0000064183.V263010.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3, and 6 Information is not available for prospective residents’ to make an informed choice about where to live or their contractual arrangements with the home. Without a record of an assessment of prospective residents care needs, prior to them moving into the home, there is no evidence of assurance that care needs will be met by the home. EVIDENCE: The statement of purpose and service user guide have not been given to residents or prospective residents and whilst a copy of a sample contract/statement of terms and conditions with the home is attached to each bedroom door for information, a copy, signed by both parties, has not been issued to residents or their representative. The manager assured the inspector she is assessing residents prior to them entering the home, but no evidence of the assessment was available for inspection. The home does not have the facilities or staff to be registered for residents solely needing intermediate care. Attwoods Residential Care Home DS0000064183.V263010.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 The care planning system is not clear or consistent and does not provide staff with the information they need to satisfactorily evidence residents’ needs are met. Systems are in place to access support NHS services to ensure residents health care needs are being met. The systems for administration of medications ensure residents’ medication needs are being met. Residents, and staff, were able to demonstrate how residents are treated with respect and their privacy is upheld. EVIDENCE: Five residents case files were examined, and whilst there is some improvement in the content, they remain basic and should be improved; there is no evidence the care plan is being regularly reviewed, although the acting manager and staff interviewed confirmed they are reviewed, and there is no evidence risk assessments are being made routinely. The acting manager was not aware whether one resident, whose care plan identifies the need to attend church weekly, is actually attending church. However, staff were able to confirm the resident does attend church with relatives but this is not weekly; the care plan has not been changed and there is no evidence that the change is with the agreement of the resident. A resident who was placed in the home by the Attwoods Residential Care Home DS0000064183.V263010.R01.S.doc Version 5.0 Page 10 intermediate care team, had no care plan as the acting manager said this had been taken by the intermediate care team when they discharged her over a month ago; daily records of the care provided are being kept but, without a care plan, the home cannot be sure all the resident’s personal care and oral hygiene needs are being met. One resident admitted three days earlier had not yet had a risk assessment although the social services care plan identifies the risk of wandering. The home’s assessment, made prior to the resident coming into the home to ensure needs can be met, were not evident in four of the five case files examined. The arrangements for health care support and advice is good with evidence the district nurse, community psychiatric nurse, physiotherapist, chiropodist, nutritionist and continence nurse attend the home. The optician had recently visited and a number of residents have had new glasses provided; one resident was having problems in getting used to her new glasses. The system for administration of medications is basic, however, of those checked, they were found to be correct. Residents generally appeared clean, tidy and well cared for and spoke highly of the staff and the care they received. Attwoods Residential Care Home DS0000064183.V263010.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Daily life and social activities generally meet the expectations and choice of the residents living in the home. Family and friends visit the home or maintain telephone contact and this enriches the lives of the resident. Meals are nutritious and offer a varied diet for residents. EVIDENCE: Residents said they are able to make choices about their daily routines. They can get up and go to bed when they wish and one resident said “staff do as you ask”. A bath rota is in operation, but residents and staff said bathing is according to choice. Activities are available ie dominoes, jigsaws, colouring books and library books, changed every other month, but the acting manager and staff stated these are rarely used as residents are not interested. However, an activities co-ordinator is employed for two hours every Friday and residents did say they were happy just to read and watch television. One resident who made model aeroplanes prior to coming into the home said he would like to continue with his hobby and the acting manager said she would discuss this with him and the family to arrange what they could. Someone from the local church visits monthly and brings a church magazine and talks through it to the residents. A Christmas party is scheduled to take place on 9th December which will include relatives and friends. Entertainers visited the home earlier in the year, but they have not been recently and the acting Attwoods Residential Care Home DS0000064183.V263010.R01.S.doc Version 5.0 Page 12 manager was not sure how to contact them. Birthdays are celebrated by having a tea party and birthday cake to which relatives are invited. Lunch on the day of the inspection was braising steak, carrots, swede, broccoli, cauliflower and potatoes followed by banana and custard. The meal was nicely presented, looked nutritious and plentiful. The residents all spoke highly of the food provided and staff said residents views are accommodated in putting menus together, eg one resident asked for smoked haddock with a poached egg and this now appears on the menu every month. Attwoods Residential Care Home DS0000064183.V263010.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The complaints process in this home is poor with no complaints information available to residents. Current recruitment practice is not sufficient to ensure residents are free from the risk of abuse. EVIDENCE: A book is being kept for recording complaints although no entries have been made. Residents do not have a copy of the home’s complaints procedure, although they did say if they had any concerns they would speak to the acting manager. There is an outstanding requirement for the home’s policy for whistle blowing to be amended in line with the Department of Health guidance “No Secrets” and the acting manager was given information as to how a copy of the document can be obtained. All staff have had satisfactory Criminal Records Bureau (CRB) checks except for one member of the care staff who commenced working in the home during July and has not yet had a check applied for. Two members of staff were interviewed and one said she has completed a unit on the protection of vulnerable adults whilst taking NVQ level II but it was not evident that either of the two members of staff had seen the home’s policy and procedures. Attwoods Residential Care Home DS0000064183.V263010.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,24,25 and 26 The new owner has commenced a programme of redecoration and refurbishment of the home, but until this is complete the home does not present as a homely and comfortable environment for residents. The call alarm does not maximise residents’ independence in communal areas of the home. Until the programme of fitting radiator guards is completed residents cannot be sure they live in safe surroundings. The odour on entering the home and in one resident’s bedroom is not conducive to the home being a clean and hygienic place for residents to live. EVIDENCE: The home has recently come under new ownership and the new proprietor has commenced a programme of redecoration and refurbishment. Two bedrooms have been completed and look very attractive and some new furniture has been installed in the entrance and dining room. The central heating boiler has been replaced and a new stair lift installed. A requirement made at the last inspection for the call alarm to be extended to communal areas in the home remains outstanding. The home has three bathrooms, one is not used and only one has a bath hoist. The assisted bath is on the first floor and is not accessible to residents who are not mobile. At the time of the inspection two Attwoods Residential Care Home DS0000064183.V263010.R01.S.doc Version 5.0 Page 15 toilets were out of order and the hot water outlet to the bath on the ground floor was running at 48 degrees C. The acting manager made arrangements for the plumber to call two days later to adjust the water temperature and to repair the toilets. In the meantime, the acting manager was to inform staff to ensure bath water was within the limits to prevent scalding. One bedroom door (room 4) does not close into the rebate and the acting manager stated the handyman would attend to this. Fire extinguishers had been checked during August 2005. One resident said his bed is uncomfortable as his feet hang over the end; the acting manager is to look at ways of ensuring this resident’s comfort when in bed. There is an offensive odour on entering the home and in one bedroom despite the best efforts of the home in managing this problem. The environmental health officer inspected the kitchen 02/06/05 and no serious concerns were noted in the report. Attwoods Residential Care Home DS0000064183.V263010.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The home cannot be sure residents are in safe hands at all times until training is complete and the home’s recruitment practices improve. EVIDENCE: Fourteen residents live in the home at the present time, although one was in hospital at the time of the inspection. Two staff are on duty on all shifts and, in addition, the acting manager is present on the early and late shift except for weekends. The acting manager is reviewing staffing levels at peak times and also for weekends. One new member of staff has commenced working in the home since the last inspection and despite the acting manager stating a Criminal Records Bureau check has been applied for, there was no evidence in the records seen. The member of staff commenced working 16/07/05 without confirmation of clearance from the protection of vulnerable adults list, however, the acting manager stated the staff member only works under supervision at all times but this is not sufficient to meet the requirements. A dementia awareness course through Hull College which commenced at the time of the previous inspection, has recently been completed by all staff and seven members of staff are currently taking health and safety. A course on nutrition is planned for the near future. Three members of staff have NVQ level II and a further three are taking the qualification; two more are to enrol. Attwoods Residential Care Home DS0000064183.V263010.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 The manager is working in an acting capacity only and, until an application is made to the Commission for a registered manager, this does not meet the legal requirements for managing the home. Some areas of health and safety have the potential to put residents at risk. EVIDENCE: The home had been up for sale since the previous owner died in December 2004; the new owner was registered with effect from the beginning of September. The previous manager retired earlier in the year and the acting manager has been in post since then and has been managing the home in difficult circumstances. She has an NVQ level II qualification and no previous managing experience. The owner has been approached with a view to her enrolling to take NVQ level IV in management and care which is a requirement for registration as the manager; application has not yet been made to the Commission to register a manager. Attwoods Residential Care Home DS0000064183.V263010.R01.S.doc Version 5.0 Page 18 The acting manager stated staff and residents meetings are held monthly and minutes were seen of the last staff meeting but none were available for the residents meeting. The registered provider has not yet made a report to the Commission of monthly, unannounced, visits to the home which are required. The home is not involved with residents’ financial arrangements, except for four residents who the home keeps small amounts of money on their behalf. Money, receipts and records were checked and generally found to be in order; one account was £2.00 up. Certificates for the six monthly thorough examination of the stair-lift and bath hoist remain outstanding requirements, as does the landlord’s gas safety certificate. The home displays a health and safety poster in the entrance to the home, but the manager’s statement of the policy, organisation and arrangements for maintaining safe working practice remains an outstanding requirement from previous inspections. Fire alarm and emergency lighting checks are being recorded weekly and fire extinguishers are labelled as being checked August 2005. The last recorded fire drill took place during April 2005, but staff confirmed further drills have taken place but have not been recorded. There is no evidence staff are having fire safety lectures twice a year. The incidence of accidents were seen to be adequately recorded. Attwoods Residential Care Home DS0000064183.V263010.R01.S.doc Version 5.0 Page 19 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 1 1 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 1 x x 2 x 2 1 1 STAFFING Standard No Score 27 2 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x 3 x x 1 Attwoods Residential Care Home DS0000064183.V263010.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard 1 Regulation 4,5,6 Requirement Timescale for action 31/12/05 2 2 4,5,6 3 3 14,15,17 4 3 14 Make available to residents’ an up to date statement of purpose which includes all requirements listed in Schedule 1 of the Care Homes Regulations and provide a service user guide to residents’ and prospective residents’ which includes all the issues listed in National Minimum Standard 1.2 (Outstanding since previous inspections) Residents’ who are funded by the 31/12/05 local authority must have a statement of terms and conditions with the home in addition to the social services contract and all privately funded residents must be given a contract (Outstanding since the last inspection) The registered person must 14/11/05 ensure an assessment is made of the residents needs and obtain a copy of the assessment The registered person must 14/11/05 confirm in writing to the resident, the care home is suitable for the purpose of meeting their needs DS0000064183.V263010.R01.S.doc Version 5.0 Attwoods Residential Care Home Page 21 5 7 15 6 7 16 18 22 12,13,17, 19 8 19 23 9 22 23 10 25 13,23 11 25 13,23 12 27 18 13 31 8 14 33 26 Residents’ care plans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet their health and welfare needs. Residents’ care plans must be kept under review. (Outstanding since the last inspection) Supply to all residents a copy of the home’s complaints procedure The procedure for whistle blowing must be updated in line with the DOH guidance “No Secrets”. (Outstanding since the last inspection) The progress so far made with the internal decoration of the home must continue. (Timescale extended) The call alarm system must be extended to both lounges and the dining room. (Outstanding since the last inspection) The programme for fitting radiator guards must be completed for bedrooms and communal areas. (Outstanding since the last inspection) Ensure hot water outlets in areas used by residents is thermostatically controlled to maintain a temperature of no more than 43 degrees C. (Outstanding since the last inspection) Ensure sufficient staff are on duty at all times. A review must be undertaken of staff numbers on duty at peak times and also weekends when the acting manager is off duty The home must be run by a manager who is registered with the Commission. (Outstanding since the last inspection) The registered provider must make monthly unannounced visits to the home in accordance DS0000064183.V263010.R01.S.doc 30/09/05 31/12/05 31/01/06 30/04/06 30/04/06 30/04/06 14/11/05 31/12/05 31/10/05 14/11/05 Attwoods Residential Care Home Version 5.0 Page 22 15 38 10,13,16, 17 16 38 10,13,23, 17 17 18 19 38 38 18 10,13,18 13,23 13,19 with the Care Homes Regulation, and provide the Commission with a copy of the report Provide the Commission with evidence the stair-lifts and bath hoist have had a six monthly thorough examination by a competent person. (Outstanding from previous inspections) Provide the Commission with evidence the home has a current landlord’s gas safety certificate. (Outstanding since the previous inspection) Staff must be suitably trained in fire safety and attend fire safety lectures twice a year Ensure all fire doors close into the rebate at all times A Criminal Records Bureau check must be applied for before staff commence working in the home 14/11/05 14/11/05 31/12/05 14/11/05 14/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard 24 28 29 Good Practice Recommendations The resident whose feet extend over the end of the bed must have his sleeping arrangements reviewed to ensure his comfort in bed A minimum ratio of 50 trained members of care staff at NVQ level II or equivalent should be achieved by 2005 Care staff must be employed in accordance with the code of conduct and practice of the General Social Care Council and be given copies of the code. (Outstanding from previous inspections) The registered manager should have a qualification at level IV NVQ in management and care, or equivalent, by 2005 The manager must provide a written statement of the policy, organisation and arrangements for maintaining safe DS0000064183.V263010.R01.S.doc Version 5.0 Page 23 4 5 31 38 Attwoods Residential Care Home working practices Attwoods Residential Care Home DS0000064183.V263010.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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