Inspection on 09/08/06 for Ball Tree Croft

This inspection was carried out on 9th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Ball Tree Croft 22/11/05

Ball Tree Croft 27/06/05

Ball Tree Croft 04/10/04

Ball Tree Croft 22/04/04

Ball Tree Croft 12/08/98

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Thorndene

Insight - Eastchurch

Southfields

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Dovedale Court

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

CARE HOME ADULTS 18-65 Ball Tree Croft Western Road North Sompting Lancing West Sussex BN15 9UX Lead Inspector Mrs Kerry Leppard Key Unannounced Inspection 9th August 2006 10:30 Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 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 Ball Tree Croft DS0000037421.V300091.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 Adults 18-65. 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. Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ball Tree Croft Address Western Road North Sompting Lancing West Sussex BN15 9UX 01903 753330 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) www.westsussex.gov.uk West Sussex County Council ****Post Vacant**** Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd November 2005 Brief Description of the Service: Ball Tree Croft is a Care home registered to provide care and accommodation for up to 16 Service Users with Learning Disabilities between the ages of 1865. The home is situated within Sompting, next to a doctors surgery and within walking distance of other local amenities. The home has its own mini bus and car. Accommodation is provided within two units, each consisting of eight single bedrooms, lounge/dining area, kitchen, laundry and bathroom facilities. The Registered Providers of the service are West Sussex County Council. The Council have undertaken a consultation process on the future of the home and a decision has been taken to close the home once new services have been created. It is anticipated that this will take between 2 - 3 years. During this time the current residents of the home will be supported to find alternative accommodation through the ‘Place to Live’ project. The registered manager position is currently vacant. The responsible individual on behalf of West Sussex County Council is Mr. John Dixon. The current fees are £485. Additional charges are made for hairdressing, toiletries, magazines, chiropody and aromatherapy. The inspection report is made available in the main entrance of the home. Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit was conducted unannounced on Tuesday 8th August 2006 between 10.30am and 6.30pm. Prior to the visit information was requested and received from the home in the form of a questionnaire. Comment cards were supplied to the home for distribution to both residents and relatives/visitors and prior to the visit four resident and six relative/visitor comment cards were received. The inspector met nine residents and five members of staff during the course of the visit. The inspector spoke with three residents and three members of staff. The acting manager was also present and available to assist the inspector. Findings and comments from comment cards and discussions have been included in this report. What the service does well: What has improved since the last inspection? There were no requirements for improvement on the home’s last inspection report. However flooring in the main lounge / dining room has been replaced as recommended in the providers monthly reports of visits to the home. Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 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. Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The individual needs of prospective residents are assessed prior to admission to the home. EVIDENCE: It was judged at the last inspection that the home operates an effective procedure for assessing residents needs prior to them coming to live at Ball Tree Croft. This could not be fully assessed during this visit, as the home has not admitted anyone since the last inspection. Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents assessed needs and personal goals are reflected in their individual plan and residents are involved in the process of developing their plan. Records need updating to ensure they provide an accurate reflection of resident’s needs. Residents are able to make decisions about their lives with support from staff if it is needed. Residents are supported to take risks through a process of assessment to ensure their safety and wellbeing. EVIDENCE: Three care records were looked at as part of case tracking the care provided at Ball Tree Croft. The records sampled included information about individual resident’s personal, social and health care needs and acknowledged their personal preferences and Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 10 goals. Picture format documents are used and some parts of the care records are written as if by the resident themselves. Where the care provided is complex the inspector found detailed guidelines for staff to follow to meet the needs of the resident and feedback from staff providing one to one support indicates they had been involved in producing these guidelines. Unfortunately, of the three records sampled only one had been reviewed in the last year and through observation and discussion the inspector concluded that due to changes in the resident’s needs this record did not accurately reflect the resident’s needs and the care provided. Due to the fact that person centred planning review meetings were overdue it was not always clear how much progress had been made toward achieving the goals set by and for residents. The acting manager explained that review meetings have been delayed due to training that was needed and now this has been completed review dates have been set and planned to ensure all records are up to date. It is recommended that this work get underway as soon as possible to ensure that information about resident’s needs and the instructions care staff are to follow to meet those needs are accurate and up to date. Those care records seen indicate that where it is possible residents have been supported to make decisions and choices about their personal goals. Alternatively, an advocate was involved in one recent review and staff with knowledge of the resident also participate in the decision making process. Risk assessments are included within the care plans and identify areas of risk, the degree of risk and action necessary to minimise the risk for individual residents. Similar to care planning documents the inspector’s observations were that some risk assessments were no longer relevant or needed updating to reflect the resident’s changing needs. Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents enjoy a variety of activities inside and outside the home. Residents are part of the local community Residents are supported to maintain family relationships and friendships. Resident’s rights and responsibilities are recognised Residents are offered a varied diet and mealtimes are relaxed. EVIDENCE: Most residents attend local day centre services and for those who choose to no longer attend this type of activity the home has an activity co-ordinator. This person is employed to work across the seven day period and the acting manager explained how the activity co-ordinator is being used imaginatively to provide one to one support for residents. Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 12 Ball Tree Croft has a variety of resources for use by residents including a snooker table, table tennis table, a sensory room, an aromatherapy room and the services of an aromatherapist and a visiting music therapist also. Discussions indicate that local amenities including restaurants, shops and parks are accessed by residents with support from staff, one resident said ‘I like going out to dinner’. The home holds a disco regularly and alternate weeks residents attend discos locally. One resident told the inspector that a fellow resident was currently on holiday and that she had enjoyed a holiday earlier in the summer. Discussion and observation indicates that staff provide support to residents to enable them to keep in touch with family and friends. One resident was supported to make a phone call and was offered privacy to do this and another explained to the inspector that her family visit on occasion. All relatives/visitors who completed a comment card said they are welcomed in the home at any time. From observation and discussions the inspector concluded that residents are supplied with a key to their room and move freely between their bedrooms and the communal areas depending on whether they wish to have company. The inspector discussed with the acting manager ways in which the use of keys to resident’s bedrooms could be reviewed to respect resident’s privacy at all times. During this visit the inspector observed lunch and tea time meal arrangements. At lunchtime in one house a resident prepared a sandwich with minimal support and guidance offered by the member of staff on duty. Another resident was given more support to eat in accordance with his needs. The atmosphere in both houses was relaxed and cheerful with residents and staff chatting over their food. At tea time residents gathered in the dining area in the main block to eat their meal, the inspector was advised that this is a trial at the moment and will be reviewed to see how successful it is. Prior to the meal residents were asked and supported to lay the tables and following the meal a resident was cleaning the tables. Rotas of jobs such as these have been prepared using photos of residents and were seen to be on display in both houses. The choice of meals offered to residents during the evening of this visit was gammon and pineapple with peas and boiled potatoes or salmon salad. Residents who completed a comment card said they ‘always’ or ‘usually’ enjoy the meals at the home and comments included ‘I like the Sunday roast the best’ and ‘Could be better-I don’t like salad’. Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents receive personal support in accordance with their needs and preferences. Resident’s health needs are met. The home’s policies, procedures and practises in relation to medication protect residents. EVIDENCE: Care records sampled indicate that where support with personal care is needed detailed guidelines have been produced for staff to follow to ensure resident’s preferences are respected. Half of the residents who completed a comment card said they ‘always’ receive the care and support they need, the remaining half said this was ‘sometimes’ the case and one commented that sometimes they bath themself. Records also indicate where residents need only guidance or prompting to maintain their personal hygiene. On the morning of this visit most residents had gone out, the inspector observed that those who remained at home got up and ate breakfast at a Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 14 leisurely pace and both houses were relaxed throughout the day. Staff who spoke with the inspector were clear that Ball Tree Croft is each resident’s home and is to be treated by staff accordingly. Records and discussions with staff also indicate that they support residents to attend health care appointments and access specialist services such as neurologists, community nurses and occupational therapists to meet their health care needs. Records in relation to health care appointments had not been completed and should be updated as part of the review of care records. Arrangements for the storage and administration of medicines were found to be satisfactory. Senior staff who have received training administer medication and medication received into the home is recorded on Medication Administration Records (MARs). MARs were sampled and were found to be complete. To further improve medicine handling in the home, care plans should be drawn up to guide staff as to the triggers for administering medicine that is prescribed on an ‘as needed’ basis, this helps protect staff from the risk of wrongful administration. Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents and their relatives feel their views are listened to and acted upon. Staff are trained to protect residents from abuse. EVIDENCE: Although the complaints procedure was not on display in the home, picture boards were available to support residents to communicate to staff some problems they may have. All residents who completed a comment card said they know who to speak to if they are not happy and that staff listen and act on what they say. Similarly, relative/visitors who completed a comment card said they are aware of the home’s complaints procedure and commented positively on the way the home responds to issues, they said ‘Whenever I phone Ball Tree Croft my queries are always dealt with efficiently and in a friendly manner’ and ‘All problems are dealt with quickly and professionally by members of the staff at Ball Tree Croft’. The inspector spoke with a staff member who has been employed since the last inspection who said that an abuse awareness session had been provided as part of the Learning Disability Award Framework (LDAF) safe practitioner training and was therefore able to demonstrate a good understanding of the Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 16 types of abuse and her responsibility to report any suspicion or evidence of abuse in accordance with the home’s whistle blowing policy. In addition to this training the staff member said this has been discussed with staff at team meetings and the person in charge advised the inspector that he had conducted a briefing session for staff recently. Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents live in a comfortable, homely and safe environment. The home is clean and hygienic. EVIDENCE: The home provides accommodation in two house, both of which comprise eight bedrooms over two floors, a kitchen, laundry area, a communal lounge/dining area and two bathrooms, one of which provides assisted facilities. The main house also provides a large dining/lounge area. There were no requirements for action in respect of the environment on the last report however the registered providers monthly visit reports indicate that recommendations in relation to the environment are being addressed, specifically the flooring in the large dining/lounge area has recently been replaced. A fire officer report dated April 2006 made requirements in relation to locks on fire exits and the evacuation procedure, which the acting manager confirmed have been addressed to ensure the safety and wellbeing of residents and staff. Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 18 Two domestic staff are employed during weekdays to maintain cleanliness in the home. Residents who completed a comment card said the home is clean and fresh and this was the inspector’s observation during this visit also. Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents are looked after by competent care staff. However the number of staff who hold a National Vocational Qualification (NVQ) does not meet the National Minimum Standard. Recruitment procedures should be improved to ensure they are robust for the protection of residents. A programme of training is in place and provision is being audited to ensure staff skills are up to date. EVIDENCE: The inspector observed staff communicating effectively and respectfully with residents during this visit. The atmosphere during the visit was relaxed, staff were approachable and feedback indicates that residents have good relationships with staff. From discussion and records the inspector concluded that new staff complete Learning Disability Award Framework (LDAF) safe practitioner training. However, records also indicate that this training may not be provided for sometime following commencement of employment at Ball Tree Croft. The Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 20 inspector therefore discussed with the acting manager the benefit of recording the ‘in house’ induction that, discussion indicates, is carried out with new staff and includes shadowing an experienced member of staff and induction to the fire procedure (see also standard 42). This will also support the home to ensure staff meet the requirements of the Skills for Care within the timescales laid down. Records and discussions also indicate that staff have done other training courses including fire and manual handling and some training in specific topics such a downs syndrome and dementia has also been provided in the past. The acting manger is in the process of auditing training to ensure all staff training in mandatory topics is up to date, it is recommended that this work continue and be used to develop a training plan for the home to ensure staff are trained to meet resident’s needs. Information provided prior to the inspection indicates that 39 of care staff have achieved an NVQ (National Vocational Qualification) at Level 2 or above, this figure is less than the National Minimum Standard. The acting manager advised the inspector that plans are in place to continue providing staff with NVQ training and achieve the National Minimum Standard. Two recruitment records were sampled during this visit, the inspector found that one lacked a second written reference in relation to the applicant, otherwise the records included an application, references and Criminal Records Bureau (CRB) disclosures that had been obtained prior to the applicant commencing employment. For the protection of residents the registered persons must ensure that all information required by Schedule 2 is obtained before a member of staff commences employment at Ball Tree Croft. Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The homes manager is not currently registered to carry on the service. The management approach is open and inclusive and resident’s views are sought. Some work is needed to implement a system of quality assurance that involves residents in the development of the service. Improvements are underway to ensure staff are trained to protect the health, safety and welfare of residents and themselves. EVIDENCE: The manager will be submitting an application for registration in the near future. Staff feedback indicates that the management approach is open and senior staff are approachable. Resident’s views are sought through house meetings Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 22 and their person centred planning meetings. It is a recommended that this work continues and a system of quality assurance be introduced to involve residents in the development of the home and the review of plans and objectives for the service. Information provided prior to this visit indicates that equipment in the home is serviced regularly, however confirmation of an electrical wiring certificate was not provided. It has been noted on the provider’s monthly visit reports that records of fire training do not demonstrate that all staff have received training at satisfactory intervals, in addition the information provided prior to the inspection indicates that the last fire training session was provided ten months ago. In order to address this, the person responsible for fire training is reviewing how training is provided to ensure staff receive regular updates. It has also been recommended that induction records include reference to the fire training provided to new staff (see standards 32&35). One staff member who spoke with the inspector demonstrated a good understanding of the procedure to follow in the case of a fire. The inspector discussed with the acting manager the requirement under Regulation 37 of the Care Homes Regulations 2001 to report incidents that affect the health and well being of residents at Ball Tree Croft and one written report has been received since the visit. Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 24 N/A 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. Standard Regulation Requirement Timescale for action 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 Standard Good Practice Recommendations Ball Tree Croft DS0000037421.V300091.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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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