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Inspection on 15/11/06 for Beech Lodge - Deaf-initely Independent

Also see our care home review for Beech Lodge - Deaf-initely Independent for more information

This inspection was carried out on 15th November 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Throughout, residents all demonstrated a friendly and tolerant approach to each other and to staff and visitors, and the warm and relaxed atmosphere prevalent throughout can only reflect well on them and on staff, management and the ethos of the home. The staff throughout the organisation all made sure they were effectively communicating with the residents, and were paying attention to them. Equally, residents were confident in communicating with staff and with visitors. The service ensures that there is a wide variety of activities to suit residents` wishes and needs and to help widen their experiences and increase their life skills and independence.

What has improved since the last inspection?

The home continues to improve the environment, and to make it better and safer for residents, in accordance with the organisations own improvement schedules. A relative of a resident commented on how the environment had improved greatly over the past few years.

What the care home could do better:

The home needs to ensure that the homely, resident-focused nature of the home is not compromised by a proliferation of notices drawing staff attention to issues that could be addressed elsewhere.

CARE HOME ADULTS 18-65 Beech Lodge - Deaf-initely Independent 28 Warwick New Road Leamington Spa Warwickshire CV32 5JJ Lead Inspector Martin Brown Key Unannounced Inspection 15th November 2006 2:00 Beech Lodge - Deaf-initely Independent DS0000004233.V318273.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 Beech Lodge - Deaf-initely Independent DS0000004233.V318273.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. Beech Lodge - Deaf-initely Independent DS0000004233.V318273.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech Lodge - Deaf-initely Independent Address 28 Warwick New Road Leamington Spa Warwickshire CV32 5JJ 01926 337743 01926 337743 di@leamspa282.freeserve.co.uk 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) Deafinitely Independent Acting manager: Tim Wood. Care Home 8 Category(ies) of Learning disability (8), Physical disability (8), registration, with number Sensory impairment (8) of places Beech Lodge - Deaf-initely Independent DS0000004233.V318273.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. All service users must have a learning disability and a hearing disability. The home may also provide care for one person over the age of 65 who is named in the application for variation dated 28th October 2005. 31st January 2006 Date of last inspection Brief Description of the Service: Beech Lodge is a parent led voluntary organisation that provides 24-hour personal care for eight adults who are deaf and also have a learning disability. It is a large detached property, formerly a hotel. It is on a busy main road, near to a college of further education, shops and parks. It has gardens to the front and a tarmac drive leading to a large space for cars and a small courtyard garden at the rear and an enclosed garden to the side. On ground floor level there is a hall, a spacious lounge, a large dining room, an equally large communal kitchen/dining room and two staff offices. Leading to the rear of the building there is a short flight of steps into the back corridor. Here there are two bedrooms with en-suite facilities, suitable for people with physical disabilities. The staff sleeping-in room is situated in the same area. A large, new laundry has been created. The corridor ends in a back door straight out onto the tarmac parking area. There is a double garage and a walled courtyard garden with barbecue. There are large, dry cellars at the bottom of a flight of stairs. On the first floor there are two bedrooms with en-suite facilities for residents and another staff office. There is a flight of stairs leading to the top floor. There is a small seating area on the landing and a door leads through to a lobby with four more bedrooms off this, with en-suite bathrooms. There is a small, shared kitchen off the lobby that is suitable for making snacks and drinks. Fees per person per week range from £788.75 to £946.10 there are extra charges in respect of transport, holidays, activities and equipment. Beech Lodge - Deaf-initely Independent DS0000004233.V318273.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been made using evidence that has been accumulated by the Commission for Social Care Inspection. This includes information provided by the home, questionnaires returned by residents and relatives, and a visit to the home. Five feedback cards returned by relatives and other visitors to the home, including care professionals were all positive. Five questionnaires returned by residents in the home were also positive, with comments such as “me like beech house” and “key worker help me”, being typical. The pre-inspection questionnaire was completed and returned by the service, accompanied by a good deal of information concerning the running of the home. The inspection visit was unannounced, took place on 15th November 2006, between 2.00pm and 8pm, and was combined with an inspection of the organisation’s adjacent home, Chestnut Lodge. An interpreter was present for over two hours of the inspection to assist the inspector in interviewing residents. All residents were seen over the course of the inspection, as were care and administrative staff, the acting manager, and the managing director. A tour of the premises was made, relevant documentation was looked at, staff and residents spoken with, and observations of the home in action were made. All staff, management and residents were welcoming, helpful, and friendly throughout. What the service does well: Throughout, residents all demonstrated a friendly and tolerant approach to each other and to staff and visitors, and the warm and relaxed atmosphere prevalent throughout can only reflect well on them and on staff, management and the ethos of the home. The staff throughout the organisation all made sure they were effectively communicating with the residents, and were paying attention to them. Equally, residents were confident in communicating with staff and with visitors. The service ensures that there is a wide variety of activities to suit residents’ wishes and needs and to help widen their experiences and increase their life skills and independence. Beech Lodge - Deaf-initely Independent DS0000004233.V318273.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Beech Lodge - Deaf-initely Independent DS0000004233.V318273.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 Beech Lodge - Deaf-initely Independent DS0000004233.V318273.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. 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 this service. Potential residents can be confident that the service would fully assess their needs to ensure that they could be amply met. EVIDENCE: There is a clearly set out, up to date Statement of Purpose for the home, setting out its aims and how it is run for the people living there, including clear statements of residents’ entitlements. There have been no new residents in the past twelve months. The assessments and introductory procedures for the most recent admission, on Chestnut Lodge, were seen to be satisfactory. The managing director advised that any new admissions in the future would be subject to similarly thorough procedures. Beech Lodge - Deaf-initely Independent DS0000004233.V318273.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. 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 this service. Residents can be confident that their assessed and changing needs are reflected in their individual plans, that they are helped to make decisions about their lives, and supported to take risks. EVIDENCE: Residents have copies of care plans that they keep in their rooms unless they specifically wish not to, which was the case with one person. These care plans are easy to read, filled with positive photographs of the person enjoying activities, and have ‘service user friendly’ information relevant to that person, and evidences their involvement and agreement with their plans of care. Detailed care plans are kept in office. These are reviewed twice yearly; formally with social services care management involvement, and ‘informally’ by the home. Relatives and residents are encouraged to be fully involved in these reviews. Risk assessments were seen to cover relevant aspects of an individual’s life, with specialist involvement being used to support plans of care where appropriate. Beech Lodge - Deaf-initely Independent DS0000004233.V318273.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are supported to take part in a variety of activities that they enjoy, both in the home, the local community, and further a field, and are supported in positive relationships. They are encouraged and helped to exercise their rights and responsibilities in their daily lives, and enjoy a healthy diet in congenial surroundings. EVIDENCE: A full schedule of activities for staff was seen, showing how staff are deployed to support residents throughout the week. Activities detailed for service users include a variety of college courses, games nights, outings to pubs and clubs, horse riding and swimming for those who have those interests. A timetable shows a busy schedule of college activities. A list of activities organised by the service throughout the past two years showed a wide variety of activities to suit every taste, from stock car racing to boat trips, and from musicals to picnics. Residents have enjoyed a variety of holidays over the past year, and were happy to discuss these. Beech Lodge - Deaf-initely Independent DS0000004233.V318273.R01.S.doc Version 5.2 Page 11 One resident was going to see a pop favourite that evening, and was clearly looking forward to it immensely. It was part of her birthday ‘treat’ and staff were clearly making a big fuss of her to compensate for other sadnesses in her life. The manager anticipated being up late to let in the returning ‘pop’ fan. The service supports two residents who are in a relationship, offering nonjudgemental guidance and practical help. Another resident spoke positively of contacts outside the home, and had also received extensive support and guidance through recent difficult times. An evening meal was taken with residents, which was a relaxed, congenial event, involving good natured banter by residents with the cook that evening. Residents are offered a choice; one resident chose to eat after everyone else had finished. Beech Lodge - Deaf-initely Independent DS0000004233.V318273.R01.S.doc Version 5.2 Page 12 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. 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 this service. Residents can be confident that they are receiving personal, emotional and health care support in line with their own needs and wishes and in appropriate ways by staff who understand what those needs are. Medication is soundly managed and the service encourages responsible self-medication. EVIDENCE: Throughout, staff were observed to be treating residents with respect and dignity, and to be aware of health and support needs, and to be addressing them and to be addressing them in a supportive and natural way. Where there are behavioural issues, staff were seen to be consistently following guidelines agreed with outside professionals. Residents access community services as detailed in their individual care plans Discussion with staff and residents, and observation of interactions made it clear that the service helps meet residents’ emotional, as well as physical needs, either by their own efforts, or by facilitating and supporting outside contacts and networks. Responses from residents indicated that they were all very positive about the role and efforts of the service in helping maintain and improve their quality of lives. Beech Lodge - Deaf-initely Independent DS0000004233.V318273.R01.S.doc Version 5.2 Page 13 Personal support and staff awareness and communication for one resident with dual impairments was explained, and staff interactions with her were observed. Staff were clear as to her support needs. Records of medication were seen to be accurate. The system, including a backup check, was satisfactorily explained. Where epilepsy is an issue, suitable protocols and training are in place to enable appropriate treatment, should it be necessary. Appropriate protocols were seen for ‘as required’ medication, and risk assessments are in place to support residents who self-medicate. Beech Lodge - Deaf-initely Independent DS0000004233.V318273.R01.S.doc Version 5.2 Page 14 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. 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 this service. Residents can be confident that their views are listened to and acted upon, and that they are protected from abuse. EVIDENCE: Residents, in the questionnaires they filled in, supported by staff, wrote that they knew who to complain to, and the named person was ‘staff’ or ‘carer’. There were no complaints in the complaints log. Discussion with residents drew out no divergence in what they wanted and how the home was run. All residents have contacts with signing persons outside the home, either family, in day services, or advocates. There is an advocate who meets residents regularly, and who chairs residents’ meetings, who is not officially linked to the service. Staff explained how one person who has dual impairments, is able to express any concerns. There are appropriate policies and procedures in place to help protect residents against abuse, full and ongoing training for staff ensures that they are aware of them. Appropriate action, including a referral to Protection Of Vulnerable Adults and resulting in dismissal, was taken in the past twelve months in respect of two care workers whose actions had fallen far below what should be expected, although it did not impact directly on residents’ well-being. Beech Lodge - Deaf-initely Independent DS0000004233.V318273.R01.S.doc Version 5.2 Page 15 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. 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 this service. Residents benefit from a clean, well-maintained environment that is subject to a continuing programme of refurbishment and up-grading. There is a danger that a proliferation of notices aimed primarily at staff can impinge on the homely nature of the environment. EVIDENCE: The home was clean and tidy during this unannounced inspection. Details of the extensive refurbishment and plans were provided in the preinspection information. One front bedroom is currently being completely renovated. The home has spacious communal areas and spacious bedrooms. Some of these were seen, and are furnished and decorated in accordance with residents’ needs and wishes, and reflected their individual likes and personalities. Beech Lodge - Deaf-initely Independent DS0000004233.V318273.R01.S.doc Version 5.2 Page 16 In acknowledging that the spacious size of the communal lounges could be counter productive in terms of homeliness, the acting manager advised that the dining room had recently been rearranged to effectively give part of it over to a smaller lounge area, with sofas grouped round a television. This gave a choice of viewing in the communal areas (all the residents have televisions in their own rooms) as well as a smaller space, which was preferred by at least one resident. Laundry facilities and procedures are suitable to meet current needs. There were a number of notices throughout communal areas of the home, largely aimed at staff, such as one reminding staff that no more than one staff at a time should be outside having a cigarette. The acting manager and managing director both agreed that in most cases, such information is best conveyed in staff meetings and staff handovers and folders. Beech Lodge - Deaf-initely Independent DS0000004233.V318273.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a properly recruited and well-trained staff team who provide effective support in enhancing their quality of life and helping them further develop life skills. EVIDENCE: Records demonstrated that recruitment procedures are sound and include all necessary checks, including Criminal Record Bureau checks. Staff advised that residents are consulted and meet staff applicants before appointments are made. This was evidenced by discussion with residents in Chestnut lodge, and by examination of records. Beech Lodge - Deaf-initely Independent DS0000004233.V318273.R01.S.doc Version 5.2 Page 18 The home was able to provide extensive training details demonstrating comprehensive staff training in mandatory and relevant areas. Staff were able to demonstrate in discussion their knowledge and training, and observations of staff interacting with service users showed they had a good knowledge of their needs and how to meet them. The majority of staff were seen to be very proficient in signing and understanding residents signing, and those newer staff who were not yet fully proficient were confident they were learning fast. There was no indication of any residents being frustrated by an inability to make their needs known to staff. Rotas and observations on the day showed that there were sufficient staff on duty to meet residents’ needs. Staff advised that staffing was made available to cover specific outings and events. Beech Lodge - Deaf-initely Independent DS0000004233.V318273.R01.S.doc Version 5.2 Page 19 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. 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 this service. Residents benefit from a well-run home, in which their health, safety and welfare is promoted, and in which their views and the views of significant others inform the development of the service. EVIDENCE: Beech Lodge has recently appointed a manager who is currently going through the process of registration with the Commission for Social Care Inspection. The managing director advised that this had been actioned a number of weeks ago and that there have been delays in responding from CSCI. The manager advised that he is on course to complete his Registered Manager’s Award by the end of the year. The Managing Director, who was also present during the early part of the inspection was previously the Registered Manager, and is based in the home on a full-time basis. Beech Lodge - Deaf-initely Independent DS0000004233.V318273.R01.S.doc Version 5.2 Page 20 Information provided prior to the inspection showed that the service is able has a detailed program of building renovation and improvement, a clear structure and a clear statement of purpose. The ethos demonstrated throughout both homes was one that promoted the well being and development of the people living in the home, providing a skilled, specialist service to that end. Questionaires sent to professionals were seen. These were very positive in their responses. It was clear throughout that residents ‘ views are heeded, and that developments in the home are done mindful of resident’s wishes. One example was of how rooms and a kitchenette had been arranged to facilitate the independence and wishes of two service users. In some instances, as with changes to the lounge/dining room, staff try to anticipate residents’ wishes, or offer alternatives. In that instant, the change was found to be very popular with at least one resident by her increased use of it, rather than anything she might sign. Regulation 26 visits are undertaken by an outside consultant. Copies of these reports were seen. These were generally very positive, and had also highlighted in the past small items of concern or areas with scope for improvement, which had consequently been addressed. The pre-inspection questionnaire completed by the home indicated that all matters relating to health and safety in the home were managed appropriately, and that all required records and checks are up-to-date. A tour of the premises, discussions with staff and management showed nothing to contradict this. Any potentially hazardous substances were locked away. The home has a policy of using only domestic, rather than commercial or industrial products. Fire doors were seen to be operated suitably, with suitable closure devices on, staff and residents were aware of the procedure in the event of the alarms flashing and sounding. Beech Lodge - Deaf-initely Independent DS0000004233.V318273.R01.S.doc Version 5.2 Page 21 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 4 33 X 34 3 35 4 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x Beech Lodge - Deaf-initely Independent DS0000004233.V318273.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? no 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. 1 Refer to Standard YA24 Good Practice Recommendations It is recommended that the service reviews the number and necessity of notices aimed primarily at staff that are on walls in communal areas. Beech Lodge - Deaf-initely Independent DS0000004233.V318273.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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