CARE HOME ADULTS 18-65
Benjamin House 41 Ormerod Road Burnley Lancashire BB11 2RU Lead Inspector
Jeff Pearson Unannounced 28 July 2005 09:30 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 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 Stationary 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. Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Benjamin House Address 41 Ormerod Road Burnley Lancashire BB11 2RU 01282 835926 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Bridget Mary Healy Care Home (CRH) 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (MD) of places Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home will accommodate up to 10 adults up to the age of 65 years who have mental health problems. Date of last inspection 6th January 2005 Brief Description of the Service: Benjamin House is part of Healy Care Dispersed Home Scheme which consists of three terraced properties. An additional property is utilised as an office facility. The properties are situated upon the same road, in what is primarily a residential area. Benjamin House is in close proximity to a number of resources and community facilities, and is registered to accommodate 10 adults under the age of 65 with a mental illness. The accommodation available is homely and domestic in style. There are two lounges (one designated as a smoking room) and a dining kitchen with conservatory area. There are six single bedrooms (four with en-suite toilets) and two twin bedrooms. Work to further develop the accommodation is being carried out. Staff are on duty to provided support 24 hours per day. Transport is available to enable service users to visit relatives, take short trips and also outings within the community. Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 8 hours. There were 7 service users accommodated. During the inspection 5 service users, the house manager and staff were spoken with. The files of 3 service users were examined along with various other records, including the records of the two most recently employed staff. A tour of the premises was carried out. Two completed ‘comment cards’ were received from service users. What the service does well: Benjamin House had a relaxed, friendly atmosphere relationships between everyone seemed good. One person said, “I really like living here” People living in the home were being helped to make decisions and choices within their daily lives. They were involved with day-to-day matters and future planning. Individual Plans drawn up with each person, made sure staff knew how to support them. House meetings were held on a regular basis so people could voice their opinions and make suggestions. Everyone living in the home was having some contact with the local community and people were being supported to take part in various activities. Contact with relatives and friends was good; people said they were keeping in touch with families. “My dad came for a visit and I speak with my brother on the phone”, one person said. People were getting support with medical needs, such as seeing the Doctor or attending hospital appointments. Arrangements had been made for people to have annual holidays. One person commented, “ We had a great time, it was a good holiday” Providing people with some one to one support is part of the homes routine practice. Staff were sensitive and respectful towards people living in the home and showed a real interest in their well being. Service users said they were happy with their rooms, most had brought or bought items to personalise them. Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
There were lots of matters needing attention; it was of concern that most were remaining from previous inspections. The guide to the home needed to be improved, so people are clear what services and accommodation is available. Peoples’ assessment details needed to be available, to show they have been assessed and their needs can be met at the home.
Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 7 To protect peoples’ rights, the contracts of residence should be further developed to specify more clearly terms, conditions and rules. If peoples’ choices are in any way restricted, this needs to be agreed with them and recorded in their individual Plan, to show this is in the person’s best interest. More attention must be given to people taking risks and how staff should respond to these situations. More staff were needed during the day and in the evenings, to make sure people get enough support, as and when they need it. To make sure peoples’ medication is managed as safely as possible, staff needed further training, medication guidelines needed updating and clear instructions should be written on ‘when necessary’ medication. Guidelines for protecting people from abuse needed updating, to make sure staff do the right things. Work was still needed to improve areas of the home. Some bedrooms needed more things, unless people agreed they didn’t want or need them. People living in Benjamin House, their relatives and others must be formally asked if things are OK, to make sure the home is being run in their best interests. To make sure everything in the Benjamin House is as safe as possible, all areas and routines must be carefully considered to reduce the risk of harm to people living there, staff and visitors. 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. Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 9 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 standard(s) 1,2,3,5, The homes statement of purpose and service user guide were still inadequate, they did not provide accurate and sufficient information to enable current and prospective service users to be clear about the services and facilities provided. Service users initial assessment details were incomplete or not available. Therefore, it was not clear if their needs had been fully assessed or that they could be met at the home. The lack of progress in addressing previous requirements, suggested the home was unable to appropriately meet service users needs and aspirations. Individual contracts/terms and conditions were not in place for all service users and contracts were insufficient in detailing the specifics of occupancy and safeguarding rights. EVIDENCE: The statement of purpose, and service user guide, were available but they had not been updated to include appropriate specific information. Service users spoken with were not aware of the service user guide. A copy of the last inspection report was available. Service user files did not include appropriate assessment details. There was no evidence to indicate, that new service users had been informed in writing that the home could meet their needs. Several requirements and recommendations from the previous inspection were found to be outstanding.
Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 10 Only one service users file included a copy of a contract of residence. The contract had not been updated to include further good practice safeguards. Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 11 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 standard(s) 6,7,9 Improvements in the content of individual Plans had resulted in a more effective response to service users support needs. Limitations on choice needed to be recorded in agreement with individual service users and appropriate others, to ensure any restrictions are in the person’s best interest. Systems were in place to enable service users to make decisions and choices, as individuals and as a group. Assessing responsible risk taking needed further attention, to ensure a reasonable balance is achieved between independence, choice, rights and personal safety. EVIDENCE: Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 12 Individual Plans included more specific details of service users support needs, goal planning and action to be taken by staff. Reviews had been carried out. Service users had been involved with defining their Plans; most had signed in agreement with them and were aware of their contents. The house manager explained some service users had restricted choices, in relation to monies, eating sweets and going out independently. Daily care notes included comments about service users making their own decisions. Service users were seen to make decisions and choices about aspects of daily living, such as making meals and going out. Service users said house meetings were held regularly, and that they felt involved with day-to-day matters in their home. Some risk assessments had been completed, others needed updating or defining in response to individual circumstances. Risk assessments had not been completed on service users having access to hot water in their rooms. Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 13 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 standard(s) 12,13,14,15 Service users were being offered opportunities to engage in a range of activities and were supported to use community facilities. Insufficient staffing arrangements had resulted in support for service users activities/community access and one-to-one support, being limited. Arrangements were in place to enable service users to maintain links with families and friends. EVIDENCE: On the day of the inspection some service users accessed the local community. Individual activity plans were seen indicating proposed activities. Service users spoke of the various activities, both in and out of the home, including pubs, shops, church, sports centres, karaoke, DVD’s cooking and baking. Service users said they had enjoyed a recent seaside holiday, the cost of which had been included in their fees. Service users explained they were keeping in touch with members of their families, by telephone, visits or short breaks away.
Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 14 Discussion with service users and staff, along with observation of care practices, showed staffing levels did not provide sufficient support for the service users. Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 15 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 standard(s) 19,20 Service users health care needs had been identified and were being addressed. Some progress had been made with medication management, but policies and practices for managing medication remained insufficient and potentially placed service users at risk. EVIDENCE: Records indicated service users were having access to medical professionals, including psychiatric consultants; arrangements had been made for routine health checks. Service users discussed the ongoing support with attending outpatient appointments. Reviews of Individual Plans and on going monitoring records, showed referrals were being made to specialists as needed. Medication storage was secure and tidy. Service users consent to medication had been recorded. Arrangements had been made to ensure medication is appropriately managed when service users go on leave. Action had been taken to obtain dosage instructions for ‘when required’ medication, but criteria specifying when to offer this had not been defined. The medication management policies were not available, the manager said they were in the process of being reviewed and updated. Not all staff responsible for managing medication had received accredited training. Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 16 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 standard(s) 22,23 Progress had been made in providing service users with a suitable complaints procedure, which should ensure their rights to express concerns are upheld. There had been limited progress in amending the protection of vulnerable adults policies and procedures to ensure a proper response to any suspicion or allegation of abuse, this might place service users at risk. EVIDENCE: The homes complaints procedure was seen. This included clear details about how to make a complaint and how it would be dealt with and contact addresses and telephone numbers had had been included. Service users spoken with were aware of the complaints procedure; they said any problems could also be brought up in the house meetings. The record of house meetings showed various matters had been discussed. The protection/abuse policies and referral procedures were not available. The manager said they were in the process of being reviewed and updated. Some staff had received guidance on abuse and protection as part of NVQ training, or the induction training programme. Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 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 standard(s) 24,26,27,28,30, Progress had been made in improving the living environment, but some areas were still in need of attention to provide a comfortable, pleasant, living environment for all service users. EVIDENCE: The home had been extended into the next door property; this had provided additional living accommodation for the service users. The lounges were decorated to a good standard and the service users said they liked the new furniture. The dining area and conservatory provided useful space for chatting and activities. Work was ongoing to convert the former kitchen into an office and an area for smoking. There was an enclosed yard with patio furniture and shrubs, to the side of the home. The new bedrooms had ensuite toilets, were decorated and furnished to a very good standard. However one room seen needed a towel rail and lampshade. All bedroom doors had been fitted with new more suitable locks, with some service users holding keys. Service users said they were happy with their rooms, most had brought/bought items to personalise them. Some bedrooms were still in need of decorating/upgrading. Bathrooms and toilets were of good standard and provided for service users needs; thermostats had been fitted to baths and showers.
Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 18 The home was clean but one room had a malodourous smell. The laundry was easily cleanable and contained appropriate washing equipment. A cleaner had been employed to carry out domestic duties. Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,34 Daytime staffing levels were insufficient in providing appropriate support for the service users. Changes within the staff team had caused some disruption for the service users. Staff training and development was ongoing, this needed to continue to ensure all staff are appropriately trained. An improvement in staff recruitment practices and the organising of staff records, showed attention was being given to protecting the service users. EVIDENCE: Only one staff member was on rota to cover the evening shift, therefore, action needed to be taken to ensure another support worker was available to commence duty. There was one support worker and the house manager on duty. It was apparent from observation and discussion that this level of cover was not adequate in providing for the needs of service users. Nightime staffing levels had increased and a cleaner had been employed. Since the last inspection there had been changes in the staff team. Two support workers had transferred to Benjamin House from another home in the
Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 20 company and two additional support workers had been recruited. One member of staff had left. 3 support workers had recently completed NVQ level 2 and another had almost finished NVQ level 3. The house manager had completed NVQ level 4. The records of the two most recently recruited support staff were examined, both included satisfactory information. Service users spoken with expressed an appreciation of the staff team and sensitive and respectful interactions were observed. Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40,42 Although the management practices and leadership approach were satisfactory for the people living in the home, a registered manager was needed. The service users and others were not being formally consulted about the quality of the service, so had limited opportunity to influence developments in the home. The homes policy and procedures file was not available to staff, therefore service users rights and best interests may not be protected. Some arrangements had been made to maintain health and safety; further safeguards were needed to promote the well being of residents and staff. EVIDENCE: The atmosphere in the home was found to be relaxed and welcoming. Positive interactions were observed between the service users, staff and manager. An
Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 22 application for registered manager had been received at the Commission; this was being processed. Some matters were outstanding including a reference from the registered provider. There were no formal quality assurance/consultation systems in place and service users said they had not completed any surveys. The policy and procedure file was not available for staff to refer to; the manager said the policies were being reviewed and updated. Risk assessments had not been completed for all safe working practices in the home. Risk assessments had not been completed on windows and security of the building. One service users comment card indicated they only “sometimes” felt safe in the home. Staff training in safe working practices was on going, existing staff were said to have completed First Aid training. Staff files indicted 3 support workers had undertaken Infection Control training, 1 had completed a Health and Safety course. Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 2 x 2 Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x 2 3 3 x 2 Standard No 11 12 13 14 15 16 17 x 3 2 3 3 x x Standard No 31 32 33 34 35 36 Score x 2 2 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Benjamin House Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 3 2 x x 2 x F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 24 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 The statement of purpose and service user guide, must include clear factual information about the services and facilities provided. A copy of the service user guide must be given to each service user. (Timescale of 31/3/05 not met) Records of service users initial assessment must be kept available in the home. Prospective service users must be informed in writing, following assessment that the home can meet their needs. (Timescale of 14/1/05 not met) Progress must be made in addressing requirements and recommendations, to ensure the service users needs and aspirations are safely and appropriately met. Risk assessments/management strategies must be completed, on service users engaging in activities which may affect their health or well being.(Timescale of 28/1/05 not met) Staffing arrangements must be flexible and responsive to meet service users needs Timescale for action 1/10/05 2. 2 14,17 1/9/05 3. 3 12,13,16, 18,23 1/10/05 4. 9 13 1/9/05 5. 13 16,18 1/10/05 Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 25 6. 20 13 7. 20 13,17 8. 23 13 9. 24 16,23 10. 26 12,16,23 All staff responsible for dealing with medication must receive accredited medicines management training (Timescale of 31/3/05 not met) Medication management policies and procedures must be in accordance with current recgnised guidelines and legislation (Timescale of 31/3/05 not met) The protection and abuse policies and procedures must be amended to include appropriate details for responding to suspicion, allegation or evidence of abuse or neglect. Staff must be made aware of these procedures. The home must be refurbished to a satisfactory standard(Timescale of 31/3/05 not met). All Service users bedrooms must include the minimum furnishings as outlined in standard 26, of the National Minimum Standards, unless otherwise agreed. (Timescale of 26/2/05 not met) Sufficient numbers of staff who are trained and competent to meet the needs of the service users, must be on duty at all times. A formal system for reviewing and improving, the quality of care provided at the home must be implemented. (Timescale of 31/3/05 not met) Risk assessements for safe working practices must be completed. 1/10/05 1/10/05 1/9/05 1/10/05 1/10/05 11. 33 18 28/7/05 12. 39 24 1/10/05 13. 42 13 1/10/05 Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 26 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 5 Good Practice Recommendations Service user contracts should be developed to ensure that they meet the details specified in Standard 5 of the National Minimum Standards for Care Homes for Younger Adults. Copy contracts should be available on service users files. Service users Plans should describe any restrictions on choice and freedom (agreed with the service users and/or appropriate others) Clear criteria should be defined on an indivdual basis, when service users are prescribed ‘when necessary medication’ A more up to date copy of the British National Formulary should be obtained. Appropriate action should be taken to ensure the home is free from unpleasant odours. Staff should continue to be supported to undertake appropriate training. Action should be taken to ensure appropriate manager application references are forwarded to the Commission. Current policies and procedures should be available to staff at all times. 2. 3. 6 20 4. 5. 6. 7. 30 32 37 40 Benjamin House F57F079525 Benjamin House Unan V224025 250505 Stage 4 doc.doc Version 1.30 Page 27 Commission for Social Care Inspection 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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