Inspection on 21/09/05 for Bewsey House

This inspection was carried out on 21st September 2005.

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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bewsey House 06/01/06

Bewsey House 08/02/05

Bewsey House 16/11/04

Similar services:

Sunny Bank (P.R.S.) Ltd

Ashwood Court Unit 1

Thornton Lodge

Alfred House Residential Care Home

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Fernhaven

Thames House

Creative Support

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

CARE HOME ADULTS 18-65 BEWSEY HOUSE 8 Bewsey Road Bewsey Warrington WA7 2JW Lead Inspector David Jones 9 and 21 th st Announced September 2005 10:00 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. BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bewsey House Address 8 Bewsey Road Bewsey Warrington Cheshire WA7 2JW 01925-414961 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) Warrington Community Care Susan May Brown Care Home 18 Category(ies) of MD Mental Disorder (18) registration, with number MD(E) Mental Disorder - over 65 (18) of places BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 This home is registered for a maximum of 18 service users to include: * Up to eighteen service users of either sex aged eighteen to sixty five years, in the category of MD (mental disorder, excluding learning disability or dementia). 2 3 The manager achieves the Registered Manager`s Award by 2005. The registered person must, at all times, employ an experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 8 February 2005 Brief Description of the Service: Bewsey House is managed by Warrington Community Care, a registered charity. The home is registered with the CSCI to provide care and support for 18 adults in the category of mental disorder, excluding learning disability or dementia. The current age range is from 18 to over 65 years of age. However it has been agreed that the accommodation of residents who are under 40 years of age or younger would be inappropriate and arrangements are being made to change the conditions of registration accordingly. There are 18 single bedrooms on two floors, One large and three small lounges, a dining room, kitchen and laundry. There is a lift to the first floor and there are pleasant and well-established gardens to the rear. The premises have been adapted over the years but are not appropriate for people who have profound mobility problems. The home is within easy walking distance of some day centre facilities, such as Warrington Day Centre and Warrington Workspace. The offices of the Company, of Making Space and Warrington town centre are also nearby. BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on 9th and 21st September 2005. Five residents, three members of staff ,the registered manager, the service manager and the care co-ordinator were spoken with during the inspection. Inspection comment cards were received from six residents, two relatives and two social work teams, a Community Psychiatric Nurse and tow General Practitioners. Staff were observed interacting with and supporting residents. The gardens and some parts of the building were looked at, as were some records along with the case notes of three residents. What the service does well: Bewsey House is run in the best interests of residents. The premises provide well-maintained, clean and comfortable accommodation. The home’s assessment procedures make sure that a resident does not move into the home without having their needs assessed by a competent person. Residents have opportunity to visit and test-drive the home before they make any decisions about moving in. Residents are encouraged to explore and take advantage of social, recreational and employment opportunities that may be on offer to them in the community. They receive personal care in accordance with their needs and wishes. Dignity is promoted and their rights to privacy and confidentiality are respected. There is a dedicated staff team who carry out their duties in good humour. Residents are treated with respect. The majority of staff have achieved an NVQ in care at level 2 or above and there is a comprehensive staff training programme in place. Staff receive regular supervision and speak highly of the manger and the organisation stating that support is excellent. The management approach creates an open and positive atmosphere. Residents are routinely consulted and involved in the day to day conduct of the home as is appropriate. BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.doc Version 1.30 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. BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.doc Version 1.30 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 standard(s) 1, 2, 3, 4 and 5. The statement of purpose and service users guide need development to make sure that residents have all the information required by the regulations and the National Minimum Standards. Without this information residents are disadvantaged when making decisions about moving in. Residents are assessed before moving into the home to ensure that their needs can be met. New residents have opportunity to visit and testdrive home before they make any decisions about moving in. Residents sign a license agreement, which confirms terms and conditions. EVIDENCE: The statement of purpose and service user guides both need updating and further development to make sure they provide residents and their representatives with all required information. See requirement 1. Reading of the case records confirmed that the home used appropriate assessment and admissions procedures. All new residents had their needs assessed by the placing agency or by senior staff before moving in. BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.doc Version 1.30 Page 9 The vast majority of residents accommodated are over 50 years of age. However current registration conditions allow for the accommodation of people with a mental disorder from the age of 18 years and there is no upper age limit. It is a matter of concern that people with vastly differing needs could be accommodated together in one home. It is also apparent that the layout of the home and facilities and services available are not suitable for the accommodation of people with profound mobility problems. Discussions with the manager and area manager after the inspection confirmed that it would be appropriate to change the conditions of registration to make sure that they are consistent with the needs of the people the home intends to accommodate. It is agreed that people who are forty years of age or younger should not be accommodated and people who have mobility needs may only be accommodated if appropriate facilities and services can be provided to meet their needs. It is recommended that the home’s “Lettings Criteria” is changed to reflect these developments. See recommendation 1. Residents are provided with details of terms and conditions of their accommodation in the form of a licence agreement. The document identifies the charges per week, the room to be occupied and grounds for termination of the agreement for both parties. BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.doc Version 1.30 Page 10 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 and 10.Care plans require further development to make sure that all residents needs are planned for. It is difficult to find some information about residents medical history as the case records are not in chronological order. The manager is introducing a new form to improve the clarity of care plans. Staff take appropriate action when residents are unwell. Residents are treated with respect and their rights to privacy and confidentiality are respected. EVIDENCE: The care planning documentation for a resident who recently moved in does not confirm how all their personal care needs are being met. See requirement 2. All other care plans seen are appropriately detailed and confirm how resident’s needs are to be met. However, some of the information is difficult to find because it is recorded in the daily progress sheets and not in chronological order in the care plan. See recommendation 2. The Services Manager and the Home Manager advised that a new form would be introduced to simplify and improve the home’s care planning systems. BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.doc Version 1.30 Page 11 Risk assessments and risk management are an important part of the home’s care planning and support arrangements. Copies of risk assessments are provided on each resident’s case records and are updated as and when circumstances change. Risk assessments that relate to hazards presented by heated surfaces should consider the individual needs and abilities of each resident and be written on an individual basis. See recommendation 3. The organisation has a policy on confidentiality that is available in the home and was reviewed in July 2004. Staff receive guidance on matters of confidentiality during their induction training and the registered manager advised that information given in confidence by residents would not be shared with relatives without their consent. BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.doc Version 1.30 Page 12 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, and 17. Residents are encouraged to explore and take advantage of any social, recreational and employment opportunities on offer in the home or local community. Personal relationships are supported and visitors are made to feel welcome in the home. The standard of catering is good. EVIDENCE: Discussion with residents and feedback in inspection comment cards indicated that some of the residents are dissatisfied with the range of activities on offer. The manager advised that she was aware of a lack of interest in some of the activities and was in the process of identifying a range of alternatives to encourage choice and participation. Other residents were satisfied with the activities. Bingo is a firm favourite of one and another said he kept himself busy working in the garden and visiting charity shops to buy records for his impressive record collection. Staff encouraged and support individual residents with their hobbies. BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.doc Version 1.30 Page 13 Information provided by visiting relatives indicated that they are made welcome in the home at any time. Residents said that they are able to see their guests in private if they wish. All residents spoken with said they are happy with the food. Choice is available with every meal and menus seen indicated that a varied and nutritious diet is on offer. BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.doc Version 1.30 Page 14 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) 18,19 and 20. Residents receive personal support according to their wishes and requirements. Staff take appropriate action when residents are ill to make sure their health care needs are met. Action must be taken to improve working relation ships with some social care professionals. The home’s medication systems make sure that residents medication is stored, recorded and administered appropriately. Assessments as to whether it is necessary to hold and administer a resident’s medication should be recorded for evaluation and review. This will make sure that those who are able to safely control their own medication are able to do so. EVIDENCE: Reading of care plans and discussion with residents confirmed that personal care is provided according to each individual’s needs and personal requirements. Care plans are fully documented in this regard. Staff take appropriate action when residents are unwell or their needs change. Records confirm contact with health care professionals on a regular basis. Information provided by visiting health care professionals indicate that staff communicate clearly, demonstrate a clear understanding of the needs of residents and work in partnership to ensure that health care needs are met. BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.doc Version 1.30 Page 15 Information provided by some social care professionals indicated that there were some misunderstandings and poor working relationships. It is recommended that action is taken to make sure that effective working relationships and good communication systems are in place between the staff and all visiting social workers. See recommendation 4. Medicines are stored, administered and recorded appropriately. The medicines cabinet and trolley have been moved to the manager’s office and securely fixed to a solid wall. Medications records confirm that medicines are administered and recorded appropriately. The registered manager advised that residents who are able to administer their own medication would be encouraged to do so within a risk management framework. Assessments as to whether it is necessary to hold and administer a resident’s medication should also be recorded for evaluation and review. See recommendation 5. BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.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 and 23. Arrangements for the protection of residents and for making complaints are effective. EVIDENCE: The home has a complaints policy and procedure in place. Three complaints had been received, investigated and partially substantiated in the last 12 months. Information provided by the manager indicated that all complaints were responded to within 28 days and action taken to address issues, where appropriate. Robust procedures for responding to suspicion or evidence of abuse or neglect are in place including whistle blowing as in accordance with the Public Interest Disclosure Act 1998. The manager said all staff had received training or guidance on adult protection procedures. Further training needs identified by the home’s staff appraisal systems would be addressed in due course. BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.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 and 30. Residents live in well-maintained, comfortable, clean and hygienic accommodation with access to appropriate indoor and outdoor communal facilities. EVIDENCE: Bewsey House is located in a residential area of Warrington with easy access to the local shops and general amenities. The home is well maintained with good quality furnishings and fittings. It is set within its own grounds and there are gardens for residents to enjoy. It was noted that a resident’s bed was positioned along side an unprotected radiator. The resident was at risk of being burned. The manger took immediate action to make sure that residents are protected from unguarded radiators that may have a surface temperature higher then 43 degrees centigrade. BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.doc Version 1.30 Page 18 The home’s general risk assessment was reviewed taking into consideration the abilities and needs of each resident, as appropriate. Two radiators were fitted with guards. It is recommended that each new individualised risk assessment is recorded and kept with the respective person’s case notes. See recommendation 3. The communal areas of the home had been redecorated and new carpets had been provided in both smaller lounges. BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.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) 31, 32, 33, 35 and 36. Staff are employed in appropriate numbers and skill mix sufficient for the well being of residents. EVIDENCE: Discussion with residents and staff and information provided by visiting relatives indicated that staff are employed in sufficient numbers. However, information provided by visiting social workers indicated that there had been times when there had been insufficient numbers of staff on duty. The Registered Manger confirmed that there had been occasions in the recent past when the dependency levels of a number of residents had changed significantly and staffing levels had been insufficient. Further discussion with the Care Coordinator indicted that the home needed to make arrangements to make sure that additional appropriately trained staff are available at times of high demand. See recommendation 6. Staff spoken with presented as competent and knowledgeable. They were observed to carry out their duties and responsibilities with skill, care and attention to detail. Scheduled supervision is provided six times per year. BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.doc Version 1.30 Page 20 The manager confirms that Warrington Community Care operate a comprehensive staff-training programme that includes “Skills For Care” staff training standards. More than 50 of the staff team have achieved a qualification in care at NVQ level 2 or above. Training provided for staff in the last 12 months included, mental health awareness, the protection of vulnerable adults, TOPSS (Skills For Care) induction training for new staff, the registered managers award, managing change, fire awareness and equal opportunities. BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.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, 40 and 42. The registered manager is qualified, competent and experienced to run the home and meet its stated purpose aims and objectives. The management approach creates an open and positive atmosphere. Arrangements are in place to assure the health and safety of residents and staff. EVIDENCE: The registered manager is experienced in the field of mental health and has achieved the Registered Managers award and an NVQ level 4 in care. Residents spoken with and comment cards received from six others indicated that all liked living at the home. They said they were well cared for, treated well and their privacy was respected. Residents are consulted and involved with the development of their care plans and the general running of the home. Small group meetings known as lounge meetings are held on a regular basis. BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.doc Version 1.30 Page 22 Staff speak highly of the manger and the organisation stating that support, leader ship and guidance is excellent. Information provided by the manager confirmed that appropriate maintenance checks; fire protection procedures and other health and safety precautions are carried out on a regular basis. The home’s polices and procedures are reviewed and updated on an ongoing basis. The current list of available policies does not included guidance for staff on risk assessment and management. In updating its policies and procedures the organisation should confirm that it has a full set of documents by checking the list with National Minimum Standards, Care Homes for Younger Adults, Appendix 3. See recommendation 7. BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.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 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score 3 3 x x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 BEWSEY HOUSE Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x 3 x F51 F01 S27000 Bewsey House V231484 090905 Stage 4.doc Version 1.30 Page 24 No. 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 YA1 Regulation 4 Requirement The registered persons must ensure that the Statement of purpose and the service users guide contain all information as required by the regulations and the national minimum standards. The registered persons must ensure that care plans confirm how the respective resident’s health and welfare needs are to be met. Timescale for action 31.10.05 2. YA6 15 Immediate and ongoing. 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 Ya1 and 2 Good Practice Recommendations The registered persons should develop the lettings criteria to confirm that the home is unsuitable for the accommodation of people with profound mobility problems and that the minimum age for people to be accommodated is 40. The registered persons should simplify and reorganise care plans to improve access to information for residents and staff. Developments in care needs should be entered on the care plan in chronological order. F51 F01 S27000 Bewsey House V231484 090905 Stage 4.doc Version 1.30 Page 25 2. YA6 BEWSEY HOUSE 3. YA9 The registered persons should make sure that risk assessments that relate to hazards presented by heated surfaces consider the individual needs and abilities of each resident and are written on an individual basis. The registered persons should take action to make sure that effective working relationships and good communication systems are in place between the staff and all visiting social workers. The registered persons should make sure that assessments as to whether it is necessary to hold and administer a resident’s medication are recorded for evaluation and review. The registered persons should make contingency arrangements ensure that additional appropriately trained staff are available at times of high demand. The registered persons should ensure that the home maintains a full list of policies and procedures as detailed in Appendix 3 of the National Minimum Standards for the information and guidance of staff. 4. YA18 5. YA20 6. YA35 7. YA40 BEWSEY HOUSE F51 F01 S27000 Bewsey House V231484 090905 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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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