Inspection on 16/06/06 for Broadlands Nursing Home

This inspection was carried out on 16th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Broadlands Nursing Home 12/06/07

Broadlands Nursing Home 15/12/05

Broadlands Nursing Home 01/08/05

Broadlands Nursing Home 25/11/04

Broadlands Nursing Home 13/09/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

Tudor Lodge

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

CARE HOMES FOR OLDER PEOPLE Broadlands Nursing Home 51 Burdon Lane Cheam Surrey SM2 7PP Lead Inspector Margaret Lynes Key Unannounced Inspection 16th June 2006 09:55 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Broadlands Nursing Home DS0000019080.V300573.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Broadlands Nursing Home DS0000019080.V300573.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broadlands Nursing Home Address 51 Burdon Lane Cheam Surrey SM2 7PP 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) 020 8661 1120 020 8661 1768 Mr N Baloo Mrs Anita-Marie Porter vacant Care Home 25 Category(ies) of Dementia (25), Mental disorder, excluding registration, with number learning disability or dementia (25), Old age, of places not falling within any other category (25) Broadlands Nursing Home DS0000019080.V300573.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th December 2005 Brief Description of the Service: Broadlands is a pleasant home situated in a quiet residential area close to Cheam village. It is situated close to public transport links, including rail services and motorways. The home provides nursing care for elderly, mentally frail, residents. There are some nine double bedrooms and seven single. The majority of the bedrooms are situated on the ground floor. There is a large, attractive and well-kept garden, overlooked by a spacious conservatory in which the residents take their meals. The home provides information about its services in a Service User Guide, which is made available to current and potential Service Users. Additional information can be found in the home’s Statement of Purpose. The current weekly fees (as provided at the time of this inspection) range from £580 £620. Broadlands Nursing Home DS0000019080.V300573.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over the course of a little under seven hours and consisted of examination of documents; discussion with service users, relatives and staff, and a tour of the premises. There were five requirements outstanding from the previous inspection. Of these two have been met, while one was improved upon, but still not fully met. It was both disappointing and of concern to find that the requirements regarding staffing levels and proprietor monitoring visits were unmet. This inspection has resulted in a further 12 requirements being made. These relate to record keeping, the environment, health and safety, quality assurance and staff hours. Due to the outstanding requirements, and concerns over hot water temperature, two Immediate Requirement Notices were issued. Evidence to support the comments below was gathered from a range of sources – the service users themselves, relatives, members of staff and inspection records. What the service does well: What has improved since the last inspection? As the home has taken action to meet two of the requirements, it has to be acknowledged that some improvements have been made. This will have a beneficial effect on the quality of the service being provided. Broadlands Nursing Home DS0000019080.V300573.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Broadlands Nursing Home DS0000019080.V300573.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Broadlands Nursing Home DS0000019080.V300573.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (6 is not applicable) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. One of the files inspected did not contain any form of pre-admission assessment, which means that the home is not always determining each individual’s diverse needs and planning for them before they move into the home. EVIDENCE: The files of four service users were inspected. All but one contained a placing authority assessment, provided prior to the placement taking place. A relevant pre-admission assessment could not be found on one file however meaning that the home was inconsistent in its admission practice, and may well admit a service user whose needs are relatively unknown and, therefore, may not be met by the service on offer. Broadlands Nursing Home DS0000019080.V300573.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each of the files inspected contained a care plan, which means that staff have recorded the basic information necessary to plan the individual’s care. Not every file contained a risk assessment however, which means that service users may be placed, unnecessarily, in harms way. Residents have access to health care services that meet their needs, both within the home and in the local community. Two errors found within the medication charts. As has been said before in inspection reports, any mistakes made in giving out medication can have serious consequences for service users. Staff were generally aware of the need to treat residents with respect and to consider dignity when delivering personal care. Lack of information regarding the action residents would like staff to take in the event of their [the service users] death means that it is feasible that their wishes may not be followed. Broadlands Nursing Home DS0000019080.V300573.R01.S.doc Version 5.2 Page 10 EVIDENCE: Each of the files inspected contained a care plan, which was being reviewed monthly. This is good practice however the home needs to better evidence how service users are involved in the planning of their care. Only two of the files (inspected) contained a risk assessment, however they all contained a manual handling assessment. Service users are able to access community based medical services, and they are all registered with a local GP. As a result of a recent (partially substantiated) complaint about lack of information being passed to families, and questions about when the home’s GP should be consulted about the wellbeing of a service users, the manager has drawn up new guidelines for staff with regard to liaison with the GP. Following requirements in previous inspection reports, the wound care documentation was, on this visit, found to be up to date and accurate - an improvement on previous visits. While service users do not routinely undergo a nutritional assessment, the manager was confident that staff had sufficient knowledge to be able to quickly assess if a resident was not eating/drinking sufficiently well and they would then seek medical advice. While the medication administration records were much improved, due to one gap in the charts, and a number of instances where staff had not indicated why medication had been withheld, this Standard cannot be said to be met. Staff were observed over the course of lunch, and also afterwards, when service users were sitting in the lounge. Generally they were seen to treat the residents kindly, if a little loudly in some instances, however the Inspector felt that staff could be a little more attentive when assisting service users with their meals (see Standard 15). The manager is seeking a training course for staff in dealing with death/dying and bereavement. She was reminded of the importance of ensuring that the wishes of service users in the event of their serious illness/death were recorded. The home also needs to have in place a resuscitation policy and procedure, which includes guidance for staff when calling an ambulance. Although the resident information records that are used have specific space in which staff can record a resident’s wishes in the event of their serious illness and death, very little had been recorded. This is important information and staff must make every effort to obtain it. Broadlands Nursing Home DS0000019080.V300573.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a number of recreational activities, so as to try to satisfy the service users social and recreational needs, and individual choice and control is encouraged. This means that the lifestyle in the home aims to match residents’ expectations and preferences. Service users receive a well-cooked and appealing diet, which means that their nutritional needs are catered for. Visitors are made welcome. EVIDENCE: While activities are not arranged for every day, they do take place on a regular basis, and include a monthly visit from external musical entertainers. The home is fortunate to have an active relatives committee, who assist in providing recreational pursuits for service users. Although it was felt that there was a sufficient number of activities on offer, it was suggested to the manager that as the majority of the current resident group suffered from dementia, a review of activities might prove beneficial. The specialised field of dementia care is constantly being reviewed and new innovations being presented – including ways to stimulate service users. Broadlands Nursing Home DS0000019080.V300573.R01.S.doc Version 5.2 Page 12 Normally, the home can rely on the services of two cooks. Unfortunately, at present, neither is at work, which means that the catering role falls upon the shoulders of the care staff, including the manager. While the latter gave assurances that only staff who had undergone a basic food hygiene training course were permitted to take on the cooking, this situation cannot be maintained indefinitely. If is strongly recommended therefore, that a temporary cook is engaged. That having been said, the lunchtime meal was sampled and found to be satisfactory. It is felt, however, that while care staff may be able to cope for a short period, they do not possess the skills and knowledge that a specifically trained cook would have in catering for up to 25 elderly persons with specific care needs. While staff were generally patient with service users who required assistance with their meals, it was observed that they could be a little more attentive while feeding residents, and ensuring that faces were kept free of food and fluids. The day of this inspection was very warm, so it was surprising to find that there were no jugs of cold drinks in evidence in the main lounge, or, indeed, within reach of those service users who were in their bedrooms. While the manager gave assurances that cold drinks were in the fridge, this is not really of much help to elderly, often mobility and cognitively impaired residents who may not think to ask for a drink or be able to get up and get one. Broadlands Nursing Home DS0000019080.V300573.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure in place, which is accessible to service users. There is also an adequate adult protection procedure in place which, if followed by staff, will offer sufficient protection to service users. EVIDENCE: One complaint, as referred to in Standard 8, has been made to the Commission since the last inspection. This related to relatives complaining that they were not kept informed regarding a service user’s health, and also that the service user’s GP was not promptly informed of concerns. This complaint was partially substantiated and the manager required to improve the lines of communication in the home, including providing staff with clearer guidance as to when a GP should be consulted. This has been done. As noted on previous visits the home has an adequate adult protection policy and procedure in place and some staff have attended POVA training in recent months. Broadlands Nursing Home DS0000019080.V300573.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although a number of requirements have been made with regard to the premises, overall the home was found to be clean and well maintained in most areas. This means that service users are provided with a pleasant, homely and comfortable environment. EVIDENCE: A tour was made of the bedrooms and communal areas. The entire home was clean and in general well maintained, although it would greatly benefit from refurbishment as it is starting to look a little shabby and worn. A number of requirements have been made, and these relate to the need for minor repairs to a tap in bedroom 9; the need to deep clean or replace the carpet, and repair the cracks in the wall in bedroom 8; the need to ensure that the bath hot Broadlands Nursing Home DS0000019080.V300573.R01.S.doc Version 5.2 Page 15 water temperature does not exceed 43°C; and the need to fit a door guard (or other suitable fire safety device) to the door to the lounge. It is acknowledged that there is a rolling programme with regard to the need to ensure that every bedroom has an item of lockable furniture and a bedside lamp, and for this reason a requirement has not been made in this respect. The home was found to be very clean and hygienic throughout. Broadlands Nursing Home DS0000019080.V300573.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. From the rotas provided the Inspector was not fully satisfied that the number of staff on duty would result in the service users needs being consistently met. Almost all of the care staff have either an NVQ level II award or are in the process of obtaining one. This means that service users are being looked after by staff who understand their basic care needs. In addition to the aforementioned NVQ courses, some staff have been enabled to attend other training courses. This means that they should have the competencies necessary to provide a good level of service. EVIDENCE: The 4-week rota provided indicated that there were 13 occasions when the number of qualified or care staff on duty fell below the previously agreed minimum levels (even taking into account under occupancy). These levels should be 2 qualified staff with 4 carers on duty in the morning; one qualified nurse with 4 carers on duty in the afternoon/early evening; and 1 qualified nurse with 2 carers on duty overnight. Broadlands Nursing Home DS0000019080.V300573.R01.S.doc Version 5.2 Page 17 It was also of concern to find that some staff were working a day shift then immediately going on to cover a waking night shift. One must query the quality of their work when on duty for such long hours. A number of staff are currently undergoing an NVQ level II course. Once they have completed it over 90 of the carers in this home will have achieved an NVQ award. This is commendable. In addition to the NVQ, some staff have also attended training in dementia care, manual handling, infection control, food hygiene and adult protection. It was not possible to assess Standard 29 as no new staff have been recruited since the last inspection visit. Broadlands Nursing Home DS0000019080.V300573.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has the necessary experience and skills required, and while there needs to be some tightening up of practice in some areas, the overall management approach was satisfactory. The home has in place a quality assurance system, however it is some time since an audit of service user views was conducted which means that it is feasible that the home is not run in the best interests of the service users. The records relating to service users’ monies (pocket money and allowances) were accurate, which means that residents’ monies are safeguarded. Inconsistent staff supervision means that it is feasible that staff are not receiving the management support that they require, and also that they may have aspects of their practice which need to be improved, but which senior Broadlands Nursing Home DS0000019080.V300573.R01.S.doc Version 5.2 Page 19 staff have not picked up on. This could have a detrimental effect on service users. Due to the failure to evidence that all essential maintenance was up to date, it was not felt that the health and safety of either residents or staff was being promoted as well as it should be. EVIDENCE: While overall the level of care is good, improvement is needed with regard to documentation and record keeping, the environment, staffing and health and safety measures. These all fall under the remit of the manager of the home. It would be of great benefit if the manager could be supplied with a computer. There are a number of quality assurance systems in place, and they are being utilised on a regular basis – with the exception of surveying the residents, relatives, staff and other stakeholders. It is some time since such a survey was carried out, and the manager was advised that one should be conducted at least annually, and the results made public. More emphasis also needs to be put on looking at equality and diversity, and ensuring that both are an integral part of the ethos of the home. The manager looks after the pocket money for several service users. The written records appeared accurate, and matched the amount of money held for each service user. The need for regular staff supervision was discussed with the manager. While the proprietor of the home is accurate when stating that the Regulations do not require supervision every two months, this frequency is recommended in the Standards and is seen as good practice. This notwithstanding, the evidence of any staff supervision was negligible. The manager explained that she is in the process of revising the proforma currently in use to make it more fit for purpose. It is hoped that this will lead to more regular supervision taking place. While most of the issues relating to health and safety were satisfactory the Inspector was unable to evidence that the gas installation maintenance was up to date, that the electrical installation had been reviewed (in the last 5 years) or that the necessary hot food, fridge and freezer temperatures were being monitored daily. Where maintenance certificates are issued it is important that at least a copy is sent to the home and not just kept at the head office. Broadlands Nursing Home DS0000019080.V300573.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Broadlands Nursing Home DS0000019080.V300573.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 13 Requirement The manager must ensure that medication administration records are accurately kept at all times. The previously set timescale has not been fully met. The Registered Person must ensure that they (or their nominee) visit the home on a monthly basis and that a report of each visit is produced. The previously set timescale has again not been met. Staffing levels must be increased so that the minimum levels previously agreed are maintained at all times. The previously set timescale has again not been met. All service users must be assessed prior to admission taking place. A risk assessment must be undertaken for each individual service user. Staff must ascertain and record the wishes of each service user in the event of their serious illness/death. A resuscitation policy & procedure also need to DS0000019080.V300573.R01.S.doc Timescale for action 16/06/06 2. OP33 26 23/06/06 3. OP27 18 16/06/06 4. 5. 6. OP3 OP8 OP11 14 13 12 16/06/06 30/07/06 30/07/06 Broadlands Nursing Home Version 5.2 Page 22 7. 8. 9. OP19 OP19 OP19 23 13 23 10. 11. 12. OP19 OP27 OP27 13, 23 18 18 13. OP33 24 14. 15. OP36 OP38 18 13, 23 be established. Repairs need to be made to the tap in the sink in bedroom 9. The bath hot water temperature must not exceed 43°C. The carpet in bed 8 requires replacement or deep cleaning. The cracks in the wall need to be repaired. A suitable fire safety device needs to be fitted to the lounge door. Staff should not work a day shift immediately followed by a waking night shift. The staff rota must clearly indicate who is covering catering duties and they cannot also be rostered for care duties. Periodical quality assurance surveys of service users, their relatives, staff and other stakeholders must be carried out and the results made public. The manager must ensure that staff receive regular supervision. The registered person must ensure that all maintenance contracts are up to date and this can be evidenced. 30/06/06 16/06/06 30/07/06 30/07/06 23/06/06 23/06/06 30/08/06 30/07/06 30/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP12 Good Practice Recommendations Efforts should be made to better evidence service user involvement in care planning. It would be good practice to review the activities available to take into account any new developments in dementia care. DS0000019080.V300573.R01.S.doc Version 5.2 Page 23 Broadlands Nursing Home 3. 4. 5. 6. 7. OP15 OP15 OP19 OP30 OP31 If the absence of the cooks is going to be prolonged, consideration should be given to appointing a temporary cook. Staff should ensure that cold drinks are frequently offered/ on display during periods of hot weather Consideration should be given to the refurbishment of the home. It would be good practice for staff to attend training in caring for people with mental health illness. The proprietor should give consideration to providing the manager with a computer. Broadlands Nursing Home DS0000019080.V300573.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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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