Inspection on 12/09/05 for Bromsgrove Road, 5

This inspection was carried out on 12th September 2005.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bromsgrove Road, 5 10/11/09

Bromsgrove Road, 5 02/08/07

Bromsgrove Road, 5 28/06/06

Bromsgrove Road, 5 07/12/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Bromsgrove Road, 5 5 Bromsgrove Road Droitwich Spa Worcestershire WR9 8LR Lead Inspector R McGorman Unannounced Inspection 12th September 2005 10:00 Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 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 Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bromsgrove Road, 5 Address 5 Bromsgrove Road Droitwich Spa Worcestershire WR9 8LR 01905 774263 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) MacIntyre Care Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The current Statement of Purpose and Service User Guide for the home will be reviewed and produced in the MacIntyre format by 30th June 2005. Staffing levels will be maintained in accordance with the contact time specified by Worcestershire County Council (see `Staffing Schedule`) and reviewed in consultation with the CSCI by 30th June 2005 to reflect the revised Statement of Purpose. Any improvements required by other regulatory agencies will be carried out within time-scales agreed with the CSCI and by 30th September 2005 at the latest. 21st December 2004 3. Date of last inspection Brief Description of the Service: 5, Bromsgrove Road is registered to provide residential care for up to 4 adults who have a learning disability, and may include one person with an additional physical disability. The premises is a semi-detached property, situated on the main road on the outskirts of Droitwich Spa, within easy access of the town centre, and various amenities and facilities. The Registered Provider is MacIntyre Care, who has recently taken over this responsibility from the Royal Mencap Society. The stated purpose of the organisation is, ‘to be recommended and respected as the best provider of services for people with learning disabilities throughout the United Kingdom.’ Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of this routine unannounced inspection was to follow up previous requirements and recommendations, to monitor the care provision at the home, and to investigate an anonymous complaint. The inspection was undertaken over two days, as the acting care manager was on leave at the time of the first visit. Time was spent talking with 3 members of staff and 3 service users, who all indicated they were happy to be living and working at 5, Bromsgrove Road. A tour of the building was also undertaken. The care records of service users were seen, and detailed discussion held with the acting manager in respect of one person who had been demonstrating very challenging behaviour. The records kept in respect of the maintenance of equipment and safe working practices were also checked. What the service does well: The home has a friendly and happy atmosphere, and service users are involved in the daily routines within the home. Everyone goes to college, attends day placements and has a varied programme of leisure activities. The staff team is fairly new and the morale is good. There is evidence of a commitment to their work, and they are well motivated, and provide a high standard of support for service users. The initial assessment process is thorough and staff are able to demonstrate a good understanding of the needs of service users. Risk assessments are in place. The acting manager has an organised approach to her work. The records were well maintained and up to date. The privacy of service users is respected, they are aware of their rights, and are encouraged to voice their opinions. Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 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. Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 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 the following standard(s): 1,2,4 & 5 Documentation is in place to provide information to service users or their representative, but this needs further development to ensure that relevant details enable an appropriate decision about their future care needs. The admissions procedure is followed in detail, and all proposed admissions to the home are planned very thoroughly, over several weeks, to ensure an appropriate decision is made, both by staff at the home and also the service user. Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 Page 10 EVIDENCE: A Statement of Purpose and the Service Users Guide have been produced by MacIntyre Care, and provide much of the information identified by this standard. Further amendments are necessary to ensure clarity, and these will be discussed with the Regional Manager, in due course. The complaints procedure, which is included in these documents, also needs to be reviewed. The Terms and Conditions of residence for each service user had been agreed with the previous proprietor, and therefore needs to be updated, to reflect the current situation. The admission procedure includes extensive assessment by staff from the home, and a Community Care Assessment is provided by a social worker. A gradual introduction is made to the home following the initial referral, and a place is only offered if it seems likely that a suitable service can be provided for the prospective service user. Admission is agreed on a trial basis initially. The file of a service user admitted to the home quite recently, confirmed that appropriate procedures have been followed. Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 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 the following standard(s): 6,8,9 & 10 The service users plan of care is based on the initial assessment, which clearly identifies their assessed needs, and how these will be met. Service users living at the home are supported in making choices in all areas of their lives. Risk management strategies enable a responsible approach to the risks associated with the various activities of daily living. Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 Page 12 EVIDENCE: An individual plan of care is produced for each service user, based on the initial assessment undertaken during the admission process. The care plan of one service user was checked in detail, and was found to be very comprehensive. There was evidence of person centred planning being developed. The needs and individual preferences of each service user are identified as far as possible, and their participation in the daily life of the home, is constantly encouraged. Regular weekly meetings are held with service users, with a record maintained, of any issues that are discussed. Regular agenda items include food, activities and the accommodation. Risk assessments are completed, in relation to the premises, to the activities undertaken, and any restrictions that may be imposed, and also in respect of every aspect of the life of each service user. A policy on Confidentiality has been produced by MacIntyre Care, which is clearly understood by staff, and reassures service users that information about them is handled appropriately. Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 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 the following standard(s): 11,12,13,14 & 15 The opportunities made available to service users, and their regular involvement with family and friends, enables them to live as fulfilling a life as possible. Service users are involved in all the arrangements at the home, and everyone is involved in planning their daily activities, both within and outside the home, which ensures a good quality of life for each individual. Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 Page 14 EVIDENCE: Service users are encouraged to follow an ‘ordinary’ life style as far as possible, by using the same facilities as other members of the community, and being involved in a range of leisure activities, of which a detailed record is maintained. Service users have enrolled at college and participate in various courses that include cookery, computer studies, pottery, arts and crafts, life skills and gardening. In addition, some service users attend day centres, the Social Education Centre, and Top Barn Farm. Arrangements for holidays are made, as appropriate, and some service users also spend weekends and Christmas with family. Activities in which service users are involved are many and varied, and may be in-house or in the community. These include, household tasks, assisting with preparing meals, knitting, drawing, going for a walk, shopping, line dancing, swimming, keep fit, going to the pub or out for a meal and playing bingo. Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 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 the following standard(s): 18,19 & 20 Support is provided to each service user, and encouragement given to promote independence as far as possible, in meeting the personal care needs of each individual. Advice and guidance is available from the primary healthcare teams, and associated specialists, to ensure that the health needs of service users are fully understood, and that appropriate responses are made. Arrangements for the safe administration of medication are in place at the home. Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 Page 16 EVIDENCE: The personal and care needs of service users are well documented, and there is evidence to show how staff understand and respond to them in an appropriate way. Personal care is provided in privacy. The healthcare of service users is closely monitored, and additional specialist support and advice is sought from the primary health care team, and other health professionals, when necessary. Evidence was found of the support being currently provided to staff at the home, in respect of a service user whose behaviour has been challenging to the service during recent months. Service users are enabled to visit their GP, or the practice nurse, when appropriate, to seek medical treatment, or for advice. A well-person health check is arranged for each person, at the local medical centre. Visits to the optician, chiropodist and the audiology clinic are organised when necessary, and regular dental checks are also undertaken. A Health Action Plan, which forms part of the national development framework for people with a learning disability, is being developed for each service user living at the home. Medication arrangements at the home are satisfactory. A monitored dosage system is in use, and regular checks by the pharmacist are undertaken. The Medication Administration Records are being completed appropriately. The advice of the Pharmacist Inspector is to be sought in regard to the medication regime of a service user living at the home. Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 A satisfactory complaints procedure is followed at the home, and service users are encouraged and enabled to express their views and opinions. The manager demonstrated an awareness of the issues relating to abuse, which should ensure the protection of service users, although the need for further training for some staff was identified. EVIDENCE: A complaints procedure has been produced and is included in the information provided to service users. The document has been discussed with individual service users and is produced in a format that is understandable to them. They are provided with coloured cards to enable them to direct their complaint to the appropriate person. A record of complaints is maintained, although none have been received at the home recently. An anonymous complaint was made recently to the Commission, and the concerns are currently being investigated. The management of the home is able to demonstrate a clear understanding of the issues relating to abuse. The need for training for all staff on the Protection of Vulnerable Adults (POVA) has been identified. A copy of the procedures for responding to suspicion or evidence of abuse, together with the organisations policy on physical intervention should be submitted to the Commission. Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,28 & 30 The premises are suitable for their purpose. They are comfortable and clean, and ensure as far as possible that the safety and wellbeing of service users is promoted. The location of the house is convenient to local services and facilities, and the layout provides adequate communal space for the needs of service users. The standard of the accommodation is satisfactory, and provides service users with a comfortable and homely place to live. Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 Page 19 EVIDENCE: The premises at 5, Bromsgrove Road, is a semi-detached house with accommodation on two floors, which is maintained to a satisfactory standard, and is suitable for its purpose. The home is not able to accommodate wheelchair dependant people. The limited garden to the rear of the property consists of a yard and a decking area, with some raised flowerbeds, which is accessible to service users. The local park is used by service users, who go there for walks quite regularly. There are no facilities for car parking at the house. There are four single occupancy bedrooms for service users, which comply with the space requirements, although they do not have a wash hand basin for the use of residents. The bedrooms seen were nicely furnished and had been personalised by their occupants. The communal areas of the home are nicely decorated and comfortably furnished. There is a pleasant lounge/dining room, for the use of service users. The home is clean and free from offensive odours. Procedures are in place in regard to the control of infection, and training is given to staff on health and safety matters. There were no outstanding requirements following the last visit of the Environmental Health officer. The Fire Safety Officer inspected the home in April 2005 and the recommendations made following the visit have been implemented. Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35 & 36 The home has a new team of staff, which is now working ensure that the needs of service users living at the home are effectively met. The training programme available to staff provides then with the competencies necessary for them to be effective in their work. Supervision procedures ensure that all staff are given appropriate support. Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 Page 21 EVIDENCE: The rotas indicate that appropriate staffing levels are maintained to provide for the identified needs of service users, although there has been a complete change of staff during recent months. Three new members of staff have joined the group, and the situation is now more settled. There had been excessive use of agency staff, and to provide adequate cover for the service, the acting manager was required to work additional shifts and several on call/sleep-in duties each week, but this too has now been resolved, although there is still the need to employ some agency staff. A training programme is in place at the home, and the new members of staff have undertaken induction training, which has included, Fire Awareness, Basic First Aid, Health & Safety and Basic Food Hygiene. The training needs of staff are reviewed, and a training record is maintained in respect of each member of staff. Proposed courses for the next 3 months include, Person Centred Planning, Managing Challenging Behaviour and Physical Intervention. Supervision sessions are organised on a monthly basis, and an annual appraisal is to be undertaken with each member of staff. Staff meetings are held approximately every month. Comments from staff are very positive about their experiences of working at the home, and also of being employed by MacIntyre Care, which will inevitably be of benefit to service users. Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,41,42 & 43 The home is well managed at present, but a registered manager needs to be appointed in order to comply with legislation. The health, safety and welfare of service users is promoted and protected in respect of all safe working practices. The support provided to staff by the area manager, ensures the promotion of the aims and objectives of the home. Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 Page 23 EVIDENCE: The management structure for 5, Bromsgrove Road includes a Service Manager, who is now located in Worcestershire, and a Regional Director and a Managing Director who work at Head Office in Milton Keynes. The home does not have a Registered Manager in post, but the Acting Manager, Mrs Julie Bedford has responsibility for the day to day running of the service. Support is provided by the Service Manager and also from the registered manager of another home in the area. Safe working practices are in place at the home, and staff received training in all aspects of health and safety. The Company employs an officer to advise on health and safety matters. Risk assessments are completed for all safe working practices. The records were not checked in detail during the inspection, although those seen had been completed to a satisfactory standard. The Fire Log indicated that weekly checks of the fire alarm system, and practice evacuations are undertaken. Regular maintenance and servicing of equipment had been done, and temperature checks undertaken. There has been some misinformation passed to the home in respect of Notification to the Commission, under Regulation 37, of death, illness and other events, which may adversely affect the well-being or safety of any service user. The requirement was discussed with the Acting Manager and written guidance provided. The Commission had not received a recent report on the conduct of the care home, from or on behalf of the Responsible Individual, in respect of the monthly visits to the home, under Regulation 26. Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 Page 24 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 X 3 2 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 2 3 X 3 X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X 2 X 2 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bromsgrove Road, 5 Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 2 X X X 3 2 2 DS0000064301.V253107.R01.S.doc Version 5.0 Page 25 YES 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 6 Requirement The statement of purpose and the service users guide must be revised to accurately reflect the services and facilities available The contract/statement of terms and conditions must be amended to reflect the organisational changes Training must be provided for staff on all aspects of abuse and the protection of vulnerable adults A wash hand basin must be provided in each bedroom A manager must be appointed at the home and an application for registration submitted to the Commission without further delay Notification must be made to the Commission of the occurrence of all accidents, injuries, illness and incidents in accordance with Regulation 37 and Standard 42 The person carrying out the monthly visit must prepare a written report on the conduct of the care home, and a copy must be submitted to the Commission Timescale for action 31/10/05 2 YA5 15 31/10/05 3 YA23 13 31/12/05 4 5 YA25 YA37 23 8 31/03/06 31/12/05 6 YA42 37 31/10/05 7 YA43 26 31/10/05 Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 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 2 3 4 5 Refer to Standard YA6 YA19 YA33 YA35 YA36 Good Practice Recommendations Further development of Person Centred Planning should be undertaken by staff at the home Health Action Plans should be introduced for all service users The staffing arrangements at the home should ensure that the use of agency staff is limited Ongoing training should be organised for all staff at the home Supervision arrangements for staff at the home should be further developed to include an annual appraisal Bromsgrove Road, 5 DS0000064301.V253107.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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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