Inspection on 08/08/05 for Browfield Residential Care Home

This inspection was carried out on 8th August 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Browfield Residential Care Home 05/11/08

Browfield Residential Care Home 22/11/06

Browfield Residential Care Home 11/01/06

Browfield Residential Care Home 14/03/05

Browfield Residential Care Home 22/09/04

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

CARE HOME ADULTS 18-65 BROWFIELD RESIDENTIAL CARE HOME 159/161 Walmersley Road Walmersley Bury BL9 5DE Lead Inspector Lucy Burgess Unannounced 8 August 2005 th 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. BROWFIELD RESIDENTIAL CARE HOME F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Browfield Residential Care Home Address 159/161 Walmersley Road Walmersley Bury BL9 5DE 0161 797 8457 0161 797 8457 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Jacinta Ormerod Mrs Margaret Motby CRH PC Care Home Only 14 Category(ies) of MD Mental Disorder - 10 registration, with number MD(E) Mental Disorder over 65 - 4 of places BROWFIELD RESIDENTIAL CARE HOME F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: That the home is registered to a maximum of 14 service users to include: Up to 10 service users in the category MD (Mental Disorder excluding learning disability or dementia under 65 years of age). Up to 4 named service users in the category MD (E) (Mental Disorder excluding learning disability or dementia over 65 years of age). The service should employs a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 14th March 2005 Brief Description of the Service: Browfield is a residential care home providing accommodation and support for up to fourteen people who are recovering from a mental illness. The home is registered to provided support for up to 4 people over the age of 65 years. The property comprises of two large terrace houses, which are adjoining. Accommodation is provided on three levels and includes 10 single bedrooms and 2 double rooms. There are 3 lounges and a dining room. The home is situated on a main road approximately 1 mile from Bury town centre and is easily accessible for public transport. Local shops, pubs and other amenities are situated nearby. BROWFIELD RESIDENTIAL CARE HOME F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day for a period of 7.5 hours. The inspector took the opportunity to look round the home, view records as well as talk with a number of residents. Discussion and feedback was also held with the Owner and Manager. The home is registered to provide accommodation for up to 14 people. At the time of the inspection there was one vacancy. Not all the standards were looked at during this inspection. Key standards not addressed will be look at during the next inspection. What the service does well: What has improved since the last inspection? The manager has arranged for work to be carried out throughout the home, which is making an improvement to the environment. Further work is planned. Feedback received from one resident was that she was very happy with the changes that had been made within her bedroom and bathroom and that “things were much easier”. Improvements have also been made with regards to the choice of activities being offered to some residents, encouraging them to take part in new activities or take part in things of interest. BROWFIELD RESIDENTIAL CARE HOME F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 Page 6 Care plans were better organised. Information was clear and gave staff details about the resident, their support needs and how they should be met. Further training has also been offered to staff giving them knowledge and skills in supporting residents with mental health needs. The medication system had been improved. Items were stored safely. Minor changes were needed to the records so that they clearly stated what medication is being given to the residents and practice is seen to be safe. 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. BROWFIELD RESIDENTIAL CARE HOME F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 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 BROWFIELD RESIDENTIAL CARE HOME F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 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) None EVIDENCE: The key standards will be addressed at the next inspection. BROWFIELD RESIDENTIAL CARE HOME F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9 and 10 Residents care plans and risk assessments clearly identify the support needs of service users and how these should be met ensuring their health and well being is maintained. Residents expressed they were well cared for and were clearly involved in making decisions about their lives. EVIDENCE: Detailed care plans and risk assessments have been developed and include information regarding individual’s physical, emotional and mental well-being. Files were orderly and separated into specific areas. Plans are reviewed regularly or as needs change. This was evidenced on those files seen. It is suggested that plans are signed by the residents to evidence their involvement and agreement. Where formal mental health reviews had been held these had involved relevant health and care professionals who provide additional support to the residents. Changes in needs, medication etc were clearly recorded. Risk assessments have also been completed. These identify issues related to the person mental health needs, possible triggers, changes to be aware of and methods of intervention. The Community Psychiatric Nurses (CPN) and hospital consultants provide on-going support and advise to the team. BROWFIELD RESIDENTIAL CARE HOME F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 Page 10 Additional records are also held. Each resident has a communication diary, which is completed by the staff on a daily basis. This enables information to be passed within the team of individuals’ daily activities, if any issues have arisen or for monitoring purposes. The manager also completes a weekly update, summarising events from the previous week and if any follow up action is needed. This was seen to include the monitoring of service users dietary needs and mental health due to recent changes in their health and behaviour. All action is highlighted and staff are requested to read information when starting each shift ensuring they are up to date with current needs and support to be offered. Residents are able to make decisions about their lives enabling them to increase their independence. Residents are able to come and go freely pursuing activities of their choosing and this was observed during the inspection. Residents follow various leisure activities preferring not to undertake formal courses or therapeutic employment opportunities. Daily routines are based on individual preferences, age and motivational levels. From feedback received and through observations made residents are happy with the support they receive. Interactions with staff were seen to be open and friendly. Residents felt they could speak with the manager and staff in confidence. Staff were found to have a good awareness of individual needs. Information regarding the residents is held securely within the staff office. This is accessible to staff to refer to throughout the day. Comments received included, “we get on well with all the staff”, “they always knock before coming into my room”, “ I feel happy and settled” and they’re brilliant”. Residents felt that the staff understood there needs. A random sample of resident’s money held on their behalf was checked. These were found to be accurate and appropriate records made. A number of residents also have separate savings accounts. BROWFIELD RESIDENTIAL CARE HOME F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 Page 11 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) 11 to 17 Residents choose how they wish to spend their time taking part in a variety of activities, which they enjoy. They participate within the community, enabling them to lead valued lives, develop skills and increase their independence. Support is offered where required. Regular contact is made with family and friends and open visiting is encouraged. The meals are good and offer choice, providing residents with a varied diet. EVIDENCE: Residents pursue a variety of activities both in and away from the home. Generally individuals at present have chosen not to pursue formal courses or therapeutic employment. One individual however does attend a local day centre each week. The home is situated on a main road and is easily accessible for the local buses to and from Bury. All but one resident has a bus pass. There are also local shops, churches and pubs within walking distance of Browfield. BROWFIELD RESIDENTIAL CARE HOME F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 Page 12 Activities are provided within the home and these include video nights, board games, bingo etc. Routines are very much dependant on the needs and wishes of individuals. Encouragement is offered enabling individuals to pursue their own interests. For example one resident enjoys gardening, therefore several garden pots and flowers have been purchased, which have then been made up and sit in the homes back yard. Garden furniture has also been purchased so that individuals can sit outside and enjoy the good weather. Other residents have been encouraged to make use of the local park. The manager arranged for the use of a wheelchair for one person who has difficulties with mobility so that she too could visit the park. A number of residents choose to pursue their own interests visiting the local shopping centres, meeting friends and family. Several of the residents have planned a holiday. One resident following the inspection was going to the south coast with her partner for a holiday, while later in the year a small group with staff support have arranged a few days in Blackpool. Those residents spoken with were looking forward to their holidays. Individual rights are promoted. Residents are given their mail unopened and those who wish to have keys for their own room. Menus are in place offering a variety of meals. Alternatives are available for those who do not want the main option. Several areas had been identified in relation to residents dietary needs i.e. diabetes, eating disorder and the need for weight loss. Alternative options are provided with regards to sugar free items or build up drinks. Additional monitoring is also undertaken where staff will record diet intake and weights. Action would be taken with referrals to the dietician if a need were identified. Residents also benefit from regular contact with family and friends. Several individuals have regular visits to and from members of family, this is encouraged. One resident who had recently celebrated her birthday said that her children and grandchildren had visited her and that staff had made a birthday cake for them to share in the privacy of one of the lounges. Feedback received, included that residents felt they were able “to do there own things” and were looking forward to their holidays both with and without the staff. BROWFIELD RESIDENTIAL CARE HOME F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 Page 13 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 to 21 The health and personal care needs of residents are consistently met ensuring their well-being is maintained. Positive relationships have been developed with specialist health services ensuring residents health is promoted. Improvements have been made in relation to the medication storage system however records need to be expanded upon ensuring residents are protected and practice is safe. EVIDENCE: Documentation is held with regards to resident’s mental and physical health. Relevant health care professionals are involved ensuring sufficient support and monitoring is provided. Formal reviews as required under the Mental Health Act are made and detail the stability, progress or concerns in relation to the resident’s mental health. Detailed information is recorded within the care plans outlining the needs of individuals and how they are to be met giving clear directions to those offering support. Personal care support is provided in varying degrees depending on needs and information is recorded. In the main residents are prompted in maintaining their own personal care. Two residents who share a downstairs bedroom have an en-suite bathroom, which has recently been adapted with a walk in shower and chair. This enables staff to assist them in meeting their personal care needs. BROWFIELD RESIDENTIAL CARE HOME F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 Page 14 The medication system was examined. Improvements have been made by the home following an inspection by the CSCI pharmacist. Areas of development were found with regards to hand written records where changes have been made to medication. Where doses have changed or stopped information needs to clearly evidence when such changes were made and by whom. The same information is required for new medication and double checked ensuring what has been recorded reflects what is detailed on the prescription. This will ensure that medication is being administered as prescribed and practice undertaken by staff is safe. Practice in relation to controlled drugs was found to safe and appropriate records made. Recent medication training has also been undertaken by some members of the team. Residents’ medication is also regularly reviewed with health professionals ensuring the stability of their mental health. Generally service users do not self medicate. One resident held some medication. This involved the completion of a risk assessment, which was agreed by relevant parties and is monitored to ensure that the resident is able to manage. This gives residents further opportunities to learn new skills and take responsibility in maintaining their overall well-being. The manager has spoken with each of the residents with regards to their wishes in the event of ill-health or death. For those who have specific wishes this has been detailed on their care plan, others have preferred not to discuss the matter and this has been respected. BROWFIELD RESIDENTIAL CARE HOME F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Systems were in place with regards to the investigation of complaints and adult protection issues, ensuring that residents were listened to and protected. EVIDENCE: Clear policies and procedures are in place covering these standards. No complaints have been received either by the home or CSCI. A copy of the Local Authorities Vulnerable Adults procedure has been accessed. The team have some knowledge in relation to the procedure to follow and recent training has been completed, evidence is to be placed on file. Residents spoken with were clear about what they could do if they had any concerns or complaints. Residents felt they were able to raise any issues with the staff, manager or owners. The home also has further written policies and procedures for adult protection these include dealing with whistle blowing, aggression, service users finances and missing persons. BROWFIELD RESIDENTIAL CARE HOME F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 Page 16 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 & 30 Browfield provides a comfortable, clean and homely environment for the residents living there. The environment is currently being improved with the on-going refurbishment taking place. EVIDENCE: Browfield is a large property that is in keeping with those around it. All but two of the bedrooms are single, with only one having en-suite facilities. Several areas have recently been refurbished and redecorated, which have enhanced the environment. This has included new carpets to the hall, stairs and landing and redecoration of several bedrooms and bathrooms. The manager has identified further work within the dining room, smoke lounge and additional bedrooms. These have been included within the homes refurbishment programme. It is anticipated that the work will be completed by the end of the year. Residents spoken with were happy with the improvements made to their rooms and had been involved in planning the work and choosing colours. Although not every room was seen, those looked at had been personalised with resident’s belongings. BROWFIELD RESIDENTIAL CARE HOME F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 Page 17 The home also has a dining room and three lounges, two of which are the designated smoking areas. Residents were seen to spend time relaxing in all areas. A separate office is also provided. There are two bathrooms as well as the en-suite on the ground floor. This has recently been fitted with a walk in shower along with suitable aids to assist the residents. One resident stated this “had made things much easier”. The home employs designated domestic staff that undertake a majority of the domestic tasks, however additional tasks are carried out by the support staff. The environment was seen to be clean and odour free. BROWFIELD RESIDENTIAL CARE HOME F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 Page 18 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 to 36 Staff at the home are experienced and in sufficient numbers to meet the needs of service users. A programme of training has been identified equipping staff with the knowledge and skills needed in meeting the needs of service users. Recruitment and selection procedures need to be improved ensuring that the service users are protected. EVIDENCE: The manager of the home has recently been registered by the CSCI as registered manager for Browfield. Previously the owner had managed the home. The changes in management appear to have worked well and positive relationships have been developed within the team. The majority of staff have worked at the home for a number of years and have developed good working relationships with the service users who in the main have also been resident at the home for long periods of time. Staffing levels are sufficient to meet the needs of the residents. As the staff team is small with little turnover, recent recruitment has not been undertaken. The Manager is aware of the information to be held on staff personnel files as well as Criminal Record Checks. Staff files seen did not hold all information required. New recruitment information has been developed and should be used when recruiting new staff so that all necessary details and BROWFIELD RESIDENTIAL CARE HOME F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 Page 19 checks are carried out prior to commencing work. Criminal record checks have previously been carried out on all staff, several were identified for renewal and these should be applied for. Recent training has taken place and has included, Topss Internet induction (1 day), medication, food hygiene, vulnerable adults and mental health issues. Further training has been planned in relation to health and safety and dementia. Training records are held however some evidence was not found. These should be developed. The home also hold a Topps induction booklet, this would be used as part of the in-house training with all new staff along with the formal 1-day training course. Five members of the team have recently completed the NVQ training and are currently awaiting verification of their results. The manager has already achieved the Level 4/Registered managers Award. A supervision system has also been introduced. From records seen not all staff had received regular 1-2-1 support session. The manager explained that several meetings have been held for those completing the NVQ training, whilst team meetings had been used as a form of supervision for others. This practice is agreed as a form of support for all team members however there may be specific issues that staff members wish to discuss individually with the manager, therefore every effort should be made for supervision to be made available. Records are made of all supervisions and minutes of team meetings. BROWFIELD RESIDENTIAL CARE HOME F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 Page 20 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) None EVIDENCE: The key standards will be addressed at the next inspection. BROWFIELD RESIDENTIAL CARE HOME F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 2 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 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 BROWFIELD RESIDENTIAL CARE HOME Score 3 3 2 3 Standard No 37 38 39 40 41 42 43 Score x x x x x x x F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 Page 22 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 20 Regulation 13 Requirement That all hand written medication sheets for new medication is are signed and stipulates the commencement date. That all changes to medication sheets are signed and dated and stipulate who authorised such change. That CRB checks are carried out for thse staff identified at inspection Timescale for action 30 September 2005 30 September 2005 30 October 2005 2. 20 13 3. 34 19 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. Refer to Standard 6 23 35 36 Good Practice Recommendations That service users sign care plans to evidence their involvement and agreement. That evidence of staff training in relation to Vulnerable Adults is placed on file. That individual training profiles clearly evidence courses completed. That formal supervision is held with all staff a minimum of 6 times per year. BROWFIELD RESIDENTIAL CARE HOME F56 F06 S8421 Browfield V212772 080805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Turton Suite, Paragon Business Park Chorley New Road Horwich Bolton, BL6 6HG 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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