CARE HOMES FOR OLDER PEOPLE
Brownhill Lodge 334 Brownhill Road Catford London SE6 1AY Lead Inspector
Ornella Cavuoto Unannounced Inspection 14th February 2006 10:00 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 Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 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. Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Brownhill Lodge Address 334 Brownhill Road Catford London SE6 1AY 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) 0208 6984978 tom_erman@hotmail.com DSRE Services Limited Mr Samuel Jeyachandran Daniel Care Home 21 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (21), Physical disability (1) of places Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. This home is registered for 21 persons of whom up to 21 can be elderly 1 person, aged 55 years or above, suffering from a mental health disorder Up to 10 elderly persons can have dementia Up to 4 elderly persons can have a physical disability 1 person, aged 55 years or above, with a physical disability Date of last inspection 11th August 2005 Brief Description of the Service: Brownhill Lodge is a large detached house in Catford, South East London. Work is being done to make all parts of the home accessible. There are good local public transport links. The home is situated on the South Circular Road. It is approximately 10 minutes walk from a parade of local shops and a short drive from Catford town centre, which has some larger shops. It is registered to provide 24-hour care for 21 older people 10 of whom can have dementia. The aim of the home is to provide high quality residential care and support services in a homely and caring environment in which residents can be persuaded and will be encouraged to determine the pattern of their lives. The home has one double bedroom shared by two service users and the remaining service users each have a single bedroom. It consists of a ground floor and two other floors, which are now serviced by an accessible lift. There are no ensuite facilities but there are three bathrooms and seven toilets. (One bathroom currently being converted to become a shower room) There are links with local health services for on-going advice and follow-up visits. Most referrals are drawn from social services department through the home finding scheme. The home employs a registered manager, sixteen care staff, one senior care staff, one full time cook and cleaner. Staff are experienced and are well trained. A newly appointed registered manager recently came into post in January 2006. Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was unannounced inspection that took place over one day. The registered manager, who only began working at the home in January 2006, was present for the inspection. The responsible individual who previously was the registered manager for the home was also present for part of the inspection. In addition four care staff, five service users and a relative were spoken to. A tour of the premises and inspection of records was also undertaken. What the service does well: What has improved since the last inspection?
The home has taken action to ensure that service users living at the home have an annual review by the placing authority. The complaints policy has been revised to ensure that it includes clear timescales for the process. The home has also addressed the issue of providing
Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 Page 6 a written outcome to the complainant. A complaints log has been put in place to record all complaints including low-level complaints and dissatisfactions. Formal complaints are investigated in detail and addressed appropriately. The number of staff who have obtained a National Vocational Qualification (NVQ) Level 2 in care or are in the process of undertaking the qualification has increased which will place the home on target for over 50 of the staff team being qualified. 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. Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 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 Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 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): 1,2 & 3 Standard 6 is not applicable. Potential service users do not currently have all of the information they need to make an informed choice about where they live. Not all service users have been issued with a written contract/statement of terms and conditions with the home. Service users are admitted on the basis of a full needs assessment being obtained. EVIDENCE: It was reported that the Statement of Purpose is presently being reviewed and is to be updated. Once completed a copy of this should be sent to the Commission for Social Care Inspection (CSCI). The Service User Guide was looked at. This also needs to be reviewed and updated. At present it does not include all the information required by the standard and regulation. For example, it does not include a description of the individual accommodation and communal space provided or relevant qualifications and experience of the registered provider, manager and staff (See Requirements). It was reported that the contract/written statement of terms and conditions is presently being revised and once completed will be issued to all service users.
Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 Page 9 A copy of the revised contract should be sent to CSCI once completed (See Requirements). There was evidence that the home does obtain full needs assessments for service users prior to their admission. In respect to a previous requirement that all service users must have an annual care review involving their social worker this has been met. There was evidence to demonstrate that four service users have had an annual review and that the registered manager had written to social services to prompt them about the need for reviews to be conducted with other service users living at the home. Also, the previous requirement that specified that a service user admitted in January 2005 has a formal placement review to ensure there is agreement the home is meeting her assessed needs has been met. Evidence was seen that this has been carried out. Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 Page 10 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&9 Care plans do not currently set out in detail service user’s health, personal and social care needs. Service users are not presently being completely protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: The home is presently using the standex format for drawing up care plans and risk assessments for service users. The registered manager reported that the care plans are not being completed appropriately by staff who clearly need advice and training on how to use the standex format effectively. This has been arranged and was due to be held the day following the inspection. It was evident from the care plans inspected that there are problems in respect to care planning. Six care plans were looked at of which three did not have a completed care plan. The other care plans were not very detailed or comprehensive. However, all the plans inspected had a detailed long-term assessment of need that appears to being used as the care plan by care staff. This did evidence that health care needs are being addressed and did include details of personal preferences around personal care routines and some social care needs. There was evidence of daily recording. There was also a record of visits from other professionals, which evidenced that there is good liaison with
Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 Page 11 a range of health care professionals such as chiropodists, district nurses speech therapists, opticians amongst others. Risk assessments were generally inadequate and did not clearly address risks in relation to falls or manual handling or other specific risks presented by the individual needs of service users. The previous requirement that risk assessments showing high or medium levels of risk should be supported with clear guidance for staff has not been met. Five of the care plans had not been signed by the service user, relative or a representative although the registered manager signed one of the care plans with consent of the service user. There was also limited evidence that monthly reviews are being carried out (See Requirements). In respect to medication, the home has a comprehensive medication policy. It was reported that only those staff that have been trained administer medication and one staff member in particular takes responsibility for the reordering of medication. A sample of Medication Administration Record (MAR) sheets was inspected and there were a couple of errors identified in relation to medication not being signed for and codes where medication was unable to be administered not being entered. It was also noted that the temperature of the fridge used for the cold storage of medication although monitored is not being recorded to ensure it remains between 2- 8c. The room temperature also needs to be monitored and recorded to ensure the temperature does not exceed 25c (See Requirements). Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 Page 12 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): None of the above standards were inspected on this occasion as they were looked at the last inspection and considered to have all been met. EVIDENCE: Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 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 &18 Although amendments to the complaints policy have been made further amendments are still required to ensure that service users are clear about their rights when making a complaint. Service users are protected form abuse. EVIDENCE: A previous requirement that the complaints policy must be reviewed to include all the requirements of the standard and that complainants should receive the outcome of the complaint in writing has been partially met. The complaints policy now includes clear timescales for the process although the policy still needs to be slightly amended as the way it is presently written infers that CSCI can be contacted if the complaint is considered not to have been dealt with by the home satisfactorily rather than that CSCI can be contacted at any stage of the complaints process. Also, it does not include any reference or information regarding access to external advocacy services (See Requirements). Subject to a previous requirement the home now has a complaints log in place for monitoring complaint trends and which includes the date the complaint has been received, who has investigated the complaint and whether or not the complaint has been upheld. A previous recommendation that staff awareness should be raised regarding recording complaints has been addressed. The home has received one formal complaint since the last inspection. There was evidence that a very detailed investigation had been undertaken. The matter had been addressed appropriately and a written outcome was sent to the person who made the complaint.
Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 Page 14 The home has an adult protection procedure that is not very detailed although the registered manager reported that he has obtained a copy of London Borough of Lewisham’s Adult Protection Policy and Procedure which was seen and are very detailed and comprehensive and are used for reference by staff. A whistle blowing policy is also in place. Ten out of the twelve permanent staff have been on adult protection training. Staff spoken to confirmed they had received training and two of these were agency staff who have worked for the home for many years. It was evident that they had a good working knowledge around adult protection. The home has not had any adult protection investigations. Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 Page 15 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): 21,22, &26. There are sufficient toilets and washing facilities although one of the showers on the ground floor needs to be modified as it is not currently accessible to service users. Service users have the specialist equipment they require to help facilitate their independence. The home is clean and free from any offensive odours. EVIDENCE: The home has sufficient toilets and washing facilities with three bathrooms, two of which have showers and toilets on the ground floor as well as a separate toilet and a bathroom and two toilets on the first floor. However, one of the bathrooms on the ground floor was supposed to be converted into an accessible shower room but instead a separate shower was added to one of the ground floor bathrooms that cannot be used by service users as it has been raised off the floor making it difficult for service users to get into. The bathroom that the shower is situated would be particularly difficult for wheelchair users to access. It was reported that estimates have been obtained
Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 Page 16 to carry out the work on the shower to place it on ground floor level but no date was known for when the work is to start (See requirements). The majority of the home is wheelchair accessible. There is a passenger lift and the home has use of hoists and assisted bath equipment for service users. The home did have an occupational therapist assessment completed of the home’s facilities and equipment. This made recommendations and requirements for the home to address. However, this was not fully inspected on this occasion and will be addressed in more detail at the next inspection. The home was clean, hygienic and free from offensive odours on the day that the inspection was carried out. The home has separate laundry facilities with a permeable floor. The washing machine used by the home has the specified programming ability to meet disinfection standards and therefore control the risk of infection. Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 Page 17 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): 27,28&29 There are sufficient staff who are skilled to ensure that service users needs are being met. There are increased numbers of staff who have attained the National Vocational Qualification (NVQ) Level 2 in care or are in the process of doing it to ensure that service users are in safe hands. Service users are supported and protected by the home’s recruitment policy and practices. EVIDENCE: The home’s rota was checked and accurately reflected staff on duty the day the inspection was carried out. The home has three care staff on duty in the morning and afternoon/evening shifts and two staff who do a waking night. The home has four agency staff that form part of the staff team in that they have worked for the home for many years and are very familiar with the way the home is run and the needs of service users. There is also a domestic a cook and handyman. A previous requirement was stated from the last inspection that a minimum of 50 of care staff must be supported to attain the NVQ Level 2 in care. This has now been met. There was evidence to indicate that five staff have now achieved the NVQ Level 2 whilst one care staff member has a NVQ Level 3. Also another four staff are presently in the process of undertaking the qualification. Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 Page 18 In relation to recruitment six staff files were inspected and found to include all the documentation required by regulation but three of the files did not include a recent photograph (See Recommendations). Although two of the most recent staff members who have been working at the home for a few months had been allowed to commence work based on Criminal Record Bureau (CRB) checks from a previous employer the home had appropriately carried out POVA First Checks and completed new CRB application forms. Also, in respect to these members of staff there was no evidence on their files that they had been issued with terms and conditions. However, the responsible individual who was present at the inspection did have terms and conditions for both staff members to sign that were seen and one was signed on the day of the inspection as the staff member was on duty. However, the home needs to ensure all staff have terms and conditions in place as soon as possible after they begin employment with the home (See Recommendations). Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 Page 19 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): 31,35 & 38 The home is run and managed by a person who is fit to be in charge and able to discharge their responsibilities fully. Service users financial interests are safeguarded. The health, safety and welfare of service users and staff are generally well promoted and protected although there needs to be an up to date fire safety risk assessment in place. EVIDENCE: The previous registered manager left her post at the end of December 2005 and is now working part time for the home as the responsible individual. A new manager was appointed meeting the previous requirement specified at the last inspection who has undergone the registration process but has only been in post since January 2006. The new registered manager is a qualified nurse and also has completed a diploma and certificate in management studies. He also stated that he would like to undertake the Registered Manager Award (RMA) to update his knowledge and has submitted an application form to Lewisham
Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 Page 20 College. He has many years of experience working in the social care field. He was a services manager for Southwark Social Services responsible for a number of older people and learning disability residential care homes and day centres and has worked for other organisations in both the voluntary and private sectors. The home manages the personal allowance for a number of the service users living at the home. It was reported that the registered owner acts as appointee for one of the service users only and where possible the home tries to encourage service users to look after their own finances or that they are managed by relatives. There is a policy and procedure in place regarding service users finances. All service user finances are kept in the home’s safe in the registered manager’s office. They are individualised and are kept in separate paper envelopes. It would be advised that the home look into alternative ways of holding service users money. For example, plastic wallets with a zip that would be more secure (See Recommendations). Each service user has an individual book in which all financial transactions are recorded and signed for by two staff members or a staff member and the service user themselves. Receipts are also issued to service users for any transactions carried out and copies are kept by the home. The registered manager carries out a weekly self- audit. A random sample of service users accounts were inspected and found to be accurate. There was ample evidence to indicate that the home does promote and protect the welfare of service users and staff. There was evidence that staff have received training to promote safe working practices such as manual handling, food hygiene and also in first aid. There are policies and procedures for infection control and around other aspects of health and safety. Maintenance certificates were checked in relation to the gas boiler, electrical appliances, the passenger lift, bathing aids and hoist equipment, the call system and fire alarm which were all in order and up to date. In respect to fire safety there was evidence that regular fire drills have taken place and call points have been tested weekly. However, although there was a building risk assessment in place a fire safety risk assessment was not available on the day of the inspection. It was reported by the responsible individual that this has been redone and had been checked by the LFPEA who approved it. A copy of this need to be submitted to CSCI (See Requirements). Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 Page 21 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 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 X X 2 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 2 Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 Page 22 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 OP1 Regulatio n 4&5 Requirement Timescale for action 31/05/06 2. OP2 3. OP7 The registered person must ensure that the Statement of Purpose and Service User Guide are updated and a copy of the updated Service User Guide is issued to all service users. A copy of the updated Statement of Purpose must be sent to CSCI. 5 (1) (b) The registered person must 31/05/06 ensure that all service users are issued with a contract outlining the terms and conditions of their stay within the home, which they sign and a copy kept on their individual files. A copy of the contract should be sent to CSCI. 15(1)&(2) The registered person must 31/05/06 (c)&(d) ensure that service user plans sets out in detail the action that needs to be taken by staff to ensure all aspects of the health, personal and social care needs of service users are met. Also, that the care plan is signed by the service user, their relative or a representative where appropriate to indicate their involvement in the care
DS0000025613.V282699.R01.S.doc Version 5.1 Brownhill Lodge Page 23 4. OP7 5. OP9 6. OP9 7. OP16 8. OP21OP22 planning process and that care plans are reviewed monthly. 13(4)(b)& The registered person must (c) ensure that all service users have a detailed risk assessment in place that includes action and control measures to address any risks identified and these should be reviewed regularly. 13 (2) The registered person must ensure that the systems in place for the administration and recording of medication are used consistently, specifically that all staff ensure they sign the medication administration record sheets for medication that is given to service users and appropriate codes are entered when medication cannot be given to service users. 13 (2) The registered person must ensure that the temperatures used for the cold storage of medication is monitored and recorded on a daily basis to ensure it stays between 2-8c. Also that the temperature of the room where medication is stored is monitored and recorded to ensure it does not exceed 25c. 22 The registered person must ensure that the complaints policy is amended to make it clear that service users can contact CSCI at any stage of the complaints process and also information is included of how service users can contact external advocacy services to support them if required. 23(2)(a) The registered person must (c)&(n) ensure that the shower located in the ground floor bathroom is adjusted to ground level making it accessible to all service users.
DS0000025613.V282699.R01.S.doc 31/05/06 31/05/06 31/05/06 31/05/06 31/08/06 Brownhill Lodge Version 5.1 Page 24 9. OP38 13(4)(a) The registered person must &23(4)(a) ensure a fire safety risk assessment is completed and accessible and a copy of this is sent to CSCI. 31/05/06 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. 3. Refer to Standard OP29 OP29 OP35 Good Practice Recommendations The registered manager should try to ensure that all staff files include an up to date photograph. The registered manager should try to ensure that all staff are issued with terms and conditions as soon as possible after being employed to work in the home. The registered person should consider using plastic wallets with a zip to store service users personal allowance rather than paper envelopes to keep monies safe and secure. Brownhill Lodge DS0000025613.V282699.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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