Inspection on 30/08/06 for Burking Banks

This inspection was carried out on 30th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Burking Banks 28/06/07

Burking Banks 02/11/05

Burking Banks 02/06/05

Burking Banks 07/10/04

Burking Banks 16/06/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Burking Banks 69-73 Moorlands Road Dewsbury West Yorkshire WF13 2LF Lead Inspector Bronwynn Bennett Unannounced Inspection 30th August 2006 08.15 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 Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Burking Banks Address 69-73 Moorlands Road Dewsbury West Yorkshire WF13 2LF 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) 01924 456653 01924 457285 Mr Kevin Martin Ms Ann Fisher Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd November 2005 Brief Description of the Service: Burking Banks is a care home registered to provide personal care for up to 35 older people. It is situated in a residential area of Dewsbury, a short journey from the town centre. The home is easily accessible by public transport and is within easy reach of the local hospital. The home is made up of two houses linked by a first floor corridor. Both parts of the home have their own dining rooms, lounges and kitchen areas. The main meals are cooked in a central kitchen. The home has an extension to one of its lounges which makes the outdoor patio area accessible for service users. The gardens to the home are well maintained. Parking is available at the rear of the home. The home is furnished in a homely style, with six smaller communal rooms rather than one large one. The provider informed the Commission for Social Care Inspection on 30/8/06 that the fees range from £321.25 to 344.71. There are additional charges for hairdressing and newspapers. Information about the home and the services provided are available from the home in the Statement of Purpose and the Service User Guide. Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit carried out by the inspector. The inspector arrived at the home at 8.15am and left at 5.15pm. During this visit the inspector spoke to some service users, some of the staff and the home’s manager Mrs Ann Fisher. The inspector read care records, audited a sample of medications, reviewed staff recruitment and training records and carried out a tour of the home. Prior to this visit, the Commission for Social Care Inspection sent ten questionnaires to service users living at Burking Banks. Eight completed questionnaires were returned. There were thirty-one service users living at the home on the day of this visit. Surveys were sent to ten service users’ relatives and 6 GPs. The inspector received responses from four relatives and 2 GPs. Other information used as part of this inspection process includes notifications from the home to the Commission for Social Care Inspection about deaths, illnesses, accidents and incidents at the home, copies of the monthly management visit reports produced by the care provider and a pre-inspection questionnaire completed by the manager. The inspector would like to thank everyone for their assistance during this inspection process. What the service does well: The service users have their needs assessed prior to admission into the care home. The service users said that they always receive the care and support they need. The staff are caring and supportive to the needs of the service users and continue to work hard to meet their needs. There were many positive comments made about the staff at the home from both the service user survey and during the visit to the home. The service users are treated in a dignified and respectful manner by the staff. The service users’ care records are detailed and give clear information of the care required by the individual. Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 6 The staff work hard to ensure the cultural, social and recreational needs of the service users are being met. The service users made positive comments regarding the standard of meals served in the home. During this visit the inspector noted that the food served was well presented and looked appetising. Seventy per cent of the care staff have achieved NVQ (National Vocational Qualification) level 2 or above. What has improved since the last inspection? What they could do better: The home’s medication policy and procedure does not sufficiently protect the service users and must be addressed. Service users are protected from abuse but this protection would be further enhanced if all the staff completed adult protection training. Cleaning schedules and domestic arrangements should be examined in the home. The home’s recruitment practices must improve to ensure that they are safe and offer protection to the service users. The registered person should continue to develop the home’s quality assurance policy and procedure in order to ensure the home is run in the best interests of the service users. The registered person should develop a staff training and development programme to ensure the staff are appropriately trained to meet the needs of the service users. Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 7 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. Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 8 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 Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. The service users have their needs assessed prior to admission into the care home. Quality in the outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The care records for four service users were audited as part of this visit, all of which contained evidence of a social services assessment and a pre-admission assessment completed by the home. Five respondents to the service user survey said they did receive enough information about the care home before they decided to move in. Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 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): 7,8,9 and 10. Generally the service users’ health, personal and social care needs are set out in the individual plan of care. There is a risk of service users’ health care needs not being fully met when risk assessments are not formulated for all identified areas of risk. The home’s medication policy and procedure does not sufficiently protect the service users. Service users are treated with dignity, respect and privacy. Quality in the outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Six service users who responded to the survey said that they always receive the care and support they need. During this visit the staff were observed supporting service users in a caring and dignified manner. Respecting the service users’ privacy and dignity is identified in the individual care records. The GP responses to the survey said that they are always able to see their Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 11 patients in private. The service users spoken to said the staff are caring and helpful. One service user said “the staff are lovely”. The care records for four service users were audited. All the care records looked at contained care plans and all but one of the care records contained risk assessments. The overall detail in the care records looked at was good and gave clear information of the care required by the individual, and gave guidance to staff of the actions that must be taken to ensure the needs of the individual service user are met. Not all the daily records looked at gave detailed information that related to the service users’ care plans or how they had spent they day. It was noted that the quality of recording by one of the staff was more detailed than other entries. Good practice should be shared so that all the staff can work towards developing their report writing skills. Generally, risk assessments are in place and service users have assessments for nutrition and tissue viability (to measure the risk of developing a pressure sore) and the weights of service users are recorded. All the records audited were up to date and reviewed. The home’s medication system was audited and the medication for four service users was checked. Three of the medications could not be fully reconciled with the records kept. One medication had been changed by hand on the Medication Administration Record (MAR) and there was no reason recorded. These issues were discussed with the manager. The remaining medication was accurate. The manager has recognised there are some issues with the present medication system. The current arrangements for medication supplied to the home will be changed. Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 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): 12,13,14 and 15. The service users’ cultural, religious, social and recreational needs are being met, and they are supported to maintain contact with their family and friends. Service users are supported to exercise choice and control over their lives. The home provides the service users with a varied and nutritious diet. Quality in the outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The service users spoken with said that their friends and family are always made to feel welcome when visiting the home. Four relatives who responded to the survey said that staff always welcomed them into the home at any time. The service users spoken with said that they are able to see their friends and relatives in private if they wish. The home has trained one of the staff in how to run a craft group. Five service users who responded to the survey said there are activities arranged by the home that they can take part in. Some service users spoken to said they had chosen not to take part in activities and this had been respected by the staff. The service users’ preferred activity is documented in their individual plan of care. On the day of this visit, an organist played in the morning and a musical entertainer visited the home after tea. Other activities provided are aromatherapy, church service, craft group, keep fit and a hairdresser visits the Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 13 home on a weekly basis. Service users are supported to access activity outside the home such as visits to church and the theatre. Service users are supported to handle their own finances if they wish and there is locked space available for this purpose. Individual rooms were seen during a tour of the home and service users had personalised their rooms. Six service users who responded to the service user survey said that they always enjoyed their meals at the home. There were some comments made such as “Love them” and “the food is of a high standard”. The home offers a four weekly menu that offers a choice and a variety of foods. The service users spoken to said the food served in the home is nice and there is always plenty to eat. The inspector noted that there were drinks and snacks served to service users between meals. The food provided is well presented and appetising, the inspector sampled a fruit crumble dessert that was very nice. The tea served on the day of this visit was home made soup and a selection of sandwiches that was enjoyed by the service users. The inspector observed staff supporting service users appropriately at mealtimes to enjoy their meal. Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Service users and their relatives are confident their complaints will be listened to and acted upon. Service users are protected from abuse but this protection would be further enhanced if all the staff completed adult protection training. Quality in the outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The home has a complaints policy and procedure displayed in the home. The service users spoken with said they knew who to speak to should they have any concerns or complaints. From the survey, seven service users said they knew who to speak with should they have a complaint, and three relatives said that they were aware of the home’s complaints procedure. There have been four recorded complaints during the last twelve months, all of which are now resolved. The staff spoken with had a good understanding of adult protection issues and the necessary action that must be taken should there be any allegations of abuse. However, some of the staff spoken with were not aware of the home’s whistle blowing policy and the home’s manager should address this. The manager said that adult protection is discussed as part of induction training. Some staff said they had not received adult protection training. All Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 15 staff must receive this training as soon as possible after commencing employment. Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Generally the service users live in a safe and well maintained environment. The home is generally clean. Quality in the outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Three service user surveys said that the home is always fresh and clean. However, one relative commented in the survey that there were odours present in the home. Some of the service users’ rooms seen had been personalised by the service users. There have been many improvements carried out at the home since the last visit. Three bedrooms have been decorated complete with replacement furniture. Two lounges have been decorated complemented with replacement Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 17 furniture. Three toilets have been replaced and fitted with non slip floor covering. In addition some blinds, curtains and carpets have been replaced. As part of the many improvements carried out at the home, some exterior windows and facia boards have been replaced. The required window restrictors have not been fitted to all the new windows. The manager should ensure all the windows are fitted with restrictors in order to sufficiently protect the service users. A requirement is made regarding the matter in this report. The manager said that they are awaiting quotes for the identified bathroom. This should now be addressed with some urgency. The identified toilet should also be redecorated. The smoking areas of the home are fitted with extractors but, on entering the home, there was an odour of cigarette smoke. While completing a tour of the home, the inspector noted that some areas of the home were in need of a thorough clean. This was identified at the last visit to the home. The screen in a shared room was dirty; this poses a potential health and safety risk and must be addressed. A dining area was in need of a thorough clean and a replacement refrigerator. A medication trolley is placed in the conservatory and this area is also used for smoking. To promote good hygiene practice, the trolley should be placed in a more suitable area. The manager should implement cleaning schedules and examine the current domestic arrangements in the home. Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 18 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 and 30. There are care staff employed in sufficient numbers. The current domestic arrangements are not adequate. There is ongoing training for the staff who receive induction and ongoing training. The recruitment process must be improved to ensure the service users are sufficiently protected by the home’s recruitment policy. Quality in the outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: There are sufficient numbers of care staff employed to meet the needs of the service users. The current arrangements for domestic staff requires improvement to ensure that domestic staff are employed in sufficient numbers to ensure all areas of the home are clean and hygienic. Service users who responded to the questionnaire said that there are usually staff available when they are needed. A relative who responded to the questionnaire said that the staff are polite and helpful. There were many positive comments made about the staff during this visit, such as the staff are helpful. Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 19 There is 70 of the care staff working in the home with NVQ level 2 or above in care. Three staff files were audited. Two of the files audited did not contain the checks required prior to their employment. None of the records looked at had completed employment histories. The home should ensure the employment histories for all the staff working in the home are explored and recorded in the individuals’ files. There was some evidence that some of the staff has completed some induction training. However, there was no evidence that this induction meets National Training Organisation targets. The manager said that all new staff would be registered to undertake the C I S (Common Induction Standards). Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. The service users live in a home that is run by a manager who is fit to be in charge. Generally, the home is run in the best interests of the service users. The financial interests of the service users are safeguarded. The health and welfare of service users and the staff is promoted and protected. Quality in the outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The home has a registered manager, Ms Ann Fisher. The service users spoken with spoke highly of the home’s manager. The staff said that the manager was approachable and supportive. Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 21 The service users that responded to the survey said that they knew who to speak to if they were not happy. The manager has taken some action since the last visit to improve the home’s quality assurance. The manager said the results from their survey, that has been aimed initially at service users’ relatives, has proved positive. The inspector gave advice of how to progress further with quality assurance. Three service users’ finances were audited. These records were correct. Service users are supported to handle their own finances should they wish to do so and locked facilities are available in individual rooms for this purpose. A sample of health and safety records was checked and found to be up to date. The fire records were checked and there is weekly testing of the home’s fire alarm system and emergency lighting. The staff complete fire training updates every six months and take part in regular fire drills. Two staff have completed infection control training. This training should be extended to all the staff to promote good hygiene practices. The home has a trainer that delivers training for all staff in safe movement and handling practices. The inspector noted a service user being moved using poor movement and handling practice. This was discussed with the manager who said she would address the matter. Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 1 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Timescale for action The registered person shall make 30/09/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The registered person shall make 30/11/06 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. All staff should receive adult protection training and it would be useful for staff to undertake the local authorities vulnerable adults training. The registered person shall ensure that all parts of the care home to which service users have access are so far as reasonably practicable free from hazards to their safety. Window restrictors must be fitted to all service users rooms. Satisfactory standards of hygiene must be maintained throughout the home to DS0000026268.V301954.R01.S.doc Requirement 2. OP18 13 (6) 3. OP19 13 (4) (a) 13/09/06 4. OP26 16(2) (j) 30/09/06 Burking Banks Version 5.2 Page 24 minimise the risk of infection. Areas of poor practice detailed in the body of this report must be addressed. Previous timescale of 03/12/05 not met. 5. OP27 18 (1) (a) Domestic staff must be employed in sufficient numbers to ensure the home is maintained in a clean and hygienic state. Previous timescale of 03/01/06 not met. The registered person shall not employ a person to work in the care home unless - they have obtained in respect of that person the information and documents specified in schedule 2 of the Care Homes Regulations 2001. Previous timescale of 03/12/05 not met. The registered person shall establish and maintain a system for monitoring the quality of care provided at the care home. Consultation should take place with the residents as part of the quality assurance process. A report in respect of any review should be supplied to the Commission and made available to the residents. Previous timescale of 03/04/06 not met. 30/09/06 6. OP29 19 (1) (b) (6) (i) 30/10/06 7. OP33 24 (1) (2) (3) 30/10/06 Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 25 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 OP8 OP19 OP30 Good Practice Recommendations All service users should have a risk assessment in place for any identified healthcare need. The identified bathroom and toilet should be updated and redecorated. The registered person should develop a staff training and development programme to ensure the staff are appropriately trained to meet the needs of the service users. To ensure safe working practice: All staff should be trained for infection control. The registered person should monitor the movement and handling practices of staff. 4. 5. OP38 OP38 Burking Banks DS0000026268.V301954.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB 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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