Inspection on 19/01/09 for Burntwood Hall

This inspection was carried out on 19th January 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Burntwood Hall 24/10/07

Burntwood Hall 24/10/06

Burntwood Hall 29/11/05

Burntwood Hall 21/06/05

Burntwood Hall 03/02/05

Burntwood Hall 16/06/04

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Abbey The

Snydale Care Home

Hawkhills

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Beeches The - North Yorkshire County Council

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Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Burntwood Hall Moor Lane Brierley Common Barnsley South Yorkshire S72 9HB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mike ONeil     Date: 1 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Burntwood Hall Moor Lane Brierley Common Barnsley South Yorkshire S72 9HB 01226780222 01226713645 none Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Angela King Type of registration: Number of places registered: Guardian Care Homes (UK) Limited care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 42 The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP and Dementia - Code DE Date of last inspection Brief description of the care home Burntwood Hall is situated on the South Yorkshire/West Yorkshire border. The home is a detached property within its own grounds and is in open countryside. Village amenities are approximately five minutes drive from the home. The home is registered to provide personal care for older people on a long term or short-term basis.A unit to Care Homes for Older People Page 4 of 29 Over 65 0 42 42 0 Brief description of the care home cater for the needs of 15 people with dementia is sited on the first floor. A passenger lift serves the first floor. Accommodation is provided in single and double rooms at ground floor and first floor levels, with views over the open countryside and landscaped gardens. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is what was used to write this report. Information about the home kept by the Commission for Social Care Inspection. Information from surveys that were returned to us by 10 people and 8 staff. Observations from health and social care professionals during their monitoring and advisory visits to the service over the past month. An unannounced visit to the home. This was carried out by Michael ONeil and Jayne White, regulation inspectors on 19th January 2009 over a totalled period of 12 hours Care Homes for Older People Page 6 of 29 and included talking to 5 staff and Angela King, registered home manager about their work and the training they have completed. And checking some of the records, policies and procedures the home has to keep. Some time was spent observing staff supporting people and talking with 7 people and 4 visiting relatives. We wish to thank the people living in the home, staff, and relatives for their time, friendliness and co-operation throughout the inspection process. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: Peoples care plans still need further attention and more detail so that the staff know what to do for each person. Some medication procedures need improving to ensure that people are protected. To maintain peoples dignity, privacy screens need to be fitted in shared rooms. Toilets and bathrooms should be redecorated and refurbished and touches added to make them more domestic in style and so less clinical. Care Homes for Older People Page 8 of 29 Information requested by the CSCI must be returned within legal and agreed timescales. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were individually assessed prior to admission to ensure their needs could and would be met. Evidence: Three care plans checked showed that people within the service had been assessed before moving into the home. Risk assessments and a plan of care reflected any specialist interventions. The assessment forms checked were detailed and fully completed. The manager and senior staff liaised with professionals, the person and their families to find out about peoples needs. Records show that a home manager visited people and undertook assessments, prior to admission. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person had a plan of care, however two of the three plans checked did not include sufficient detail to ensure that all peoples needs were being met. Peoples health is monitored and arrangements for dealing with health issues were met with support from health professionals. People were treated with respect and said they were happy with the care they received. Medication procedures did not fully protect peoples health and welfare. Evidence: Three peoples care plans were checked. The peoples care plans checked were good in that they contained some details about the persons personality and their preferences and choices. Over the past month the community matron from Barnsley Primary Care Trust (PCT) has provided support and some training for staff and has been monitoring peoples care plans. Feedback from the matron and from other social care professionals Care Homes for Older People Page 12 of 29 Evidence: is that there has been some improvements in the standard of peoples care plans over the last months. We found that the standard of one persons care plan was good and that the plan had been regularly reviewed and the changes in the persons health were being observed and recorded. Staff must now work to improve everybodys care plan to reach this standard. Risk assessments were included within all the care plans checked and included moving and handling, nutritional, skin integrity, and other risk factors. The other two care plans however were inadequate because: Staff failed to develop a detailed care plan for two people when the risk assessment, mentioned above, identified that the person was at risk of developing pressure sores. Staff had only recorded that the persons risk level must be monitored, and had not recorded other interventions they would need to provide to minimise the risk of a person developing a sore. These may include interventions such as closely observing the persons skin condition, encouraging the person to change position regularly and ensuring the persons skin is kept clean and dry. Staff, particularly on the night shift, were failing to record times they made entries in the plans. Staff must be reminded that peoples care plans are a legal document and must always be signed, dated and timed. There was no evidence recorded to show that people and/or their relatives were involved in drawing up and reviewing the care plans. Staff, when writing peoples daily notes, were not being reflective of the information actually recorded in the persons care plan.There were no records to evidence that staff had met certain care needs of people over several days. Documenting, for example fine today, sat watching television, relatives visited is not sufficient when recorded, in isolation, in a persons daily record. Records of peoples belongings, where available on file, were out of date and did not provide sufficient information to identify the items. All the care plans identified that a range of health professionals visited the home to assist in maintaining peoples health care needs. People said they had regular contact with their GP and other health professionals such as district nurses and opticians. An optician, district nurse and G.P visited people on the day of our visit. People looked clean, well dressed and had received a good level of personal care. Care Homes for Older People Page 13 of 29 Evidence: Some ladies had an appointment with the hairdresser who was visiting the home on the day of our visit. People told us The staff are kind Im happy here Its a lovely home. Relatives said The care couldnt be much better I have no grumbles about the care given by staff Im kept informed about what is going on and whenever I visit the staff are always pleasant. Medicines were securely stored in locked trolleys within a locked room. Medicine Administration Records (MAR) checked were completed with staffs signatures. Staff said they had received medication training. We saw certificates of this training. Peoples health and welfare was not fully protected however because Some handwritten MAR sheets checked did not contain General Practitioners or two members of staffs signatures alongside any directions regarding the dosage of the medication or the time the medication was to be given. The reason why we make this requirement was found on one persons handwritten MAR sheet. Only one member of staff had checked the record. The Staff member had recorded that a person should receive 500mg of a drug instead of 500 mcg. Fortunately on this occasion this risk of accidental overdose was remote as we worked out that 1000 tablets would need to have been given to the person to actually administer the handwritten amount. Staff should have realised at this point the potential error. However first hand evidence of the risk involved has now been highlighted to the staff of Burntwood Hall. Staff were aware of the need to treat people with dignity and respect. During our visit we saw good interactions between people and staff. Staff took time to explain what task or support they were about to offer people. Care Homes for Older People Page 14 of 29 Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had a choice of lifestyle within the home and were able to maintain contact with family and friends ensuring that they continued to be involved in community life. People were able to make choices about daily living and be involved in some social activities.Meals served at the home were of a good quality and offered choice to ensure people receive a balanced diet. Evidence: People said they were able to get up and go to bed when they chose and generally how they spent their day and evenings. They said they often went out with their families. Relatives said they were able to visit at any time and were made to feel very welcome. We saw that everyone coming to the home was offered hospitality and staff took time to make sure friends and family were made to feel comfortable whilst visiting. People and relatives said that there were some activities planned. Events had been held at the home over the past month and some people had also attended events within the local community. Care Homes for Older People Page 16 of 29 Evidence: Staff were making an effort to provide a stimulating environment for the people. Staff and people were enjoying a quiz programme on the television. The staff member was trying to include as many people in this activity as she could. Staff were enthusiastic about expanding their knowledge and said they would like more training in caring for people with memory loss. We discussed the sort of training that would benefit staff. This could include training on issues such as person centred care. There was not enough information displayed in the home, particularly in the unit on the first floor that may help people with orientation. Clocks around the home were large and showed the correct time, however, apart from the menu being displayed the wipe boards were left blank. Displaying information such as the date, the menu for the day, the weather and a news item, may help the people further with orientation to time and place. The mealtime experience for people in the home was very positive. The tables were set nicely with cloths, condiments and matching crockery and when the meal was served people said The food is good Very good meal. Staff were supporting people with their meal in a polite and discreet way. People said they were always offered a choice and asked what they wanted for their breakfast, lunch and teatime meals. People said they were offered drinks on a regular basis throughout the day. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints procedures were in place and people and their relatives felt confident that any concerns they voiced would be listened to. Staff had an understanding of the procedures to be followed should they suspect any abuse at the home, so helping to ensure that people were protected from abuse. Evidence: People and their representatives had been provided with a copy of the homes complaints procedure, which was also on display in the entrance hall. This contained details of who to speak to at the home and who to contact outside of the home to make a complaint should they wish to do so. People and relatives said that they knew who the manager was and that she was always visible around the home. They said that they felt very comfortable in going to the manager knowing that any concerns they may have would be addressed. Adult safeguarding case conferences have been held regarding the service over the past few months. One referral is currently ongoing at the service. The manager and operations director of Guardian Care Homes (UK) Ltd have been involved and cooperated fully with all investigations and any safeguarding meetings held. Some recommendations, surrounding documentation, have been made through safeguarding Care Homes for Older People Page 18 of 29 Evidence: procedures and the manager and company have agreed to implement and meet these recommendations. The local safeguarding policies and procedures were available to the staff. Staff said they had undertaken Safeguarding Adults training, and the manager was able to evidence this by producing the training records. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main the home was clean, pleasant and hygienic. Some areas of the home are in need of redecorating and refurbishing. Evidence: The home was generally clean and tidy. People, and relatives said the home was always kept very clean. Lounge and dining areas were domestically furnished to a good standard. People said they were very comfortable at the home. Their bedrooms contained a variety of their own furniture and touches such as ornaments and pictures. This gave their rooms a homely feel. Some unpleasant odours were noticeable in three bedrooms checked. The unpleasant smells in these rooms should be eradicated. The manager said the carpets are cleaned daily in the affected rooms. Clearly this cleaning isnt eradicating the unpleasant odours so other measures should be considered. The first floor lounge was hot, stuffy and airless. A fan was in use in the room to keep the temperature cool even though it was snowing on the day of our visit. There is no window that allows fresh air into the lounge. One window looks out onto a corridor and the other window, a skylight, does not open. We would recommend that the skylight be altered to allow it to open. This would then provide people with fresh air and allow them to hear noises from the outside. Activities could also be provided for people in the first floor dining room, which Care Homes for Older People Page 20 of 29 Evidence: is bright and has several opening windows. No privacy screens were available in a shared room. Privacy screens need fitting or portable ones purchased so that peoples privacy and dignity can be maintained. The bathrooms and toilets on the ground floor of the home are all in need of refurbishment. Some of the baths/showers are damaged and all the rooms are very stark and clinical some floor coverings are also stained. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff were employed in sufficient numbers and recruitment procedures promoted the protection of people. People receive care from a well-trained staff team. Evidence: People spoke highly of the staff team and said staff always listened and acted on what they said. People said that staff were always available when needed. Staff and the manager confirmed that staffing levels were adequate for the current numbers of people resident at the home. Previous weeks duty rotas were checked. These showed that 5 care staff were rostered to work during the day and 3 care staff were rostered to work at night. Three staff files were checked at this visit. The files contained a range of information including two references and a declaration of health and identification. The staff had undertaken a criminal record bureau check (CRB), at the enhanced level. This confirmed thorough recruitment practices were in place, which was sufficient to safeguard people. The manager said that all staff working at Burntwood Hall have had satisfactory employment checks carried out. Care Homes for Older People Page 22 of 29 Evidence: Staff were enthusiastic about expanding their knowledge and said they would like more training in caring for people with memory loss. Staff said that they really enjoyed working at the home and got a lot of job satisfaction. Staff were able to talk about the various training courses that they had attended. Development and training records were checked these records showed when staff had completed mandatory training and refresher training. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The procedures and ethos of the home ensure that the home is run in the best interests of people who use the service. The homes procedures promote the health, safety and welfare of people who use the service and the staff. Evidence: The manager, Angela, has many years experience within the caring profession and has completed the Registered Managers Award. Staff, people and relatives spoke highly of the manager and said she was always available and very approachable. The home had a good quality assurance system. There was evidence of internal auditing of the homes environment, services and records. Staff meetings were held and minutes of these meetings were seen. The responsible individual visited the home on a regular basis, a report was written following the visits. People who use the service and their families met with the manager of the home on a regular basis. The results of completed Care Homes for Older People Page 24 of 29 Evidence: questionnaires returned from people and relatives had been collated to determine satisfaction ratings. This information was displayed on a notice board in the home. These quality assurance systems will help to ensure that the service is operating in the best interest of the people who live there. The service had failed to complete and return their Annual Quality Assurance Assessment to the CSCI within the required time. This is a legal requirement under the Care Home Regulations 2001.This failure was discussed with Angela and she fully understood the need, in future, to return the assessment on time. Angela gave assurances that the latest AQAA would be returned to the CSCI within the next 10 days. A sample of monies that was looked after on behalf of people living at the home was checked. Records were kept and money tallied with the records. The temperature of the hot water in two bathrooms was found to be within safe recommended limits. Records showed that the temperatures were being regularly monitored and were recorded as being within safe limits. A fire risk assessment was in place at the home. No issues requiring attention were highlighted in the assessment. Staff said they had received recent fire safety and other health and safety training .A sample of records showed that staff were receiving this statutory training. At the time of the visit fire exits were clear and hazardous products were safely stored in the home. This will promote the safety and welfare of the people. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The care plan must set out in detail the action, which staff need to take to meet all aspects of the health and personal needs of the person. (Pressure sore prevention) To ensure peoples health needs are met. 01/05/2009 2 9 13 Clear and safe procedures must be in place for the recording and safe administration of medicines (handwritten MAR). To protect peoles health and welfare. 01/05/2009 3 19 12 Peoples privacy and dignity must be maintained. (Privacy screens shared rooms) To maintain peoples privacy. 01/05/2009 4 33 24 In future the service must provide to the CSCI, within one month of the request, a report covering the 01/05/2009 Care Homes for Older People Page 27 of 29 requirements highlighted under regulation 24. (AQAA) To ensure that the home is run in the best interests of people. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 An up to date inventory of each persons personal furniture, equipment and other belongings should be recorded on their personal file. The inventory should provide sufficient information to enable identification of the items. People and/or their relatives should be involved in drawing up and reviewing their care plans. Staff should ensure that all written entries they make in peoples care plans are dated, timed and signed. The persons daily notes should reflect the information actually recorded in the persons care plan. Arrangements should be improved so that people can be orientated to date, time and place. Toilets and bathrooms should be redecorated and refurbished and touches added to make them more domestic in style and so less clinical. Rooms should be provided that have natural ventilation. All parts of the home should be kept clean and free from offensive odours. Further training in dementia care would increase staff members knowledge and awareness of the needs of people with memory loss and dementia. 2 3 4 5 6 7 7 7 12 21 7 8 9 25 26 30 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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