Inspection on 13/07/06 for Carisbrooke House Residential Home

This inspection was carried out on 13th July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Carisbrooke House Residential... 06/10/08

Carisbrooke House Residential... 21/06/07

Carisbrooke House Residential... 24/10/05

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

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

CARE HOMES FOR OLDER PEOPLE Carisbrooke House Residential Home 10-11 Sandown Road Great Yarmouth Norfolk NR30 1EY Lead Inspector Hilary Shephard Unannounced Inspection 13th July 2006 10:30 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 Carisbrooke House Residential Home DS0000064315.V304693.R02.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. Carisbrooke House Residential Home DS0000064315.V304693.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carisbrooke House Residential Home Address 10-11 Sandown Road Great Yarmouth Norfolk NR30 1EY 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) 01493 855915 Mr Selvaratnam Balaratnam Care Home 22 Category(ies) of Dementia - over 65 years of age (2), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (22) Carisbrooke House Residential Home DS0000064315.V304693.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Mr Balaratnam to undertake appropriate training to ensure he can carry on the home with sufficient care, competence and skill. A minimum of three care staff to be on duty during daylight hours. Date of last inspection 24th October 2005 Brief Description of the Service: Carisbrooke House is a care home providing personal care and accommodation for up to 22 older people which includes 2 residents who have dementia and 1 with mental health needs. The home is located on a street close to the seafront of Great Yarmouth and consists of two adjoining large three storey terraced houses, with small patio areas at the front of the building. The accommodation includes 12 single and 5 shared bedrooms, some with en-suite facilities. Three lounges located on the ground and top floors and a ground floor dining room make up the communal rooms. Access to the upper floors is by a shaft lift. There is on street parking at the front of the building. The home charges from £268 to £325 for shared rooms and from £281 to £338 for single rooms. Additional charges are payable by residents for hairdressing, chiropody, toiletries and newspapers/magazines. Carisbrooke House Residential Home DS0000064315.V304693.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home and this report gives a brief overview of the service and the current judgments for each outcome group. The home has experienced some difficulties with management since the last full inspection visit in October 2005. The manager appointed in October 2005 failed to meet her management responsibilities and the Commission intends to refuse her registration, she resigned her position in May 2006. A new manager was appointed in May 2006 and has yet to apply to the Commission for registration. A total of 11 requirements 7 of which are repeated from previous inspection visits and 2 recommendations were made as a result of this visit. What the service does well: What has improved since the last inspection? Carisbrooke House Residential Home DS0000064315.V304693.R02.S.doc Version 5.2 Page 6 An unannounced visit was carried out in April 2006 and this showed serious failures regarding recruitment practices, staff training, induction, supervision, medication, quality monitoring and care planning. The July 2006 visit showed the newly appointed manager had made significant improvements to the recruitment process, ensuring that all staff are properly vetted before they start work. Medication management and administration has improved and residents are no longer at risk from poor medication practices. There is still a need for medication to be fully audited by the home. Care planning is in the process of being reviewed. The manager and the deputy manager are currently working on improving the way care plans are written. Some redecoration has been carried out since April 2006, and the new manager has eradicated the offensive odour in one of the bedrooms. The new manager has also improved residents’ privacy and dignity by allocating a separate room for hairdressing. What they could do better: Care plans need further improvement and must include the following: • • • • • needs that have been identified in initial assessments must be followed through in the care plan: full and clear guidelines for staff to meet residents individual needs, including social and emotional needs: more detail in the daily records about how residents have spent their day: dated nutritional assessments: accurate risk assessments identifying risks on an individual basis, particularly regarding use of bed rails. Garden space needs developing to meet the needs of the residents and the barbed wire along the top of both back walls needs to be changed to something less dangerous (to residents) and ugly. The two small patio areas at the front need tidying up. Staff must complete formal induction training and at least 50 of the care staff must achieve NVQ level 2. Quality monitoring needs to be undertaken. The poor attitude of one member of staff must be dealt with immediately to reduce the risks to the residents. Interaction and attention to residents social needs needs to improve. Carisbrooke House Residential Home DS0000064315.V304693.R02.S.doc Version 5.2 Page 7 The physical layout of the home is confusing and disabling and needs to be adapted where possible and developed into one that assists confused and physically disabled residents to be as independent as possible. The manager needs to address the issue of the chiropodist attending to residents’ feet in the lounges in full view of everyone. The risk of cross-infection must be reduced by installing hand-washing facilities in all toilets and bathrooms. Pre-admission information must be updated and given to prospective residents. The home must make every effort to assess the needs of residents admitted for short-term care before they are admitted. 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. Carisbrooke House Residential Home DS0000064315.V304693.R02.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 Carisbrooke House Residential Home DS0000064315.V304693.R02.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): 1, 3, 6 Quality in this outcome area is adequate. The outcome of this group of standards could be good if the home assessed all residents before admission with an assessment that includes reference to their social needs and if residents and relatives were provided with information in the form of an up to date service user guide to help them make their choice. Residents are not provided with enough information before admission and by not assessing the needs of the residents admitted for short-term care their health care needs may be compromised. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Carisbrooke House Residential Home DS0000064315.V304693.R02.S.doc Version 5.2 Page 10 Care plans confirmed that the format for assessing residents before admission remains unchanged since the last full inspection (24/10/05) The format is good and covers all aspects of their physical and mental health, but omits reference to residents social needs. Residents (except those receiving short-term care) are visited before admission but the information provided about the home is only verbal. A requirement has been made regarding pre-admission information and a recommendation regarding assessments. Carisbrooke House Residential Home DS0000064315.V304693.R02.S.doc Version 5.2 Page 11 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, 10 Quality in this outcome area is adequate. The outcome of this group of standards could be good if: • all care plans reflected needs identified in initial assessments • care plans gave full and clear guidelines for staff to meet residents individual needs • daily records were more detailed • medication was fully audited • nutritional assessments were dated and risk assessments accurately assessed risks on an individual basis Residents care is being compromised because not all care plans address residents care needs and use of bed rails has not been properly risk assessed. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Carisbrooke House Residential Home DS0000064315.V304693.R02.S.doc Version 5.2 Page 12 The random inspection visit carried out on 6th April 2006 set 3 requirements regarding care plans, falls risk assessments and for use of bed rails to be properly risk assessed & not used inappropriately. None of these have been fully met yet, but the home has seen a change of manager since the random visit which has caused a delay. The visit carried out in July 2006 showed some improvement to the way care plans were being updated and reviewed. Risk assessments for use of bed rails have not been updated and do not adequately identify or address the risks to the resident. Medication practices have improved significantly since the random medication inspection visit in April 2006. 5 requirements were made following that visit, 3 have been fully complied with and 2 partially complied with. At the July 2006 visit, one resident said the staff were good at maintaining her dignity, particularly when she was being moved in the hoist. Requirements have been repeated from the random inspection visits in April 2006 regarding care planning and medication. Carisbrooke House Residential Home DS0000064315.V304693.R02.S.doc Version 5.2 Page 13 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, 15 Quality in this outcome area is good. The lifestyle experienced by the residents is generally positive and enjoyable, family contact is encouraged and maintained, and residents are enabled to make choices about their lifestyle. Meals are well prepared and nicely presented. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The way activities are provided has changed little since the last full inspection in October 2005 and the random visit in April 2006. A recommendation was made following the random visit for staff to improve the way they interact with residents and not to leave it all to the activities coordinator, but because they were short staffed at the July 2006 visit, it was difficult to see if this had improved. Carisbrooke House Residential Home DS0000064315.V304693.R02.S.doc Version 5.2 Page 14 The home continues to be welcoming to residents’ visitors and one resident said their relatives were made welcome and were allowed to visit at any time. Since the last full inspection in October 2005, two cooks have left and have now been replaced. Lunch was observed at the July 2006 visit which had been nicely cooked and well presented. Residents said they enjoyed it. Carisbrooke House Residential Home DS0000064315.V304693.R02.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good. Residents are confident their concerns are listened to and acted upon and the home makes every effort to protect them from harm. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The July 2006 visit showed that the home has a complaints procedure which is displayed on the back of the bedroom doors, it was slightly out of date as it contained the previous managers details. Residents and staff are aware of who to take concerns to and said they were confident these would be taken seriously and acted upon. The manager is aware of her responsibilities regarding the management of complaints and said none have been received since she took up her post in May 2006. A recommendation has been made regarding the complaints procedure. Carisbrooke House Residential Home DS0000064315.V304693.R02.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, 20, 26 Quality in this outcome area is adequate. The outcome of this group of standards could be good if the environment was more suited to the needs of elderly, frail, confused and disabled people and if the risk of cross infection was reduced by installing proper hand washing facilities in resident areas. The interior and exterior of the home is not ideal for the needs of older, physically disabled people as it does not create an enabling environment. However, the home is generally safe except for the lack of soap and towels in toilets and is reasonably decorated. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Carisbrooke House Residential Home DS0000064315.V304693.R02.S.doc Version 5.2 Page 17 Bedrooms are located over three floors and accessible (except ground floor) only via stairs or a lift. Most bedrooms are hard to find and access for residents is difficult without staff assistance although the previous manager had made some effort to improve signage. The home has varied their registration to allow the accommodation of two people with dementia, however, the confusing and inaccessible layout of the home prevents any further admissions of people with dementia. Two requirements were made following the visit in April 2006 regarding hairdressing facilities and odour. A visit to the home in June 2006 showed that the manager had made the 1st floor shower room into a hairdressing room and had eradicated the odour. The visit in July 2006 showed the home to be clean and pleasant smelling, however none of the toilets contained soap or towels. The back of the home has two concreted areas either side which are accessible via steps from one of the lounges and the kitchen but have yet to be developed into proper garden space. Requirements have been made regarding the premises, garden and hand washing facilities. Carisbrooke House Residential Home DS0000064315.V304693.R02.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, 30 Quality in this outcome area is adequate. The outcome of this group of standards could be good if at least 50 of staff had NVQ 2 (or above) and formal induction training was in place. Residents care is compromised because not all staff have received formal induction, there are not sufficient numbers of NVQ trained staff and one member of staff has a very poor attitude. However, the home does protect residents from harm by following safe recruitment practices. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The visit of 13 July 2006 showed adequate numbers of staff on duty that were meeting the physical needs of the residents. The duty roster seen for the week of the July visit showed the home was meeting their registration conditions regarding staffing levels. Residents said they were satisfied with the care they received and did not have to wait long for staff assistance. Carisbrooke House Residential Home DS0000064315.V304693.R02.S.doc Version 5.2 Page 19 Observations made during the July 2006 visit showed that one member of staff did not interact well with any of the residents, some of whom indicated that they did not like her attitude towards them. She also demonstrated poor practice whilst feeding a resident. The manager said she was aware and was in the process of dealing with it. A requirement regarding induction training was made following the visit in April 2006 but this has not yet been complied with, however, new staff are being provided with a basic overview of the home and their responsibilities. The last full inspection in October 2005 showed the home was recruiting staff safely, which had changed by the visit carried out in January 2006. This showed the manager (employed following the visit in October 2005) had employed staff without following any safe vetting procedures. This had not improved at the April 2006 visit but staff files seen at the July visit showed the newly appointed manager was following safe recruitment practices. A requirement following the last full inspection was made about food hygiene training for all staff. Most have completed this and the new manager intends for the remaining 3 to undertake this training within the next 6 months. The July 2006 visit showed that 2 out of 14 care staff had NVQ 2 and 1 had NVQ 3 which is a significantly lower number qualified than at the October 2005 visit. Pre inspection information supplied in May 2005 by the previous manager confirms that 4 care staff with NVQ 2 had left the home since October 2005. A requirement has been repeated from the October 2005 and the April 2006 visits regarding training. Carisbrooke House Residential Home DS0000064315.V304693.R02.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, 38 Quality in this outcome area is adequate. The outcome of this group of standards could be good if the home monitored the quality of service provided, set up and maintained systems regarding staff training, induction, supervision and care planning and properly assessed the use of equipment, particularly bed rails, for residents use. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Visits to the home in January and April 2006 showed significant failures from the previous manager who had been appointed in October 2005 and left in May 2006. Carisbrooke House Residential Home DS0000064315.V304693.R02.S.doc Version 5.2 Page 21 Requirements were made following the April 2006 visit regarding quality monitoring and staff appraisal and supervision. The visit in July 2006 showed that these requirements remained outstanding. Some staff files indicated that some staff supervision has been carried out. A new manager was appointed in May 2005 and has yet to apply for registration. The visit to the home in July 2006 showed the home to be well organised with staff working together as a team. The atmosphere was relaxed and calm and residents were well aware of who the manager was and knew they could go to her with their concerns. The visit in April 2006 showed residents finances were in good order and the July 2006 visit showed no changes made to the way this system is managed. Safety records showed the home is managed in a safe way except the use of bed rails (see detail recorded under Health and Personal Care). Requirements have been repeated from the April 2006 visit regarding quality monitoring, staff supervision and bed rails. Carisbrooke House Residential Home DS0000064315.V304693.R02.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 1 X 3 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 3 2 2 X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Carisbrooke House Residential Home DS0000064315.V304693.R02.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? 7 repeated. 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 Regulation 5 (2) Requirement The registered person must supply a copy of the homes service user guide to each resident before admission. The registered person must ensure a written care plan is completed for each resident which clearly sets out how their needs in respect to their health and welfare are to be met. Repeated, deadline of 31/07/06 not met. The registered person must take steps to ensure full and accurate records for the receipt, administration and disposal of medicines are completed at all times in a way that enables medicines to be fully accounted for. Repeated, deadline of 28/04/06 not met. The registered person must provide the Commission with documentary evidence that all members of staff authorised to handle and administer medicines at the home have received suitable training. DS0000064315.V304693.R02.S.doc Timescale for action 31/10/06 2. OP7 15 (1) 31/10/06 3. OP9 13 (2) 17 (1) 31/08/06 4. OP9 18 (1) 31/08/06 Carisbrooke House Residential Home Version 5.2 Page 24 5. OP19 23 (2) (a) 6. OP20 23 (2) (o) 7. OP26 13 (3) 8. OP30 18 (1) (c) (i) 9. OP33 24 10. OP36 18 (2) Repeated, deadline of 20/05/06 not met. The registered person must ensure that the physical design and layout of the premises is suitable to meet the needs of the residents. The registered person must ensure that the external grounds provided for residents are suitable, safe and well maintained. The registered person must ensure that suitable arrangements are in place to prevent the spread of infection particularly regarding handwashing facilities. The registered person must ensure staff are provided with training appropriate to the work they perform particularly regarding induction, NVQ and basic food hygiene. Repeated, most recent deadline of 31/05/06 not met. The registered person must establish and maintain a system for reviewing and improving the quality of care provided and must make a report available to all participants and the Commission. Repeated, deadline of 30/06/06 not met. The registered person must ensure that all staff are appropriately supervised. Repeated, deadline of 30/06/06 not met. The registered person must ensure that unnecessary risk to the health or safety of residents are identified and minimised, particularly regarding the use of bed rails. DS0000064315.V304693.R02.S.doc 31/12/06 31/12/06 31/10/06 31/10/06 31/10/06 31/10/06 11. OP38 13 (4) (c) 31/08/06 Carisbrooke House Residential Home Version 5.2 Page 25 Repeated, deadline of 30/04/06 not met. 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. Refer to Standard OP3 Good Practice Recommendations The registered person is recommended to complete preadmission assessments on all prospective residents and should ensure these assessments contain reference to their social needs, hobbies and interests. The registered person is recommended to update the complaints policy to include the name of the new manager. 2. OP16 Carisbrooke House Residential Home DS0000064315.V304693.R02.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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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