Inspection on 07/03/07 for Carisbrooke Nursing Home

This inspection was carried out on 7th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 Nursing Home 21/03/06

Carisbrooke Nursing Home 14/09/05

Carisbrooke Nursing Home 03/03/05

Carisbrooke Nursing Home 05/05/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

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

CARE HOMES FOR OLDER PEOPLE Carisbrooke Nursing Home 50 Teignmouth Road Torquay Devon TQ1 4ET Lead Inspector Mandy Norton Unannounced Inspection 7th March 2007 12:30 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 Nursing Home DS0000028649.V327446.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. Carisbrooke Nursing Home DS0000028649.V327446.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carisbrooke Nursing Home Address 50 Teignmouth Road Torquay Devon TQ1 4ET 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) 01803 326409 01803 313368 Mrs Betty Delicia Miller Betty Delicia Miller Care Home 25 Category(ies) of Physical disability (25) registration, with number of places Carisbrooke Nursing Home DS0000028649.V327446.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home is registered as a Care Home with Nursing for a maximum of 25 Service Users in the categories of PD 25, TI 25 Date of last inspection Brief Description of the Service: Mrs Betty Miller, the proprietor and Matron, established Carisbrooke Nursing Home in 1971. It is located in the Torre area of Torquay, close to local amenities. The home is registered to provide general nursing care within 18 single rooms (14 of which have en-suite facilities), and 3 double rooms. It provides nursing care for long and short- term admissions for physically disabled, palliative care and post- operative care (convalescence). The home is arranged on 3 floors with access via a passenger lift and a small stair lift to 3 double rooms on the top floor. The garden is well kept and accessible to Service Users. There is a variety of equipment to support physically disabled Service Users needs and specialist equipment is available following an assessment of need. A registered nurse is on duty at all times supported by a team of Health care assistants, administration, catering, domestic and maintenance staff. The fees charged range from £469 to £520 (February 2007). People requiring ‘continuing care’ have their fees negotiated by the placing authority on an individual basis. ’The latest inspection report is displayed in the entrance foyer and the manager was advised that the Statement of Purpose should be updated to include information about where people can access the latest report if they do not have access to the internet. The contracts issued include name and date of admission and who pays the fee, how the fee is broken down and the total fee, plus the homes terms and conditions of residency. Carisbrooke Nursing Home DS0000028649.V327446.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place from 12.30 pm until 4 pm and was conducted with the matron who is also the proprietor. A tour of the home was carried out. The report contains views from the completed staff surveys returned (12) reflected throughout, information taken from the completed pre inspection questionnaire and views of Service Users spoken on the day of the inspection. Service Users seen were not always able to fully express themselves verbally or comment on the care they received. What the service does well: Carisbrooke is homely, comfortable and welcoming. The staff are trained and competent in their jobs and there was a calm atmosphere during the inspection with staff interacting well with the Service Users. The information about the home given to prospective Service Users and or their representatives has sufficient detail to allow an informed decision to be made about moving into the home. When possible, prior to admission, the matron or one of the senior nurses visit the person in their current setting to perform a full needs assessment in addition to receiving care plans from other social and health care professionals. Once admitted to the home Service Users needs are set out in a care plan, the plans provide sufficient information for care staff to be able to meet the individuals’ health, social and psychological needs. The processes in place protect the health and welfare of the Service Users such as the complaints procedure and health and safety procedures. Regular training for the staff helps to assure the people living in the home that they are well looked after. Service Users are able to maintain contact with family and friends and exercise choice and control over their lives. Service Users receive a wholesome appealing diet. Alternatives to the menu are always available. The home is tastefully decorated and furnished and presented as clean and hygienic. Carisbrooke Nursing Home DS0000028649.V327446.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Carisbrooke Nursing Home DS0000028649.V327446.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carisbrooke Nursing Home DS0000028649.V327446.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use this service or are prospective Service Users have good information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that people’s diverse needs are identified and planned for before they move to the home. This home does not provide intermediate care although it does admit some Service Users for convalescence post operatively. EVIDENCE: The matron said that pre admission documentation includes information about Service Users assessed needs, equipment required, medications, next of kin and general information about the person. She has found on one occasion when a visit was not carried out that the Service User had problems that the Carisbrooke Nursing Home DS0000028649.V327446.R01.S.doc Version 5.2 Page 9 home are not registered to manage, therefore a pre admission visit is now always carried out by the matron or one of the senior nurses. A brochure that includes the up to date Statement of Purpose is given or sent to every person wishing to move into the home. An up to date Statement of Purpose was included with the pre inspection questionnaire and includes all of the information required. All of the above information is also available at all times in the entrance foyer. Although the home does not provide intermediate care some Service Users are admitted for respite care following surgery. They have access to the physiotherapist employed by the home - one session a week is included in the fee. More sessions can be ‘purchased’ by the Service User if they wish and it is felt appropriate. Carisbrooke Nursing Home DS0000028649.V327446.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager promotes and maintains Service Users health and ensures access to health care services to meet assessed needs. The homes medication systems protect the welfare of residents. Service Users are treated with respect and their right to privacy is upheld. EVIDENCE: Three (3) care plans were examined; in all of those seen there were assessments which provided information about skin integrity, moving and handling, safety - including risk of falls, use of bed rails consent and basic risk assessment and nutritional screening. The information generates the plans of care, which provide the basis for the care to be delivered. Carisbrooke Nursing Home DS0000028649.V327446.R01.S.doc Version 5.2 Page 11 The care plans were clear and easy to understand and had been regularly reviewed. In some cases it was evident that the plans had been created and reviewed with input from the residents and/or their representatives. It was recommended that a more in depth bed rail risk assessment be introduced and any lap straps in use should have a separate risk assessment carried out and documented. Records are maintained for all visits to the home by social or health care professionals, all residents are registered with a GP. Records in care plans detailed outpatient appointments and GP visits showing that health resources are enabled to use health resources. The medication system is well managed. The matron said stock is checked weekly and ordered monthly as often as possible. Disposal of unused/ out of date medication is safe, well recorded and removed by a licensed contractor. Staff were overheard knocking on doors prior to entering rooms of Service Users. Appropriate interactions between staff and Service Users was heard during the inspection. The matron insists on matching crockery and cutlery and all Service Users have linen napkins at mealtimes. She provides in house training sessions on how to lay a tray ‘properly’. She said she considers all interactions with Service Users important and expects her staff to engage with Service Users in an appropriate manner. She is often in the home when she is not on duty and constantly observes the staff carrying out their duties. Carisbrooke Nursing Home DS0000028649.V327446.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Effort is made by the home to provide an activities programme and social interaction/stimulation for Service Users. Service Users are able to maintain contact with family and friends and exercise choice and control over their lives. Service Users receive a wholesome appealing diet and are not rushed encouraging the mealtime to be a social event. EVIDENCE: A tour of the home showed some Service Users in their rooms watching appropriate TV programmes, listening to the radio, reading newspapers or magazines and chatting with visitors. Communal space includes a conservatory, where most of the activities take place, and a dining room, part of which can be used as a quiet seating area. There is level access to well laid gardens where seating is available for Service Users use. Carisbrooke Nursing Home DS0000028649.V327446.R01.S.doc Version 5.2 Page 13 An activity programme is in place, information about what is scheduled is displayed within the home. These include movement to music and crafts with a recreational therapist, these are well attended. Outings and trips are arranged on an individual basis. There is a monthly Holy Communion session held in the home. The menus (provided with the pre inspection questionnaire) are very varied and alternatives are always available. The menu has stated on it that ‘always available: cold meats, fresh fruit, cheese and biscuits, a selection of yoghurts, beverages and mineral water’. All of the Service Users spoken to said that the meals are exceptional, many of the completed staff surveys indicated that the meals served are excellent. The matron takes great care to ensure meals are served attractively and with the amount the Service User wants. Trays are laid, the meal is served and individually taken to Service Users rooms by the care staff. This process was seen during the inspection and ensured that Service Users food was hot enough when delivered to them and that the staff member could make the Service User comfortable for their meal and give any assistance as required. The pre inspection questionnaire included an example of the Christmas 2006 menu, this was well presented and included 3 days menus, all varied and specially created for the season. House wines were included on the menu. Staff were seen assisting Service Users at a mealtime. The pureed meals were in proportion and colourful. Specialist diets are catered for. Information about the Service Users requiring these was available in the kitchen for the catering staff to refer to. Service Users can eat in their rooms or in the dining room, wherever they choose. Carisbrooke Nursing Home DS0000028649.V327446.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users and their relatives/friends know how to make a formal complaint. People are safe living in this home. EVIDENCE: The complaints procedure was seen displayed within the home and is in the Statement of Purpose, given to all Service Users and /or their representatives prior to admission. The matron says she carries out a daily ‘round’ at different times of the day and Service Users will often talk to her about any concerns at this time. She said she has an open door policy for Service Users, visitors and staff to approach her and discuss any issues. Minutes were seen of the trained staff meeting held on 1st February 2007. The matron said that separate meetings are held for care staff to discuss relevant issues. The pre inspection questionnaire states that there have been no complaints or adult protection referrals since the last inspection. Carisbrooke Nursing Home DS0000028649.V327446.R01.S.doc Version 5.2 Page 15 Eleven (11) of the thirteen (13) completed staff surveys indicated they were aware of adult protection procedures (one did not complete that section of the survey). The training record supplied with the pre inspection questionnaire indicates that new staff have induction training that includes information about adult protection issues. Carisbrooke Nursing Home DS0000028649.V327446.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 25 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is safe and well maintained and clean and hygienic ensuring the Service Users live in a satisfactory environment. EVIDENCE: A tour of the home showed that Service Users rooms contain personal items including furniture, ornaments and pictures. Service Users able to give an opinion said that they liked their rooms and found them comfortable. The en – suite facilities benefit form double doors, in most cases, for ease of access for those people in wheelchairs or that use walking aids. The home appeared well equipped to meet the needs of Service Users identified with moving and handling risks and disabilities that affect their capability to bathe. Specialist mattresses and cushions and adjustable beds Carisbrooke Nursing Home DS0000028649.V327446.R01.S.doc Version 5.2 Page 17 were seen in place for those Service Users requiring them. There is c all bell system throughout the home, Service Users seen in their rooms all had the bell placed within their reach. There is a conservatory and a dining room on the ground floor. The decoration and furniture was domestic in nature and appeared to be of good quality. There are no TV’s in the communal areas. All rooms benefit from their own TV. The matron has replaced some recently with wall mounted flat screen TV’s. There are a variety of toilet facilities, for use by Service Users, throughout the home. There is a shaft lift and a stair lift for access to a 3 double rooms with steps leading to them. The home has a well - laid and maintained garden with seating available for Service Users to use. Many rooms benefit from views over the gardens. Hand washing facilities were seen throughout the home as were protective gloves and aprons. The laundry has one washing machine, with a disinfecting sluice cycle, and a large tumble dryer. The laundry assistant and the manager said that this was sufficient for the washing the home produces. The kitchen appeared well equipped and although small it is organised in such a way that the catering staff can manage the meals required for the number of Service Users living in the home. The matron/proprietor has an ongoing plan for refurbishment and redecoration as she takes a great pride in the appearance of the home and the quality of the fixtures and fittings. The pre inspection questionnaire provided information about maintenance records held that indicates the home is well maintained and safe, this includes: hoist checks, weekly fire alarm checks, central heating checks and fire equipment checks. Some of these checks are carried out by outside contractors. Some documents were checked to confirm the information provided on the pre inspection questionnaire. During the inspection the home was clean and tidy. Carisbrooke Nursing Home DS0000028649.V327446.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sufficient numbers of staff with appropriate skills and knowledge to meet the needs of Service Users in this home. The homes recruitment procedures protect Service Users from being placed at risk of harm or abuse EVIDENCE: The matron/proprietor is supernumerary but spends a lot of time in the home. There is also a trained nurse on duty 24 hours a day supported by at least 5 carers in the morning, 3 in the afternoon and 1 overnight. The matron said that care staff are divided within the home so that they all have 4 Service Users to look after each morning. The pre inspection questionnaire states that there are nine (9) level one nurses and one (1) second level nurse employed in the home, they are assisted by eighteen (18) care assistants, over 50 (8) of whom have achieved a National Vocational Qualification (NVQ), level 2 or above, in care. There are also ten (10) ancillary staff (catering, laundry, domestic, activities and maintenance) and a secretary employed in the home. (Not all of the staff are full time). Carisbrooke Nursing Home DS0000028649.V327446.R01.S.doc Version 5.2 Page 19 The home also admits people with ‘continuing care ‘ needs and works well with other professionals using the Liverpool Care Pathway (a plan that provides guidance on different aspects of palliative care required, irrespective of diagnosis, including comfort measures, psychological, spiritual and family support: more information can be found on www.mariecurie.org.uk). The inspector examined the training file (January 2006 – January 2007) which detailed individual training planned and provided, including: pressure area care, continence promotion, moving and handling, bed making skills and fire training. All of the completed staff surveys (13) confirmed that there are regular staff meetings and that the matron meets with them regularly. They indicated that appraisals and supervision also take place. This was confirmed when staff files were examined. The inspector looked at two (2) staff files - these contained 2 written references, interview records, proof of Criminal Records Bureaux (CRB) checks and identity information. Service Users able to express an opinion said the matron and other staff were kind and helpful. Carisbrooke Nursing Home DS0000028649.V327446.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is managed by an experienced Registered Nurse. There is a formal quality assurance system in place. Personal money held in the home on behalf of Service Users is managed appropriately. The registered provider shows a responsible attitude toward promoting and protecting the health, safety and welfare of Service Users and staff. EVIDENCE: The matron /proprietor of this home is a 1st level registered nurse who has a Registered Managers Award. She established the home in 1971. She shows Carisbrooke Nursing Home DS0000028649.V327446.R01.S.doc Version 5.2 Page 21 strong leadership qualities and expects high standards from her staff. The completed staff surveys indicate that her management style is respected and staff are clear about what she expects from them. There are clearly defined roles amongst the staff with trained nurses having responsibility for specific areas such as medicines ordering and induction training. The home has its own complaints process, safe recruitment practices and numerous training opportunities (see standards 27 – 30). She believes in providing good quality care, meals and environment and ensuring people are treated with kindness and dignity. She measures this by visiting the Service Users regularly to assess the level of service they are receiving and has satisfaction surveys given/ sent to Service Users and/or their representatives for feedback. Any actions required as a result of these is discussed at staff meetings and is documented in the minutes. Safety notices were displayed throughout the home including action to be taken in case of fire. The completed PIQ indicates that all equipment is regularly maintained and tested. PAT testing stickers were seen on electrical equipment throughout the home. The fire and accident book were examined and found to be completed as required. Statutory training in fire safety, manual handling and food hygiene (documented in the January 2006 – 2007 training file examined during the inspection) takes place to ensure safe working practices are used throughout the home. The inspector was shown he records and storage of personal money held in the home on behalf of Service Users. Best practise systems are in place for the protection of both residents and staff – receipts are stored for auditing purposes and the money is stored securely. Carisbrooke Nursing Home DS0000028649.V327446.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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 3 X 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 4 Carisbrooke Nursing Home DS0000028649.V327446.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Carisbrooke Nursing Home DS0000028649.V327446.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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