Inspection on 20/07/06 for Charnwood Hall Nursing Home

This inspection was carried out on 20th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Charnwood Hall Nursing Home 12/01/06

Charnwood Hall Nursing Home 13/09/05

Charnwood Hall Nursing Home 10/03/05

Charnwood Hall Nursing Home 22/09/04

Charnwood Hall Nursing Home 08/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Charnwood Hall Nursing Home 38 Charnwood Road Shepshed Loughborough Leicestershire LE12 9QF Lead Inspector Mrs Gillian Adkin Unannounced Inspection 20th July 2006 09:30 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 Charnwood Hall Nursing Home DS0000054117.V304379.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. Charnwood Hall Nursing Home DS0000054117.V304379.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Charnwood Hall Nursing Home Address 38 Charnwood Road Shepshed Loughborough Leicestershire LE12 9QF 01509 650717 01509 506300 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) Quality Care Midlands Ltd Mrs Lynne Stinchcombe Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25), Physical disability over 65 years of age of places (25) Charnwood Hall Nursing Home DS0000054117.V304379.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No additional conditions of registration. Date of last inspection 12/01/06 Brief Description of the Service: Charnwood Hall Nursing Home is a Care home situated centrally in Shepshed Leicestershire. The home is owned by a Limited Company called Quality Care Midlands Limited. It is registered to accommodate twenty-five residents with physical disabilities and old age. It is situated on a main road within a fiveminute walk of the town centre. It is also on a public transport route. Facilities close by include several churches, and a number of social amenities including restaurants, a bowling green, local market and a number of public houses. The local community centre is within walking distance of the home. The registered provider employs registered nurse , care and ancillary staff (a number of whom have been employed for many years). The town has two main GP practises which service users are registered with. Charnwood Hall was originally a Manor House, which was developed and modernised by the present owners. It is traditional in design and is furnished and fitted to a good standard and offers service users comfortable, homely surroundings. It has a main lounge, which includes a dining room. A separate dining room is located next to the lounge, this was being extended. The home has two floors with a passenger lift between each floor. The home has fifteen single bedrooms and three double of which seven are en-suite. A conservatory was being built. The home has off street parking Charnwood Hall Nursing Home DS0000054117.V304379.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The service was inspected against the Regulations as in the Care Standards Act 2000.This was an unannounced inspection, which took place over 5.5 hours and commenced at 09.30 am on 20/07/06. The registered manager assisted at the inspection. The focus of inspections is on outcomes for residents living at the home and obtaining their views of the service provided. This process considers whether the home meets the National Minimum Standards and highlights areas, which might need further development or improvement. The method of inspection used is called “case tracking’ which involved selecting two residents and tracking the care they received this was achieved by discussion with them, their relatives and associated staff. Residents were selected randomly. Staff were observed at work and providing care. During this inspection a tour of the rooms (occupied by those case tracked) and associated communal and external areas took place and the inspector viewed internal records, and care plans. Comments made by residents about the home during this inspection were extremely positive. Nine residents completed comment cards with the assistance of staff. No relatives were available for discussion during the inspection. Typical resident/ staff /visitors comments included: “I remember being assessed by the manager whilst I was in hospital” “I always get my laundry back in good time it is managed well” “Meals are of a very high standard and the portions are just too big for me” “My dressings were changed regularly the nurses involved are very particular, they have done marvels with my leg ulcers” “I can visit the home and pop in and see my friends anytime” “We are given very good handovers so know if any thing changes in the care we provide” “I took four residents out in their wheelchairs last week we went around the town for a walk” “ I like the way we are looked after and that everywhere is clean and comfortable. “We intend to improve our quality assurance monitoring this year” “ I cannot say enough about the staff they are marvellous” “ I have completed some more training recently which has made me more aware of recommended guidelines regarding food and nutrition” “ I am happy with everything here I love it here and glad I am here” Charnwood Hall Nursing Home DS0000054117.V304379.R01.S.doc Version 5.2 Page 6 What the service does well: 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. Charnwood Hall Nursing Home DS0000054117.V304379.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 Charnwood Hall Nursing Home DS0000054117.V304379.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3.6 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to the service. A qualified person assesses residents before admission; this process involves residents/relatives and other professionals. Residents are assured that their needs can be met in the home. EVIDENCE: Evidence was found during inspection of care records to demonstrate that a robust assessment of needs is undertaken before admission and where required additional assessments for nursing care are conducted. District nurses are also involved in assessing residents for nursing care. Two residents were case tracked who had recently been admitted to the home, one was able to give comments about their assessment, the other was unable to remember. The resident said that they remembered the registered manager visiting them I hospital and asking “lots of questions” The statement of purpose and service user guide (information about the home) were provided and were conclusive although recommendations were made to include the internal arrangements for managing residents personal money. Charnwood Hall Nursing Home DS0000054117.V304379.R01.S.doc Version 5.2 Page 9 One resident said they had received a contract and service user guide (brochure and information about the home) they stated that they had been recommended the home and despite not visiting the home before being admitted felt confident that this was the right home. Charnwood Hall Nursing Home DS0000054117.V304379.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents are needs are met by a plan of care and robust management of medication is in place. Residents consider that their personal needs are always met in a manner, which is respectful and suits them. EVIDENCE: Both of the people case tracked had a plan of care in place (a care plan describes how residents specific needs are to be met) All residents have a named nurse and a key worker who have specific responsibilities in meeting these needs and are responsible for the updating and general up keep of records. All residents are registered with a local General Practitioner practise and responses seen on a recent quality assurance survey indicated that they considered the home to be excellent and provided an excellent working partnership with the primary care team (doctors and district nurses) Both resident’s tracked were unaware of their care plan however one resident had memory difficulties. The registered manager said that she had taken a great deal of time to explain and remind the other resident about the care plan and its contents . Care records inspected were reflective of the initial Charnwood Hall Nursing Home DS0000054117.V304379.R01.S.doc Version 5.2 Page 11 assessment of needs and included essential risk assessments. All care plans had been reviewed regularly. One resident said that she was kept informed by nurses of any changes to care, this was particularly important to the resident in relation to the management of leg wounds She stated, “Nursing staff have done wonders with my legs”. Evidence was seen in care records of the management of dressings. The nurse involved discussed with the inspector how she had tried recommended new dressings with the support of the General Practitioner and had achieved great success with previously difficult wounds had now healed. Both residents tracked were registered with the local General Practitioner practise and evidence was obtained by inspection of records and through discussion with residents to demonstrate that appropriate professionals were involved in residents care and that treatment was obtained when required. Staff spoken with informed the inspector that they were aware of the contents of care plans and although not actively involved in them were regularly updated on changes at handovers. Minutes of a recent staff meeting were seen and covered areas such as basic hygiene needs, pressure area and catheter care. Neither of the residents’ case tracked administered their own medication. The medicines policy provided was current and met with current legislation and recommended guidelines. The registered manager provided evidence of monthly audits demonstrating a commitment to ensuring medication is managed appropriately. Medication procedures including blister packs, records, storage, and disposal were checked and were appropriate to meeting recommended guidelines. Evidence was seen of the safe management of diabetic medication and blood sugar monitoring. Residents confirmed that staff never left them alone until they had taken their tablets. Observation of staff at work indicated that their approach was appropriate and comments received during inspection indicated that all residents’ considered their privacy and dignity was respected, this included both of the persons tracked. Charnwood Hall Nursing Home DS0000054117.V304379.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.14.15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Provision of good quality meals and varied activities has resulted in resident’s individual requirements being met and a high level of satisfaction with the service provided. EVIDENCE: Discussions with residents took place around their views of the lifestyle they experienced in the home. Two residents’ tracked said that they are given a choice of routines and staff were flexible. Social histories were well documented in care plans. An activities organiser works in the home three times a week for two hour sessions, providing a variety of entertainment and 1-1 activities including walks in the town. One resident said that previous to coming into the home she enjoyed painting and hoped that the activities lady would set up a painting group. Another resident tracked previously kept dogs. Although the home previously was visited by PAT dogs (dogs who provide therapy for people in care homes) this was no longer happening. The registered manager said that they had organised a specialist group of people to provide an alternative activity next month involving a variety of animals. Residents were seen taking an active part in a music /singing session during the inspection. Charnwood Hall Nursing Home DS0000054117.V304379.R01.S.doc Version 5.2 Page 13 One resident tracked informed the inspector that they preferred their own company and chose to stay in their room. No specific issues were raised by residents about routines and flexibility. One resident did however state that the timing of the mid day meal was an issue for them, this related to their preference about a later lunchtime. Discussion with the cook and the registered manager indicated that these concerns had never been raised with them and that the resident could have their midday meal whenever it was convenient to them. They agreed to talk to the residents after the inspection to confirm this. The activities organiser and staff were praised by service users, visitors and staff for their hard work and enthusiasm. Observation of staff at work identified that service users were given choices and assisted to make decisions. Discussions with the cook indicated that she was fully aware of the nutritional needs associated with a service users’ case tracked and of current good practise and government recommendations regarding healthy eating. She stated she had recently attended some training in food and nutrition and was in the process of making some gluten free cakes. All residents spoken with during this inspection said that food was of high standard and offered choices. Comments received on comment cards received indicated that all service users were very happy with food provided. Cold drinks were readily available and hot drinks were provided. A small shop is now provided for residents to buy sweets, toiletries etc, all profits are put back into the residents fund for activities /outings etc. Charnwood Hall Nursing Home DS0000054117.V304379.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16.18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service The home has a clear and accessible complaints and adult protection procedure, which promotes an open and positive approach to problem solving and ensures the protection of service users. EVIDENCE: Observation of training records and information provided demonstrated that most staff had received adult protection training; furthermore 98 of staff are qualified at either level 2 or 3 NVQ (a recognised qualification in care) this course covers management of abuse. Discussion with residents and observation of the survey they had completed indicated that staff were respectful. Residents tracked stated they were fully aware of the complaints procedure and comments received indicated that residents’ had not felt the need to complain. Residents spoken with appeared to understand the process and said they would talk to the manager or deputy manager The complaints procedure is prominently displayed in the home. Complaints records seen indicated that there had been no complaints internally since before the last inspection. One resident spoken with said, “I feel safe living at the home” Charnwood Hall Nursing Home DS0000054117.V304379.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to the service The home is clean and hygienic and reasonably maintained but would be more homely if attention was given to decoration and replacement of carpeting. EVIDENCE: Positive comments were received from residents about the cleanliness of the home. Observation of rooms and communal areas provided demonstrated that the home is clean and hygienic. The rooms of residents tracked were inspected and appeared homely and contained fixtures and fittings appropriate to them. Rooms were appropriately sited near to bathing and toileting facilities. One resident tracked preferred to stay in their own room during the day but came down stairs occasionally, they were able to do this by using the lift. Bedrooms and some communal areas seen had been redecorated and rooms contained some items of personal belongings. A resident informed the inspector that although they were occupying a double room at present they Charnwood Hall Nursing Home DS0000054117.V304379.R01.S.doc Version 5.2 Page 16 had been made aware that this would be a shared room in the future. This had been fully agreed before admission. External areas seen provided adequate space for residents to go outside and garden furniture was in place. The home was being redeveloped during this inspection and the extended dining room and conservatory was nearing completion. Residents spoken with had been kept informed of the new developments. The inspector requested a copy of the completion certificate when signed off by the building inspector. Discussion with the laundry staff indicated that facilities provided are suitable for the upkeep of laundry for the number of residents in the home. Washing machines are of an industrial type and have sluicing facilities (a programme for removing bad stains or soiling). Laundry staff are on duty every day. Residents said that laundry always came back to them “clean and ironed well”. Laundry staff spoken with said that they are able to label clothing when it comes in to prevent residents receiving the wrong laundry back. Maintenance records provided by the registered provider indicate that all routine maintenance tests are carried out; these include fire testing, lectures and drills. Staff records seen indicate that training has been provided in infection control, staff were aware of the basic infection control measures required. Charnwood Hall Nursing Home DS0000054117.V304379.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service The home provides sufficient numbers of staff with the skills and training necessary to meet the needs of service users. EVIDENCE: Information provided by the registered manager demonstrated that currently the home are providing above the number of recommended hours as in guidance by the Department of Health Residential Forum(this is guidance about recommended staffing levels which consider the levels of dependency of residents). The manager’s hours are included into the rosters, she has one day per week to complete management tasks. Many of the registered nurses and care staff working in the home staff have been employed for a number of years and residents indicated that this provided a level of stability and familiarity. Residents were noted to use pet names for some staff, and informed the inspector that they enjoyed the company of staff. No agency staff were identified on rosters seen and bank staff are regular staff. The manager and senior nurse are very proactive in seeking out and providing training for staff. Some training is internal and some provided by external trainers. Currently 98 of staff have an NVQ qualification in care. This is to be commended. Charnwood Hall Nursing Home DS0000054117.V304379.R01.S.doc Version 5.2 Page 18 The registered manager undertakes recruitment of staff and evidence was provided of an interview record. Staff files for staff associated with those residents case tracked were inspected and contained most of the information and references required. One file inspected contained an incomplete work history and no criminal conviction declaration, this was completed however during the inspection. The registered manager has taken advice from the Criminal records department and intends to update police checks every three years. It was recommended that application forms be checked thoroughly before interview to ensure that all information is fully completed, particularly work histories and criminal conviction disclosures. Charnwood Hall Nursing Home DS0000054117.V304379.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31.33.35.36.38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The effective leadership of the home and well supervised staff who are aware of policies and procedures ensures that resident’s safety; best interests and rights are protected. EVIDENCE: The registered manager has significant previous experience working in and managing large care homes, she has a management qualification. The manager demonstrated her commitment to updating skills and maintaining her professional registration. Information was supplied to the Commission for Social Care Inspection before this inspection relating to the general management of health and safety in the home. The information provided indicated that the home employs a part time Charnwood Hall Nursing Home DS0000054117.V304379.R01.S.doc Version 5.2 Page 20 maintenance person; accurate maintenance records and procedures are being maintained. Accident records were not inspected on this occasion. Exploration of additional documents including personal risk assessments indicated that overall reasonable measures are taken to minimise risk and promote and protect residents’ best interests. Evidence was seen of residents and staff meetings taking place; the next meeting was arranged for residents at the end of the month. The last staff meting was held six months ago and had a number of items on the agenda affecting residents’ wellbeing including personal hygiene, catheter care, staff attitude, general cleanliness of the home etc. These were fully discussed with the manager. Discussion with her indicated that relatives are encouraged to attend. Staff supervision is routinely undertaken and records were seen. Staff spoken with praised both the manager and nurses for their support. The most recent quality survey was undertaken in 2005 and this years survey was due to go out after completion of the new dining room and conservatory to obtain residents views. A general maintenance audit was recorded in 2004 but not since, the manager said that a weekly audit of the home is undertaken but records were not in place to confirm this. The finance policy was seen and the maximum amount of cash the home are prepared to mange is detailed on the residents contract. It was recommended that this be detailed on the service user guide (residents information guide) Money and accounts belonging to those residents tracked were inspected and were found to be in order and well audited. Charnwood Hall Nursing Home DS0000054117.V304379.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 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 3 X 3 X 3 X X 3 Charnwood Hall Nursing Home DS0000054117.V304379.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? 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 Charnwood Hall Nursing Home DS0000054117.V304379.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX 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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