Inspection on 21/02/06 for Chestnuts Nursing & Residential Care Home (The)

This inspection was carried out on 21st February 2006.

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

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

Other inspections for this house

Chestnuts Nursing & Residential... 09/10/07

Chestnuts Nursing & Residential... 17/01/07

Chestnuts Nursing & Residential... 11/05/06

Chestnuts Nursing & Residential... 22/08/05

Chestnuts Nursing & Residential... 01/02/05

Chestnuts Nursing & Residential... 23/07/04

Chestnuts Nursing & Residential... 14/01/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Chestnuts Nursing & Residential Care Home (The) 63 Cambridge Park Wanstead London E11 2PR Lead Inspector Ms Gwen Lording Unannounced Inspection 21st February 2006 09:40 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 Chestnuts Nursing & Residential Care Home (The) DS0000025950.V274645.R01.S.doc Version 5.1 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. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V274645.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Chestnuts Nursing & Residential Care Home (The) 63 Cambridge Park Wanstead London E11 2PR Address 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) 0208 989 3519 0208 530 6211 Ms Avril Stein Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (45), Physical disability (6) of places Chestnuts Nursing & Residential Care Home (The) DS0000025950.V274645.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service can only admit people in the category of PD (Physical disability) who are 55 years of age and above. 22nd August 2005 Date of last inspection Brief Description of the Service: The Chestnuts is a care home registered to provide accommodation with personal care and nursing for up to fifty-one residents, including six places for residents over 55 years who have a physical disability. The registered provider is the sole proprietor. The large property is situated in its own grounds with a large secluded garden to the rear. The majority of rooms are single and all have en suite facilities. There are two passenger lifts, with access to all floors. The home is set well back on a busy main road in Wanstead, in the London Borough of Redbridge. The home is well served by public transport and close to shops and other local amenities. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V274645.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 9.40am. It took place over seven hours during the late morning and afternoon. The inspection was undertaken by two inspectors. There is now a registered manager in post who is working to improve standards. Discussion took place with the registered manager, the home’s proprietor, administrative staff and several members of nursing and care staff. A tour of the home took place and the Inspectors were able to speak to several residents and one visiting relative during the course of the visit. A number of staff and care records were inspected. An Immediate Requirement Notice was issued for action to be taken concerning the storage, recording and administration of Controlled Drugs. The Commission is aware of an adult protection matter that is subject to ongoing investigation. The registered persons are working co-operatively with the Commission and the local authority to address this matter. This was the second statutory inspection visit in the inspection programme for 2005/2006. Over the course of these two visits, all key standards have now been assessed The Inspectors would like to thank the staff and residents for their input during the inspection. What the service does well: What has improved since the last inspection? The proprietor has recruited a manager who is now registered with the Commission. She is qualified and experienced person and has already prioritised areas for development which will improve the quality of care to residents. For example, continence assessments, manual handling assessments and odour control and cleanliness of the home. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V274645.R01.S.doc Version 5.1 Page 6 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. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V274645.R01.S.doc Version 5.1 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 Chestnuts Nursing & Residential Care Home (The) DS0000025950.V274645.R01.S.doc Version 5.1 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): The above standards were not tested on this visit. However, evidence from the last inspection was that: • Appropriate pre-admission assessments are carried out for all residents prior to them moving into the home. Care plans are drawn up from the information in this assessment, ensuring that the needs of the residents are identified, understood and met. The home does not offer intermediate care. EVIDENCE: The above standards were not specifically tested on this visit, as there were no outstanding requirements in relation to these standards. At the time of the last inspection, all of the outcome standards were assessed as met. These standards will be re-tested at a future inspection. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V274645.R01.S.doc Version 5.1 Page 9 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): Standards 7, 8 and 9. Residents health, personal and social care needs are clearly set out in an individual plan of care and provide staff with the information they need to satisfactorily identify and meet residents needs but staff are not consistently following care plans which is detrimental to the quality of care. Residents are not routinely encouraged to use aids to hearing and seeing, since the home recently introduced a system for “the safe storage” of hearing aids and spectacles at the nurses station. This is to the detriment of the quality of life and independence for residents in the care home. There are clear medication policies and procedures for staff to follow. However, the unsafe practice of some nursing staff around the recording, storage and administration of Controlled Drugs is of serious concern and could result in residents being put at risk. Standard 10 was not tested on this visit. However, evidence from the last inspection was that: • Residents are treated with respect and the arrangements for their personal care ensure that their right to privacy is upheld. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V274645.R01.S.doc Version 5.1 Page 10 EVIDENCE: From examining the care plan of the resident involved in the ongoing adult protection investigation it was evident that staff are not implementing the guidance in respect of this resident, in accordance with the specific care plan. It was noted that hearing aids and spectacles were being stored on shelves within the nurse’s station on the ground floor. The deputy manager stated that this was a recent change in order to provide “safe storage” for resident’s hearing aids and spectacles. These were given to residents when they had visitors or the individual requested them. This is a totally unacceptable practice as it fails to promote independence and protect residents and detracts from their quality of life. An audit was undertaken of the management of medications within the home. The following serious concern was noted and an Immediate Requirement Notice was issued: A Controlled Drug (Fentanyl Patches) was being stored in the medicine trolley and not as required in the Controlled Drugs cupboard, which complies with the Misuse of Drugs (Safe Custody) Regulations 1973. The receipt, administration and disposal of the Controlled Drug was not being recorded in a Controlled Drugs register. This is a serious failure by nursing staff. All nursing staff must abide by the home’s medication policies/ procedures; the Misuse of Drugs Act 1971; and the Nursing and Midwifery Council (NMC) Standard for administration of medication. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V274645.R01.S.doc Version 5.1 Page 11 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): Standard 14 The lifestyle within the home matches the expectations and preferences of some residents, but others need support to exercise choice and control over their lives within their individual capabilities. EVIDENCE: Older people moving into care homes will have differing expectations and preferences as to the lifestyle within the home. Some people will want a wellorganised life, whilst others will want to maintain a level of independence. The home needs to taken into account the variation in preferences and capacity of individuals living in the home. At the last previous two inspections a requirement has been made around the philosophy of the home being conducted as to maximise residents individual capacity to exercise personal autonomy and choice. However, the Inspector noted that there are still notices displayed in the home of either a prohibitive or instructive nature. For example ‘Service Users are not allowed to use the lift unless accompanied by a health care assistant’. Through previous discussions with the deputy manager it is apparent that these instructions are intended to address potential health, safety and welfare concerns i.e. the safety of residents whilst operating the lift. It is also acknowledged that the registered provider has the responsibility to ensure, so far as is practicable the health, safety and welfare of residents. However, this does not recognise or take into account the Chestnuts Nursing & Residential Care Home (The) DS0000025950.V274645.R01.S.doc Version 5.1 Page 12 individual capacities of residents living in the home. Any such decisions must be based on a risk assessment of the individual’s vulnerability with evidence of regular reviews. This will ensure that residents are encouraged and supported to exercise choice and control over their lives, whilst equally ensuring and maintaining safe working practices. This is a re-stated requirement from the last two inspections and must be complied with by the new timescale. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V274645.R01.S.doc Version 5.1 Page 13 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): Standards 16 and 18 The home has a complaint policy/ procedure and a policy for recording incidents/ accidents. However, the management of these records is not robust and does not ensure that there is a proper response to any concerns about the welfare of residents. EVIDENCE: Whilst records are being maintained of complaints and incidents, from viewing the incident record it was apparent that such incidents are not always being notified to the Commission in compliance with Regulation 37 and follow up action was not always recorded. Following one incident staff had made an entry of the incident retrospectively and this statement was not recorded in the incident book but was separately attached by staples. Such records must be maintained in a secure manner and reported on directly into the appropriate records. Additional loose-leaf records have the potential to become detached and misplaced or lost. Nursing and care staff receive training in Adult Protection/ Abuse Awareness and this has now been extended to include ancillary and administrative staff. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V274645.R01.S.doc Version 5.1 Page 14 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): Standards 19, 20, 22 and 25 The overall atmosphere in the home is welcoming, with access to indoor and outdoor communal facilities. There are a number of matters highlighted, which put people at risk and do not provide safe and comfortable surroundings for residents to live. EVIDENCE: The following areas were identified as still requiring attention since the last inspection: • Bathrooms on all floors were being used to store equipment such as, wheelchairs, hoists and other sundry items of equipment. Therefore these bathrooms are not available for residents who might wish to use them independently, nor are the rooms suitable for staff assisting residents with their personal care. Alarms in residents’ bedrooms were not always within their reach, particularly during the daytime, when residents were seated away from the alarm cord located near their bed. It is important that staff regularly DS0000025950.V274645.R01.S.doc Version 5.1 Page 15 • Chestnuts Nursing & Residential Care Home (The) check to ensure residents have the means to summon assistance, should they need it. These are unmet requirements from the last inspection and must be complied with by the new timescale. The following matters of concern were identified at this inspection as requiring attention: • Portable heaters were being used in several bedrooms and in the downstairs lounge. It was not clear as to why this additional source of heating was required. However, the Inspectors noted trailing cords and some heaters were in close proximity to residents lounge chairs. The registered manager addressed this matter immediately. The cupboard on the ground floor used to store (COSHH) Control of Substances Hazardous to Health materials/ substances was found to be unlocked. Staff stated that they had only left the cupboard unattended for a minute or two. All facilities used for the storage of COSHH materials/ substances must be kept locked when not in use. The Garden room on the ground floor has facilities to be used as either a quiet lounge or a small dining area, with direct access by a lift. This is a communal facility for residents but is not being used to its full capacity or is being used for other purposes. On the day of the visit no residents were seen to be using this room but the room was used later in the afternoon for a training session for staff, despite there being a designated training room on the top floor. Some staff were also using the room earlier in the day to hang up their outdoor clothing. • • The registered providers must review the use of all communal facilities in the home to utilise them to the best advantage of residents and to make them accessible and safe. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V274645.R01.S.doc Version 5.1 Page 16 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): Standard 27, 28 and 29 The Inspectors were not satisfied that the numbers of staff on duty were sufficient to meet the assessed needs of residents and that residents were in safe hands at all times. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. EVIDENCE: During discussions with the manager she advised the Inspectors that she had instructed staff not to attend to residents single handedly. This instruction had been ignored by some staff, which has resulted in the ongoing adult protection issue. During the visit it was noted that at times residents were left unattended in lounges. At all times there must be at least one member of staff visible to residents to give immediate assistance whenever necessary. An examination of the files of four staff employed since the last inspection, showed that the home is undertaking all the necessary checks to ensure the protection of residents. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V274645.R01.S.doc Version 5.1 Page 17 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): Standard 31, 35 and 37 Whilst there is a qualified manager who is registered with the Commission, she appears to have no day-to-day authority to increase staffing, or purchase equipment, which may be needed for the care and protection of residents. The current office arrangements for the registered manager do not enable her to discharge her responsibilities in an effective manner. The registered manager ensures that there are adequate and appropriate safeguards in place to protect the interests of residents where they do not wish to, or lack capacity, to control their own finances. EVIDENCE: The registered manager has now been in post for several weeks and has made good progress in prioritising areas for development and to improve the quality of care to residents. For example, continence assessments, manual handling assessments and odour control and cleanliness of the home. However, she has Chestnuts Nursing & Residential Care Home (The) DS0000025950.V274645.R01.S.doc Version 5.1 Page 18 also identified the need for additional ancillary staff but at the time of the inspection she had not been given authority to recruit. The proprietor should ensure that the registered manager, who also has responsibilities under the Care Home Regulations, is equipped with a working budget to cover areas such as training and staffing. This will give her the ability and flexibility to ensure that staffing levels are appropriate to meet the identified needs of residents at all times. The manager does not have a designated office, which enables her to maintain a high profile within the home for the benefit of residents, staff and visitors. The present arrangement is sharing office space with administrative staff or the small nurses station on the ground floor. This does not provide the manager with suitable arrangements to undertake meetings with staff, relatives, inspectors or receive/ make telephone calls in private and with regard to the confidential nature of any discussions and the overall monitoring of the quality of care. The shared office is situated beyond the kitchen area and is not easily accessible to residents or visitors wishing to meet with the manager. The proprietor has designated the small nurses station on the ground floor as the registered managers office. There are no other suitable areas in the vicinity for the nurse’s station to be relocated. This will cause difficulties with the storage, recording and maintenance of day-to-day records by nursing and care staff. It has also been suggested that the visitor’s room on the top floor can be used by the manager for private meetings. However, this detracts from the facilities for residents and their visitors. The registered person employs an accountant who is responsible for the maintenance of records with regard to the day-to-day expenditure for individual residents. Small sums of money are kept for the payment of hairdressers, chiropodist and toiletries. Written records of all transactions, including receipts for expenditure, were viewed during the inspection and these were found to be in good order, with two signatories where necessary. Neither the registered person nor the registered manager acts as an appointee for any of the residents and relatives are encouraged to take responsibility for the finances. Where there are no relatives or friends, the matter is referred to the sponsoring authority or a solicitor to take responsibility for the finances All money is held securely in a safe. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V274645.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 X 2 X 2 X X STAFFING Standard No Score 27 2 28 2 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 X X 3 X 2 X Chestnuts Nursing & Residential Care Home (The) DS0000025950.V274645.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP14 Regulation 12 Requirement The registered persons must conduct the home as to maximise residents’ individual capacity to exercise personal choice. Any such decisions made to limit this must be based on a risk assessment of the individual’s vulnerability with evidence of regular reviews. (Timescales of 31/03/05 and 30/09/05 not met) Suitable provision must be made for the appropriate storage of aids and other equipment. (Timescale of 30/09/05 not met) All staff must implement an individual’s specific plan of care to ensure the resident receives a consistent quality of care. All aids to hearing and seeing must be managed so as to promote residents independence and protect the individual. All nursing staff must abide by the home’s medication policies/ procedures; Misuse of Drugs Act 1971; and the Nursing and Midwifery Council (NMC) Standard for administration of DS0000025950.V274645.R01.S.doc Timescale for action 31/03/06 2. OP22 23 31/03/06 3. OP7 15 31/03/06 4. OP8 12 31/03/06 5. OP9 13 21/02/06 Chestnuts Nursing & Residential Care Home (The) Version 5.1 Page 21 6. OP16OP18 OP37 OP19 13,22 & 37 13,16 & 23 7. medication. All records of complaints and incidents must be maintained robustly, up to date and in a secure manner. The registered persons must ensure that: • All parts of the home to which service users have access are so far as is reasonably practicable free from hazards to their safety. • Any activities in which service users participate are so far as is reasonably practicable free from avoidable risk. • Unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. The registered providers must review the use of all communal facilities in the home to utilise them to the best advantage of residents and to make them accessible and safe. The registered persons must review the staffing levels and ensure that there are sufficient staff on duty at all times to meet the assessed needs of all residents. The registered persons must ensure that the home is operated and managed in a manner to ensure sufficient care, competence and skill, according to the numbers and needs of residents. The Commission must be notified without delay of all occurrences, including death, illness and other events, in compliance with Regulation 37 of the Care Homes DS0000025950.V274645.R01.S.doc 21/02/06 21/02/06 8. OP19OP20 OP24 23 30/04/06 9. OP27OP28 18 31/03/06 10 OP31OP32 10 31/03/06 11. OP37 37 21/02/06 Chestnuts Nursing & Residential Care Home (The) Version 5.1 Page 22 Regulations 2001. 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 OP31OP32 Good Practice Recommendations It is strongly recommended that the registered proprietor identify and designate suitable office accommodation for the registered manager. This will enable the manager to maintain a high profile within the home. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V274645.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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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