Inspection on 03/11/05 for Crossways Residential Home

This inspection was carried out on 3rd November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Crossways Residential Home 07/02/07

Crossways Residential Home 27/07/05

Crossways Residential Home 16/03/05

Crossways Residential Home 13/09/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Crossways Residential Home North Terrace Mildenhall Suffolk IP28 7AE Lead Inspector Kevin Dally Unannounced Inspection 3rd November 2005 10:00 DS0000024368.V264175.R01.S.doc Version 5.0 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 DS0000024368.V264175.R01.S.doc Version 5.0 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 Adults 18-65. 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. DS0000024368.V264175.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Crossways Residential Home Address North Terrace Mildenhall Suffolk IP28 7AE 01638 515556 01638 712730 christaylor@nhs.org.uk 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) National Autistic Society Mrs Christine Joy Taylor Care Home 8 Category(ies) of Learning disability (8) registration, with number of places DS0000024368.V264175.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th July 2005 Brief Description of the Service: Crossways is part of the National Autistic Societys Mildenhall Service, which comprises Crossways and Middlefield Manor (the second, larger Care Home situated approximately 2 miles from Mildenhall in Barton Mills). The Home provides residential care for eight young adults with Autistic Spectrum Disorders. The Home is a large detached house (formerly a private residence) in a residential area close to Mildenhall town centre, at the junction of two main roads. The entrance to the Home is from Folly Road and there is a small parking area for the Homes two vehicles as well as for visitors. The Home is well maintained, clean, light and airy and the eight service users are accommodated in single bedrooms; three on the ground floor and the remaining 5 on the first floor. Two bedrooms have the additional benefit of en suite facilities and there are sufficient bathrooms and toilets to meet the needs of the eight residents. The Home has a fitted kitchen, a laundry area, a large lounge, dining room as well as a separate but adjoining quiet room. The residents also have use of a pay phone for incoming and outgoing telephone calls. DS0000024368.V264175.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report follows an unannounced inspection at Crossways, a care home that provides care and support for up to eight younger adults with Autistic Spectrum Disorders. The inspection was conducted over a 4.25 hour period from 9.45 am to 2 pm. Mrs Christine Taylor, the home’s manager, was present throughout the inspection, and contributed fully to this process. Time was spent individually with 3 residents and 1 staff member and direct feedback was received about the quality of the services offered. This inspection found that of the 38 National Minimum Standards inspected, that the home fully met all 38 of these standards. Two of the 38 standards were assessed as “standard exceeded”. What the service does well: What has improved since the last inspection? Since the previous inspection the home has ensured that restrictions on the freedom of residents is fully recorded. Risk assessments around the hot water in the laundry and shower room are now in place, and demonstrate that these pose only limited risks to the existing residents. Vulnerable Adults training had been provided for one staff member and the bathroom door had been repaired. A check of the personal money held for residents was found fully in order. DS0000024368.V264175.R01.S.doc Version 5.0 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. DS0000024368.V264175.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000024368.V264175.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, 5 Residents can expect that they will receive good quality, informative and helpful information about the service provided. They could expect to have their care needs properly assessed and appropriately met by the home. EVIDENCE: The manager confirmed that the home continued to use the needs assessment form for the assessment of any new residents. This would involve extensive assessment around that potential residents identified needs and requirements, and would also consider the opinions of the residents of the home, before a placement was confirmed. Although there have not been any new clients admitted to the home since 1997, the manager has undertaken a number of care needs assessments on potential residents. However, after assessment, the home decided they would not be able to adequately meet their needs. One resident’s records examined revealed that extensive assessment had been undertaken for this resident, and that the assessment had been reviewed in September 2005. This included assessment of their support and care needs. DS0000024368.V264175.R01.S.doc Version 5.0 Page 9 Three residents spoken with confirmed that the home continued to meet their personal care and support requirements. One resident stated that the “staff are great”, and spoke of how they had access to a college course, including computer works, maths and an English course. Further, that they were able to learn more about writing their own food menu. Another resident confirmed that they were able to maintain their own personal care and manage their own room with support from the staff. Staff spoken with and records checked confirmed that staff were appropriately trained to meet the specialised needs of residents with Autistic Spectrum Disorders. This included autism training, epilepsy and behavioural de-escalation training. One care plan examined revealed that staff had undertaken a detailed assessment of the residents care needs including a behavioural support plan, which confirmed that the residents support needs could be met. From the information gathered it was clear that the home was able to meet any specialised requirements of the service user group. One resident’s records checked included a copy of a contract of residence, and which was presented in a picture form, so was easy to understand. This had been signed and dated by the resident. DS0000024368.V264175.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 Residents can expect to receive very detailed planned care which would be regularly updated and which would reflect their individual needs and wishes. Furthermore, they can expect to be enabled to make decisions about their life, and be supported to achieve more independence, and to follow their own personal goals. EVIDENCE: One resident’s care and support plan was checked. Care records included a very detailed assessment of the residents needs and included a personal profile, communication profile, significant events profile, personal care, education plans, and a summary of life long goals. In addition to these documents there was a detailed behavioural support plan for this resident, which provided positive guidance for staff, should they have to manage difficult behaviours. This support plan included the residents likes and dislikes, triggers, cues to behaviours, rewards and motivations, general strategies, specific behaviours, medication, routines and dietary factors. The residents care plan had been signed and dated, and had been reviewed and updated in DS0000024368.V264175.R01.S.doc Version 5.0 Page 11 September 2005. Staff spoken with stated that even though they had become quite familiar with the needs of the residents, care plans were referred to when needed, and that these were used to record significant changes. Due to the continued high quality of information provided by the care plans, standard 6 was considered as above the national minimum standard. Three residents were spoken with and all confirmed that they continued to enjoy life at the home. One resident spoke of how they were able to attend college independently, without support from the staff. This resident also spoke of the personal interests that they were able to pursue, which included the collection of videos and following their favourite football team. A second resident confirmed that they were able to be quite independent, that they managed their own personal care and managed their own room, including being responsible for its cleaning. A third resident confirmed that they were able to access the community without support from the staff. They revealed that they visited the local pub and met with friends, and were able to enjoy an evening out. This information supported the view that residents were able to work towards their own goals and were able to be independent, and choose how they ran their lives. Residents, the manager and staff confirmed that residents were able to participate in the day-to-day running of the home, the most regular event being the selection and purchase of their own food. The quality action group, which was run by the residents, would check with other residents the types of meals they would like for the coming week. Meal planning would then occur, and this would be checked with the manager to ensure that the meals offered were balanced and wholesome. Residents were then assisted to purchase the ingredients and were then supported to cook meals for themselves. Regular meetings also ensured that feedback was received from the residents about issues that affected their life at the home. All residents were encouraged to live as normal a lifestyle as possible and this was undertaken within a risk assessment framework. Significant risks would be identified and the benefits versus the hazards of the activity would be considered. Where the benefits outweighed the hazards, strategies would be developed and agreed with each resident to ensure their safety, and this would then be pursued. The manager confirmed that records were maintained within locked cabinets, and that computers were password protected. Further staff were aware of their obligations around data protection to maintain residents confidentiality, and this was further reinforced at NVQ training sessions. DS0000024368.V264175.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 17 Residents can expect to have very good opportunities for personal development and participation within the local community, and as a result of these opportunities, they could expect to lead a more independent and fulfilling lifestyle. Relatives and friends can expect to be made welcome when visiting the home. Residents can expect to receive meals that are nutritious, balanced and meet the needs of the residents. EVIDENCE: Residents continued to have good access to and were able to participate in the local and wider community, including educational and work activities during the day, and social and leisure activities after hours and at the weekends. Three residents spoken with confirmed the various activities undertaken during the week, which included visiting day centres, college, workshops, arts and craft centres and computer sessions. One resident showed the computer work that they had undertaken that day; whilst another revealed the very large jigsaw puzzle they were working on. One resident’s day care programme confirmed that they have a full schedule of varied activities throughout the week that enabled both work related and social opportunities for personal development. DS0000024368.V264175.R01.S.doc Version 5.0 Page 13 Residents continued to make contact with their friends and families. Due to the excellent opportunities provided by the home, standard 11 was considered as above the national minimum standard. The menu plan for the week and the record of meals received by residents was checked and this revealed that residents continued to receive a choice of well balanced, varied, and appropriate meal choices for the service user group. The main meal of the day was provided at teatime, and which was served after residents had returned from their work placements. This week’s main menu choice included lasagne, fish Creole, lamb chops, chicken curry, grilled fish and roast ham. One day was marked as a “free day” and residents would usually choose their own takeaway meal. Each of the three residents spoken with confirmed their satisfaction with the meals provided. They also confirmed that they had an opportunity to cook their own favourite meals. The meal records of one resident revealed the very good meal choices that had been provided for that resident. DS0000024368.V264175.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Residents can expect to receive good quality personal healthcare support, including the administration of medication. EVIDENCE: Residents spoken with confirmed that they received support for any personal care that was required. Three residents spoken with confirmed that they individually managed their own personal care, and that staff were available, should they need their assistance. One resident’s care plan provided very good details of the care support that was required by that resident and included guidance for staff around washing, bathing, shaving, toileting, cleaning teeth and dressing. Staff were noted as respecting all resident’s need for privacy, while continuing to provide essential support where necessary. Crossways continued to promote and maintain residents health care, and records checked were found maintained, which included a record of visits to or from their Doctor, the Chiropodist, Dentist and the Optician. Staff confirmed that staffing levels were adequate ensuring appropriate personal care and time available to meet the health care needs of the residents of the home. One staff member spoken with did not raise any concerns about staff levels. DS0000024368.V264175.R01.S.doc Version 5.0 Page 15 The accident log was checked and found to contain one recorded accident during the last 12-month period. Medication procedures were checked and the home continued to use the Medication Dispensing System (MDS) system with blister packs and Medication Administration Records (MARS) sheets, to record administered medication. One resident’s medication records checked were found to be well organised, recorded and completed. At the previous inspection, medication policy was checked and found to provide guidance around the storage, recording, administration, re-ordering, receipt and maladministration of medication. DS0000024368.V264175.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Residents can expect to have their complaints taken seriously and acted upon. Residents safety will be ensured by appropriate policies and procedures, training and recruitment checks. EVIDENCE: The home’s complaints procedure described for a resident how to make a complaint to either the home, or the Commission for Social Care Inspection (CSCI), and the time scales involved. The complaints procedure was discussed with residents and how they can complain. No complaints had been received by the home or made to the CSCI within the last 12 months. The home had suitable Adult Protection policies and procedures in place and the manager was aware of her obligation in the reporting of any allegations of abuse to Social Services, the police and/or the CSCI. One staff member’s records checked included a Criminal Records Bureau (CRB) disclosure, 2 references and an identity check, and that they were currently on adult protection training. DS0000024368.V264175.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Residents can expect to find the home clean and hygienic, and generally well maintained and comfortable. 24, 25, 26, 27, 28, 30 EVIDENCE: The home provides accommodation for up to eight younger adults within a large detached house (formerly a private residence) in a residential area close to Mildenhall town centre. The home was found well maintained, clean, light and airy and the eight service users would be accommodated in single bedrooms; three on the ground floor and the remaining 5 on the first floor. Two bedrooms have the additional benefit of en suite facilities and there are sufficient bathrooms and toilets to meet the needs of the eight residents. The home has a fitted kitchen, a laundry area, the lounge/dining area, as well as a separate but adjoining quiet room. On the day of the unannounced inspection the house was found to be very clean and hygienic and was well maintained. Both the upstairs and downstairs bathrooms and toilet areas were found to be clean and well maintained. Three residents, rooms checked were found to be appropriately maintained, equipped and clean, and the décor was appropriate to the individual residents. DS0000024368.V264175.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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, 32, 33, 34, 35, 36 Residents could expect the home to be adequately staffed, with employees who were competent, supervised and trained to meet the specialised needs of the service user group. Residents could expect that they would be safe due to the homes recruitment procedures. EVIDENCE: The home continued to maintain a minimum of two care staff on each duty during waking hours, and two staff on a sleepover during the night period. An additional carer is also employed to manage any “extra hours” required during the day, in order to accompany some residents into the community. The manager was available during office hours, Monday to Friday. Residents and staff spoken with, and the rota checked confirmed that sufficient staff were employed to meet the needs of the service user group. Residents comments about staff included “staff were great”, or “I receive support from staff” or “I am well treated by staff”. The manager confirmed that some staff had been sick recently, but that existing staff had been very supportive in ensuring that gaps in the rota were covered. Records checked confirmed that staff had been appropriately trained and were able to undertake their respective job roles, and were able to meet the needs of the service user group. One staff member’s records included a copy of their job description. DS0000024368.V264175.R01.S.doc Version 5.0 Page 19 One staff member’s recruitment records were checked and suitable recruitment and employment procedures were found in place. The staff member’s records included CRB and POVA checks, 2 written reference references, proof of identity, an application form, and a contract of employment. The records of one staff member checked revealed that the staff member continued to receive appropriate training. Examples of this included induction training, Studio 3 training (behavioural training) food hygiene, Spell 1 training (Training in Autism) medication, first aid, Cardio Pulmonary Resuscitation training, adult protection training, and health and safety training. Records revealed that this staff member had achieved their National Vocational Qualification (NVQ) level 3 in care, training. Staff spoken with and records revealed that supervision continued to be undertaken on a regular basis. DS0000024368.V264175.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,41,42,43 Residents could expect that the home would be well managed, and that the environment would be maintained and safe. Residents could expect to have their personal money protected. EVIDENCE: The home was well managed with sufficient support and management to ensure the efficient and effective management of the home. The home’s aims and objectives encouraged a culture of resident inclusion, choice and independent living opportunities. A brief environmental tour of the premises was undertaken of the ground and first floors. This included checking the hot water tap temperatures of the bath on the first floor, which was found to be safe. A risk assessment had also been produced for both the ground floor laundry and shower hot water tap temperatures and it was determined by assessment, that these did not pose any risk to the current service users. DS0000024368.V264175.R01.S.doc Version 5.0 Page 21 At the previous inspection some service users personal finance records were found incorrect, with 2 small discrepancies in the accounts noted. Two records were therefore checked, and both the records and cash held balanced. Fire records were checked and a fire risk assessment was found in place, and the records also revealed that fire tests had been undertaken each week. Records were checked and noted as follows. Service user records • Care plans: 1 resident had a care plans in place (Refer to Standard 6) • Needs Assessments: A needs assessment was in place for 1 resident user. (Refer to Standard 2) • 1 residents personal risk assessment was in place. (Refer to Standard 9) Employment records • Employment information: 1 staff members records examined had CRB and POVA checks, 2 references, an application forms, a medical declarations, an identity checks, and a job description in place. (Refer to Standard 34) Staff rota • The staff rota was checked and found to provide sufficient staff cover for the week of the inspection.(Refer to Standard 33) Medication records • 1 residents medication records checked were found appropriately maintained and up to date. (Refer to Standard 20) Menu records • The homes menu plan and food record for one resident was checked and was found appropriately maintained.(Refer to Standard 17) Records of complaints and or abuse • The complaints book was appropriately maintained with an appropriate policy in place. (Refer to Standard 22) Records of accidents • The record book revealed that 1 resident had had an accident in the last 12 months (Refer to Standard 19) DS0000024368.V264175.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 x 3 LIFESTYLES Standard No Score 11 4 12 3 13 3 14 3 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x 3 3 3 DS0000024368.V264175.R01.S.doc Version 5.0 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 DS0000024368.V264175.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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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