Inspection on 12/05/05 for Cumberland Gate, 44

This inspection was carried out on 12th May 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cumberland Gate, 44 08/01/07

Cumberland Gate, 44 22/11/05

Cumberland Gate, 44 04/03/05

Cumberland Gate, 44 17/11/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 44 Cumberland Gate 44 Cumberland Gate Netherton Liverpool L30 7PZ Lead Inspector Debbie Corcoran Unannounced 12th May 2005 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 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 Stationary 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. 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 44 Cumberland Gate Address 44 Cumberland Gate Netherton Liverpool L30 7PZ 0151 531 6039 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Autism Initiatives Ms Susan Ann Windsor Care Home 3 Category(ies) of LD Learning Disability (3) registration, with number of places 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Service users to include up to 3 LD The service should, employ a suitably qualified and experienced manager who is registered with the CSCI. Date of last inspection 4.03.2005 Brief Description of the Service: 44 Cumberland Gate is a small home registered for three people who have a learning disability. The service is provided by Autism Initiatives. Autism Initiatives was formerly called the Liverpool and Lancashire Autistic Society and it was established in 1971. It is in the voluntary sector and has charitable status. Autism Initiatives provide a range of services to adults and children who have autism. These services include residential care, day care, supported tenancies, outreach, domiciliary care, respite and educational services. 44 Cumberland Gate is a four bedroom property located on a residential housing estate in Thornton, Merseyside. The house is a domestic property which promotes the principles of ordinary community living. The service users are supported by a small well established staff team. There are two staff on duty to support the service users throughout the day and a sleep in member of staff. 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspection was unannounced and took place over 4.5 hours. During the visit two of the three service users were spoken with and four members of the staff were spoken with either on an informal group basis or on a one to one basis. A tour of the home was carried out. Service user plans, staff files, health and safety records and other relevant records were examined in some detail. What the service does well: What has improved since the last inspection? Staff have started to use pictures as a way to communicate with one of the service users. This is proving to be a successful way of enabling the service user to express their choice. Pictures are also being used to help one of the service users to develop their independent living skills. A number of staff have received training in using the pictures and this training will be provided to the remainder of the staff team in the near future. Staff training records are up to date and provide clear information as to the training each member of staff has had and when this has taken place. Members of the staff team reported the staff moral and team spirit to be good. There has been some redecoration in shared areas such as the lounge and dining room and in one of the service user’s bedrooms. 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 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. 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 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 standard(s) 1, 5 There is little information to provide to prospective service users as a service user guide is still in the development stage. The service users do not benefit from having a statement as to the terms and conditions of their occupancy as they do not have a form of contract with the home. EVIDENCE: The home has a statement of purpose which includes the use of photographs so that service users and relevant others can see what the home looks like. It was reported that a service user guide is being developed but is not yet complete. The home has been given numerous requirements to produce a service user guide and continues to fail to meet this standard. The guide should be produced to provide current and prospective service users with information on the home and it should be produced in accessible formats. Service users have not been provided with a contract / statement of terms and conditions. A contract should be developed and provided to service users which sets out the services and facilities offered by the home, terms and conditions of occupancy, fees, rights and responsibilities of parties and other issues as outlined in the national minimum standards. 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 Page 9 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 standard(s) 6, 9 Service users have a plan of care which clearly reflects their needs and the plans are reviewed and updated regularly. When service users are involved in an activity which involves taking risks the risk is assessed and managed in order for service users to maintain and develop their independent living skills. EVIDENCE: Each of the service users has a care plan. The plans include information on how to meet the person’s physical, social and emotional needs. The care plans focus on the support the service user needs as a result of living with autism and provide the staff team with information on the service users needs, goals and routines. The standard of the plans is good and staff are aware of the plans and therefore the service users benefit form staff being consistent in their approach to them. The plans had recently been updated. Each of the service users has a review of their support every six months. These reviews usually involve a meeting which includes the service user, members of their family or other representatives, social worker and relevant others. When a service user is involved in any activities which are thought to present a risk then a risk assessment is carried out. The risk assessments include a good level of information on what the potential risks are to the service user and the steps which staff need to take to minimise the risk or prevent the risk from 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 Page 10 occurring. The risk assessments cover many different aspects of the service user’s support. For example support with keeping safe, using public transport, dealing with socially difficult situations. The risk assessments, which were looked at, had recently been reviewed and updated. One of the service users is encouraged to communicate his needs and choices through the use of pictures. This is a valuable means of communication and is enabling the service user to make everyday choices. A member of the staff team described how they are attempting to introduce the use of pictures and different formats to provide information to the service users. Through discussions with service users, staff and care planning it is evident that service users are involved in the practical day to day running of the home with regard to household tasks for example shopping, cooking and cleaning. Staff rotas were examined and these are drawn up to reflect the needs of the service users. For example, wherever possible the same member of staff will be rotad to support a service user with a particular activity each week. This is to aim for consistency for the service user. Written guidelines as to how to support the service users with their usual activities have been produced by staff so that if another member of staff provides the support they are aware of the needs and routines of the service user. 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 Page 11 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 standard(s) 11, 12, 13, 14, Service users are supported by staff to develop their emotional, social and independent living skills. Staff support service users to use local facilities and pursue their leisure interests. Staff support service users to attain their personal aims and goals. EVIDENCE: Each of the service users has a plan of care which includes goals for personal development and which give the service users and staff targets to aim for. The plans are reviewed every six months and the goals / aims are changed accordingly. During the inspection one of the service users was out on a social trip on a one to one basis, another of the service users was supported one to one at home. Service users attend a resource centre for part of the week. This can range from one day per week to four days per week. One of the service users attends college and one of the service users has a part time job at a local shop. Records and discussions with one of the service users and staff suggest that the service users are using local facilities on a regular basis. These include 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 Page 12 going to the cinema, pubs, local walks and shops. All of the service users use public transport regularly and have a travel pass for this. Daily records show that one of the service users is supported to go on a long walk regularly. One of the service users has recently had a party to celebrate his birthday and two of the service users are going on holiday in the near future. Information on service users support needs for all activities are recorded in their care plan. This is a good means of ensuring people are supported appropriately by staff during any given activity and to ensure consistency. Staff rotas and discussions with members of the staff team confirmed that two members of staff are on duty to support the three service users at all times and this allows for a good level of one to one support for service users and enables them to pursue their own interests. When necessary staffing levels are increased to three to ensure that service users can be involved in activities which they enjoy. Care plans include a good level of information on the service users needs in relation to leisure and employment. 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 18, 19, 20 Service users are supported by a staff team who know their personal care needs and preferences well. Service users are supported in all aspects of their physical and emotional needs. Medication is handled safely and in accordance with policies and procedures. EVIDENCE: Staff have supported the service users for a considerable length of time and therefore have a good understanding of their personal support needs. Service user plans include written guidelines as to how to support the service users with personal support. Staff are aware of these guidelines are therefore clear as to what each of the service users needs and routines are and the service users benefit from consistency in how they are supported. Each of the service users has a separate file / record relating to their health care needs. These records showed that service users are being supported to attend a variety of health appointments. Appointments for annual health checks are a little out of date. Records showed that service users weight is regularly checked and monitored. 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 Page 14 The home maintains a record of all medication received, administered and stock checked. Information is also maintained on what medication is taken for and the possible side effects of the medication. Health and medication reviews form part of the general review process. There is a policy on medication and medication guidelines at the home. Two members of the staff team have received training in the administration of medication. This should be extended to all members of the staff team. 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 Page 15 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 standard(s) 23 Policies, procedures and practices are in place which aim to prevent an abusive, neglectful or issue self harm from occurring. Systems are in place for dealing with allegations of abuse and staff are trained in identifying signs of abuse. The lack of a policy and procedure on service user’s payment of travel expenses to staff leaves service users and staff in a potentially vulnerable position. EVIDENCE: The home has an adult protection policy and procedure and a whistle blowing policy. Staff records show that all staff have received training in adult protection. Where appropriate there is information in service user files on responding to challenging behaviour and guidelines which are specific to the needs of the individual. Staff training records show that staff have received training in responding to challenging behaviour. In order to safeguard service users the home has a policy and procedure on the management of service user’s money, valuables and financial affairs. However, at a previous inspection it was identified that staff are paid directly by service users if the service user travels in the member of staff’s car. There is no policy and procedure on service users money being paid to the organisation / staff for travel purposes and this therefore leaves both service users and staff in a vulnerable position. A requirement was given for this to be addressed but the issue remains outstanding. The deputy team leader reported that this policy is being developed by the quality assurance manager at Autism Initiatives. A representative from Autism Initiatives carries out financial audits at the home. 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 Page 16 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 standard(s) 24, 25, 26, 27, 28, 30 The home is generally well presented, homely, safe and clean. Service users bedrooms are personalised with their own belongings and can be locked for their privacy. Health and safety precautions are taken and all relevant safety checks are up to date. EVIDENCE: 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 Page 17 A tour of the premises was carried out. The home is an ordinary sized domestic property which meets the standard for minimum average living space. A dining room provides space for service users to have some privacy if they so wish. The home was originally a three bedroom property. However one of the bedrooms has been partitioned so as to make an additional bedroom. This has resulted in one of the service user’s bedrooms being small. The room is below 10sqm but is the same size as before 31.01.02 and therefore meets the standard. This room has been redecorated and refurbished since the previous inspection. Each of the service users bedrooms are fitted with a lock. Service users are reported to choose their own furniture and the bedrooms do appear personalised. One of the service users said that they were happy with their bedroom and it was clearly personalised with their own belongings. The bathroom is suitable to the needs of the service users. This room has recently been refurbished and redecorated. A number of doors in the house need to be painted or replaced. Woodwork in a number of areas around the house including the lounge needs to be painted. This is letting the overall appearance of the house down. Records of fire and health and safety checks were looked at and found to be up to date. Water temperatures are regulated. This was tested in the bathroom and was close to 43 c thus ensuring the service users are not at risk from scalding. The home was presented as clean and hygienic. Staff have received training in health and safety issues including food hygiene. Policies and procedures are in place in relation to health and safety, infection control, food hygiene. 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35,36 The service users benefit from the support of a well established staff team who have a good knowledge of their needs and the issues which effect their lives. Staff training opportunities are good and in line with the needs of the service users. Recruitment procedures are good and aimed at the ensuring the protection of service users. EVIDENCE: Records confirmed that there are two members of staff available at all times to support the service users. This results in a good level of one to one support available to service users. Staff have received training in health and safety related skills and in issues which relate more specifically to the needs of the service users. For example understanding autism. This means that the service users benefit from being supported by staff who have a good level of understanding of their needs. A small number of staff have a National Vocational Qualification (N.V.Q) in care and two members of staff are currently undertaking the qualification. The assistant team leader reported that a team training plan has been developed but this was not available at the home. 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 Page 19 Staff recruitment and selection policies and procedures are in place. Examination of staff files showed that two written references are obtained for new employees and criminal records disclosures are obtained prior to the commencement of employment. Service users are reported to be involved in staff recruitment and selection across the organisation but there was no evidence that this has included the people living at 44 Cumberland Gate Members of the staff team reported that they are well supported by the current manager and are receiving regular recorded supervision. One of the service users gave good feedback on members of the staff team. The staff team is well established. The newest member of staff was recruited approximately 1 year ago and a number of members of the staff team have worked at the home for a significant number of years. This means that the service users and staff have had the opportunity to build long standing relationships and staff have a good understanding of the needs, routines and preferences of the service users. 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 42 Service users and staff are not clear as to what the management arrangements will be for the home for the foreseeable future. Practices which promote the health and safety of service users and staff are in place. The service users have not benefited from regular unannounced visits to the home carried out by a representative from Autism Initiatives. EVIDENCE: The manager has been absent from work for a number of months and there is no indication as to when she will be returning to the home. A temporary manager is currently managing the home. Whilst this is an acceptable interim arrangement it is not appropriate in the longer term and should be addressed. The registered provider should provide the Commission with updated written information on the management arrangements. A number of policies and procedures are in place which aim to ensure the health and safety of service users and staff and these include policies on health and safety, infection control, fire safety and moving and handling. 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 Page 21 Fire safety and health and safety practices are adopted. Records of fire and health and safety checks were checked and found to be up to date with the exception of the fire alarm which should be tested more frequently, this was discussed with the manager. Water temperatures are regulated. The temperature of the water was tested in the bathroom and was close to 43 c thus ensuring the service users are not at risk from scalding. The registered person should ensure that the home is visited on an unannounced basis at least once per month and provide a report on the findings of the visit to the Commission in line with Regulation 26 of the Care Home Regulations 2001. These visits should form part of the quality assurance process and should involve seeking the views of service users (and their representatives as appropriate) and staff in order to form an opinion on the standard of care provided. 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 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 1 x x x 1 Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 x x x Standard No 11 12 13 14 15 16 17 3 3 3 3 x x x Standard No 31 32 33 34 35 36 Score x 3 3 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 44 Cumberland Gate Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 3 x F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 Page 23 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. 1. 2. Standard YA 1 YA 5 Regulation 5 Requirement Timescale for action 7.07.05 7.08.05 3. YA 23 4. 5. 6. YA 20 YA 19 YA 26 A service user guide must be produced 5(c) A standard form of contract for the provision of services and facilities by the home to service users must be produced. 13 (6) There must be a clear policy and procedure on service users money being paid to the organisation / staff for travel purposes. 18 (c ) (1) Staff who are responsible for the administration of medication must be appropriately trained. 12 (1) (a) All records relating to health appointments must be clear and up to date. 23 (2) (d) Internal doors must be repainted or replaced. Internal woodwork is in need of repainting. 7.08.05 7.09.05 7.07.05 7.08.05 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. 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 Page 24 Refer to Standard Good Practice Recommendations 44 Cumberland Gate F53 F03 S5238 44Cumberland Gate V235648 120505 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection 2nd Floor Burlington House Crosby Road North Waterloo L22 0LG 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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