Inspection on 10/10/06 for Danson House Residential Care Home

This inspection was carried out on 10th October 2006.

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

Other inspections for this house

Danson House Residential Care... 20/06/08

Danson House Residential Care... 10/09/07

Danson House Residential Care... 12/01/06

Danson House Residential Care... 21/07/05

Danson House Residential Care... 05/01/05

Danson House Residential Care... 07/07/04

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

CARE HOMES FOR OLDER PEOPLE Danson House Glynde Road Bexleyheath Kent DA7 4EU Lead Inspector Ms Pauline Lambe Key Unannounced Inspection 16th October 2006 10:00 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 Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Danson House Address Glynde Road Bexleyheath Kent DA7 4EU 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) 020 8304 3762 020 8301 2646 www.kcht.org Kent Community Housing Trust Mrs Nicole Sandra Shilling Care Home 46 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (45) of places Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registration for 1 service user in category DE(E) (female) for named service user only. 12th January 2006 Date of last inspection Brief Description of the Service: Danson House is owned and managed by Kent Community Housing Trust which is a charitable not for profit trust. The home was purpose built and provides accommodation on two floors. It is located in a residential road within walking distance of shops, a mainline railway station and bus routes. The home is registered to provide personal care and accommodation for 46 older people. The building is divided into five separate units, Silver (10 beds), Katie (9 beds), Family (10 beds), Royal Blue (9 beds) and Rehab (8 beds). Each unit has a lounge/dining area, kitchenette, toilet/bathroom facilities and bedrooms. One of the units in the home provides short-term care for eight service users who require rehabilitation. Specialist advice, assessment and equipment are provided for the service users on this unit. There is parking to the side of the property with garden and patio areas at the rear. The home also provides day care for older people. This part of the service is not regulated. The current fees range from £410.06 - £430.81. Residents pay privately for items such as hairdressing, chiropody, newspapers and social outings. Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit for this unannounced inspection was commenced on 16th October 2006 for 6.75 hours. A second visit was made to the home on 24th October 2006 for 2 hours to complete the inspection. The assistant manager and staff assisted with the inspection; forty-three residents were in the home and there were three vacancies. The service was last inspected on the 12th January 2006. The inspection included a review of information held on the service file, a tour of the premises, a review of records, talking to residents, staff and visiting professionals and reviewing compliance with previous requirements. Following the site visit contact was made with relatives and others to get their views of the service. Feedback on the service was generally positive. The home had a stable management team and overall residents and relatives were satisfied with the care provided. Management however must review the staffing levels in the home and ensure these are adequate to meet the needs of all residents. What the service does well: What has improved since the last inspection? The statement of purpose had been reviewed and a copy was given to the inspector. Improvements had been made to care plans and those seen showed how identified needs were to be met. Screening in the shared rooms was adequate. A copy of the home’s maintenance programme had been sent to the Commission together with a report on the review of staffing levels. Danson House DS0000006792.V310540.R01.S.doc Version 5.2 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. Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. Adequate information was provided for prospective residents about the service. Prior to admission residents had a care needs assessment completed by staff. The arrangements made for residents requiring rehabilitation were satisfactory and met their needs. EVIDENCE: Since the last inspection the statement of purpose had been updated and a copy was given to the inspector. Copies of the service user guide were seen in some of the bedrooms viewed. Nine completed resident comment cards were received and six showed residents had been provided with adequate information about the service. Care plans seen included pre-admission assessments and some also had the care manager assessment papers. Following this assessment management confirmed in writing to residents that the home was suited to meeting their needs. Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 9 A separate rehabilitation unit was provided. Staff worked with residents and other professionals, such as occupational therapists, to promote independence and to assess residents’ ability to return home. Residents on this unit who spoke to the inspector said they were satisfied with the help and support they received while in the home. Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. Care plans seen reflected residents needs and how these were to be met, however there was no evidence to show that residents were involved in preparing these. Arrangements were in place to ensure residents’ healthcare needs were met. Medicines were generally well managed with some minor improvements needed. Overall residents and relatives were satisfied with the quality of care provided and the way they were treated by staff. EVIDENCE: Three care plans were viewed, two for long stay and one for rehabilitation residents. These included assessments and up to date care plans to show how care needs were to be met. Care plans were reviewed monthly and six monthly with relatives and, staff said, with the resident. However the care plan documentation did not include any evidence that residents were involved with preparing their care plans. Relatives contacted said they were usually involved with care planning on admission but not much after that. Recommendation 1. Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 11 Residents were registered with a GP and were supported by staff to access routine and specialist healthcare services as needed. During the inspection the visiting district nurse took time to talk to the inspector. In her opinion staff were committed to meeting the healthcare needs of the residents. She said they made appropriate referrals to the nursing service and followed advice given. The home had a good working relationship with the service and made direct referrals for nursing care and advice. Records seen for accidents to residents were well written and audited by the home manager monthly. Relatives contacted said staff kept them informed about their resident’s health and were satisfied with how healthcare needs were being met. Adequate storage was provided for medicines. Each unit in the home had its own medicine trolley. Records were kept for medicines received into the home, administered and returned to the chemist. Records seen were up to date and accurate. Medicine records for three residents were checked and found to be correct. Controlled medicines were stored and managed appropriately. There was no system in place to monitor the temperature of the medicine storage rooms and the record kept for the fridge temperatures showed these were too high on occasions. Also the fridge provided was not specific for the storage of medicines. Internal and external medicines were stored together. Requirement 1. Residents seen said they were satisfied with the way staff treated them. This was supported by the information in the completed comment cards received by the Commission. Relatives contacted following the inspection said residents were treated well by staff and that residents were well presented. However a number of residents and relatives raised concerns about the amount of agency staff used in the home and this was causing problems due to lack of continuity of care. Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 15. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. Residents seen were satisfied with the activities provided. Adequate arrangements were in place to ensure residents maintained contact with family and friends. A new food supplier was being tried and residents were invited to comment on this. Menus seen showed a varied diet was provided but there were problems currently with the use of agency staff in the kitchen. EVIDENCE: The home had a full time activities organiser for the long stay residents and a part time organiser for the rehabilitation unit. The activity staff were responsible for organising and facilitating activities, social events, entertainment and outings. A weekly activity programme was provided and included a variety of activities such as gentle exercises, quizzes, board games, arts and crafts, bingo, reminiscence sessions and cooking. Morning and afternoon sessions were arranged so that residents on all of the units had the opportunity to attend. Social events such as coffee mornings, themed days, visiting entertainment and day trips were arranged and a mobile shop enabled residents to purchase small items such as toiletries, birthday cards and sweets. Residents seen and feedback received from residents and relatives showed that they were satisfied with the activities provided. Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 13 An open visiting policy was provided. Relatives and residents were satisfied with visiting arrangements and from observation relatives visiting were known to staff. One relative said that when they requested a private area to visit their resident, besides the bedroom, this was provided. Residents seen said they could make decisions about their life. However not all residents maintained this ability. Staff said that at the time of admission they worked with relatives to become familiar with resident preferences. Relatives contacted confirmed this did happen. Residents said they had a choice of meal, could choose what to wear, some said they could choose the time they wanted to go to bed and also whether they wanted to join in the activities. Staff were observed encouraging residents to make decisions such as where they wanted sit, if they wanted to join in activities and what meal to have at lunch time. The organisation had recently introduced a new food supplier and this was being tried in the home. Residents’ opinions about the food provided varied with some being positive and some negative about it. Residents did say they had a choice of meal and could have a cooked breakfast. The cook was quite stressed due to staffing problems. The home currently had only the full time cook and a part time kitchen assistant in post and relied on agency staff to cover a high percentage of shifts. This made keeping routine work such as cleaning and cleaning schedules up to date difficult. At the time of this inspection a recruitment drive was in place to address staff vacancies. Requirement 2. Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. Adequate procedures were in place to manage complaints and adult protection. Residents and relatives seen or spoken with said they knew how to make a complaint. EVIDENCE: A complaints policy and procedure was provided. A copy of this was included in the service user guide. A system was in place to record complaints made about the service. Since the last inspection one complaint had been made and records seen showed this had been appropriately managed. The home received seven compliments in the same period. Relatives and staff seen and spoken with during the inspection said they knew how to make a complaint. The home had a policy and procedure relating to adult protection. Staff spoken with had a good awareness of adult protection and how to manage such a situation. Since the last inspection staff had access to training on this topic. At the time of this inspection the local authority were investigating one allegation of abuse to a resident. Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. The environment was clean and tidy and the décor and furnishings were satisfactory and generally met the needs of the residents. Adequate bathing facilities were provided. EVIDENCE: At the start of this inspection furniture was being moved from homes that were closing down in the organisation to this home. Staff were busy arranging these replacement items in the home. Systems were in place to monitor safety in the home. A full time maintenance technician was employed and ensured day-to-day maintenance issues were addressed. The standard of décor and furnishings provide were adequate and there were no major environmental issues noted. Some issues noted were that the smoking room was being used to store a large number of boxed continence products, which could pose a fire risk and did not make the room very welcoming for residents. The assistant manager ensured these items were removed from the room during the inspection. The carpet on Silver unit was quite stained. The garden Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 16 was well maintained a provided a pleasant and relaxing area for residents to enjoy. Requirement 3. Adequate bathing and toilet facilities were provided and areas seen were clean and tidy. Assisted baths had up to date service certificates. Hot water temperatures checked were within safe limits. Residents and relatives did not raise any concerns about the environment. The home was generally clean and no unpleasant smells were noted. Relatives and residents were generally satisfied with the standard of hygiene in the home however one resident said that ‘the home could be cleaner’. Hand washing facilities were provided where waste was handled. Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30. Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to the service. Staffing levels must be reviewed and action taken to increase the staff compliment as needed. Staff had access to training relevant to the work they did. Some improvements were needed to recruitment procedures. EVIDENCE: At the last inspection it was noted that there was an increase in the number of residents attending for day care and this led to additional demands on staff time. A requirement was made at the last inspection to review staffing levels in view of this. Staffing levels were reviewed but staff numbers had not been increased. On the day of this inspection there was one carer on duty on Silver unit to provide care to nine long stay and five-day care residents. Staff on duty said that on occasions the home could have eight-day care residents in the home. To ensure the needs of all residents are met these staffing levels must be reviewed. Current staffing levels were one team leader and six care staff for the morning shift, one team leader and five care staff for the afternoon shift and one team leader with two care staff at night. At night staff had access to on-call staff in an emergency. Since management introduced team leaders some time ago care staff felt that overall they had lost some care hours. Although team leaders were part of the care team they had specific responsibilities, such as managing medicines, which made it difficult for them to be involved with hands on care. Another issue at this time was staff vacancies. From information provided a high percentage of agency staff had been employed in the home during the period Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 18 July to September 2006 and this situation continued. A recruitment drive was in place to address this issue. Relatives and residents both commented on the number of agency staff employed and the negative effect they felt this had on the service provided. Comments made included ‘agency staff don’t seem to know what they are doing’ and ‘staff do not have time to talk’. Requirement 4. From the information provided in the pre-inspection questionnaire 65 of care staff had achieved NVQ 2 qualification or above. Management were committed to providing this training for all care staff and some were completing level 2 and 3 NVQ qualifications Four employee files were viewed. Only one of these complied fully with regulation. Omissions noted were one file had only one written reference and this had not been verified as genuine, one file did not have a recent photo and one reference had not been verified and one file did not have any proof of identity. Requirement 5. Staff spoken with said they had access to training relevant to their role. They said they had access to regular update training on areas such as moving & handling, fire safety and adult protection. Since the last inspection staff also had access to other training such as fire safety, infection control and food hygiene. Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. The home had a stable management team. A quality assurance system was in place. Safe systems were in place to manage resident’s personal allowances. Attention was given to ensuring a safe environment was provided but some improvements were needed to fire safety tests and records kept of fire drills. EVIDENCE: The management arrangements in the home were stable and the manager was registered with the Commission. Staff were happy with the level of support they received and indicated that the management team were approachable and helpful. Relatives supported this comment. The home had a recognised system in place to monitor the quality of care provided in the home. The manager completed reports to head office about significant issues such as accidents and complaints monthly. Senior Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 20 management or managers from other homes undertook regular audits. An external auditor assessed the home to ensure that it met the requirements for ISO accreditation. Regular unannounced visits were undertaken to comply with regulation 26 and reports sent to the Commission on a regular basis. Management assisted residents to maintain and manage their personal allowance only. Safe systems were in place to manage this and all residents had access to their personal allowance. Records were kept for money received and spent and individual records maintained on the computer, which were made available to residents or relatives. The records for two residents were checked and found to be correct. A large and small safe were provided and the administrator kept a list of the safe contents. For residents in the rehabilitation unit money and records were kept in the small safe and no record was kept on the computer. Recommendation 2. A random selection of health and safety records were viewed. All of the records seen complied with health and safety requirements, were well organised and up to date. Systems were in place to ensure that daily, weekly and monthly checks were undertaken. At the last inspection it was recommended that fire drill records included information about the time that the drill had taken place and staff response. There was no evidence to show that fire drills were held at times to include night staff. The fire records seen showed that the fire alarm was not tested weekly since 08/09/06. This was apparently because the maintenance technician was occupied in other homes. Fire safety straining had been provided to staff over two sessions on 05/04/06 and 03/05/06. Requirement 6. Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 2 X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 22 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 OP9 Regulation 13 Requirement The registered person must ensure that adequate systems are in place to safely store medicines: • The fridge used to store medicines must be suited to this purpose. • The temperature of the medicine storage room must be monitored. • Internal and external medicines must be stored separately. The registered person must ensure adequate and capable staff are on duty in the kitchen and systems in place to monitor the hygiene standards of the kitchen during the period of staff shortages. The registered person must keep all areas of the home clean and take steps to reduce or remove risks to resident safety. The carpet in Silver unit must be cleaned or replaced as required at the last inspection. The smoking room must not be used to store combustibles and must be available to residents at DS0000006792.V310540.R01.S.doc Timescale for action 04/12/06 2. OP15 16 04/12/06 3. OP19 23 04/12/06 Danson House Version 5.2 Page 23 4. OP27 18 5. OP29 19 6. OP38 23 all times. The registered person must 04/12/06 increase the number of staff provided in the home to ensure that there are adequate numbers of staff on duty at all times to meet residents needs. (Timescale of 31/03/06 was not met). The registered person must 04/12/06 ensure that all information required by regulation and schedule 2 is obtained for employees prior to commencing work in the home. The registered person should 04/12/06 ensure that fire drill records include the time that the drill took place and how staff responded. 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. 2. Refer to Standard OP7 OP35 Good Practice Recommendations The registered person should ensure evidence is provided to show that where possible residents are involved with preparing their care plans. The registered person should ensure copies of the personal allowance records for residents in the rehabilitation unit are maintained as currently there are only the records held in the small safe. Danson House DS0000006792.V310540.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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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