Inspection on 09/03/07 for De Lucy Street (5)

This inspection was carried out on 9th March 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

De Lucy Street (5) 15/02/06

De Lucy Street (5) 02/12/05

De Lucy Street (5) 14/02/05

De Lucy Street (5) 28/09/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 De Lucy Street (5) 5 De Lucy Street Abbeywood London SE2 9ER Lead Inspector Keith Izzard Unannounced Inspection 9th March 2007 12.00p De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 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 De Lucy Street (5) DS0000036880.V320176.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 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. De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service De Lucy Street (5) Address 5 De Lucy Street Abbeywood London SE2 9ER 020 8311 1571 020 8311 1571 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) Greenwich Council *** Post Vacant *** Care Home 4 Category(ies) of Learning disability (4) registration, with number of places De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th February 2006 Brief Description of the Service: The home is situated in a residential area, within easy reach of local amenities and public transport facilities. It is a two-storey, purpose built end of terrace property, which opened initially in November 1988. It has two single bedrooms on the ground floor, two single bedrooms on the upper floor, two bathrooms with WC’s, a lounge, kitchen/diner and a laundry room. The house has a garden to the rear and off-street parking for two vehicles. The property is owned by London and Quadrant Housing Association and managed by Greenwich Social Services under the Greenwich Living Options Scheme. The home accommodates four adult service users of both sexes on a long- term placement basis and there are no vacancies currently. De Lucy Street (5) DS0000036880.V320176.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 completed over a period of five hours on 9th March and 2nd April 2007. Two members of staff and the newly appointed manager assisted the Inspector in a constructive and helpful manner. All of the residents were attending their day centre placements, or other activities, on both days of the inspection and therefore were not seen by the Inspector, nevertheless, it was pleasing to note that all were engaged in activities outside of the home. The service was last inspected in February 2006. Four requirements were made at the last inspection and one had not been complied with and therefore restated in this report. Two recommendations made in the previous report had been positively responded to. The inspection included a review of information received about the service, a tour of the premises, an examination of inspection of records, including care plans and health and safety records. What the service does well: What has improved since the last inspection? The new manager has identified a need to update risk assessments and for greater efforts to be made to facilitate residents’ communication and individualisation of activities and outings. De Lucy Street (5) DS0000036880.V320176.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. The summary of this inspection report can be made available in other formats on request. De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 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 De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate admission procedures were in place to comply with these standards. EVIDENCE: Standard 2 The admission procedures in place complied with the requirement of this Standard. As no new residents had been admitted since the introduction of the National Minimum Standards the procedures had not been implemented and could therefore not be assessed in practice. Nevertheless, The manager is aware of the requirements should any new residents be admitted to the home. De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments were available for all residents, they were comprehensive but some updating of risk assessments is required. Residents were involved with decisions made about their lives and lifestyle. EVIDENCE: Standard 6 Two care files and individual plans were examined in respect of two residents’. Individual plans were comprehensive and involved service users and their representatives, including family or advocates and other professionals involved. These plans are reviewed with outcomes clearly stated and agreed by all participants. Records seen were comprehensive and up to date. However, De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 Page 10 it was noted that some records were retained in slings within the office drawers and that it is recommended that all current information be retained in individual care files for ease of reference. See Recommendation 1 Standard 7 Any restrictions placed on residents are few and would be for the safety and welfare of service users, for example leaving the home unaccompanied. Evidence was available from the residents’ records examined that they are enabled to express choice in what they do and staff record these occasions. On a daily basis, staff do make attempts to involve service users in the running of the home this is evidenced in the daily diaries for residents but is limited to minor domestic tasks such as putting clothes away helping with cleaning and meal preparation depending on ability and this would always be under the direct supervision of staff members. Enabling residents to express their choice in relation to outings, meals and activities are promoted by showing pictures and direct reference to specific items and the historical knowledge built up by staff members about individuals and recorded in their care files. The manager has sought assistance from a Speech and language Therapist to promote further development of staff members in assisting residents with their communication difficulties. This is a good initiative and it is recommended that these developing skills are maximised and must be extended to develop the introduction of residents meetings on a regular basis, please see Standard 39. See Recommendation 2 & See Requirement 5 Standard 9 Risk assessments are readily available for all bank or agency staff that may be less familiar with residents’ needs. However, the new manager told the Inspector that some updating of the risk assessments was necessary, this is currently underway, and the manager stated that these assessments will now be located within the new care files that are about to be introduced. See Requirement 1 De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Attention was given to meeting the leisure and social needs of the residents. Meals provided were varied and planned to meet the resident’s choice and preferences. EVIDENCE: Standards 12-16 All four, residents attend day centres for part of the week and have direct payment workers provided on other days this facilitates the opportunity to develop life skills. It was noted that a reduction in the level of direct payment worker support was under consideration, this must be reviewed within the context of the overall staffing complement as any such reduction would have De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 Page 12 implications for the level of staffing within the home that is required. Please see Standard 33. See Requirement 4 Staff members within the home supported residents to develop daily living skills in line with their individual abilities. Records showed that residents were supported to access leisure activities of their choice and to integrate with the community. A range of outings, for example, visits to pubs, cinemas, shops, parks, football games, sightseeing and an annual holidays were recorded including residents’ comments on how they enjoyed these events. Following a recommendation made at the previous inspection, the home has resolved the difficulty in providing a driver to maintain outings and visits for residents. Residents were enabled to choose their own clothes and hairstyles, when accompanied by staff members on shopping tips and were also supported to choose their own decoration and personal items for their own rooms. Residents were supported to maintain positive relationships with their family and the manager has referred individual residents to the local advocacy and befriending services where appropriate. The manager reported that regrettably there are still delays being experienced in the provision of advocates. In view of the fact that one resident has no parental contact and it is lessening for two others, continued efforts should be maintain to provide independent advocates for them. See Recommendation 3 Standard 17 Varied and nutritious meals were provided to meet residents’ preferences and a rota of meals provided was seen over a period of four weeks and a good supply of both fresh and frozen food was seen stored in the home. None of the service users require a special, or culturally appropriate diet, but some require their food to be cut up and two require specific assistance from staff to enable them to eat safely and ensure appropriate intake. Relevant risk assessments addressed these issues and had been completed by a member of the speech and language therapy service to advise staff members and this is now being further developed, as mentioned in Standard 7. De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s personal physical and emotional needs were being met and with the involvement of the resident, as far as this, could be achieved, as all residents have severe communication difficulties. Medicines were assessed as safely managed on the day of inspection. EVIDENCE: Standard 18 Care plans showed the level of personal care required and how this was to be provided. The care plans examined were up to date and included comprehensive risk assessments, but the latter required some updating See Requirement 1 De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 Page 14 Standard 19 Residents were supported to access health services appropriately and had these provided either in the home or attended local clinics and surgeries. Evidence was available of hospital appointments that had been organised and for follow up of medical conditions in respect of three of the residents, as recorded within their daily diaries and appointments books. Standard 20 Medicines were generally well managed, the MAR sheet examined, showed that medication had been given accurately and this was recorded appropriately. The system for receiving and disposal of unused medication was in place and staff members had received updated training in medication organised by a Boots Pharmacist. Medication is retained within a lockable cabinet designed for the purpose within the kitchen area, however the cupboard should have items stored in a more tidy fashion. See Recommendation 4 De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate systems were in place to ensure residents were protected from abuse and to manage complaints about the service. EVIDENCE: Standard 22 The home had local policies and procedures to deal with complaints, however, no complaints had been received by the home. Standard 23 The home had a copy of the London Borough of Greenwich local policies and procedures to deal with any allegations of abuse. Staff members have received training on adult protection and any suspicions or allegations of abuse would be referred to the Greenwich Community Learning Disability Team for investigation. There were no allegations of abuse made about the service to the home or the Commission since the last inspection. Accidents records were well maintained and any unexplained injuries would be referred to CDLT for investigation. One such incident was referred and had been substantiated as an accident. This De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 Page 16 involved an injury to a resident following a tripping incident in the home and had resulted in a review of flooring provided in the home and particularly the resident’s bedroom carpet. De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a homely and comfortable environment that is safe clean and hygienic. The home must implement the requirements of an Environmental Health officer report regarding a separate sink for hand washing in the kitchen area. EVIDENCE: Standard 24 A recent Environmental Health Officer report has required that a separate small hand - washing sink be installed in the kitchen area, this must be complied with. See Restated Requirement 2 De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 Page 18 All residents have their own single rooms. All bedrooms occupied by service users were seen by the Inspector, during a tour of the building, and they had all been personalised and were tastefully furnished and decorated. Standard 28 A range of comfortable, safe and fully accessible shared spaces is provided both for communal activities for private use, however, both the standard of curtains and floor coverings throughout the buildings must be assessed and in particular any needs arising out of the recent review of one resident regarding safe floor covering must be implemented as soon as possible in order to prevent falls. See Requirement 3 Standard 30 The Home was clean and tidy on the day of the inspection, and soap and towels was available in the bathrooms and toilets. The kitchen work surfaces were clean and tidy with utensils and equipment appropriately stored. All cleaning materials were locked away and subject to COSH procedures. The home has a washing machine with a sluicing facility within a dedicated laundry area with appropriate washable surfaces and sealed floor. De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff members were competent, qualified and adequately trained and recruitment practice met the Standard. The numbers of staff need to be reviewed in the event of any reduction of direct payment worker support. EVIDENCE: Standard 32 The home has already achieved the required minimum of 50 trained to NVQ Level 2. From interviews with two care workers and the evidence of training provided for staff the Inspector felt that, overall, there was a good level of skills and experience and that those staff observed had the requisite attitudes and characteristics necessary to adequately support service users. Standard 33 De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 Page 20 In view of the apparent proposed reduction in direct payment worker provision there must be a corresponding overall review of the staffing requirement within the home in order to ensure that the needs of residents continue to be adequately met. See Requirement 4 The new manager informed the Inspector that the frequency of staff team meetings had reduced and that this would now be increased in order to fully meet this Standard. See Recommendation 5 Standard 34 Two personnel files were examined for more recent staff recruited and recruitment practice was found to be in accordance with the requirements of Regulation 19 and Schedule 2 of the National Minimum Standards Standard 35 Training records for individual staff members were seen and this showed that a good level of training had been provided and was being planned for the future. Induction training had been provided for new staff and foundation training following this and included annual updates in fire training and moving and handling, as required, on an annual basis. De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run and the health and safety of residents promoted. Residents must have regular meetings and surveys must be conducted of their relatives and involved professionals to comment on the service provided for residents. EVIDENCE: Standard 37 The manager is very experienced and has the necessary NVQ4 qualification. Staff members interviewed stated that manager is approachable and supportive, had a good rapport with residents and they would not hesitate to discuss any concerns about the home or the welfare of residents with her. Communication within the home was of a good standard and the manager, overall, complies with the requirements of Standard 37. An application for registration with CSCI by the manager must now be made. De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 Page 22 Standard 39 Whilst residents are encouraged to express their views on the running of the home and attempts are being made to improve this, please see Standard 7, they do not have regular meetings, as required, in this Standard. The home must also ensure that there is an annual survey of the views of residents, their relatives/ advocates and any professionals involved with residents and this survey must be made public and a copy sent to CSCI. See Requirement 5 Regular visits to the home had been made by the responsible person, on a monthly basis, as required, reports of these visits were sent to CSCI. Standard 42 A number of records to do with safety and maintenance were seen by the Inspector and were found to be up to date and well recorded. The manager confirmed that all staff had annually updated fire training. In respect of other checks the implementation of day- time fire drills, alarm tests and checking of fire prevention equipment was recorded and up to date. Evidence was available that routine servicing and testing had taken place in respect of health and safety requirements and in accordance with information recorded on the pre inspection questionnaire. De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 Page 23 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 1 X X 3 X De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 Page 24 Yes 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 YA9 YA24 Regulation 5 23 Requirement All risk assessments in respect of residents must be updated as stated by the manager. A dedicated wash hand basin for staff members who prepare food must be installed in the kitchen, as required by the Environmental Health Inspector. Restated Requirement, previous timescale of 01/03/06 not met. The action required arising from the health and safety assessment in respect of one resident, in relation to danger of tripping must be implemented as soon as possible. In the event of a reduction in direct payment worker support for residents, a review of the adequacy of staffing provision must be conducted. This is to ensure that the needs of residents would continue to be met. Annual surveys of the views of residents, their relatives or advocates and involved professionals must be conducted. Residents meetings must be held on a regular basis. DS0000036880.V320176.R01.S.doc Timescale for action 01/06/07 01/07/07 3 YA28 23 01/06/07 4 YA33 18 (a) 01/07/07 5 YA39 4& Schedule 2 01/06/07 De Lucy Street (5) Version 5.2 Page 25 6 YA37 8 The acting manager must submit an application for registration as the manager to CSCI. 01/06/07 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 YA6 YA7 Good Practice Recommendations It is recommended that care records are retained in care files rather than loose within sections of a filing drawer. The skills to be acquired by staff members from the Speech and Language Therapist, to assist residents to communicate, should be implemented as fully as possible to maximise residents’ self expression and self determination. Renewed efforts should be made to provide advocates for those residents without, or diminishing parental contact. The medicine cabinet should be kept in a more tidy condition. Staff meetings should be held more frequently, as identified by the manager. 3 4 5 YA15 YA20 YA33 De Lucy Street (5) DS0000036880.V320176.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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