Inspection on 03/03/06 for Denmark Lodge

This inspection was carried out on 3rd March 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Denmark Lodge 29/04/09

Denmark Lodge 15/05/08

Denmark Lodge 21/05/07

Denmark Lodge 09/11/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Denmark Lodge 38 Denmark Road Gloucester GL1 3JQ Lead Inspector Ms Lynne Bennett Unannounced Inspection 3rd March 2006 14:30 Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 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 Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Denmark Lodge Address 38 Denmark Road Gloucester GL1 3JQ 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) 01452 383888 www.carehomes.co.uk Cathedral Care (Gloucestershire) Limited To be appointed Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th November 2005 Brief Description of the Service: Denmark Lodge is a detached Victorian house, which has been modernised for its current purpose and is adjacent to a sister care home called Denmark House. Each resident has their own bedroom and there is a kitchen, dining room and spacious lounge. Outside, there is a large level garden. Both care homes provide care for people with a learning disability and access between the properties is via patios at the side of the buildings. The home is situated in a residential area and close to all the amenities of Gloucester. The home shares use of both a car and a people carrier with Denmark House. Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place during an afternoon in March 2006. One person is living at the home. There are six vacancies for which referrals are being processed. The person living at the home is receiving 1:1 support. There is presently no registered manager. The responsible individual and the registered manager for Denmark House are managing the home until an appointment is made. Neither were present during this inspection. The person living at the home has autism and no verbal communication. They were spoken to and observed during the inspection. A care assistant and senior staff from Denmark House were also spoken with. A range of records were examined including the service user plan and health and safety records. Staff records were not available for inspection. What the service does well: What has improved since the last inspection? What they could do better: The service provided at Denmark Lodge is running in conjunction with that of Denmark House. At the time of the inspection meals were being provided from Denmark House and when additional staff are required to take the person out of the home then this is done with staff and service users from Denmark House. During the inspection staff from Denmark House were coming into the home through the lounge to access the office without consideration of the needs of the person living there. There are concerns that this practice will continue as more people move into the home and that the two services will become as one. The homes are separately registered and Denmark Lodge must be allowed to develop and grow independently of Denmark House. There are a number of issues that need to be dealt with urgently including: • putting in place a range of social, recreation and leisure activities Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 Page 6 • • • • providing the person living at the home with access to snacks and the provision of food to prepare meals registering the person living at the home with a range of healthcare professionals such as a dentist and chiropodist improving medication administration systems providing a safe environment in which to live – drawing up risk assessments, completing health and safety checks and portable appliance testing. 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. Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 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 Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: The key standard –2- was met at the first inspection in November 2005. Records for new referrals were not available for inspection. Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 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 the following standard(s): 6 and 9. A regular review of care plans will provide staff with the information they require to meet the changing needs of the person living at the home. Increasing the range of risk assessments will protect people living at the home from the risk of harm. EVIDENCE: The service user plan for the person living at the home was examined. Staff indicated that care plans are being reviewed and amended. These were put in place in August 2005. A placement review was held with the placing authority in October 2005 from which they produced a statement of need, review and care plan. Care plans used by the home must now be reviewed and put in place to reflect any changes identified in these documents. There was evidence that some needs identified at this review are being addressed such as using a hot tub and researching appropriate places to swim but other needs such as referral to a range of healthcare professionals and structured activities are not yet in place. (See standards 12 and 19). A range of observation and monitoring sheets are used by the home as well as a daily recording system. Incident forms are available but were not being used. There were at least two incidents noted in the daily records where help Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 Page 10 was required from Denmark House to enable staff to support the service user. Observation charts noted the type of behaviour but a fuller report was needed. It is suggested that the incident reports should have been used. Staff also need written guidance about what they should do in these circumstances. A risk assessment must also be in place. Accessing staff from Denmark House must only be an emergency option. The care plan for the person living at the home indicates that support is required on a 2:1 ratio when out and about in the community. If there are further incidents in the home where 2:1 support is required then the home must review the staffing ratio with the placing authority. It is acknowledged that these risks will be reduced as more people move into the home and the numbers of staff on duty increase. Incidents where the use of physical intervention is used must be reported to the Commission for Social Care Inspection under Regulation 37. This is a requirement outstanding from the previous inspection. A Positive Handling Plan is in place indicating when physical intervention may be used and by whom. The plan appears to have been drawn up by the previous manager. A suitably competent and qualified person must draw up such a plan. Staff receive training in Positive Handling from an external provider accredited by BILD. A missing person’s form is on file but this has not yet been completed. This should be done. There are two risk assessments in place dated August 2005. Additional risk assessments need to be drawn up as the range of activities increase – such as for swimming. A lone working risk assessment also needs to be put in place for staff. Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 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 the following standard(s): 12,13,15,16 and 17. The range of opportunities being provided need to be increased to offer the person living at the home a structured programme of leisure, educational and social activities. Any limitations to freedom or choice must be recorded, recognising the rights and responsibilities of the person living at the home. A healthy and balanced diet needs to be provided to the person living at Denmark Lodge by offering greater access to meals and snacks in their home. EVIDENCE: Daily records, observation of the person living at the home and discussions with staff confirmed that there is very little structure to the person’s day. They have just started using a hot tub and sensory room at a local day centre. Staff said that the person appears to enjoy these activities. The care plan from the placing authority notes a range of activities that the person enjoys both within their home and outside but there was very little evidence of these happening on a regular basis. The activity plan reflects activities noted in the placing authority care plan with an emphasis on Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 Page 12 accessing open spaces and being out in their local community. This is not yet being implemented. Occasional drives out are arranged as well as visits to Denmark House. Staff said that the person has a guitar that they enjoy using. There appears to be a reliance on accessing staff from Denmark House to enable the person to go out. Although this will change as more people move into the home it is important that the person living there has access to a structured programme of activities meeting their needs. At the review in October there was discussion about enabling the person living at the home to visit their family in London. This has not yet been arranged. Their family were due to visit the home but the visit was cancelled. Staff support the person to meet with other people living at Denmark House. However staff indicated that they are respectful of the person’s dislike of group situations. Attendance at the day centre is in the company of another person from Denmark House. The person living at the home has access to all parts of the house excluding the kitchen that has a keypad on the door. There must be a risk assessment in place detailing why this restriction is in place and it must be recorded in the person’s care plan. It was noted that staff use a listening device to monitor seizures during the night. A protocol must be in place detailing when this is to be switched on and consent recorded for its use. At the time of the inspection meals were being provided from Denmark House. Although there is a fully fitted kitchen at Denmark Lodge this is not used for food preparation. There were also no provisions for snacks or hot drinks. Squash is being provided for the person living at the home. They occasionally like to have a hot chocolate but there was no provision for this. There was also no fresh fruit. The home must provide provisions for meals and snacks to be prepared at Denmark Lodge. A record must also be kept of the meals eaten by the person living there. Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 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 the following standard(s): 19 and 20. The physical and emotional needs of the person living at the home are not being met. Improvements need to be made to the systems in place for the administration and control of medication to ensure the protection of the person living at the home. EVIDENCE: The person living at the home has been registered with a local doctor and there was evidence of regular appointments and medication reviews. Diary entries indicated that the person had been experiencing several nosebleeds when questioned staff verified that an appointment had been made with their doctor. There was no evidence that the person has been registered with a Dentist, Optician, or Chiropodist or that appointments had been made since they moved into the home. These must now be made with a matter of urgency. There was evidence that a referral had been made in October 2005 for the input from an occupational therapist and a consultant psychiatrist. However there was no evidence that the person had seen either of these healthcare professionals. These referrals must be followed up. Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 Page 14 Medication systems were examined. Staff complete training in the ‘Safe handling of medications’ as part of their NVQ Awards. The following issues need to be addressed: • Handwritten entries on medication administration records must be initialled and then should be countersigned by another member of staff • a protocol must be put in place for the administration of Rectal Diazepam • only staff trained in the use of Rectal Diazepam must use this medication; training must be put in place for staff. • a stock control system needs to be put in place for medication. This can be done using the administration record identifying stock at the start of the month and stock at the end of the month. Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: These key standards were inspected in November 2005. A recommendation was made to provide staff with training in the protection of vulnerable adults. Training records were not available at this inspection and so this has become a requirement of this report. Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 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 the following standard(s): 28 A comfortable lounge and separate dining area complement individual accommodation. EVIDENCE: The key standards were inspected in November 2005 and were all found to have been met. It was noted during the inspection that there were only two dining room chairs in the home. According to staff the others were at Denmark House. The person living in the home prefers to use a dining table and chair in the lounge. Sufficient chairs must be provided in Denmark Lodge. This will be monitored at future inspections. Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 33. Some training is provided for staff enabling them to gain the skills and qualifications necessary to support the person living at the home. The assessed needs of the person living at the home may not always be met by the current staffing levels. EVIDENCE: There have been no new members of staff employed since the last inspection. Staff files were not available for inspection. Staff stated that they are registered to complete NVQ Level 2 Awards in Care and that other training has been provided in Fire Safety, Manual Handling and Basic Food Hygiene. It would also be expected that staff supporting a person with Autism would access some form of specialist training in Autism. This will be monitored at the next inspection. At present one member of staff supports the person living at the home unless they go out in the community when they require a 2:1 ratio. It appears that doubling up with staff from Denmark House is providing this level of support. However if another service user were present this would indicate the staffing ratios are incorrect. When scheduling the activities for the person living at Denmark Lodge there needs to be considerable planning to provide the correct staff ratios. Rotas were not available for examination at the home. This will be monitored at future inspections. (See also Standard 6) Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39,41 and 42. A quality assurance system will help the organisation to monitor and review the development of the home. Health and safety procedures need to be improved to provide a safe environment for the person living at the home. EVIDENCE: Since the last inspection the registered manager has resigned. The responsible individual and registered manager of Denmark House are managing the home until a manager is appointed. The responsible individual is completing Regulation 26 visits to the home and sending a written record of this visit to the Commission. Evidence of other records which provide a quality assurance system were not available for examination. There is an expectation that this information will be available at the next inspection. Under Regulation 17 the responsible person must make sure that all required records are available to staff and for inspection. Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 Page 19 A selection of health and safety records were available for examination. Some of the requirements issued at the last inspection were complied with. Water temperature checks are in place and being recorded. Although it is recommended that the temperature is recorded rather than a tick. There did not appear to be an environmental or fire risk assessment in place. COSHH data sheets are not kept in the home and hazardous products were stored in an unlocked cupboard. This information must be provided and hazardous products stored securely. Fridge and freezer temperatures are not being taken because food used by the person living at the home is not stored in the fridge. Certificates are in place for gas, electric installation and the servicing of fire equipment (21.10.05). Portable appliance testing expired in November 2005. The responsible person must supply evidence to the Commission that this has been completed. An Environmental Health Report appears to have a number of outstanding recommendations including a handrail to the staircase and a hazard analysis for the kitchen. These must now be actioned. At the time of the inspection the wrong certificate of registration was displayed in the home. A new certificate was issued when the previous registered manager left the home. This certificate must be displayed under Section 28 of the Care Standards Act 2000. Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 Page 20 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 X 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 X 23 2 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 2 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 2 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 2 x LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 2 2 X X X 2 X 2 2 2 Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 Page 21 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 YA6 YA6 Regulation 15(2) 18(1)(a) Requirement The responsible person must review and amend care plans on a regular basis. The responsible person must make sure that staff levels are appropriate to the needs of the service user. The responsible person must produce guidance and risk assessments as indicated in the standard. Ensure all staff have access to and know how to report events, which affect the well being of residents. (Timescale of 19/12/05 not met). Timescale for action 30/04/06 30/04/06 3. YA9 13(4) 30/04/06 4. YA9 37 30/04/06 5. YA12 6. YA16 7. YA16 16(2)(m)(n) The responsible person must put in place social, leisure and educational activities appropriate to the needs of the service user. 17(1)a The responsible person must Sch. 3.3q put a risk assessment in place for any limitations or restrictions on freedom of movement/choice. This must also be noted in service users’ care plans. 12(1) The responsible person must DS0000062183.V294350.R01.S.doc 30/04/06 31/05/06 31/05/06 Page 22 Denmark Lodge Version 5.1 8. YA17 16(2)(h)(i) 9. 10. YA17 YA19 17(2) Sch. 4.13 13(1)(b) 11. 12. YA20 YA20 13(2) 13(2) 13. 14. 15. YA20 YA23 YA28 13(2) 18(1)(c) 22(3)(g) 16. YA41 17 17. 18. YA42 YA42 13(4)(a) 13(4)(a) 19. YA42 13 put in place guidelines for the use of a listening device and obtain consent for its use. The responsible person must supply wholesome and nutritional food in Denmark Lodge, involving the service user in the preparation of meals if they wish. The responsible person must keep a record of food provided for service users. The responsible person must register or refer the service user with healthcare professionals as indicated in the standard. Handwritten entries on medication administration records must be initialled A protocol must be put in place for the administration of Rectal Diazepam. Staff must receive training in the use of Rectal Diazepam. A medication stock control system needs to be put in place. The responsible person must arrange training for staff in the protection of vulnerable adults. The responsible person must provide sufficient chairs in the dining room to meet the needs of people living at the home. The responsible person must make the necessary records available to staff and for inspection. COSHH data sheets must be obtained and hazardous products stored securely. Portable appliance testing must be completed and evidence supplied to the Commission when carried out. Review Standard 42.1 to 42.9 and ensure that all records are DS0000062183.V294350.R01.S.doc 10/03/06 10/03/06 10/03/06 10/03/06 31/03/06 31/03/06 31/05/06 31/05/06 31/03/06 31/05/06 31/03/06 30/04/06 Page 23 Denmark Lodge Version 5.1 being maintained and checks are up to date. Also that documentation is clearly labelled and easily accessible to staff. (Timescale of 24/02/06 not met) 20. YA42 23(2)(a)(b) The responsible person will make sure that the recommendations from Environmental Health are put in place. The correct certificate of registration must be displayed. 31/05/06 21. YA43 Sect 28 CSAct 2000 31/03/06 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. 3. 4. 5. 6. Refer to Standard YA6 YA6 YA9 YA20 YA42 YA3 Good Practice Recommendations Incident forms should be used. Competent and qualified persons should compile Positive Handling Plans. The missing persons form should be completed. Another member of staff should countersign medication administration records. Water temperatures should be recorded on the checklist. Review the decision of the funding authority not to provide a named person to support a resident. Review the need for an advocate. Review the ongoing external professional agency support to ensure this is being fully provided. Continue to develop the care plan for a resident 7. YA6 Denmark Lodge DS0000062183.V294350.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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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