Inspection on 10/11/05 for Derwent Lodge

This inspection was carried out on 10th November 2005.

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

The inspector 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Derwent Lodge 19/07/07

Derwent Lodge 17/07/06

Derwent Lodge 01/06/05

Derwent Lodge 06/09/04

Derwent Lodge 16/04/04

Derwent Lodge 30/10/02

Similar services:

Trevayler Residential Care Home

Thornham Grove

Thistle Hill Hall

Conifer Lodge

Westwood Lodge

Egerton Lodge Care Home

Alfred Minto House Care Home

St Matthews Unit

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

CARE HOME ADULTS 18-65 Derwent Lodge Derwent Lodge 11 Beaufort Street Chaddesden Derby DE21 6AX Lead Inspector Jenny Thornton Unannounced Inspection 10th November 2005 02:00 Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Derwent Lodge Address Derwent Lodge 11 Beaufort Street Chaddesden Derby DE21 6AX 01332 347597 01332 347597 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) Rethink Vacant Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Where residents over the age of 65 are residing in the home consideration is given to the Care Homes for Older People National Minumum Standards With written agreement of the National Care Standards Commission residents over the age of 65 who meet the registration category may be accommodated. The Conditions of Registration to be reviewed annually Age range of Service users 18 - 65 years on admission. Date of last inspection 1st June 2005 Brief Description of the Service: Derwent Lodge care home provides nursing and personal care for up to sixteen people, eight males and eight females, aged 18 to 65 years, with mental health needs. Residents are supported to take part in daily living and social activities, and lead a more independent lifestyle. The home is a purpose built detached bungalow in Chaddesden, close to local shops, facilities and a bus route, and is a short distance from Derby city centre. All bedrooms are single rooms with ensuite facilities. The home has male and female facilities, with separate lounges (smoking and non-smoking) dining room and kitchen. The home has a large garden. Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspection was unannounced and started at 2.30pm. The visit lasted 5 hours. The Inspector spoke to ten residents and all staff on duty. The Inspector looked round the home and examined various records. The home has made good progress towards meeting the requirements and recommendations from the last inspection report. What the service does well: What has improved since the last inspection? Additional staff have been recruited and staffing cover has increased, which has enabled staff to take residents out more. Staff morale and teamwork has improved. Staff have been given more responsibility to develop their role and work more closely with residents. Key workers were spending more one to one time with residents to develop their social interests and daily living skills. Residents were attending more activities outside the home to occupy their day. New menus had been introduced, which included residents’ preferences and choices, and a dietician had been consulted to ensure that the menus provide a well-balanced and nutritious diet. Residents care plans were being updated to provide more detail as to how their needs were being met. Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 6 A refurbishment plan and costings had been produced to ensure that furnishings are replaced when they become worn. 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. Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Arrangements are in place to ensure that residents’ needs are fully assessed and met prior to and following admission to the home. EVIDENCE: The statement of purpose clearly sets out the services provided and had been updated to include all the required information. The new service users guide and licence agreement was being approved, prior to issuing a copy to residents. Residents had received a copy of the previous guide and licence agreement. No new residents had been admitted to the home since the last inspection. Two resident’s care plans reviewed contained a detailed assessment and information about their needs and preferences. Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 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): 7 and 9 The home enables residents to lead a more independence lifestyle and make decisions about their daily lives. EVIDENCE: Observations and discussions with residents and staff showed that residents are encouraged to make choices and decisions about their lives, and are involved in all aspects of life in the home. Residents had a say in the running of the home and felt able to express his views. Regular house meetings continue to be held. Discussions with residents and staff confirmed that residents were supported to take risks, as part of an independent lifestyle, based on their individual risk assessment. Residents risk assessments were jointly reviewed through the care programme review process. Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 10 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): 14, 15, 16 and 17 Contact with family and friends is supported ensuring residents maintain links with family and friends. Considerable work goes into meeting individual’s social, religious and cultural needs; although resident’s care plans did not clearly set out all needs and how they were being met. EVIDENCE: Residents were supported to maintain regular contact with family and friends outside the home. Residents were encouraged to take pride in their appearance and their preferred style of dress was respected. Four residents went on holiday to ‘centre parcs’ in the summer, which they enjoyed. Key workers were spending more 1-1 time with residents to develop their social interests and daily living skills. Residents confirmed that they attended various leisure and social activities of their choice outside the home to occupy their day. Residents were supported to develop daily living skills, and help with various housekeeping duties around the home such as setting the table, making a snack, hovering and cleaning their room. Care plans had Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 11 been updated and were been reviewed at least monthly; residents had signed their care plan and monthly reviews, where in agreement. Two care plans examined did not detail all daily living and social needs, and work being undertaken to develop these skills. The home values and meets residents’ religious and cultural needs, although one resident’s care plan relating to her religious and cultural needs did not clearly show how her needs were being met. The above issues were highlighted on the previous inspection report. Relationships observed between residents and staff were positive and respectful. Importance is given to building positive relationships, and ensuring a consistent approach and clear boundaries for residents in relation to acceptable behaviour. New winter menus had been introduced; residents had been involved in completing these. Residents had suggested that the weekly menus provide an optional choice of meals from different cultures, and this was included in the new menus. The menus provided a good variety and choice of foods, and the cook had sought the advice of a dietician to ensure that the menus provide a well-balanced and nutritious diet. The meals included home cooked foods, which residents said they enjoyed. A cooked breakfast option is now provided at the weekend in response to residents’ suggestions. Residents spoke highly of the meals provided at the home and said that their dietary needs and preferences were met. Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 20 Personal support is offered in a way that promotes resident’s privacy, dignity and independence. Procedures in place for the safekeeping and handling of medicines safeguard residents’ welfare. EVIDENCE: Residents said that their privacy and dignity is respected, and that their personal care needs were appropriately attended to, where required. Checks carried out showed that good systems were in place relating to the administration and management of medicines in the home to safeguard residents welfare. Records relating to ordering, receipt and disposal of medicines were kept to ensure that medicines are appropriately handled. The home had satisfactory storage facilities to ensure that medicines are kept securely. Arrangements were in place to ensure that resident’s medication was regularly reviewed. No residents currently administered their own medicines; qualified nurses continued to administer all medicines. Medication administration records were clearly printed by the dispensing pharmacist, and had been duly signed except for a couple of gaps, where staff had no signed or completed the appropriate code on the chart. Records were in place to record the daily temperature of the medicines fridge, to ensure it remained within the Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 13 required temperature. The home had a thermometer to measure the maximum and minimum temperature of the fridge, although daily checks of the fridge temperature were not maintained and staff only recorded the minimum temperature. Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Residents are encouraged to express their views and are confident that their views are listened to and acted upon. Procedures are in place to protect residents from harm or abuse, although not all staff had received training on the vulnerable adults procedure. EVIDENCE: The home has a clear complaints procedure, which was displayed in the home and included in the service users guide, which residents had received a copy of. Residents spoken with considered that staff are approachable and that concerns are listened to and acted upon. Staff found the acting manager approachable and felt able to raise any concerns about the home. Complaints tend to be dealt with at an informal stage where possible, which results in the home receiving few formal complaints. The home had received no formal complaints in the last six months. A complaints form is provided to record formal complaints received about the service, although staff on duty were unable to locate this. Copies of the form have since been placed in the home’s complaints file. Procedures were in place to safeguard resident’s safety and welfare. There have been no allegations of abuse at the home in the last year. The home’s vulnerable adults policy and procedure stated that staff worked to the local adult protection procedures. The manager has since confirmed that all staff receives training on prevention of abuse as part of their induction. Not all staff on duty had a clear understanding of the Local Authority’s procedure vulnerable adults procedure. The manager has since confirmed that the majority of staff had attended Derby City’s protection of vulnerable adults Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 15 training. Information relating to the Protection of Vulnerable Adults was available, although the nurse in charge was unable to locate a copy of the Local Authority’s Vulnerable Adults policy. The manager has since located a copy of the policy and placed this on the home’s file, and agreed to obtain copies of the reporting forms from Social Services. Resident’s managed their own finances and allowances, where possible. Staff were not an appointee for resident’s finances or personal allowance; resident’s allowances were paid directly into their own bank account. A number of the residents had a small amount of money in safe keeping at the home; and money was kept securely. Clear procedures were in place and appropriate records were kept of money in safekeeping to safeguard resident’s interests. Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 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): 24 The home provides a comfortable and safe environment for people to live in. EVIDENCE: Residents consider that the facilities are homely and comfortable, and that the home is kept clean and free from odours. This was the case at the time of this inspection. The home opened in 2002 and the furnishings and fittings have generally worn well, although staff have identified that areas require redecorating and refurbishment, including drawers, wardrobes, beds and carpets. The Inspector noted that the drawer fronts in two bedrooms and the wardrobe doors in one bedroom were broken. The carpet in one bedroom was discoloured in areas, and one resident’s pillow was flat and worn. The carpet to the lounge and day areas was stained in areas; staff confirmed that the carpets had recently been industrially shampooed. The acting manager has since confirmed that a refurbishment plan and costing have been produced, although there has been some slippage in the timescales for replacing furniture and carpets. The manager said that areas identified on this inspection were due to be addressed. Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 17 A new maintenance person had been appointed and was due to take up post. Staff confirmed that satisfactory arrangements were in place to cover general repairs and maintenance work, until the new maintenance person took up post. Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34, 35 and 36 The staff team provides consistency of care for residents, and staffing cover has increased which has enabled staff to spend more time with residents. EVIDENCE: Staff and residents considered that the home provides sufficient staff and skill mix to meet individual needs. The home has an established staff team providing consistency of care for residents. Additional staff had been recruited and staffing cover had increased, which has enabled staff to take on additional responsibilities and spend more one to one time with residents. Staff considered that the acting manager runs the home in an open and positive way, and involves them in decisions about the home. Staff reported that teamwork and morale was good. Staff said that the home provides good training opportunities and that they had attended recent trained. Records supported this. The manager has since confirmed that six out of eight support staff had achieved a national approved qualification (N.V.Q) to ensure they are trained and competent to do their job, and that newly appointed care staff were undertaking the training. The Company provides an annual training programme for staff. The manager said that staff training and development needs were discussed and planned through supervision meetings to ensure that staff receives appropriate training. Arrangements were in place to ensure that staff attend all mandatory training to update their knowledge and skills. Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 19 Staff said that they received a good level of support and supervision meetings on a fairly regular basis, although these were not always planned in advance. The manager planned to set up dates for monthly supervision meetings for all staff, once additional qualified staff had taken up post. The Inspector checked the files of two members of staff last employed to work in the home, which showed that the Company followed thorough procedures to safeguard residents. The Company’s H.R. department now provided the manager with copies of the majority of employment documents and checks for new staff, including the person’s application form, references and C.R.B disclosure. Personnel files kept at the home did not include a copy of the person’s health questionnaire and record of interview; which provides a statement as to the person’s physical and mental health. The acting manager confirmed that this information was kept at the Company’s H.R office. One person had recorded their employment history in months and years, whilst the other person had recorded it in year/s, which did provide an accurate record of their employment, and identity any gaps in employment. Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Procedures have been strengthened to ensure that the home is well run. Arrangements are generally in place to safeguard the welfare and safety of residents and staff. EVIDENCE: The registered manager has been absent since the end of March 2005 and was not returning to work at the home. The deputy manager has undertaken the acting manager’s role in the manager’s absence. Interviews were being held for the manager’s position, and the deputy manager has since been appointed to this position. The Company had requested a manager application form from the Commission in respect of the new manager. Residents and staff considered that the home is well managed; the findings throughout this inspection supported this. The acting manager was due to complete an approved management qualification (Level 4 N.V.Q), and was due to commence a behaviour therapy qualification at degree level. The Company was funding one of the qualified nurses to undertake N.V.Q Level 4 management qualification. Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 21 Staff and residents considered that the home is run in an open and positive way, and they are involved in the running of the home. Procedures are in place for monitoring the care and services at the home. Residents consider that the home is run around their needs. Regular house meetings continue to be held. A team of staff were due to carry out an annual review the service, and obtain feedback from residents about their care. Records showed that the required service and maintenance checks had been carried out except for the following: • The fire alarm system was not tested on a weekly basis, as recommended by Derbyshire Fire and Rescue service. The nurse in charge agreed to address this issue. • Regular checks on the hot water temperatures were not maintained. The hot water temperature to the bath on the female unit exceeded safe temperatures. The water temperature registered 52 degrees centigrade. An immediate requirement sheet was left on the inspection to address this matter. A recent follow up visit to the home showed that the water value had been reset and that the hot water was maintained within safe temperatures. • The acting manager confirmed that the gas and electrical appliances had recently been serviced/ checked, although a copy of the service report and records were not available to support this. The manager agreed to obtain a copy of the records. Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score x 3 x 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x X x x x X LIFESTYLES Standard No Score 11 x 12 x 13 X 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x x 3 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Derwent Lodge Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 3 X DS0000031165.V265840.R01.S.doc Version 5.0 Page 23 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. Standard YA14 Regulation 15 Requirement Residents care plans must detail how their social and cultural needs are being met. (Previous timescale of 31/08/05 not met) Timescale for action 31/01/06 2. YA24 16 Rooms occupied by residents 31/01/06 must contain adequate furniture, bedding and floor coverings. The hot water temperatures to 31/01/06 the baths and showers must be checked and maintained within safe temperatures. 3. YA42 13 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 YA20 YA20 Good Practice Recommendations The maximum and minimum temperature of the medicines fridge should be monitored daily and recorded. Qualified staff should ensure that all medication administration records are duly signed or an appropriate DS0000031165.V265840.R01.S.doc Version 5.0 Page 24 Derwent Lodge 3. 4. YA23 YA24 code is completed. The manager should ensure that all staff are aware of the Local Authority’s Vulnerable Adults policy and procedure. The manager should review the home’s refurbishment plan to include revised timescales for replacing furniture and carpets. Dates for staff supervision meetings should be planned in advance. All staff should receive recorded supervision meetings at least six times a year. All staff should development plan. have an individual training and 5. YA36 6. 7. 8. YA35 YA3434 YA34 Personnel files kept at the home should include a copy of the person’s health questionnaire and record of interview. Application forms relating to employment history should record the date, month and year in which the person commenced and left each period of employment. The fire alarm system should be tested weekly as recommended by Derbyshire Fire and Rescue service. The manager should retain a copy of the last service report/records relating to servicing of the gas and electrical appliances. 9. 10. YA34 YA42 Derwent Lodge DS0000031165.V265840.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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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