Inspection on 07/03/06 for Donisthorpe Hall

This inspection was carried out on 7th 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Donisthorpe Hall 07/04/08

Donisthorpe Hall 05/12/06

Donisthorpe Hall 28/09/05

Donisthorpe Hall 17/01/05

Donisthorpe Hall 22/09/04

Donisthorpe Hall 11/02/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Donisthorpe Hall Shadwell Lane Leeds Yorkshire LS17 6AW Lead Inspector Michael Smithson Unannounced Inspection 7th March 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Donisthorpe Hall DS0000001337.V284425.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Donisthorpe Hall Address Shadwell Lane Leeds Yorkshire LS17 6AW 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) 0113 2684248 0113 2370502 maria@donisthorpehall.org Donisthorpe Hall Company Limited Mrs Maria Lyn Dunderdale Care Home 163 Category(ies) of Dementia - over 65 years of age (45), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (45), Old age, not falling within any other category (163), Terminally ill over 65 years of age (1) Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The place for TI(E) is for the named service user only Date of last inspection 28th September 2005 Brief Description of the Service: Donisthorpe Hall is a large care home, which also provides nursing care. The original house was converted in 1956 and extended over time to become what it is today. The last extension, named Silver Lodge, provides accommodation for forty service users. This area offers facilities including a kitchen, lounges, dining areas and bathrooms. All bedrooms are for single occupancy and are fitted with an en-suite. The organisation continues to improve facilities and accommodation. There is a long-term refurbishment programme, which is organised in set phases. Current work includes improved staff facilities. There are two passenger lifts available in the home, which allow service users to access all areas of the home. There are a number of communal areas including a synagogue, cinema (seating capacity for up to forty two), coffee shop, reception, physiotherapy area, sensory room and a range of sitting rooms. The overall effect is very pleasing and has made a significant impact on the entrance area. The home is situated in extensive private grounds, in a residential area of Leeds. There is ample parking for visitors and staff. The area is well served by public transport. Within the registered numbers, fortyfive people may be accommodated who are suffering from dementia or a mental disorder. Donisthorpe Hall accommodates predominantly Jewish adults and offers a strictly kosher environment. Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 7th March 2006 over one full day. Three inspectors undertook the inspection, Mick Smithson, Sean Cassidy and Stevie Allerton. This was the second inspection of the home for this year. Copies of reports for this and previous inspections are available either from the home or on the CSCI website. Time was spent on all the units. The main focus of the inspection was to look at progress made with the requirements and recommendations from the last inspection. The inspectors also looked at the environment, admissions assessments, health and safety and service user finances. At the last inspection the standards on Unit 3 (the EMI unit) were noted to be below those identified in the remainder the home. Subsequently part of the inspection focused on the improvements made to this area. The management of the home have taken on board the comments made by inspectors at the last inspection. A number of improvements have been made and more are planned. During the inspection the inspector spent time talking to service users, staff and visitors. Feedback questionnaires were also provided at the inspection. The inspectors joined the service users for lunch. The feedback provided from all people spoken to during the inspection was very positive. Complimentary comments were made about the quality of the staff, the food and the cleanliness of the environment. They felt a very good range of activities is offered and family contact encouraged. What the service does well: The home provides very good information about the facilities offered and the service provided. The information is contained in the statement of purpose, service user guide and welcome pack. The environment for service users is geared to meet their needs. Parts of the premises are still in the process of refurbishment. The completed work has been done to a very high standard. An excellent range of activities and entertainment facilities are provided. Service users said that they felt they had a very good choice of activities. They particularly enjoyed using the cinema and the coffee bar area. Many service users enjoy organising their own activities with friends and family. Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 6 The pre-admission procedure is very good and includes detailed assessment information provided prior to the admission. The admission procedure its self allows service users and family the opportunity to visit prior to admission and the staff make every effort to make new service users feel welcome. What has improved since the last inspection? What they could do better: The organisation and monitoring of finances held on behalf of service users needs to be improved. The list of current appointees needs to be up dated and the issue of pooled interest for service user savings addressed. The staff need to be assessed and monitored to make sure they understand the correct moving and handling techniques. The pressure relief turning records must be kept up to date. Locks must be fitted to bathrooms and toilets in the older facilities on Unit 3. The levels of cleaning must be improved on unit 3. The problem did appear to be one of communication between care staff and cleaning staff. The majority of the facilities were cleaned to a high standard, however a small number of areas had been missed. The dining areas in Unit 3 and Unit 5 would benefit from better separation. His would reduce the amount of noise and distraction noted in these areas. It should help to improve the dining experience for service users and staff. Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 7 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. Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 5 Potential service users are appropriately assessed and have opportunity to visit the home and find out if the service can meet their needs. There is a good standard of printed information, which outlines the services provided and what service users can expect. EVIDENCE: Care plans were sampled for assessment information and service users were spoken to, to verify how their initial introduction to the home had taken place. Each of the service users whose care plans were sampled, had had an assessment of their needs carried out, either at their home, in hospital or in other care settings. Either the service user or their family had come to look round the home; some of the service users said they were already familiar with the home through past visits to relatives, friends, etc. One of the unit managers spoke about the process of ensuring that everything is ready for the person when they are admitted; the maintenance team check that everything is in place and working, the cleaners ensure that the room is Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 10 clean, any equipment identified as being needed from the assessment is put in place (such as pressure relieving mattresses, etc), the kitchen is notified of any special diet needed and a “Welcome Pack” containing information about the home is put in the room. Once the service user is admitted for a month’s trial period, a 48-hour assessment of abilities and needs is carried out, which provides the information for the initial care plan. One of the care plans seen was for a service user who had been newly admitted. There was some good recording from staff about the person’s wellbeing during this trial period. Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9. The care documentation was informative and kept up to date. The social and health care needs of service users are well recorded. The medication storage and administration is carried out to a good standard. EVIDENCE: The care records on unit 3 were checked during the inspection. Three service user records were chosen. The records were informative and included the identified care needs of each service user. Detailed pre-admission information was available from the placing agent and the organisations own format. Each care plan included a detailed assessment of service user needs and a pen picture of their life history and medical history. The care plans follow a standard format, which covers all aspects of the care provided. The health recorded includes pressure care assessments, manual handling, bed safety rail assessments and general risk assessment. During the inspection positive feedback was provided from a visiting tissue viability nurse. She felt the home was able to meet the needs of service users who require pressure care nursing and took on board any instruction given to improve standards. Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 12 At the last inspection it was required that turning records are kept where required. These are now available, however the need to be kept up to date. The care plans are required to be up dated each month or as care needs change. It was noted that for 2 of the records chosen they were not completed for the previous month. This was raised with the ward manager who agreed to up date the information. The medicine administration charts were examined in three units within the home. Overall, the system for recording administration was good. There were a few unexplained omissions of nurse signatures and the person in charge stated that these omissions would be followed up for an explanation. The homes policies and procedures for medication were thorough and included a procedure for self-administration. Three residents stated that they had been given the opportunity to self-administer when they first arrived at the home, but they chose not to take up the offer. Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 14. Good ranges of activities are arranged for service users. The home has a very welcoming approach to visitors. Care plans prompt the staff to ensure that service users are helped to maintain contact with the people important to them. EVIDENCE: A good range of activities is offered on unit 3. A member of staff has been given the responsibility for organising activities; however, the range of activities offered is being reviewed as part of the new Dementia Strategy. It was noted that the staff do appear to have difficulties engaging some of the service users. Consideration should be given to developing the sensory room, aromatherapy and music and movement. Family contact is encouraged on the unit. A relative was present at the inspection and he felt that the home provided a very good standard of care. He felt his wife was well presented when he visits and is made to feel welcome by the staff team. He and his family like to help to feed his wife during the visits. A quiet are is made available for this to take place. This is good practice. Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 14 There is a lot of involvement from families and the wider Jewish community and the home has a lively feel, with visitors throughout the day. There are many areas throughout the home where service users can entertain their visitors, either in their own rooms, in quiet sitting areas or in the more public coffee lounges. The care plans in use contain a specific plan for family contact, reflecting the importance the service places on people being able to maintain their social networks. Some service users have their own telephones, and there is access to email facilities, especially useful for keeping in touch with family members abroad. The inspectors joined the service users for lunch. The mealtime on unit 3 is very busy with a lot of the service users requiring assistance and feeding. Nearly all the service users converge on a small dining space, which is directly next to the dining room for unit 5. Any disruption in unit 5 dining room can have an effect on the atmosphere created in unit 3 and vice versa. There is the scope to block off unit 5 which will improve the dining experience. Improvements are also being made to the dining rooms on unit 3 which will greatly improve the facilities. The dining experience on the other units was very positive. Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. The organisation demonstrates a positive attitude to dealing with complaints. EVIDENCE: The organisation has a positive attitude to complaints. The complaint information is available to service users and visitors. One complaint is currently being investigated and CSCI are being kept up to date with the investigation and outcome. Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. The building is maintained to a high standard and meets the needs of the service users. EVIDENCE: A building inspection was undertaken on all the units. On unit 3 the inspector found the standards did vary. Part of the unit has recently been refurbished. The work has been completed to an extremely high standard. The remainder of the building is maintained to an adequate standard, however plans are being agreed to further refurbish the remainder of the unit. All the bedrooms are single rooms many now having en-suite facilities. Good standards of equipment and fixtures and fittings are provided. Many of the bedrooms have been personalised by relatives and contain family photographs, pictures and ornaments. This greatly enhances the environment. Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 17 Bathrooms and toilets are located around the unit and a good range of lifting equipment is provided. A number of the toilets and bathrooms in the older part of the unit would not lock. This must be addressed. The standards of hygiene throughout the unit were good however 2 areas of concern were noted. A bedroom wall was soiled and a soiled commode pan had been left in one of the en-suites. This may be due to a misunderstanding in the areas of responsibility. The cleaning staff do not normally clean body fluids, as this is the responsibility of the care staff. It was unclear whether the care staff were aware of the soiled areas. The manager agreed to look at the communication between the cleaning and care staff. It should be noted that the remainder of the unit was maintained to a very good standard of hygiene. The unit now accommodates a significant number of service users with challenging behaviour and can on occasion be quite noisy and hectic. The organisation is looking at the future development of the unit and should consider the possibility of creating smaller units or areas within the unit, which can be separated. The home currently provides a varied standard of layout, equipment, furnishings and fittings, according to where each unit is in relation to the refurbishment and rebuilding programme. Many of the refurbished facilities exceed the expected standards and provide a high quality environment for the service users. Those areas awaiting refurbishment are still maintained to a good level of repair and all of the units inspected were kept to a high level of cleanliness. An inspection was made of the facilities in Silver Lodge (both units) and Unit 5. Silver Lodge has the benefit of being built and equipped to current standards and provides large en-suite rooms that are fully wheelchair accessible and allow sufficient space for the service users to bring items of their own from home. Electric profiling beds are provided for each room in the nursing unit and the Manager of the residential unit is budgeting for some of the same beds to replace divans during this year. All of the rooms in Silver Lodge’s units are equipped with a fridge. Service users spoken to were all pleased with the accommodation. Unit 5 provides nursing care for a mainly highly dependent group of people. A few of the rooms are en-suite on this unit, but some of the rooms are very small and staff finds it difficult to manoeuvre mobility equipment. There is also a storage problem for wheelchairs and hoists, which are currently stored in one end of the sitting room. Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 18 Sluice areas in every unit were well organised. There are policies and procedures prominently displayed for staff to follow, regarding the handling of laundry and waste matter. Service users said the laundry service was good and it was clear from conversations between a laundry assistant and the service users that care is taken with personal clothing. A good standard of cleanliness was seen throughout. Carpet washing is done on a rotational basis, but Managers can request spot cleaning where necessary and this is carried out promptly. Soap and paper towel dispensers in all areas were found to be filled and functional. Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27. The staff team contains a good mix of skills and knowledge and are able to meet the needs of all the service users. EVIDENCE: Discussion took place with the manager and a number of staff on unit 3. They all felt that significant improvements had been made. They demonstrated a very good understanding of the daily routines and the needs of the service users. The staff team contains a good mix of skills and qualifications. This includes qualified nursing and care staff. The care staff are encouraged to undertake National Vocational Qualification training. The staff team also include a good level of diversity, life experience, cultural and language skills. Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 and 38. The service has a co-ordinated approach to Health & Safety, ensuring that service users live, and staff work, in a safe environment. The organisation and safe guarding of service users personal finance could be improved. EVIDENCE: Detailed health and safety information is available and training provided for care staff. The training includes manual handling training and up dates. However 2 staff were observed carrying out an unsafe lift on a service user. This was despite adequate lifting aids being available. The managers agreed to identify whether further training was required for the 2 staff. Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 21 Health and Safety policies and procedures were seen in the appropriate places around the home. COSHH procedures in place include a locked cupboard for hazardous cleaning materials in every sluice room. Risk assessments are in place in service users’ care plans. The working practices observed during the day were good, staff clearly being mindful of maintaining a safe environment as they went about their work. The maintenance department were said to be very supportive and can do routine repairs on wheelchairs, etc., on request. Twelve residents living at the home have an appointee arranged to deal with their financial matters. Only one appointee actually works in the home at present and this person only represents the interests of two residents. Therefore, ten residents do not have any arrangement in place and no one is formally acting on their behalf. This needs to be reviewed as a matter of urgency. It was identified that the home’s system of looking after these residents’ monies should be reviewed. The current system has meant that resident’s monies are being pooled in one bank account. This means that they are not receiving individual notification of the interest they are accruing on their savings. The management team agreed that both the above matters would be reviewed and acted upon. Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 3 2 3 3 3 3 2 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 2 X X X 2 Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? No 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. 3. Standard OP8 OP21 OP26 Regulation Reg 12(1)(a) Reg 12(4)(a) Reg 16(2) Requirement The pressure relieving turning records must be kept up to date. Door locks must be fitted to the bathrooms and toilets in the older part of Unit 3. The levels of cleaning must be improved in Unit 3. This could be achieved with better communication between the care and cleaning staff. The list of appointees for service users must be up dated. The current system of pooled savings for service users must be changed to include evidence of interest being available to individual service users. Correct manual handling techniques must be used at all times. Timescale for action 01/04/06 01/04/06 01/04/06 4. OP34 Reg 20 01/06/06 5. OP38 Reg 13(5) 01/04/06 Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 24 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. Refer to Standard OP20 Good Practice Recommendations The dining areas on Unit 3 and Unit 5 should be separated to reduce the level of noise and distraction. Donisthorpe Hall DS0000001337.V284425.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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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