Inspection on 13/10/05 for Easemore Road, 164b

This inspection was carried out on 13th October 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

Easemore Road, 164b 18/08/06

Easemore Road, 164b 28/02/06

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Easemore Road, 164b 164 Easemore Road Redditch Worcestershire B98 8HH Lead Inspector R McGorman Unannounced Inspection 13th October 2005 10:00 Easemore Road, 164b DS0000064300.V248993.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 Easemore Road, 164b DS0000064300.V248993.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. Easemore Road, 164b DS0000064300.V248993.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Easemore Road, 164b Address 164 Easemore Road Redditch Worcestershire B98 8HH 01527 597883 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) MacIntyre Care Care Home 5 Category(ies) of Learning disability (4), Physical disability (1) registration, with number of places Easemore Road, 164b DS0000064300.V248993.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The current Statement of Purpose and Service User Guide for the home will be reviewed and produced in the MacIntyre format by 30th June 2005. Staffing levels will be maintained in accordance with the contact time specified by Worcestershire County Council (see `Staffing Schedule`) and reviewed in consultation with the CSCI by 30th June 2005 to reflect the revised Statement of Purpose. Any improvements required by other regulatory agencies will be carried out within time-scales agreed with the CSCI and by 30th September 2005 at the latest. The home may accommodate two service users who have additional physical disabilities. 17th November 2004 3. 4. Date of last inspection Brief Description of the Service: 164b, Easemore Road is registered to provide residential care for up to 4 adults who have mild to moderate learning disabilities, including 2 people who may also have an additional physical disability. The premises is a detached, purpose built property, situated in a pleasant residential area, within walking distance of Redditch town centre. The bungalow is located on the same site as a separate house for 4 people with mild learning disabilities, who have supported living arrangements. The Registered Provider is MacIntyre Care, who has recently taken over this responsibility from the Royal Mencap Society. The property is leased from the New Era Housing Association. The stated purpose of the organisation is, ‘to be recommended and respected as the best provider of services for people with learning disabilities throughout the United Kingdom.’ Easemore Road, 164b DS0000064300.V248993.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of this routine, unannounced inspection was to follow up previous requirements and recommendations, and to monitor the care provision at the home. The inspection took approximately 3 hours, and time was spent talking with the staff on duty, and 3 of the 4 service users living at the home. Everyone indicated they were happy to be living and working at 164b, Easemore Road. Time was also spent with the Acting Manager, Ms. Amanda Lewis. The assistance and co-operation given throughout the inspection was appreciated. A tour of the building was also undertaken, and some service users kindly showed the inspector their bedrooms. The care records were briefly seen, and also the records kept in respect of the maintenance of equipment and safe working practices were checked. What the service does well: The home has a friendly, calm and relaxed atmosphere, and service users are involved in the daily routines within the home. Everyone goes to college, or work, or attends a day placement, and each has a varied programme of leisure activities. There is evidence of an organised approach by the acting manager to her work, and she has maintained the equilibrium during a rather difficult time. The individuality of each service user is recognised, and the commitment of staff to their role in supporting and enabling service users is commendable. The home very obviously revolves around the service users. The initial assessment process is thorough and staff are able to demonstrate a good understanding of the needs of service users. Risk assessments are in place. Easemore Road, 164b DS0000064300.V248993.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. Easemore Road, 164b DS0000064300.V248993.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 Easemore Road, 164b DS0000064300.V248993.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): 1,2,4 & 5 Documentation is in place to provide information to service users or their representative, but this needs further development to ensure that relevant details enable an appropriate decision about their future care needs. The admissions procedure is followed in detail, and all proposed admissions to the home are planned very thoroughly, over several weeks, to ensure an appropriate decision is made, both by staff at the home and also the service user. Easemore Road, 164b DS0000064300.V248993.R01.S.doc Version 5.0 Page 9 EVIDENCE: A Statement of Purpose and the Service Users Guide have been produced by MacIntyre Care, and provide much of the information identified by this standard. Further amendments are necessary to ensure clarity, and these will be discussed with the Regional Manager, in due course. The complaints procedure, which is included in these documents, also needs to be reviewed. The Terms and Conditions of residence for each service user had been agreed with the previous proprietor, and therefore needs to be updated, to reflect the current situation. The admission procedure includes extensive assessment by staff from the home, with a Community Care Assessment provided by the placing authority. A gradual introduction is made to the home following the initial referral, and a place is only offered if it seems likely that a suitable service can be provided for the prospective service user. There have been no recent admissions to the home. Easemore Road, 164b DS0000064300.V248993.R01.S.doc Version 5.0 Page 10 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): 6,8,9 & 10 The service users plan of care is based on the initial assessment, which clearly identifies their assessed needs, and how these will be met. Service users living at the home are supported in making choices in all areas of their lives. Risk management strategies enable a responsible approach to the risks associated with the various activities of daily living. Easemore Road, 164b DS0000064300.V248993.R01.S.doc Version 5.0 Page 11 EVIDENCE: An individual plan of care is produced for each service user, based on the initial assessment undertaken during the admission process. The need for person centred planning to be developed was discussed with the acting manager. Requests made for formal reviews to be undertaken by the placing authority, do not receive a positive response, although an annual questionnaire is circulated. The management of the home therefore undertake their own review every 6 months with service users, with the involvement of family. Risk assessments are completed, in relation to the premises, to the activities undertaken, and any restrictions that may be imposed, and also in respect of every aspect of the life of each service user. The needs and individual preferences of each service user are identified as far as possible, and their participation in the daily life of the home, is constantly encouraged. Regular weekly meetings are held with service users, and include discussions about the menu for the forthcoming week. A policy on Confidentiality has been produced by MacIntyre Care, which is clearly understood by staff, and reassures service users that information about them is handled appropriately. A copy has been circulated to all partner agencies. Easemore Road, 164b DS0000064300.V248993.R01.S.doc Version 5.0 Page 12 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): 11,12,13,14 & 16 Service users are involved in all the arrangements at the home, and everyone is involved in planning their daily activities, both within and outside the home, which ensures a good quality of life for each individual. The opportunities made available to service users, and their regular involvement with family and friends, enables them to live as fulfilling a life as possible. Easemore Road, 164b DS0000064300.V248993.R01.S.doc Version 5.0 Page 13 EVIDENCE: Service users are encouraged to follow an ‘ordinary’ life style as far as possible, by using the same facilities as other members of the community, and being involved in a range of leisure activities, of which a detailed record is maintained. Service users have enrolled at college and participate in various courses. In addition, some service users attend day centres, the Social Education Centre, and a local nursery/ garden centre. Activities in which service users are involved may be in-house or in the community, and include, household tasks, assisting with preparing meals, going for a walk, shopping, swimming, gardening, going to the pub or out for a meal and attending the special Olympics each week. Arrangements for holidays are usually made, but it has not been possible this year due to the staffing situation at the home, although some service users have been on holiday, with their family, and they also spend weekends with them. Plans are currently being made for a holiday next year. Easemore Road, 164b DS0000064300.V248993.R01.S.doc Version 5.0 Page 14 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): 18,19,20 & 21 Support is provided to each service user, and encouragement given to promote independence as far as possible, in meeting the personal care needs of each individual. Advice and guidance is available from the primary healthcare teams, and associated specialists, to ensure that the health needs of service users are fully understood, and that appropriate responses are made. Arrangements for the safe administration of medication are in place at the home. Easemore Road, 164b DS0000064300.V248993.R01.S.doc Version 5.0 Page 15 EVIDENCE: The personal care needs of service users are well documented, and there is evidence to show how staff understand and respond to them in an appropriate way. Personal care is provided in privacy. The healthcare of service users is closely monitored, and additional specialist support and advice is sought from the primary health care team, and other health professionals, when necessary. Visits to the optician and chiropodist are organised when necessary, and regular dental checks are also undertaken. Two service users attended a chiropody appointment at the time of the inspection. Concerns were expressed that these treatments had to be paid for privately, as the National Health facilities are not adequate, in the area. A Health Action Plan, which forms part of the national development framework for people with a learning disability, is being developed for each service user living at the home, following a training course attended by the acting manager recently. Medication arrangements at the home are now satisfactory, with 2 members of staff involved when medication is administered. A monitored dosage system is in use, and regular checks by the pharmacist are undertaken. Training has also been provided for staff. The issues relating to the ageing, illness and possible death of a service user, were discussed with the manager, and the need for training to be provided, to increase the awareness of staff, is to be considered. In addition, the need for advice/advocacy was identified, for a service user without family or a representative, in regard to their wishes about after death arrangements. Easemore Road, 164b DS0000064300.V248993.R01.S.doc Version 5.0 Page 16 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 & 23 A satisfactory complaints procedure is followed at the home, and service users are encouraged and enabled to express their views and opinions. The acting manager demonstrated an awareness of the issues relating to abuse, which should ensure the protection of service users, although the need for further training for staff was identified. EVIDENCE: A complaints procedure has been produced and is included in the information provided to service users. The document has been discussed with individual service users and is produced in a format that is understandable to them, although some amendments are needed. They are provided with coloured cards to enable them to direct their complaint to the appropriate person. A record of complaints is maintained, although none have been received at the home recently. The management of the home is able to demonstrate a clear understanding of the issues relating to abuse. The need for training for all staff on the Protection of Vulnerable Adults (POVA) was discussed. A copy of the Guidelines produced by Worcestershire County Council, for responding to suspicion of abuse, have been obtained Easemore Road, 164b DS0000064300.V248993.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,28,29 & 30 The premises are suitable for their purpose. They are nicely furnished and clean, and ensure as far as possible that the safety and wellbeing of service users is promoted. The location of the house is convenient to local services and facilities, and the layout provides adequate communal space for the needs of service users. The standard of the accommodation is satisfactory, and provides service users with a comfortable and homely place to live, although the need for further attention to the heating arrangements is needed. Easemore Road, 164b DS0000064300.V248993.R01.S.doc Version 5.0 Page 18 EVIDENCE: The premises at 164b, Easemore Road, is a purpose built, detached bungalow, set back from the road, which is maintained to a satisfactory standard, and is suitable for its purpose. The home is not able to accommodate wheelchair dependant people. There are four single occupancy bedrooms for service users, which comply with the space requirements, and those seen are furnished to a satisfactory standard, and personalised by their occupants. There is also a bathroom and a shower room, with a toilet, and sleeping accommodation for staff. Concern about the heating arrangements was identified, as an ongoing problem affecting the boiler and thermostats has not been rectified, although various work had been undertaken previously. Appropriate risk assessments are in place, and precautions are taken by staff to ensure the safety of service users. The need for these matters to be resolved without further delay was discussed with the acting manager. The communal areas of the home are nicely decorated and comfortably furnished. There is a pleasant lounge, and a large kitchen/diner. The gardens, which are quite large, are accessible to service users, and these are also shared with another house which provides supported living. There is a more private patio area, which is used for dining ‘al fresco’ when the weather permits. The home is clean and free from offensive odours. Procedures are in place for the control of infection, and a copy of the policy has been submitted to the Commission. Training is given to staff on health and safety matters. There were no outstanding requirements following the last visit of the Environmental Health officer, in July 2004, when, ‘good levels of compliance were being achieved’. The Fire Safety Officer inspected the home in April 2005 and the report following the visit stated, ‘there are no outstanding fire safety concerns’. The acting manager is advised to discuss with the fire officer, the access to the premises, in the event of a fire tender being needed, as there is no vehicular route to the house. Easemore Road, 164b DS0000064300.V248993.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35 & 36 The experienced members of staff at the home, together with new staff, are working to ensure that the needs of service users living at the home are effectively met. The training programme available to staff provides then with the competencies necessary for them to be effective in their work, although further specific, care related training would be of benefit. Supervision procedures ensure that all staff are given appropriate support. Easemore Road, 164b DS0000064300.V248993.R01.S.doc Version 5.0 Page 20 EVIDENCE: The acting manager confirmed that appropriate staffing levels are maintained to provide for the identified needs of service users, although there have been several staff changes during recent months. A new member of staff is to join the team in the near future. There has been minimal use of agency staff, as the staff team have worked additional shifts to provide adequate cover for the service. A training programme is provided by the organisation. New members of staff undertake induction training, which includes, Fire Awareness, Basic First Aid, Health & Safety and Basic Food Hygiene. They should then undertake the National Vocational Qualification, and use the Learning Disability Award Framework accredited training, to provide the underpinning knowledge. Proposed courses for the next 3 months include, Person Centred Planning and communication. Supervision sessions are organised every 4-6 weeks, and monthly staff meetings are held. Comments from staff are very positive about their experiences of working at the home, and also of being employed by MacIntyre Care, which will inevitably be of benefit to service users. Easemore Road, 164b DS0000064300.V248993.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41 & 42 The home is well managed at present, but the acting manager needs to be registered in order to comply with legislation. The health, safety and welfare of service users is promoted and protected in respect of all safe working practices. The support provided to staff by the area manager, ensures the promotion of the aims and objectives of the home. Easemore Road, 164b DS0000064300.V248993.R01.S.doc Version 5.0 Page 22 EVIDENCE: The management structure for164b, Easemore Road, includes a Service Manager, who is now located in Worcestershire, and a Regional Director and a Managing Director who work at Head Office in Milton Keynes. The home does not have a Registered Manager, but the Acting Manager, Ms Amanda Lewis has responsibility for the day-to-day running of the service, supported by the Service Manager. An application for registration has been submitted to the Commission, and is currently being processed. A quality assurance system is being implemented at the home, and questionnaires have been circulated to family, friends and other agencies. Surveys of the views of service users are to be undertaken, and when audited, the results will be submitted to the Commission. The records were not checked in detail during the inspection, although those seen had been completed to a satisfactory standard. The Fire Log indicated that weekly checks of the fire alarm system, and practice evacuations are undertaken. Regular maintenance and servicing of equipment is done, and temperature checks are recorded. Safe working practices are in place at the home, and staff are given training in all aspects of health and safety. The Company employs an officer to advise on health and safety matters. Risk assessments are completed for all safe working practices. Easemore Road, 164b DS0000064300.V248993.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 X 3 2 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 X 3 3 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X 3 X 3 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Easemore Road, 164b Score 3 2 3 2 Standard No 37 38 39 40 41 42 43 Score 2 X 2 X 3 3 X DS0000064300.V248993.R01.S.doc Version 5.0 Page 24 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 6 Requirement The statement of purpose and the service users guide must be revised to accurately reflect the services and facilities available The contract/statement of terms and conditions must be amended to reflect the organisational changes Equipment must be maintained in good working order – the fault with the boiler/thermostats must be rectified without further delay. Timescale for action 30/11/05 2 YA5 15 30/11/05 3 YA29 23 30/11/05 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 Refer to Standard YA6 YA14 YA19 Good Practice Recommendations Further development of Person Centred Planning should be undertaken by staff at the home Service users should be given the opportunity to take an annual 7 day holiday Health Action Plans should be introduced for all service DS0000064300.V248993.R01.S.doc Version 5.0 Page 25 Easemore Road, 164b 4 5 6 7 8 YA21 YA21 YA23 YA24 YA39 users Training should be provided for all staff at the home on death and bereavement Discussions should take place with service users, and their family or advocate, about their wishes concerning death Training should be provided for all staff at the home on all aspects of abuse Discussions should be held with the Fire Safety Officer regarding vehicular access to the home in the event of a fire The quality assurance system should be fully implemented at the home, and a copy of the audit submitted to the Commission Easemore Road, 164b DS0000064300.V248993.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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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