Inspection on 16/06/08 for Easterlea

This inspection was carried out on 16th June 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Easterlea 20/12/07

Easterlea 16/01/07

Easterlea 21/09/05

Easterlea 04/05/05

Easterlea 20/09/04

Easterlea 26/04/04

Easterlea 02/10/03

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Easterlea Hambledon Road Denmead Hampshire PO7 6QG Lead Inspector Kathryn Emmons Unannounced Inspection 16th June 2008 09:30 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 Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Easterlea Address Hambledon Road Denmead Hampshire PO7 6QG 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) 023 9226 2551 Mr David Mitchell Miss Carol Boyce-Flowers Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A minimum of three care staff are on duty between the hours of 8.00am to 8.00pm whenever service users numbers exceed 15. These care hours must be in addition to any management hours. 20th December 2007 Date of last inspection Brief Description of the Service: Easterlea is registered with the Commission for Social Care Inspection (CSCI) to provide care and support for up to 19 Older People. The home is situated on the outskirts of the village of Denmead in Hampshire and is set back from the busy main road. Accommodation is provided over two floors, ground and first floor and a lift is provided. There are 14 single rooms, 9 of which are en-suite and 2 double rooms, with 1 en-suite. There is a large rear garden, which is accessible through the lounge and parking is available at the front of the home for up to 10 cars. The village centre is a short distance away where local shops, a post office and GP surgery are situated. The local bus stops a short distance from the home and there is also a local ring and ride bus service available. The weekly fees range from £335.00 to £507.00. Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A visit to the service took place on 16th June 2008. This visit was unannounced and took place over 6 hours. Care received by three residents was looked at in detail. This is a method called case tracking. This included looking at their personal records, a range of general home records and staff detail records. Staff were spoken with and the care they provided was observed. Two residents completed the comment cards we had sent out before the visit. We also received a completed self-audit document to provide information before we did a site visit. We also looked at how the provider makes information about their service, including making CSCI reports available to prospective residents. The commission is trying to improve the way we engage with people who use services, so that, we can gain a real understanding of their views and experience of social care services. We are using a method of working where the Expert by Experience is an important part of the inspection team and helps the inspector to get a picture of what it is like to live in or use a social care service. The Expert by Experience spoke with 8 residents and 5 staff on their own, contributed to the inspection process and provided a separate report. Comments and observations are reflected in this report. What the service does well: There was evidence that information about residents have been obtained before they went to live at the home. This means that staff can have an understanding of residents needs to ensure these can be met before an offer of admission is made. Residents made positive comments about the activities provided and example were give of the variety. This means that residents have opportunities to engage in worthwhile activities. Residents said there is a good choice of food available and they are consulted regarding the choice of food. This means that residents are able to express their opinions and are provided with a varied diet. The environment is homely and residents are encouraged to personalise their rooms to their own tastes. Cultural and religious beliefs are acknowledged and Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 Page 6 respected and support is given to residents to continue to engage in previous hobbies. Staff are motivated and enthusiastic and are positive in their job roles. The manager has a good rapport with the residents and staff. What has improved since the last inspection? What they could do better: Care plans have been improved and contain more detail than previously. All residents need to have a care plan in place so that staff can meet residents assessed needs. These need to be in place even if the resident is only staying at the service for a short time. Staff records are in place but it was not possible to evidence that all staff had received an induction, as two of the three records we looked at were not complete. All staff must be recruited correctly so that residents are supported by people who are suitable to care for them. Lack of previous employment history and satisfactory references does not give residents confidence that they are cared for by appropriate people. Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 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 Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Through pre admission assessment systems residents can be confident that their assessed needs can be met when they are admitted to the home. Up to date information enables residents to make an informed choice regarding living at the service. EVIDENCE: From looking at three resident files we could see that information regarding residents needs had been obtained before they had been admitted to the home. In one file we saw that the relative of the resident had been able to visit the service and ask questions before a decision was made for the resident to be admitted. Two documents are in place called the service user guide and the statement of purpose. These two documents are available to residents and their relatives Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 Page 10 and inform them of the services they can expect if they live at the home. Details also include who the staff are and what jobs they do, what the environment is like and what to do if they have any concerns. We saw that contracts were in place, which had been signed by the resident or their relative. The manager told us that residents are told if their assessed needs can be met by the service. This confirmation also needs to be in writing to the resident so they can be confident that their needs will be met. The manager confirmed this would now happen. Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lack of care plans and risk assessments put residents at risk of not having their needs met. Current medication recording systems keep residents safe. Access to medication needs to be reviewed. Systems in place provide access to health care professionals. Resident’s dignity and privacy is maintained. EVIDENCE: Through case tracking we looked at three residents care files. Two of the files contained care plans and risk assessments. These had been updated and contained sufficient information for care to be delivered safely. Signatures were in place, which the manager told us were to show that the care plans had been read and reviewed. It is suggested that a written record should be made to show that care plans have been updated. This would give residents confidence that a member off staff had read the daily welfare records and was aware of any change in their care needs. Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 Page 12 One of the files we saw did not contain any care plans or risk assessments apart from a self-medication assessment. This resident had been in the service for a month and the manager told us that she was not aware that plans needed to be in place for short stay residents. We were told, before this report was published as a final copy, that risk assessments had been available but were in a separate file. The letter telling us this also states that all of the relevant documents are now in one file to make it easier to find the necessary information. The manager is aware now that care plans need to be in place so staff can deliver care correctly and safely. An entry is written at least twice a day for each resident. This enables staff to see the current wellbeing and health needs for each resident. We spoke with residents and they felt staff knew their care needs. We could see from files that residents had access to doctors, nurses and other health care professionals when they needed to see them. Residents told us they saw the chiropodist on a regular basis and we saw from files that an optician had seen a couple of residents. Medication records were seen for all residents and generally records had been competed correctly. We saw that 2 inhalers were stored on the shelf in the office and these did not have the residents name on them. The keys for the medication cupboard were on display in the office. A review of this system should take place to ensure that resident’s medications are stored as safely as possible. We observered interactions between staff and residents and found these to be valuing. Staff were patient and listened to what residents were telling them. They spoke to residents in an appropriate way and addressed them in their chosen form. Support in using the toilet and taking a bath were given in a discreet way and staff were seen to knock on the doors to bedrooms and bathrooms before entering. Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with appropriate activities and are supported to continue with hobbies they enjoyed before living at the service. Staff have an awareness of residents spiritual and emotional needs. Residents have control over who visits them. Dietary needs and preferences are catered for. EVIDENCE: Residents made positive comments regarding the activity programme in place at the home. Examples given were bingo, visiting mobile library, quizzes and card games, art and craft afternoon and Pilates. An external team who specialises in Activities for Older People visit the home weekly and maintain records of the activities residents have participated in. One resident said they spent their evening in their bedroom watching television, as ‘it gets lonely in the lounge.’ We understood this was because many residents chose to retire to their bedrooms in the evening in preparation for bedtime. Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 Page 14 The manager is working towards the service having more community inclusion and offering local groups to visit the service and provide contact for the residents such as the local church and school. Currently residents are able to attend their place of worship in the community and there are also monthly visits from clergy of various denominations such as Church of England, Methodist Baptist and Catholic. The manger has a very good understanding of the different cultural and religious needs of the residents living at the service. A monthly newsletter is given to residents informing them of new staff and residents. Any events planned and any other relevant information. Residents can have visitors when they chose and there were various spaces around the home where residents can meet with visitors in private if they don’t want to use their bedroom. Staff were seen to be welcoming and accommodating to visitors who attended the home during our visit. Resident meetings take place and residents have this opportunity to raise any issue they have. Minutes are then produced and displayed around the home Residents spoken to made positive comments about the food. They said there was a good choice available and that the carers who also made the main meal of the day were aware of their likes and dislikes. The expert by experience took lunch with the resident and found the food to be “very good” and residents told her that the food is usually to their liking. Specialised diets are catered for such as a fruit free diet and sugar free meals. Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A complaints policy on display enables people to know how to make a complaint. A Safeguarding adults policy provides staff with a working awareness of what constitutes abusive practice. EVIDENCE: Prior to the visit a pre inspection self audit record was used to plan the visit to the service .This recorded that no complaints had been made. We checked this with the manager who confirmed that no complaints had been made since the last inspection. A complaints procedure is in place and is on display in the main reception area, it is also contained within the contract given to residents. Two comment cards received confirmed that residents knew how to make a complaint and who to speak with if they had any concerns. Staff spoken with knew what to do if a resident or visitor raised any issues. A safe guarding adults policy is in place. The manager confirmed that safeguarding adult training was planned and was due to be carried out in the near future. The manager also said that staff received information regarding safeguarding adult procedures as part of their induction. Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,23,24,25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and pleasant service, which they have control over. Décor and furnishings are resident’s choice and specialised equipment enables them to be as independent as possible. EVIDENCE: We toured the home and the expert by experience recorded an “overall impression is of a light, spacious friendly lounge/diner. All areas of the home are clean, no smell, with fresh flowers both in the hall and lounge.” Since the last inspection a new car park and driveway have been built and various bedrooms and communal areas have been repainted. Work was ongoing with providing a new rockery area to the rear of the home. The Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 Page 17 gardens are landscaped and have garden furniture so residents can sit outside in a comfortable environment. We saw specialized equipment such as hoists and a new hoist was being fitted for the downstairs bathroom during the visit. Residents gave us permission to speak with them in their bedrooms. We found that residents had been able to personalise their rooms with photographs, trinkets and one room even had a small fridge in place at the resident’s request. A lift is in place for residents to be able to move between floors independently. We saw residents able to move independently around the service. All corridors were free from hazards and had hand rails fitted to provide support for residents. An infection control policy is in place and staff were seen wearing gloves and aprons and using correct disposal bags when dealing with dirty laundry. Residents told us that they were very happy with the laundry service and that they always received their clothes back well laundered and no clothes went missing. Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. An enthusiastic and trained care team cares for residents. The organisations recruitment procedures do not recruit staff safely, which may place residents at risk. Staffing levels generally meet resident’s needs. EVIDENCE: Residents comment cards and comments made during the visit inform us that the residents found the care staff to be kind and helpful and “night staff were also very nice and always answered calls immediately”. One resident told us that when they had first been admitted to the service the” staff had more time to stop and chat but now they were much busier”. One staff member said that working at the service was “much more than a job”. We saw during our visit that staff were busy and in addition to providing care were also making the lunchtime meal. There were three staff on duty as well as the manager. The manager said that she also provided care as needed. Call bells were answered promptly and from speaking with staff we could see that they were l aware of residents individual likes and dislikes. Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 Page 19 Staff meetings have taken place the last one being either early 2007 or late 2006. The manager stated that staff were able to speak to her on a daily basis and raise any issues rather than have to wait for a team meeting. A training plan is in place but we were not able to see it during the visit as it was being updated. The manager told us that all staff receive an induction. This included a checklist, which must be signed off before staff are able to work without supervision. We found a checklist in one of the files we saw but one file of a new member of staff did not contain an induction checklist. The manager said the induction checklist was being updated but that the staff member had undergone their induction. One of the staff from another of the organisations homes visits the service weekly to carryout staff training. The manager is a trained trainer for first aid, heath and safety and moving and handling. The manager attends yearly updates to ensure the training she provides is current practice. Three recruitment files were looked at. Two for the newest care staff employed and one for a staff member who had been working at the service for several years. All files contained Criminal Record Bureau checks and identification. There were two references in on file and the other two files only contained one reference. One of these files did not contain any employment history. This means that staff have not been recruited safely and residents cannot be confident that they are cared for by people who have the necessary skills and attitude to care for them. The requirement to have references and full employment histories for staff had been identified and made a requirement following the previous two inspections. The manager has said that she will ensure all necessary records are in place and during the visit made arrangements to obtain a second reference for one of the files. In a written response to this report from the registered provider, when it was in draft form, we were told that two references and an employment history have been completed. Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A registered manager who has a good rapport with residents, staff and visitors manages the service. Lack of compliance with recruitment procedures has potential to place residents at risk. Quality assurance systems show how the service is run in the best interests of the service users. EVIDENCE: Since the last inspection the registered manager Ms Carol Boyce-Flowers has attained the Registered Managers Award and a Business Skills in Care award. Residents made comments such as “everything is lovely”. “‘Carol (the Manager) will always go that extra mile for you”. Staff told us that they “like Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 Page 21 and get on very well with the Manager” and that,”Carol the manager is highly regarded” and “leads by example”. Requirements were made at the last inspection and a response received from the Registered person indicated that all requirements had been met. The requirements made surrounding staff recruitment have not been met and the manager needs to take action to meet any outstanding requirements. Staff supervision sessions are now taking place but not at the required frequency. The manager has said that she is developing a system where supervision sessions will be delegated out and the correct frequency will be achieved. This means that staff will have a formalised opportunity to discuss any issues and have training needs identified. A quality assurance system is in place so residents and visitors to the home can see how the providers intend to improve the service and action any points residents raise. Residents and relatives are given a questionnaire to complete annually and quarterly committee meetings are held with the last meeting being February 2008. Each month a visit is made by one of the organisation representatives to produce a report on the conduct of the service. We were told that records are reviewed during this visit but we could not see a record of this from the reports we read from February 2007 to the last report, which was May 2008. Monthly the manager also does an audit of one area of the home such as the cleanliness of the building, supervision sessions, catering and this is made into a written report. The manager told us that no finances are looked after by the organisation and that when residents owe money for items such as hairdressing the bill is paid by the service and then a letter sent to the relative to reimburse the service. A pre inspection self audit record informed us that health and safety checks are carried out within agreed timescales. We sampled this by checking when the fire system had last been checked. We found the records to be up to date. A couple of residents told us they were aware of fire drills but were not involved in them. Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 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 3 3 3 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 2 x 3 Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? yes 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 OP7 Regulation 15 Requirement All residents must have care plans in place, which identify how their care needs are to be met. This is to demonstrate that the home is meeting resident’s personal and health care needs. This is a repeated requirement from the previous inspection of 16/01/07 and 20/12/07. 2. OP29 19 Schedule 2 Staff must not be employed in the home until all required recruitment information is obtained. This includes a full employment history and two written references, one of which is from the most recent previous employer. This is to protect residents. This requirement is a repeat from the immediate requirement letter from 16/01/07 and requirement from 20/12/07 inspection. Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 Page 24 Timescale for action 31/08/08 31/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Easterlea DS0000011757.V365310.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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