CARE HOMES FOR OLDER PEOPLE
Firgrove Nursing Home Keymer Road Burgess Hill West Sussex RH15 0AL Lead Inspector
Miss Helen Tomlinson Unannounced Inspection 29th November 2005 2pm 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 Firgrove Nursing Home DS0000048351.V265806.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 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. Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Firgrove Nursing Home Address Keymer Road Burgess Hill West Sussex RH15 0AL 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) 01444 233843 Firgrove Care Home Limited Mrs Sareeta Kumaree Lollchand Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35), Physical disability (6), Physical disability of places over 65 years of age (6) Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. A maximim of 6 service users in the PD, PD (E) category maybe admitted Only service users over the age of 50 years in the category of Physical Disability (PD) maybe admitted A maximum of 35 service users may be accommodated at any one time 19th July 2005 Date of last inspection Brief Description of the Service: Firgrove is registered as a care home with nursing to accommodate up to thirty-five residents in the category of old age, not falling within any other category (OP). The care home is also registered to accommodate up to six residents in the category physical disability (PD) and up to six residents in the category physical disability who are aged over 65 years. The maximum number of residents who may be accommodated at any one time is thirty-five. The home is a two storey converted detached house in a residential area of Burgess Hill, West Sussex. Accommodation is provided in twenty-three single and six double rooms, which are located on the ground and first floors. A vertical lift provides access to each of these floors. Communal facilities, which are located on the ground floor, include a sun lounge, a lounge/dining area which is roofed in glass and has tables with umbrellas to provide shade when needed and a small reception/sitting area. There is a large garden to the rear of the property which is accessible to residents from a patio area outside the garden lounge. There is private parking to the front of the house. Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspector arrived at 2pm and left the home at 6.30pm. The registered manager, Mrs Sareeta Lollchand, was present throughout the inspection. Over the course of the inspection eleven residents, six visitors and four staff members were spoken with. Staff were observed giving support and assistance. Three residents files were examined in detail and other records were seen as was necessary. A tour of the premises took place. Staff files were examined. Following this inspection seven requirements were made six of which remain unmet since the last inspection. Seven recommendations were made, two of which were unmet since the last inspection. What the service does well:
Residents said they liked living at the home and the staff were very friendly and helpful. Since the last inspection more permanent staff had been recruited and residents said they liked having familiar faces on the staff team. Residents spoken with about their bedrooms said they could make them personal by bringing in items such as photographs and pictures. They could spend time in their own rooms or in the communal areas, as they wished. They praised the food saying there was plenty at each meal and a choice was available. They could eat in their own bedrooms should they wish or in the dining room. At the teatime seen staff assisted residents discreetly during the meal. Residents said some activities did take place, which they could choose whether or not to join in. There were entertainers coming into the home, a bingo game was taking place during the inspection and residents said other activities were available to them. Most had their own televisions, radios etc in their bedrooms. The majority said their choices of how to live in the home and the routines they wished to follow were respected by staff. Visitors said they were welcomed into the home at any reasonable time and could see their relative in the privacy of their own room or in the lounges, as they wished. They were kept informed of any change in their relative’s condition. Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
The care plans must be kept under review in order to be up to date with the resident’s condition. All information in various plans and assessments, regarding the same issue, must be corresponding. The plans should include the social and recreational interests of the residents, including individual preferences around routine and religious needs. The charts used to document the actual care given should be completed correctly to make sure they are a true reflection of the care given. The use of the daily notes should be reviewed to make sure if something of concern is noted then it is followed up in a timely fashion. The procedure for reporting any allegation of abuse should follow the West Sussex County Council guidelines. All persons who could be in charge of the home must know what to do. There was an offensive smell in the main lounge area. All offensive odours must be eliminated as soon as possible. Fire doors must not be wedged open. A device which meets with the guidance of the fire service must be fitted. Some staff had received adequate and appropriate training for their work. Others had not with a small percentage being NVQ trained and others having received a basic knowledge during their early employment. The registered manager must make sure all staff are adequately trained to meet the needs of the residents. Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 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. Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 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 Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 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): None of these standards were assessed. Standard 3 was assessed and met at the last inspection. Standard 6 does not apply to Firgrove. EVIDENCE: Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 Page 10 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 10 All residents had a care plan. These were not always up to date with the current situation of the resident. The health care needs of the residents were assessed and met. Not all documentation was up to date. The resident’s privacy and dignity was protected. EVIDENCE: The manager said all residents had a plan of care documented. Since the last inspection old and out of date information had been removed from these plans, which meant only the relevant information was present. This was an improvement. In the care plans seen some of the information was conflicting and could lead to uncertainty about how the needs of the resident should be met. This was also the case with the health assessments, with some risk assessments for moving and handling containing different information than other plans and assessments on file. It was discussed with the manager that should the resident’s condition be changeable then this should be documented. There was a lack of plan of care for the prevention of pressure sores, despite the assessment resulting in the person being at high risk. Wound charts were not used and the actual treatment and status of wounds was unclear. Charts were in place for those poorly residents with high dependency needs. Those
Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 Page 11 seen were not fully completed with one showing no change of position over a twenty-four hour period. The progress notes were not completed on a daily basis. For one resident on the 15th October 2005 it was noted their legs were swollen. There was no further entry in the notes until 7th November 2005. There was no evidence of medical follow up for this condition. The information regarding the residents condition, in all documentation, must be reviewed at frequent intervals, kept up to date and reflect the current condition of that resident. At the last inspection bed rails were in use without protectors being in place. At this inspection those seen had protectors and risk assessments were documented. At the last inspection some residents discussed issues when they felt the staff did not protect their dignity and some practices in the home. This included having to wait too long for assistance to the toilet. At this inspection they said this had improved. The way the staff were deployed had changed and now they worked in teams, which the residents and staff said meant they could meet the resident’s needs more quickly. Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 Page 12 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): 12,13,14 and 15 Residents said they liked the activities and entertainment which was put on for them in the home. The social and recreational needs of the more dependant residents should be more fully catered for. Residents were encouraged and assisted to keep in contact with family and friends. Residents said they had a choice about most things in their lives, within the routines of the home. The food was praised by residents who said there was a choice of meal and plenty was served. EVIDENCE: Residents who were able to discuss the activities in the home said they enjoyed what was offered to them. They talked about the entertainers who came to the home, the forthcoming Christmas entertainment and other activities, such as bingo, which was taking place during the inspection. They said they could talk together, and groups of residents were seen to do this, in the garden lounge. It was unclear what recreation was provided for the more dependant residents. The social interests, history and past hobbies or pastimes were not recorded in the resident’s plan of care. This would help the staff to understand this aspect of the resident’s life and opportunities should be provided, where possible, to adapt these things to their lives today.
Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 Page 13 Visitors said they could see their relatives or friends whenever they wished. They could visit them in the lounges or their bedrooms if they wanted privacy. Visitors came to the home at various times. They said they were involved in the care of their relative, if they wished, and were kept informed of their condition. Residents said there was no church service held in the home. Some would like the opportunity to attend this. The manager said where they had been made aware a resident wanted this it was facilitated by the home. A more thorough exploration of the residents past lifestyle and interests would help staff to understand if this was something which should be offered to the resident group. Those residents who were able to express a choice in how to live their lives said the staff respected it. Most said they could choose when to get up and go to bed, although some said they could not choose as they had to fit in with the routine of the home. Their usual routines, before being accommodated in the home, where not part of the care plan. This would help to understand if the choices of all residents, including those who were unable to discuss this, were met. Relatives or friends could provide this information in the absence of the resident being able to do so for themselves. Residents said the food was good and they had a choice with plenty to eat at each mealtime. The day’s menu was displayed in the dining room and staff told residents what was for the evening meal, in advance of it being served. Residents were assisted to eat their meal discreetly. Hot and cold drinks were available and staff assisted those residents who needed this. Most residents ate in the dining room which was a pleasant environment. Those who wished to do so were assisted to eat in their own bedrooms. Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 Page 14 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): 18 The correct reporting procedure for the home was not in place. EVIDENCE: It was a recommendation, following the last inspection, that the procedure for reporting any allegation of abuse, made at the home, was changed to be in line with the West Sussex County Council guidance. This had not been done and this recommendation remains unmet. Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 Page 15 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): 19,20,24 and 26 The home was well maintained. Some aspects of fire safety in the home could put residents at risk. There was a sufficient amount of varied communal space for the residents. Resident’s bedrooms were pleasantly decorated and personalised to individual tastes. The home was clean and bright. Some bathrooms were not tidy and there was an unpleasant odour in the main lounge/dining area. EVIDENCE: The home was well maintained. A system of staff highlighting any maintenance issues was in place and the manager said they were dealt with quickly. Residents said they liked the lounges and their bedrooms. The lounges were bright with the garden lounge being a conservatory, with views onto the garden and the atrium lounge having a glass roof. The manager said all areas of the home, including the bedrooms, were redecorated on a rolling programme. At the last inspection it was required that all fire doors must be kept closed, at all times. At this inspection some were wedged open, including bedroom and the laundry door. This presents a fire hazard and must not take
Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 Page 16 place. The requirement remains unmet. Where residents choose to have their bedroom doors open then devices which meet with the guidance of the fire service must be used. Residents said they liked their bedrooms, which they could personalise with photographs, pictures and items of furniture. They were asked if they would like a key to their bedroom door and this decision was documented. The furniture in the bedrooms seen was suitable for the residents. Specialist equipment, such as mattresses and moving and handling equipment was present when needed. Most areas of the home were clean and tidy. Some of the bathrooms, particularly on the ground floor, were untidy, with hoists and other equipment stored, soiled linen and pads being inappropriately left and other items blocking access to the toilets and basins. All staff should make sure all areas accessible to residents are tidy, safe and hygienic at all times. There was an unpleasant odour in the atrium lounge. The manager said there were measures in place to eliminate this. Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 Page 17 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): 27,28,29 and 30 Resident’s needs were met by the staff on duty. Staff were recruited in a way which protects the residents. Not all staff had received training appropriate for the work they were to perform EVIDENCE: At the time of the inspection two of the four care staff on duty were in their first two weeks of working at the home. They had previous experience in care work. They were working under the supervision of an experienced member of staff who knew the residents needs well and were offering good support and advice to the new staff members. The staff worked well as a team and the qualified nurse on duty, who was in overall charge, carried out the nursing duties and administration of medication. Since the last inspection a number of new staff had been recruited and the use of agency staff had been reduced. Residents said this had improved their care, as they knew most of the staff, who were very helpful, polite and friendly. Residents said they felt the staff working in the home looked after them well. At the last inspection the recruitment of new staff did not protect the residents since the necessary information and checks were not carried out, before they started work in the home. At this inspection the file examined contained all information needed and the necessary checks had been done. The manager said that she was now making sure all information and satisfactory checks were obtained before any new staff member started work at the home. Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 Page 18 At the last inspection the registered manager discussed that some staff were reluctant to attend statutory training, such as fire and moving and handling, and this led to them not being appropriately trained for the work they were employed to do. This remained the same, despite the manager having made steps towards ensuring this training was attended. All staff must receive training to ensure they are competent to carry out the work they are employed to do and to safeguard the residents. It is the duty of the Responsible Individual and the registered manager to make sure all staff are appropriately trained. Three care staff members had completed the NVQ two. The home should have fifty per cent of staff trained to this level. A programmed of training which will ensure this is obtained should be in place. Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 Page 19 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): 31,33,36 and 38 An experienced manager runs the home. Some reviews of the quality of care were in place. These were not robust and did not include all those who had an interest in the running of the home. Staff were appropriately supervised. Generally the health and safety of the residents was safeguarded. Some issues were highlighted to the manager. EVIDENCE: The registered manager has been in post for two and half years. She is a Registered General Nurse with many years experience in the care of older people and has been the manager of other care homes previously. She has completed the Registered Managers Award and up dates her practice and knowledge by attending training courses. Since the last inspection some methods of seeking the views of the residents and staff had been introduced. Staff briefings were held daily, one to one supervision sessions had taken place and a questionnaire had been circulated
Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 Page 20 to the residents. It was discussed with the manager that whilst this was an improvement in the review of quality of care in the home, it was not a robust system, with documented outcomes. A more thorough and formal system of reviewing the quality of care and services in the home must be put into place. This should include all those with an interest in how the home is run. Since the last inspection the manager had started one to one supervision sessions with the staff. These were documented and covered specific issues, progress, training and future development. Staff said these were useful and they liked the opportunity to discuss these issues with the manager. Staff received some training on their responsibilities to make sure the health and safety of the residents was safeguarded. At the last inspection several issues were raised, most of which had been met at this inspection. Risk assessments had been carried out for those residents using the first floor bedrooms, which have balconies overlooking the atrium lounge. The format for this assessment provided a basis for decision-making. As discussed under standard eight for one resident the information in this assessment was conflicting with other information on the care plan. These assessments must be thoroughly completed and reviewed. A torn carpet in one bedroom had been replaced. At this inspection it was pointed out that there was a lip and wearing to the carpet in the doorway of the atrium lounge. This could cause a trip hazard and remedial action should take place. Wheelchairs continued to be used without footplates. The manager said some risk assessments for residents who were unable or refused to use footplates had been carried out. Other measures, such as referral back to the supplier of the wheelchair or occupational therapist, should take place to make sure the risks are minimised. Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 Page 21 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 2 2 3 x x x 3 x 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x x 3 x 2 Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 Page 22 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 OP7 Regulation 15 Requirement All residents must have a written plan of care which is relevant to their current needs. All aspects of care must be included. This requirement remains unmet since the inspection of 19/07/05. The timescale given of 30/09/05 has expired All fire doors must be kept closed at all times unless held open by a device which meets the guidance of the fire service. This requirement remains unmet since the inspection of 19/07/05. The timescale given of 19/07/05 has expired All staff must receive training for the work they are to perform. This requirement remains unmet since the inspection of 19/07/05. The timescale given of 31/08/05 has expired A system for reviewing the quality of care in the home must be established. This requirement remains
DS0000048351.V265806.R01.S.doc Timescale for action 30/09/05 2. OP19 23 (4)(c )(i) 19/07/05 3. OP30 18(1)(c )(i) 31/08/05 4. OP33 24 31/08/05 Firgrove Nursing Home Version 5.0 Page 23 5. OP38 13(4)(a) 6. OP38 13(4)(c ) 7. OP38 13(4)(a) unmet since the inspection of 19/07/05. The timescale given of 31/08/05 has expired Risk assessments, which reflect the current situation, for individual residents using the rooms with balconies must be carried out. This requirement remains unmet since the inspection of 19/07/05. The timescale given of 30/07/05 has expired Wheelchairs must not be used without footplates in place. This requirement remains unmet since the inspection of 19/07/05. The timescale given of 19/07/05 has expired. Where residents are unable or refuse to use footplates safe alternatives should be sought. The trip hazard in the doorway to the atrium lounge should be eliminated. 30/07/05 19/07/05 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP8 OP12 OP13 OP14 OP18 Good Practice Recommendations All changes in condition should be noted and appropriately followed up. Activities, which include the more dependant residents in the home, should take place. The religious and spiritual needs of the residents should be explored and met. The preferences of routines of daily life should be included in the plan of care. The procedures for reporting any allegation of abuse
DS0000048351.V265806.R01.S.doc Version 5.0 Page 24 Firgrove Nursing Home 6 7 OP26 OP30 should reflect the West Sussex guidance. All areas of the home should be kept tidy, hygienic and free from offensive odours. 50 of care staff should be trained to NVQ level 2. Firgrove Nursing Home DS0000048351.V265806.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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