Inspection on 13/07/05 for Foley House

This inspection was carried out on 13th July 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 but made no statutory requirements on the home.

Other inspections for this house

Foley House 23/08/07

Foley House 15/09/06

Foley House 12/02/06

Foley House 26/01/05

Foley House 09/07/04

Similar services:

Coopers Mill Ltd

Pocklington House

Newton Court (1-2)

Newton Court (3-4)

St Raphaels

Elkington House

Read House

Clacton Family Trust

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

CARE HOMES FOR OLDER PEOPLE Foley House 115 High Garrett Braintree Essex CM7 5NU Lead Inspector Kay Mehrtens Final Unannounced 13th July 2005 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 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. Foley House I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Foley House Address 115 High Garrett, Braintree, Essex CM7 5NU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01376 326652 01376 326652 Foley House Trust Care Home 20 Category(ies) of Sensory impairment (20), Sensory impairment registration, with number over 65 years of age (20) of places Foley House I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, under the age of 65 years, who require care by reason of a sensory impairment (not to exceed 20 persons) 2. Persons of either sex, aged 65 years and over, who require care by reason of a sensory impairment (not to exceed 20 persons) 3. The total number of service users accommodated must not exceed 20 persons 4. No more than five persons may attend the home on a daily basis in addition to those 20 accommodated. Date of last inspection 26/01/05 Brief Description of the Service: Foley House offers residential care to deaf and deaf/ blind adults. The premises has three floors and was originally built in 1881. Some areas of the home would not be easily accessible for those requiring the use of a wheelchair. The main building has seventeen rooms, most of which have en-suite facilities. There is a choice of several sitting areas and there is a separate dining room. In addition there is a purpose built unit providing modern facilities which comprises of four en-suite bedrooms, assisted bathroom, training kitchen, dining area and recreation room. This facility is also used for activities for the day care service users. The home is currently registered to cater for 5 day care service users. Foley House I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection that took place on the 13th July 2005, lasting 7 hours. The inspection process included: discussions with the manager and deputy, four staff, nine residents and one relative. There were 17 residents accommodated at the time of the inspection with one service user attending for day care. The fees were not available at the time of the inspection. There are additional charges for hairdressing, newspapers and personal items. Samples of records and residents care plans were inspected. The inspector had the opportunity to meet many residents and would like to thank them for their time and hospitality. The inspection covered sixteen standards relating to older people. The home does accommodate younger adults and this inspection highlighted shortfalls in meeting the standards for younger adults. These will be commented upon in this report and will be reviewed and inspected in more detail at the next inspection. The home has a new manager that recognised the need to develop the standards in relation to younger adults as part of the homes’ registration conditions. The new manager and her deputy approached the inspection in a positive and cooperative manner that was focused on achieving best practice to meet the needs of the residents. The home was clean and maintained to a good standard. What the service does well: The staff observed, on the day of the inspection, were very caring and supportive in their contact with the residents. The new manager is continuing the input and development of staff training with regard to British Sign Language (BSL) to ensure that the specialist provision of communication skills are there to meet the needs of the resident group. The home is well equipped to meet the needs of residents with visual and hearing impairments. Foley House I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 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. Foley House I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Foley House I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 Page 8 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 standard(s) 1, 2 and 3 Residents are provided with some information about the home. Residents are made aware of the fees and charges when moving into the home. The arrangements for pre-admission assessments are good so staff are aware of residents’ needs prior to their placement. EVIDENCE: The new manager had recently updated the homes’ Statement of Purpose. It now refers to the new stair lift and provides information about many aspects of the home. However, the Statement of Purpose does not comment upon the provision of care and opportunities for younger adults or day care services. The home is registered to accommodate younger adults, people less than 65 years with sensory impairment and to offer day care for up to 5 service users. The files sampled contained a copy of the contract details from the placing authority and a statement of terms and conditions from the home. This provided the residents with information about their fees and the care provided. The resident concerned had signed this document. Foley House I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 Page 9 The manager, deputy and a BSL signing interpreter had undertaken a recent pre-admission assessment. The approach by the manager was centred on ensuring that the correct information was gathered from the resident and their family, as well as information provided by the placing authority. The documentation seen was very detailed and covered all aspects of the residents’ care needs and history. It provided a good picture of the person being assessed and enabled them to feel part of the process. The assessments provided good information to enable the development of useful initial care plans and consistent care on admission to the home. Foley House I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 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 standard(s) 7, 9 and 10 The care plans have improved since the last inspection and provide staff with good information to meet residents’ needs. Improvements had been made with regard to medication. The communication needs of residents are generally well met. EVIDENCE: Two care files were inspected. The residents were not very aware of the meaning of a care plan but did understand and appreciate that staff needed to know how to meet their needs and felt part of the process. The care plans had improved since the last inspection. They reflected the information gathered at the assessment stage and the individual needs and wishes of the residents. There was good evidence of detailed information gathering that included the resident and their family. The format used for assessment and planning addressed all the required aspects of care and provided staff with clear actions to meet the identified needs of residents in their care. The inspector was impressed by the work put into one care plan, by the manager and her deputy. They had ensured that the immediate needs of a new resident were recorded and shared with the care staff. The staff were Foley House I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 Page 11 very aware of the needs of residents and actions were being taken to amend the care plans to reflect changes in physical, behavioural and communication needs. However, the daily recording did not reflect the insight, actions and care observed and provided by the staff, during the inspection. The notes were not very informative and were problem focussed. Many records just stated, “no problem or no change”. Care files were well organised. The care plan sampled had been regularly reviewed though there was no evidence of the residents’ input into this process. The home does need to develop resident input into care planning and other aspects of their life in the home. The home does not operate a key worker system though the manager informed the inspector that she hoped to develop this with the residents and staff. This is an area that is an expectation within the standards for younger adults and will be monitored at the next inspection. The storage and audit of medication had improved since the last inspection. The previous issues, raised at the last inspection, regarding the placing of a medication cupboard and fridge in the residents’ dining room, had been addressed. All medication is now stored in a secure room that was clean, tidy and well organised. The medication round was observed. Senior staff are trained with regard to medication administration and the process was observed to be efficient and respectful of residents’ needs and wishes. The manager intends to expand medication training for all staff so that all are aware of the procedures and medication needs of residents. The inspector observed many instances of care staff interacting with residents in a respectful and appropriate manner that ensured their dignity and confidentiality. Residents and their visitors informed the inspector that they found the staff to be “respectful, caring and polite”. The manager has organised additional training for staff in British Sign Language as she recognised the need for herself and the new staff to learn and be able to communicate better with the residents. The inspector did observe some staff sign with residents during the inspection, especially at lunchtime. However, there were several instances when staff were observed to talk to each other and visitors without signing at the same time and so this excluded the residents from the conversation. A visitor to the home also noticed this. Visitors were very complementary about the staffs’ caring and friendly approach with the residents. Foley House I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 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 standard(s) 12 and 15 Activities and daily living are limited and do not address the needs of the younger adults accommodated in the home. Catering arrangements are good. Residents enjoy a social and pleasant time during mealtimes. EVIDENCE: The home does have an activity worker during the working week and events are organised such as trips out, crafts and bingo. There were few planned activities on the day of the inspection. Staff were chatting to residents during the day and Bingo was offered in the afternoon. Residents informed the inspector that they enjoyed the activities offered. Access to the local community is limited for those residents with mobility difficulties. Residents do have access to the homes’ own transport, which is dependant upon staff being available to drive, and it is regularly used to take residents to local deaf clubs and outings. The home is not near local shops so a “shop” is provided in the home, though it was not “open” during the inspection. The home does accommodate younger adults and the manager and staff need to work with these residents to look at and develop activities, educational and leisure opportunities that are age appropriate and with their own peer group. The culture of the home is very much focussed on the elderly and a little Foley House I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 Page 13 institutional in the approach to meeting and developing the needs of younger adults. The manager was aware of the need to build on the Standards for Younger Adults and enable them to become more involved in their life, in the home and the community. The manager and deputy were advised by the inspector to look at and work upon the Standards for Younger Adults with regard to “Individual needs and choices” and “Lifestyle”– Standards 6 to 17. The home must meet these standards if it is to continue with its registration for younger adults. This will be monitored at the next inspection. The home does have the benefit of the separate lounge/kitchen/dining room equipped for deaf/blind residents. However, it is generally only used by a visiting deaf/blind group that does not include residents from the home. Some of the younger residents occasionally use this room to prepare a meal. It is an area of the home that the manager and deputy recognise could be better used with the residents, especially the younger adults. The residents enjoyed the food provided at the home. The inspector was invited to have lunch with some residents. The meal was delicious and well presented and there was a good choice, as well as other alternatives provided on request. The cook responded to individual requests in a positive and respectful manner. The residents enjoyed chatting to the cook, staff and each other. The meal was a pleasant and relaxed occasion. Some staff took the opportunity to sit and eat with the residents and it was evident that this was much appreciated by the residents concerned. It was positive to hear that the time for meals had been discussed with the residents and their comments and opinions were listened to, as they are happy with the times set. The “soft meal” provided for a resident was well presented by the cook. However, the carer assisting the resident proceeded to mix the food into an unpleasant mush so loosing an opportunity for the resident to enjoy the different tastes. Staff were also observed to leave residents that they were assisting with eating and attend to other tasks. This was a missed opportunity for these residents to enjoy a social, one to one time with a carer and their right to this was ignored. Foley House I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 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 standard(s) 16 and 18 The home has a clear complaints procedure. The manager and staff have a good understanding of the need to protect residents from abuse. EVIDENCE: The home has a good complaints policy and procedures. The home had not received any formal complaints though the manager was addressing issues raised, by some care staff, in a careful and respectful manner. The residents felt happy with the care that they receive at the home and stated that they felt no need to complain. They are aware of the complaints procedure and clear that they could talk to the new manager. The manager had planned training with regard to adult protection, bully and harassment for all staff. The staff were aware of this training and recognised the need to be aware of aspects of abuse and the issues surrounding harassment and bullying. The manager was very aware of the need to check the Protection of Vulnerable Adults (POVA) register with regard to staff employment. Foley House I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 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 standard(s) 26 Residents are provided with a clean, well-maintained and pleasant home. EVIDENCE: The premises were not fully inspected on this inspection. However, the home is well equipped to meet the needs of residents with hearing impairment and there is also a section of the home that was purpose built to accommodate residents with visual impairment. The downstairs lounge and entrance areas are large and allow residents the choice of where and who to be with, to join in activities, watch television or sit quietly. The standard of cleanliness was good. There was good evidence of the provision of infection control equipment for staff in all bathrooms as well as in the dining area. Staff were observed to be following infection control procedures, throughout the inspection, at all times whilst administering personal care to residents. The laundry area is located away form the living area and was clean and well organised. Some residents can do their own washing, if they choose to. Foley House I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Staffing levels are sufficient to meet the needs of the residents. Staff recruitment practices are not sufficient to ensure residents’ protection. EVIDENCE: Examination of the staff rota and observation during the inspection indicated that the manager and deputy are on duty until 5pm during the week. One senior and two care staff are on duty during the day, from 7.45am to 9.30pm with two waking night staff to cover the night shift. Staff are provided to escort residents to health appointments where needed. The home employs an activity worker throughout the week. Appropriate levels of domestic, administration, maintenance and catering staff are employed in the home. The staffing levels are sufficient to meet the needs of the older residents. However, as previously mentioned in this report, the home is also registered to care for younger adults. Whilst the staffing levels during the day are sufficient to meet the needs of residents, there was little evidence of additional staffing at weekends and evenings, times when younger adults may wish to access different activities and the community. The manager was aware of the need to look at staffing levels and allocation in order to address the issues raised regarding standards for younger adults. She recognised the need to work with the staff and the residents to look at developing a different approach to activities and to look at the culture of the home, which is more geared towards older people than younger adults. Staff spoken to, at the inspection, were also aware of the need to develop the standards for younger adults. They informed Foley House I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 Page 17 the inspector that they had been encouraged and supported by the new manager to look at the standards for younger adults and recognised the need to develop their knowledge. Their comments reflected a commitment to make changes, alongside the new manager, that will better meet the needs if all the residents in the home. They were positive about the changes made by the new manager and expressed a keenness to learn and develop their skills. The staff were observed to carefully explain outcomes and advice, following health appointments with residents, in answer to there queries and concerns. The inspector was impressed with one member of staff who patiently and respectfully reassured and encouraged a resident who was upset following a recent health appointment. Residents and their visitors were complementary regarding the manager and staff team. They were observed to be relaxed and happy in the company of the staff and clearly enjoyed the opportunity to talk to staff. The manager was aware of the need to enable and train staff to look at different ways of working with residents that may present some challenging behaviour, as a way to respond to the difficulties expressed by some of her staff team. The staff recruitment records were well organised. However, one application form sampled did not have a full employment history. The manager was advised to explore the gap with the staff concerned. The manager was aware of the procedure with regard to ensuring evidence of POVA and CRB checks. The staff flies contained information regarding induction and training records. Foley House I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 35 and 37 The management style is very much focussed on the best interests and needs of the residents. Records were generally well maintained though the need to ensure all recruitment checks are done remains a requirement. EVIDENCE: Residents spoke very highly of the manager and the staff team. The staff spoken to, at the inspection, felt well supported by the new manager. There was some evidence of staff finding the recent changes difficult to manage. The new manager was aware of some of their difficulties and spoke in a very positive and understanding manner about some staff issues. She recognised the need for the home to develop, especially with regard to meeting the needs of the younger people living in the home. At the same time, she was aware of the need to support the staff team and work with them in Foley House I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 Page 19 order to ensure that the home can meet the needs of the residents that it is registered to care for. Records inspected were generally well maintained. These included accident, visitors, staff rotas and residents’ possessions. The nutrition record did require more detail with regard to all meals taken by residents. Records requirements highlighted at the last inspection had been addressed with the exception of the need to ensure that gaps in employment history, for new staff, are checked. Residents’ financial records and affairs are well managed by the homes’ administrator. Foley House I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 x x 3 x 3 x Foley House I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 Page 21 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 4 Regulation 18 Requirement Timescale for action 25.08.05 2. 8 12 3. 10 12 4. 12 16 The Registered Person must ensure that staff receive training with regard to meeting the needs of deaf/blind service users. This is a repeat requirement. The timescale of 06.05.06 had not been met. 25.08.05 The Registered Person must ensure that service users are consulted on, and participate in, all aspects of the running of the home. This is with particular reference to the National Minimum Standards for younger adults. This is a repeat requirement. The timescale of 06.05.06 had not been met. The registered person must 25.08.05 ensure that the dignity of service users is maintained. This refers specifically to the practice of staff not signing when talking in the presence of residents. The registered person must 25.08.05 ensure that residents have access to activities that are age appropriate and meet their individual preferences and needs. This refers specifically to the needs of younger adults. I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 Foley House Page 22 5. 27 19 schedule 2 The registered person must ensure that staff recruitment checks are carried out. This refers specifically to the need to explore gaps in employment. 25.08.05 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. 4. 5. Refer to Standard 1 15 15 37 Good Practice Recommendations The Registered Person should ensure that the Statement of Purpose is amended to reflect how the needs of younger adults and day care service users are to be met. The Registered Person must ensure that meals for those residents that require pureed/soft food is presented in an appetising manner. The Registered Person must ensure that staff assisting residents with their meals should stay with the resident and use the time for social interaction. The registered person should enseur that nutrional records are detailed and reflect residents dietary intake. Foley House I56-I05 S17819 Foley House V238916 130705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Fairfax House Causton Road Colchester Essex CO1 1RJ 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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