Inspection on 12/06/06 for Forest Brow Care Home

This inspection was carried out on 12th June 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Forest Brow Care Home 07/02/06

Forest Brow Care Home 22/08/05

Forest Brow Care Home 10/02/05

Forest Brow Care Home 08/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Forest Brow Care Home 63 Forest Road Liss Hampshire GU33 7BL Lead Inspector Mr Rodney Martin Unannounced Inspection 12th June 2006 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 Forest Brow Care Home DS0000057070.V297018.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. Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Forest Brow Care Home Address 63 Forest Road Liss Hampshire GU33 7BL 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) 01730 893342 BRIJ Care Ltd Mrs Susan Makhzangi Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30), of places Physical disability over 65 years of age (4) Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 4 service users may be accommodated in the category PD(E) Date of last inspection 7th February 2006 Brief Description of the Service: Forest Brow is a residential care home that provides support and accommodation for older persons. The home is registered to admit up to thirty residents in the categories of old age [OP] and dementia [DE(E)]. The home is a large house that has been extended to provide accommodation over three floors, which are accessed by passenger lift. There are eighteen single bedrooms and six double bedrooms. All bar four single bedrooms have en-suite facilities. Although Forest Brow is registered for up to thirty residents the management regard the home full with twenty-five service users as five double bedrooms are occupied as single bedrooms. There are two sitting rooms, which are light and airy. The home has a one and a half acre garden, which is accessible to the residents. The home is located in a semi rural area in the small village of Liss, between Petersfield and Liphook, and is within access of local shops and larger towns in the area. The current level of fees is £397 to £600 per week. This information was contained in the pre-inspection questionnaire received in the Commission’s office on 11 May 2006. There are additional charges for chiropody, hairdressing and the purchase of newspapers and/or magazines. Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place between 9.30am and 2.15pm. An opportunity was taken to look around the home, view records and talk to three visitors, several service users and staff members, including the cook and kitchen assistant, the manager and deputy manager. On the day of the visit twenty-three service users were accommodated, with two residents in hospital. A new resident was admitted on the day of the visit. The home currently has two vacancies. In line with the Commission’s policy, all the key standards were inspected on this occasion and the two previous issues identified at the last inspection were followed up. The home was found to meeting these; namely to update the complaints procedure and ensure that a Criminal Records Bureau check is obtained prior to employment. What the service does well: The home provides a very good service, especially for those residents with dementia. The needs of residents are met within Forest Brow and there is a very relaxed atmosphere in the home. There is a good staff team, who are suitably trained and supervised to provide a good standard of care for residents. One relative said they had viewed various homes but were more than satisfied that Forest Brow was meeting their loved ones needs. The home continues to be light, clean, homely and well maintained. An environmental health officer inspected the home in January 2006 and a ‘Food Standard Award’ was presented for ‘premises, which attain and maintain high standards of cleanliness and food hygiene practice’, the award is current for one year. Forest Brow has extensive grounds that provide a safe environment for residents, especially those that wander. Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 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. Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 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 the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have their needs assessed and are able to visit prior to admission to make an informed choice about whether Forest Brow is able to meet their particular needs. Forest Brow does not provide intermediate care. EVIDENCE: Forest Brow was accommodating twenty-three residents, with five male and eighteen female service users, whose ages range from 73 to 98 years. One resident has been in the home since 1993. It is noted that three-quarters of the residents have a diagnosis of dementia and there was evidence that the home is able to meet residents’ needs. On the day of the visit a new resident was admitted, following a request to vary the conditions of registration, as the prospective service user is under the age of 65 years. The inspector discussed with the manager for the home to consider further varying the conditions of registration in order to be able to admit a limited number of prospective service users in the dementia category, Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 Page 9 below retirement age of 65 years, to avoid the need to request subsequent variations for a specific service user to be accommodated. Since the last inspection, three new residents were admitted and there were four discharges, three following the death of the resident. On the day of the visit two residents were in hospital. The manager reported that one resident was unlikely to return to Forest Brow. As noted in the description of the service, five of the six double bedrooms are used as single bedrooms and so the home tends to be full with twenty-five residents. Forest Brow currently has two vacancies. Following an initial inquiry, the manager would visit the prospective service user in their own home or in hospital and will even visit out of county, if necessary. Some of the current residents come from various parts of the south of England. The new resident admitted had visited Forest Brow prior to admission and the manager had completed an assessment in their own home. Three residents’ assessments were sampled and these were found to contain a comprehensive range of information. Pre-admission assessments were completed before residents move into the home. The assessment detailed their past medical history, current medication, mobility, activities of daily living and also included the mental health of the individual. On the day of the visit the inspector met three visiting relatives. One relative, who has been visiting regularly, said that there was a very relaxed atmosphere in the home and that their mother was very settled in Forest Brow. A resident, spoken to, said that they felt safe in Forest Brow and was well looked after. Forest Brow does not provide intermediate care, although prospective residents can come for a short respite stay, if there is a vacancy. Short stay residents are assessed in the same way as permanent residents. Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 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, 9, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for care planning are good, ensuring that the residents’ physical and emotional health needs are met. Medication practices and procedures ensure that residents are protected. Working practices in the home ensure the promotion of privacy and independence for service users. The home has clear arrangements in place for supporting terminally ill residents in the way they prefer. EVIDENCE: Each resident has an individual file, which is indexed and has sub-headings for ease of reference. The file contains the personal details of the resident including a life history, the pre-admission assessment, an assessment matrix, manual handling assessment, various risk assessments and a record of medical appointments, the care plan and review of the care plan. Forest Brow operates a keyworker system, enabling staff to get to know certain residents much better, which in turn helps in the delivery of care to the individual resident. Several residents were tracked and the records gave a clear indication of the care required. Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 Page 11 The personal and oral hygiene of each service user is maintained and recorded. A record is kept of all health professional visits. The majority of residents are registered with Hillbrow surgery in Liss; two residents are registered with Swann Street in Petersfield and one resident with the Riverside surgery in Liss. The manager reported that there is very good support from the surgeries. There is good support from the district nurses and community psychiatric nurses coming to Forest Brow. The inspector spoke to a resident in the privacy of their room. They were very appreciative of the care given them in Forest Brow and said that they were well looked after. Although they did not self medicate they knew what medication they were on and what each tablet was for. One service user, who is registered blind, receives ‘talking books’ from the Blind Association. One previous resident, with a hearing loss, had a loop installed in their bedroom to enable them to comfortably listen to their television on their hearing aid. The manager reported that the GP’s have requested to know if a resident wishes to be resuscitated or not. A form was completed on the files seen and service users wishes concerning terminal care and arrangements after death are routinely recorded. Staff have access to a leaflet, ‘what to do after a death’. Staff have received palliative care training in their NVQ [national vocational qualification] courses. Some staff have been to a funeral parlour. The home has a relevant policy on death and dying and a procedure, for staff to follow, of what to do in the event of the death of a resident. Three residents had died in Forest Brow in the previous three months, with the last one on 6 April 2006. Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to engage in a variety of appropriate age-related activities in the home. Residents are supported to maintain contact and positive relationships with family and friends. Nutritional needs of residents are well managed and offer variety and choice. EVIDENCE: The home provides various activities for residents to participate in. As previously noted, three-quarters of the residents have a diagnosis of dementia and maintaining interest and concentration span is important in providing a fulfilling life, as the use of activities can significantly improve the quality of people’s lives. A full list of activities for the month of June was on display in the hall. The manager reported that the relatives are very supportive in maintaining contact as well as fund-raising and the next project is to purchase a mini-bus to be able to take residents out to local venues et cetera. Forest Brow holds two parties each year, with a ‘Pimms on the patio party’ in the summer, which is very well attended by friends and family alike. The home is hoping to start a relatives’ support group in order to give advice and support to relatives of residents with dementia as well as raise money for various Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 Page 13 projects. Details of purchasing a comprehensive book on activities for people with dementia, from the Alzheimer Society, was discussed. Contact with family and friends is maintained and all residents have visitors. On the day of the visit the inspector met three relatives and spent some time with one. They were very complimentary about the home, stating that the food was very good, with all home-cooking, the bedroom was always spotless and there was a very relaxed atmosphere in the home. Residents come down for breakfast but the majority have it in their room. The home has a four-week menu, which was varied, providing well-balanced meals for residents. The home provides fresh vegetables each day and the cook bakes a cake each day. Residents are offered a choice for the midday meal. Care assistants go round the day before and ask and record what residents would like. Residents’ dislikes are noted and displayed in the kitchen. Lunch was observed to be unhurried, with appropriate assistance being offered where necessary. The meal was plated and residents had mince cobbler or vegetable mince and mashed potato, carrots and cabbage. Residents had banana and custard for dessert. Residents, spoken to, enjoyed their meal and said that the food was very good in Forest Brow. Residents were due to have sardines or pate on toast, with fresh fruit salad and cream for tea. The menu is displayed each day on a chinograph board, in the hall. The inspector discussed the use of digital pictures of the meals, to further assist residents with dementia to make a more informed choice. It was agreed that this idea would be followed up. Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 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): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure, which residents feel able to use and an adult protection procedure, which protects and safeguards residents from abuse. EVIDENCE: The home has a full complaints procedure, which has been updated since the last inspection. The home has a complaints log and since the last inspection one informal complaint was recorded; as the resident had not wanted the matter to be dealt with formally. The issue was satisfactorily dealt with by the home. This was confirmed when the inspector spoke to the resident concerned. Residents, spoken to, were aware of whom to complain to should they have a need to raise a complaint or issue. The Commission has not received any complaints. The home has all the relevant documentation relating to adult protection, including a whistle blowing procedure and the adult protection policy. Staff receive adult protection training as part of their induction. On the day of the visit five staff were on a protection of vulnerable adults course. One resident manages their own financial affairs and benefit book. However, as the majority of residents have dementia, seventeen residents are subject to power of attorney orders. The home does not handle residents’ money or is appointee for service users’ finances. Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 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 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, safe and pleasant environment, where they have individualised their bedrooms, to meet their needs. EVIDENCE: A tour of the building was undertaken. Forest Brow is a large building over three floors with a passenger lift. The home is situated in Forest Road in Liss Forest. Forest Brow has eighteen single bedrooms, fourteen provided with en suite toilet facilities and six double bedrooms, all provided with en suite facilities. Although Forest Brow is registered for up to thirty residents the management regard the home full with twenty-five service users as five double bedrooms are occupied as single bedrooms. There have been no changes to the building, since the last inspection, apart from bedrooms routinely decorated following vacation by the previous resident. Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 Page 16 The manager reported that a walk-in shower is to be provided, to replace the existing shower in the shower room. The home has plans to provide an extension with extra bedrooms, a staff training room, a guest room and a new kitchen. One of the lounges is to be extended to take in the existing kitchen. No start date is currently available. There is a sense of spaciousness within the home, with a large dining room, separate lounge and conservatory. The home is set in one and a half acres of garden, with a large patio area, provided with patio furniture, which is enjoyed by residents. It was a warm and sunny day and several residents were seen walking round the grounds with a staff member. There was evidence of residents’ personal belongings in the rooms. There were no adverse smells noted. The home has a separate laundry room, which is situated away from food preparation. Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by sufficiently trained and supervised staff, to ensure that their needs are met. EVIDENCE: Forest Brow employs nineteen care staff and eight ancillary staff. Since the last inspection the home has recruited three care assistant and a domestic. The manager reported that the home now has a full compliment of staff. The home had been using agency staff, especially during April and May to cover for staff that were on annual leave, sick leave and a carer leaving. Some of the existing care staff have also done extra shifts. Forest Brow operates with five carers on the morning shift, four in the afternoon and three from 8pm to 10pm. The night staff come on duty at 8pm. Twelve staff have obtained NVQ [national vocational qualification] level 2 in care, through Highbury College. One carer has obtained the A1 award as an internal assessor for NVQ training. This will benefit the staff as they will be able to assess the NVQ units completed by Forest Brow staff. It is intended that they will complete the ‘train the trainer’ course in manual handling. Staff files were viewed. These contained the application form, which included a signed declaration under the Rehabilitation of Offenders Declaration, two written references, a returned negative CRB notification and proof of identity. Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 Page 18 The home operates a comprehensive training programme for staff, including fire safety, food safety, manual handling, first aid, health and safety, infection control, NVQ, safe handling of medicines and dementia awareness. Five staff were on a protection of vulnerable adults course. The manager and deputy manager are going to attend a course on the new common induction standards. The manager is going to do a four-day first aid at work course in September 2006. Residents, spoken to, were full of praise for the staff. One said that she enjoys having a laugh with the carers. “The staff are very good and they do a good job”, was also another comment. Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 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, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provides good leadership, which ensures staff are supported and residents’ health, safety and welfare promoted through the home’s practices. EVIDENCE: The manager is suitably qualified to run Forest Brow and has many years experience of working with the elderly. She has completed the registered managers award for NVQ level 4 in both management and care. She communicates a clear sense of direction and leadership within the home. She has been able to cascade relevant training to the staff. There is an open, friendly and transparent atmosphere within the home. Residents spoke warmly of staff and the way the home is run. Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 Page 20 The home is not appointee for any service user. Seventeen residents are subject to Court of Protection orders. The home does not look after any residents’ money. For additional charges such as hairdressing, chiropody and newspapers/magazines, these are billed direct to the relative(s) concerned. The manager ensures the safe working practices by planning courses on health and safety within Forest Brow, including first aid, adult protection, manual handling, food hygiene, fire and medication. Risk assessments are in place. There are current and up to date contracts on electrical equipment as well as kitchen and domestic appliances et cetera. COSHH [control of substances hazardous to health] policies and procedures are in place. Window restrictors are in place on the windows above ground level, to ensure safety for residents. From a check of the records and practices observed in the home during the inspection, the health and safety measures taken in the home ensure the welfare and safety of the residents. Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 Forest Brow Care Home DS0000057070.V297018.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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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