Inspection on 02/08/06 for Gedling Care Home

This inspection was carried out on 2nd August 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

Gedling Care Home 03/04/09

Gedling Care Home 16/07/08

Gedling Care Home 24/09/07

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

CARE HOMES FOR OLDER PEOPLE Gedling Care Home 23 Waverley Avenue Gedling Nottingham NG4 3HH Lead Inspector Steve Keeling Key Unannounced Inspection 2nd August 2006 08:45 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 Gedling Care Home DS0000067378.V306343.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. Gedling Care Home DS0000067378.V306343.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gedling Care Home Address 23 Waverley Avenue Gedling Nottingham NG4 3HH 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) 0115 9879792 Kalbro Care Uk Limited Pauline Margaret Park Care Home 26 Category(ies) of Dementia (6), Dementia - over 65 years of age registration, with number (26) of places Gedling Care Home DS0000067378.V306343.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Within the total number of beds, a maximum of 26 may be used for the category DE(E). Within the total number of beds, a maximum of 6 may be used for the category DE. New service. Date of last inspection Brief Description of the Service: Gedling Care Home provides high dependency residential care for 26 older people in the early stages of dementia. The home has benefited from the extensive refurbishment programme and the new owner registered the home on 28th March 2006. The home is located in an inner city area of Gedling, Nottingham, close to the local shops, general practitioners’ surgery and other amenities. The home is an extended residential house, which consists of three-storeys. The home has two lounges, a conservatory and a separate dining area. The home has 20 single rooms one of which is fitted with an en-suite facility and 3 double rooms. There is a passenger lift permitting access to the first and second floor. A small enclosed garden is to the rear of the property. Gedling Care Home DS0000067378.V306343.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 over an 8.5 hour period and involved one inspector. The main method of inspection was case note tracking, this is a method of selecting residents within the home and discussing with them their expectations and experiences of living within the home environment. The case tracking method also analyses the records of the residents to ascertain if the residents identified needs are being addressed appropriately within the care home setting and that their safety and well being is being maintained. On this occasion two residents notes were case tracked. Also as part of the case tracking process, a staff member within the home was informally interviewed to further evidence the quality of care afforded to the residents. The manager and staff within the home were very helpful and cooperative thus ensuring that the inspection process progressed in a professional and efficient manner. The fee currently charged at the home range from £319 to £380. Additional expenses such as podiatry services, hair dressing and newspapers are not included in the fees charged at the home. What the service does well: What has improved since the last inspection? What they could do better: An appropriate evaluation process is available at the home but is not being utilised effectively. Gedling Care Home DS0000067378.V306343.R01.S.doc Version 5.2 Page 6 Appropriate care planning documentation is available at the home but it is not being utilised effectively. Staff at the home are not adhering to policies and procedures in relation to drug management. The social activities at the home are not sufficient to provide a stimulating environment for the residents. The staffing levels are insufficient in meeting the holistic needs of the residents. Staff at the home do not receive appropriate formal supervision sessions Bimonthly. Residents or their relatives are not currently afforded the opportunity to express opinions and concerns within an open forum such as a residents meeting. Significant events are not reported effectively to the Commission of Social Care Inspection. 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. Gedling Care Home DS0000067378.V306343.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 Gedling Care Home DS0000067378.V306343.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, 6. Quality in this outcome group is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. An appropriate evaluation process is available at the home but it is not being utilised effectively. The home does not provide intermediate care services. EVIDENCE: Kalbro Care UK Ltd has devised an effective assessment process designed to identify the resident’s holistic needs so the residents can achieve optimal physical and psychological wellbeing. It was evident that the assessment documentation is not being utilised effectively at the home. A resident who had been admitted with a medical diagnosis of dementia only had one assessment performed in relation to her “fussy eating” habits. The remaining elements within the assessment documentation which included an assessment of the residents strengths and weaknesses, behaviour, orientation, communication abilities, preferred social activities, cognition, mental status, nutritional risk assessments/weight monitoring and possessions Gedling Care Home DS0000067378.V306343.R01.S.doc Version 5.2 Page 9 on admission record had not been addressed by the designated assessor at the home. The registered person is required to provide evidence that the homes needs assessment documentation will be utilised effectively so as to identify the holistic needs of the residents on admission. Gedling Care Home DS0000067378.V306343.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. Quality in this outcome group is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Appropriate care planning documentation is available at the home but it is not being utilised effectively. Staff at the home are not adhering to policies and procedures in relation to drug management Residents at the home are afforded respect and dignity and their privacy is maintained. EVIDENCE: Kalbro Care UK Ltd has devised an effective care planning process designed to address the resident’s identified holistic needs. It was evident that the care planning procedure within the home had not been utilised effectively, as such the residents safety could be compromised. The assessment documentation within one case tracked residents notes stated that the resident required supervision whilst bathing, has a tendency to wonder at night and suffered with arthritis. No care plans had been formulated to effectively manage the aforementioned concerns although care plans Gedling Care Home DS0000067378.V306343.R01.S.doc Version 5.2 Page 11 relating to the residents paranoia, short-term memory loss and catheter care were evident. The care plan relating to the management of the residents catheter stated that the day bag should be changed on a weekly basis and the procedure should be documented in the resident daily records. The daily record did not evidence that this procedure had taken place although the manager assured the inspector that this procure was taking place and the resident also confirmed that the day bag is being changed on a regular basis. The registered person is required to demonstrate that the care planning processes within the home will be improved so as to ensure that all identified needs are addressed with an effective care plan and that elements identified within the care plans are documented within the daily progress documentation. It was evident that the temperature within the medication fridge had not been monitored effectively. It is good practice to monitor medication fridges on a daily basis to ensure that an optimum environment is maintained to prevent medication degradation. Although the facilities are in place it was evident that the procedure was not being followed. The case tracked residents Medication Administration Record (MAR) were examined at the time of the inspection and it was established that the policies in relation to the administration of medicines had not been fully adhered to. The reason for omission of medication codes was not being used correctly. Furthermore the MAR charts of a case tracked resident had gaps present with no explanation as to why the medication had not been given. The registered person is required to ensure that polices and procedures in relation to the receipt, storage, administration and disposal of medicine are followed and that staff are competent in relation to medicines management at the home. Staff interviewed on the day of the inspection demonstrated an appropriate knowledge relating to the principles of privacy, dignity and respect and how to apply these principles to the residents at the home. Residents spoken with on the day of the inspection were positive about the way staff spoke to them and also confirmed that staff always knocked on the resident’s bedroom door before entering and also stated that the staff respected the residents privacy and dignity when bathing or performing personal care. The inspector witnessed interactions between residents and staff at the home at lunchtime and it was evident that staff promoted the principles of respect and dignity at all times and displayed genuine care and compassion towards residents. Gedling Care Home DS0000067378.V306343.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, 15. Quality in this outcome group is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The social activities at the home are not sufficient to provide a stimulating environment for the residents. Residents are encouraged to maintain contact with their family and friends within the home but interactions within the broader community are limited. Residents are not encouraged to exercise choice and control over their lives. Residents are provided with a wholesome, appealing and balanced diet. EVIDENCE: Both case tracked residents stated that the home does not provide any social activities whatsoever and went on to say that they are bored. The manager at the home and a staff member on duty also confirmed the lack of stimulating activities and it was evident that little consideration is given to supporting resident’s social preferences and aspirations. The registered person is required to ensure that sufficient staff resources are provided to allow time for the staff at the home to receive appropriate activities both within the homes immediate environment and within the broader community Gedling Care Home DS0000067378.V306343.R01.S.doc Version 5.2 Page 13 There was no evidence that members from the community including the local church visit the home on a regular basis although the manager and residents confirmed that the home has open visiting arrangements. Residents know they can entertain their family and friends in their own room or use community areas of the home to talk to visitors. The case tracked residents and a relative visiting the home stated that the staff at the home are very welcoming and they have no concerns in relation to the visiting arrangements at the home. The food in the home is of good quality, well presented and meets the dietary needs of residents. On the day of the inspection the lunchtime menu consisted of roast chicken or shepherds pie with runner beans, mashed potato and mixed vegetables followed by a choice of three puddings. It is good practice to display a weekly menu in a prominent position within the home so as to promote the residents choice in relation to meal provision at the home. It is also good practice to establish a consultation process that identifies the resident preferred meals, snacks and drinks. It was evident through conversations with the residents that the consultation process in relation to meal provision is somewhat limited at the home; therefore the registered person should ensure that an effective consultation process is established. Gedling Care Home DS0000067378.V306343.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, 18. Quality in this outcome group is good. This judgement has been made from evidence gathered both during and before the visit to this service. On the whole residents feel that any concerns or complaints will be listened to, taken seriously and acted upon by the manager and staff at the home. Residents are protected from abuse. EVIDENCE: The complaints procedure is available in the home foyer for residents and their representative’s perusal. At the time of the inspection no complaints were being investigated at the home and no complaints have been received at the Commission for Social Care Inspection. The case tracked residents spoken with stated they felt safe within the home and should they have any concerns or complaints they would discuss them with the manager, although one case tracked resident believed that the manager would find if difficult to listen effectively to any complaints as she is always so busy. A staff member was spoken with at the time of the inspection and it was evident that she had and appropriate knowledge of the complaints procedure utilised at the home. She demonstrated an awareness of the immediate action to take and when and who to refer any incident on to in relation to adult protection issues. She stated that if she suspected that abuse was happening in the home or an allegation of abuse was made she would firstly discuss it with the manager at the home and if not satisfied she would discuss the matter with external agencies which would include the Commission for Social Care Inspection, Social Services or the police. Gedling Care Home DS0000067378.V306343.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, 26. Quality in this outcome group is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents live in a safe well-maintained environment. The home is clean, pleasant and hygienic throughout. EVIDENCE: The resent total refurbishment has established an environment which is wellmaintained, pleasant and safe, new mobility aids and equipment are in place to meet the care needs of the residents with restricted mobility. A choice of communal spaces is available in the home which includes two lounges, a dining room and a conservatory area in which residents can interact and meet relatives and friends it they choose. There is a choice of bathing facilities, both assisted and unassisted which include showers and baths and there are a number of toilets strategically placed around the home all of which were clean and odour free. Gedling Care Home DS0000067378.V306343.R01.S.doc Version 5.2 Page 16 The home was partially occupied at the time of the inspection but the areas that were occupied were well lit, clean, tidy and smelt fresh. The case tracked residents gave the inspector consent to examine their bedrooms. The bedrooms were found to be personalised, homely, safe and met the residents individual needs. The home benefits from an enclosed garden area, which at the time of the inspection was not well maintained and will require attention so as to provide a safe and pleasant area for resident to enjoy. Gedling Care Home DS0000067378.V306343.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, 30. Quality in this outcome group is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The staffing levels are insufficient in meeting the holistic needs of the residents and as such the resident safety could be compromised. The home utilises an appropriate recruitment policy, which is adhered to thus ensuring residents are supported and protected. Staff receive appropriate training to do their jobs effectively to ensure that residents are in safe hands. EVIDENCE: The staff rota evidenced that it is normal practice to have two members of staff on duty throughout the 24-hour period to meet the needs of the eleven residents currently at the home. The manager of the home confirmed that she was included in the daily members and that on occasions the current staff levels often results in her performing caring and domestic duties at the expense of her managerial obligations such as performing effective needs assessments and effective care planning documentation. A staff member interviewed on the day of the inspection also confirmed that the manager performs domestic duties such as cleaning resident’s rooms. The member of staff also stated that the social activities are also compromised due to the current staffing levels at the home. The registered person will be required to perform a review of the staffing levels to ensure that having regard to the size and layout of the care home, the Gedling Care Home DS0000067378.V306343.R01.S.doc Version 5.2 Page 18 statement of purpose and the number and needs of residents an appropriate compliment of staff are working in the care home to meet the maintain the health and welfare of the residents. The recruitment documentation of two members of staff employed at the home was checked and found to be satisfactory. Both staff members had undergone appropriate Criminal Record Bureau (CRB) checks and had provided two written satisfactory references. It was evidenced that staff have received mandatory training applicable to the duties they are to perform at the home and that any new members of staff will be expected to attend mandatory training provided by Kalbro Care UK Ltd. Gedling Care Home DS0000067378.V306343.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, 38. Quality in this outcome group is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Residents or their relatives are not currently afforded the opportunity to express opinions and concerns within an open forum such as a residents meeting. Minor shortfalls were identified in relation to the management of resident’s finances. Staff at the home do not receive appropriate formal supervision sessions Bimonthly. EVIDENCE: The Commission for Social Care Inspection on 28/4/06 formally interviewed the manager at Gedling Care Home and it was evident that she possessed the relevant knowledge and experience to perform the managerial duties within a care home setting. Gedling Care Home DS0000067378.V306343.R01.S.doc Version 5.2 Page 20 As mentioned earlier in the report the manager’s ability to manage the home effectively is being compromised due to inappropriate and conflicting commitments within the home environment such as performing domestic and care duties. For the manager to fulfil her managerial role effectively her level of support should be increased. It was established that the manager would be receiving additional managerial support over a two-day period so as to afford her the opportunity to address the concerns highlighted within this report. To ensure that the home is managed effectively the registered provider should ensure the additional support is ongoing rather than sporadic. Currently the resident and relative consultation process is lacking and feedback is not actively sought from service users about services provided. The registered provider should consider the use of anonymous user satisfaction questionnaires and individual and group discussions which could include the residents, relatives or representatives to ensure the care provision at the home is appropriate in meeting the needs of the residents, and residents feel actively involved in the development of the home. In protecting the resident from financial abuse it was established through conversations with the manager that residents spending money is individually stored within “poly pockets”. The monies of the case tracked residents were not examined, as they were independent in relation to the management of their pocket money. An examination of the resident’s poly-pockets and accompanying documentation indicted that a more robust system should be in place in relation to the management of residents monies. On the day of the inspection the manager initiated a residents finance book in which the residents monetary transactions could be clearly evidenced. It was established through conversations with the manager and a staff member that staff at the home have not received appropriate supervision sessions as yet due to the home only opening in March 2006. The registered person should ensure that a system is in place to afford all staff appropriate managerial supervision throughout the year. Given that the home only gained registration in March 2006 and at that time would have been required to evidence the required documents in relation to maintaining safety within the home this particular standard was not inspected on this occasion. An examination of the homes accident book evidenced that seven accidents have been recorded since the home re-opened in March 2006. Significant events should be reported to the Commission for Social Care Inspection. A discussion with the manager established that the significant events were not reported effectively to the Commission of Social Care Inspection but would be in the future. Gedling Care Home DS0000067378.V306343.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 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 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 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 2 x x 3 Gedling Care Home DS0000067378.V306343.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? N/A 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 OP3 Regulation 14 (1) (a) Timescale for action The registered person will ensure 31/08/06 that the needs of the service user have been assessed by a suitably qualified or suitably trained person The registered person shall, after 31/08/06 consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met The registered person shall make 31/08/06 arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. The registered person shall 31/08/06 ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users Requirement 2 OP7 15 4 OP9 13 (2) 5 OP27 18 Gedling Care Home DS0000067378.V306343.R01.S.doc Version 5.2 Page 23 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 Refer to Standard OP12 Good Practice Recommendations The registered provider should ensure that residents are able to enjoy a full and stimulating life style with a variety of options to choose from. The home has sought the views of residents and considered their varied interests and abilities when planning the routines of daily living and arranging activities The registered provider should ensure that residents have the opportunity to establish and maintain links with the local community The registered provider should consider the use of anonymous user satisfaction questionnaires and individual and group discussions, which could include the residents, relatives or representatives to promote the consultation process and resident choice. 2 4 OP13 OP33 OP14 Gedling Care Home DS0000067378.V306343.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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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