Inspection on 26/01/06 for George Lane, 103

This inspection was carried out on 26th January 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

George Lane, 103 27/08/08

George Lane, 103 29/08/07

George Lane, 103 09/11/06

George Lane, 103 17/10/05

George Lane, 103 22/06/04

George Lane, 103 24/02/04

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

CARE HOME ADULTS 18-65 George Lane, 103 Catford London SE13 6HN Lead Inspector Mr Sean Healy Unannounced Inspection 26th January 2006 10:00 George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 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 George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 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 Adults 18-65. 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. George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service George Lane, 103 Address Catford London SE13 6HN 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) 020 8265 8671 Providence Project Care Home 4 Category(ies) of Learning disability (0) registration, with number of places George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th October 2005 Brief Description of the Service: 103 George Lane is a converted Victorian house situated on a quiet road between Lewisham and Catford. It is one of a group of homes for adults with learning disabilities, all of which are in the London Borough of Lewisham. It is close to shopping centres, local transport and a range of public amenities. The Registered provider, Providence Project, has recently merged with two other care organisations to form PLUS (Providence, Linc, United Services). The organisation is in the process of negotiating the appropriate change in registration/certification with the Commission. The building is owned and maintained by London & Quadrant Housing Association. The home accommodates four adults with learning disabilities. It aims to provide a comfortable, homely atmosphere in a safe and clean environment. Each service user has their own bedroom, and shares communal facilities, which includes lounge, kitchen/diner and garden. At the time of this inspection, there were two men and two women service users living at the home. George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was carried out over one day. The home’s registered manager was present and co-operated during the inspection. The inspector interviewed two staff members and spoke with two service users. The inspection included a tour of the home and examination of records on care plans and building maintenance records, and staff records regarding recruitment and supervision. There were no service user vacancies. What the service does well: What has improved since the last inspection? The home has considered the wishes of service users in decorating the home and they are happy with the individuality of their rooms, which reflect their personal preferences. One stated that he loved having all his favourite music albums, and posters of his favourite music artists on display. The manager has had discussion with the local council regarding the options for improving street parking and is following these up. The job descriptions for volunteers working at the home have been revised and the rota showed that volunteers are working in addition to the basic staffing requirements. There are now four staff who have started the NVQ course, and the manager is progressing through NVQ level four. The staff team is now stable with minimal use of agency staff. The home has carried a number of service user surveys and now facilitates regular service user meetings in the home. Service users said that staff are respectful and involve them in planning activities. Care plans and service users files have been re-organised and unused information has been taken out of files to make them easier to use. George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 6 The regularity of monthly visits to the home by a senior manager has improved and reports on these visits are now being produced. 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. George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5 Prospective service users’ individual aspirations and needs are being assessed by the home. Service users are in possession of information to help them to make informed decisions about where they live, and have contracts of terms and conditions informing them of their rights and responsibilities. However, these documents need to be updated. EVIDENCE: The home has a stable group of residents, and there have been no new admissions for over two years. The home has a Statement of Purpose and Service User Guide, which now need to be updated as a result of the organisational changes that have taken place over the past year. This was required at the last inspection and is now repeated. (Refer to Repeated Requirement YA1) Service users do have individual written contracts and Assured Tenancy agreements. However, these were in need of updating to reflect the changes in the organisation. That is, the registered provider (Providence Project) has merged with another care provider to form PLUS (Providence, Linc, United Services). The new organisation must also ensure that action is taken to have amended Certificates of Registration to reflect this change, or to address any registration issues arising, and to update the home’s Statement of Purpose and Service Users’ Guide as a matter of urgency. This is a repeat of statements made at last inspection. (Refer to repeated Requirement YA5) George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 9 George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 Service users can be sure that all of their assessed needs and personal goals are reflected in their individual plan. EVIDENCE: All service users have lived at the home for a number of years and have care plans that have been developed fully over that time. Service users are enabled to lead very independent lifestyles. Individuals told the inspector that they had keys to their room, as well as the front door, and were able to go out to activities or events that they chose. Some service users are able to go out without staff assistance, and said that they visited friends and relatives nearby. One service user spoke of having enjoyed a good holiday with staff support, travelling on a canal barge with other service users last summer, and also spoke being supported to be involved in the borough’s Speaking Up group. Transport is arranged for residents who need it, and staff accompany residents to shops and cafes, etc. The home has started using a Person Centred planning approach to planning, which allows each service user to have more say and control over making things happen for themselves. George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 11 George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 13, 16 and 17 Service users have good opportunities for personal development and are part of the local community. Service users’ rights are respected and responsibilities recognised in their daily lives. A healthy diet is provided for, and meals are provided at times which suit service users. EVIDENCE: Service users attend a day centre, evening clubs, and visit friends and relatives. One resident has a job, and participates in the borough-wide Speaking Up group, which is a service user advocacy group. He also plays in a music group. One resident has a boyfriend, who she visits and who can visit her at the home once a week. All residents had photographs of friends and family, as well as of holidays and outings in their rooms. There are detailed weekly plans in place, which show activities service users have planned and there is a very positive approach to getting out in the community with service users. Comments made by service users include: “The staff are very good at helping me to go out, I help with shopping and like to go out a lot” There are no barriers in the home separating staff and service users, and all service users said they have their own keys to their home and rooms and staff George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 13 are respectful of their right to privacy. It is expected that service users will engage in all domestic activities. The specific tasks that individual service users will take part in are starting to be reflected in their individual plans. The home provides service users with goods opportunities to participate in shopping for food they like and involvement in cooking. Records of food eaten reflect a healthy and balanced diet. The records are specifically of food eaten rather than using planned menus, as the service users get to choose their meals on a daily basis. Staff and service users mingle together in a very sociable manner in the home. George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21 Service users’ wishes regarding ageing, illness and death have been fully considered. EVIDENCE: The home will provide for service users needs without regarding age as a barrier. A Requirement was made in the report of the previous inspection, that consideration was to be given to consulting residents about their views and wishes regarding ageing, illness and death. This has now been addressed for each service user. This issue has been discussed at planning meetings and service users who contributed to this report confirmed that they are happy to remain living at the home. There are no current issues regarding ageing or illness for consideration. George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Service users feel that their views are listened to and are acted on, and they are protected from abuse neglect and self-harm. However, the home’s written policy on Adult Protection needs to be reviewed. EVIDENCE: The home has a written policy on making complaints and service users interviewed confirmed that they know how to complain and who to complain to. They also said they are very happy in the home and feel that they can speak with the manager and staff if they need to. There have not been any recorded complaints in the past two and a half years. Discussions with staff showed that they fully understand the complaints procedure and are willing to use it if the need arises. Service users can clearly express their views and wishes, and feel that staff listen to them. The homes policies regarding Adult Protection needs to be updated to reflect the local authority’s current policy. The manager said that policy review had been delayed as a result of the organisation’s recent merger and that the process for reviewing policies had recently begun again. Staff are aware of how to report adult protection issues and the homes manager is regularly present in the home. (Refer to Requirements YA23) George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27 and 28 Service users live in a homely, comfortable and safe environment that suits their individual needs, although it would not be suitable for a person with mobility problems. The home is very clean and tidy. EVIDENCE: As discussed in the previous report, the home is accessed by steps, and there are steps to the rear garden. In addition, the number of stairs throughout the home would mean that this building is not be suitable for a person with mobility problems. George Lane has restricted parking along its length, which is being extended to the surrounding areas. This means that staff and visitors to the home cannot park in the near vicinity without incurring high parking charges, and being moved after a two-hour period. Staff reported that users had been told that they were not eligible for permits, and would be charged to create a disabled bay outside the home, as none of them were drivers or car owners. The manager has now begun to discuss this issue with the local council and will continue to pursue the matter. A service user showed the inspector around the building. The ground floor consists of a hallway; shared lounge; one resident’s bedroom; a toilet; and kitchen/diner. The lounge is provided with a range of very comfortable sofas, and a large television. The kitchen is very attractively laid out, with all modern George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 17 appliances, and was clean to a high standard. A door from the kitchen leads onto a paved patio area, which has an attractive patio furniture set, and on to a gravelled garden, which one resident said they helped keep tidy and looked after plants in the spring and summer. The remaining service users bedrooms are situated upstairs. The home has two toilets, one on each floor and has a separate bathroom on the first floor. All areas seen by the inspector were clean and tidy. Service users rooms are decorated to their individual tastes, and three residents said they had been involved in deciding how to decorate and are very happy with their rooms. George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33 and 35 Staff roles are clarified and they are competent, and effective, but are not qualified as yet. EVIDENCE: There are five members of care staff on the rota, plus the manager, plus one Community Service Volunteer. The manager has now clarified the volunteer’s role in a job description and the rota shows that volunteers are not part of the basic staffing level and do not provide care or support by themselves. There had been a high level of turnover of staff reported at the last inspection, but the manager clarified that in fact there had been a number of staff on annual leave at the same time, resulting in high use of agency staff. He said that this will be avoided in future and the staff team is stable. Service users said that they know they staff well and they understand how to support them. At last inspection staff indicated that they had experiences of feeling unsupported by senior management in the organisation, which had undermined morale. This was discussed with the manager after the inspection visit, and he said that some difficulties had now been resolved. Staff interviewed said that they receive supervision every three to four weeks, and that there is now a good team spirit, and they feel supported by the homes management. George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 19 Two staff interviewed demonstrated excellent knowledge of service users plans and support needs. Staff interaction with residents was warm, and friendly, and some staff are able to use Makaton signs to supplement their communication with one resident. The staff rota indicated that a minimum of two care staff were on duty during the day (9 a.m. to 10 p.m.), with one on duty after 10 p.m., who undertakes a sleep-over. At the weekend, there are two staff on duty 9 – 5 p.m., with one member of staff on duty for the remaining hours. It was stated that there might be a need to have additional staff support in the home and it is recommended that this issue investigated by the homes management and appropriate action taken. (Refer to Recommendations YA 33) The home now has four staff started on NVQ training, and currently none of the staff are qualified at this level. There were difficulties expressed in achieving the required NVQ qualifications, which were due to be implemented in 2005. The home must continue to strive to ensure that at least 50 of staff are qualified to NVQ level 2/3, and the homes management should that staff are fully supported to achieve this qualification. (Refer to Requirements YA35) Staff said that they were offered opportunities for lots of other training, and there are training plans in place for staff, as part of the performance appraisal system. The homes records show that there are training plans in place. George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41 and 42 Service users benefit from a well run home, but may not be confident that their views underpin the home’s development processes, which may result in their exclusion from this process. Service users’ rights and best interests are safeguarded, and their safety and welfare are promoted. EVIDENCE: The registered manager is very experienced in providing for the needs of this service user group, and he is very committed to developing the service provided. Service users say that they know him well and trust his management. They said that: “He is always around and even comes on holiday with us”. The manager is currently participating in an NVQ level 4 course, which he intends to complete this year. However the manager needs to submit an application to CSCI to become the registered care manager for the home. This was a requirement of the last inspection and continues to be unmet. (Refer to Repeated Requirement YA37) The home has a quality assurance system in place and service users are sometimes surveyed as to their views on how the hoe is run. There was an George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 21 annual audit system operated by the local authority, as part of the agreed partnership between providers and commissioners but this has not happened in the past 18 to 24 months. It was a requirement of the last inspection that a formal quality assurance system, and annual development plan, be put in place, and as it seems that the organisations own system, or any other system, is not being applied annually, this requirement is restated. (Refer to Repeated Requirement YA 39) The homes records held on service users have now been reorganised and are well maintained. Monthly visits by the Registered Individual are happening more regularly now, but the home does not have copies of these reports for two consecutive months in December 2005 and January 2006. Therefore the previous requirement regarding this is repeated. (Refer to Repeated Requirement YA41) Accident and incident reports are now being adequately maintained. The home has in place safe working practices and systems and training for staff to ensure that service users and staff are protected. Excellent records are being kept on fire practice drills and all equipment, including electrical and gas equipment, which are well maintained and fully certified. George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 4 27 3 28 3 29 X 30 X STAFFING Standard No Score 31 3 32 2 33 3 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X X X LIFESTYLES Standard No Score 11 3 12 X 13 3 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X 3 2 X 2 X 3 3 X George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 23 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 YA1 Regulation 17(2) Schedule 4(8) Requirement Timescale for action 30/04/06 2. YA5 6 The Registered Person must ensure that all service users have accurate and up-to-date contracts and tenancy agreements in place, that reflect any change in the organisation’s name or registration, and that all relevant documentation is updated, including the Statement of Purpose and Service User’s Guide. This was a requirement of the previous inspection, Timescale 01/02/06, still within timescale, and is now repeated with a revised timescale. The Registered Person must take 30/04/06 action to ensure that Certificates of Registration are amended, or to address any registration issues arising from the recent organisational merger. (Registration Regulations). This was a requirement of the previous inspection, Timescale 01/12/06, which was an error, and is now repeated with a revised timescale. DS0000025621.V276745.R01.S.doc Version 5.1 George Lane, 103 Page 24 3. YA23 13.6 4. YA35 18(1)a 5. YA37 8, 9 6. YA39 24(1)a, b 7. YA41 17, Sched 4(5) The registered person must ensure that the home’s Adult Protection policy is revised to reflect the current local authority’s policy and procedures for the protection of vulnerable adults The Registered Person must set targets and timescales, to ensure that all staff are supported to achieve the appropriate NVQ qualifications, to meet the requirement for the home to have 50 of staff qualified to NVQ Level 2/3 certification. The Registered Person must ensure that an application for registration of the manager is submitted to the Commission. This was a requirement of the previous inspection, Timescale 01/12/05, and is now repeated with a revised timescale. The Registered Person must ensure that a formal quality assurance monitoring system and annual development plan are put into place. A previous timescale of 30th September 2005 was not met. The last Timescale of 1/02/06 is still within timescale and is partially met, and is now revised. The Registered Person must ensure that the home retains a copy of, and notifies the Commission in respect of, all reports of visits undertaken by the Registered Provider. This was a requirement of the previous inspection, Timescale 01/12/05, partially met, and is now repeated with a revised timescale. 30/04/06 31/03/06 31/03/06 31/03/06 31/03/06 George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 25 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 YA33 Good Practice Recommendations The registered person should investigate suggestions that the home would benefit from having additional staffing hours and take any action appropriate George Lane, 103 DS0000025621.V276745.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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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