Inspection on 09/11/06 for Grace Lodge Nursing Home

This inspection was carried out on 9th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Grace Lodge Nursing Home 05/05/10

Grace Lodge Nursing Home 24/08/09

Grace Lodge Nursing Home 25/06/09

Grace Lodge Nursing Home 02/02/09

Grace Lodge Nursing Home 22/06/07

Grace Lodge Nursing Home 08/12/05

Grace Lodge Nursing Home 07/07/05

Grace Lodge Nursing Home 16/06/04

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

CARE HOMES FOR OLDER PEOPLE Grace Lodge Nursing Home Grace Lodge Nursing And Residential Home Grace Road Walton Liverpool L9 2DB Lead Inspector Natalie Charnley Unannounced Inspection 9th November 2006 10:00 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 Grace Lodge Nursing Home DS0000059144.V311397.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. Grace Lodge Nursing Home DS0000059144.V311397.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grace Lodge Nursing Home Address Grace Lodge Nursing And Residential Home Grace Road Walton Liverpool L9 2DB 0151 523 7202 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) Ocean Cross Ltd Ms Diane Hollingsworth Care Home 65 Category(ies) of Old age, not falling within any other category registration, with number (65) of places Grace Lodge Nursing Home DS0000059144.V311397.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 37 Nursing Care and 37 Personal Care in the overall number of 65 One named service user under the age of 65 years in the overall number of 65 Random inspection 28th July 2006 Date of last inspection Brief Description of the Service: Grace Lodge provides nursing and residential care and support for up to sixtytwo residents. The home is purpose built and is situated in a cul-de-sac off a busy residential/shopping area of Walton Vale Liverpool. The home is well served by public transport (bus and rail) and a motorway network is approximately ten minutes away by car. The home is built on two levels, is centrally heated and well maintained. A passenger lift and stairways access the first floor. There is a well-kept garden to the rear of the home. The home is staffed 24 hours each day with both trained nurses and care staff. A representative of the owner visits at least monthly to report on the running of the home. It costs £307-£457 per week to live at the home. Grace Lodge Nursing Home DS0000059144.V311397.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors visited the home to carry out the site visit. This was carried out over a period of one day. The inspectors arrived at the home at 09:45 and left at 16:30.The inspectors spoke with 5 staff, the home manager and 12 residents. No visitors were available at the home. The inspectors completed the inspection by looking at the homes records, a tour of the building, formal and informal interviews and information from previous inspection reports. The inspectors followed an inspection plan written before the start of the inspection using all information held on file at the Commission for Social Care Inspection regarding the home, to ensure that all areas that needed covering were done so. Feedback was given to the person in charge during and at the end of the inspection. This report is based on pre inspection information provided by the home as well a site visit. Discussion took place with regard to how the home deals with equality and diversity. The manager was able to give examples of how they had addressed this in the past and evidenced a variety of policies and procedures for both staff and residents. What the service does well: What has improved since the last inspection? A new induction pack for staff has been introduced. This now covers more subjects and allows staff to be eased into the workings of the home and the care that residents need. A new carpet has been put down on the ground floor of the home. Grace Lodge Nursing Home DS0000059144.V311397.R01.S.doc Version 5.2 Page 6 Nursing staff have been issued with extra guidance on the administration of medications. The home is looking into new ways in which tablets can be dispensed. This is to ensure the safety of residents. 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. The summary of this inspection report can be made available in other formats on request. Grace Lodge Nursing Home DS0000059144.V311397.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 Grace Lodge Nursing Home DS0000059144.V311397.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information gathered by the home before resident moves in, ensures that they can care for residents appropriately. EVIDENCE: Twelve care plans were sampled during the inspection. Six were for residential residents and six were for nursing residents. This was to ensure that good overview of the contents of these plans could be assessed. Plans were also sampled for two residents that were new to the home. A new pre admission assessment form has been devised by the home. This was found to be very detailed and just beginning to be introduced. All files contained an assessment carried out prior to a resident moving to the home. Details were recorded regarding likes and dislikes, potential risks that may arise and medical history. This document is then used by staff when developing a residents care plan. Grace Lodge Nursing Home DS0000059144.V311397.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Medication practices have improved but still pose a risk to residents. Care planning is clear for staff to follow, but does not involve the resident. Dignity and privacy is respected for residents at all times. EVIDENCE: The care plans sampled during the inspection showed that they were regularly checked by the home manager and that staff were updating them monthly. Plans not only covered medical problems but also addressed what social input residents need. This is an example of good practice. Plans varied in the standard in which they were written, but staff spoken with during the inspection clearly understood what care was needed by residents. The home need to address the fact that care plans are not made with any input from residents and their families. This is important to ensure that residents are aware of what care they are going to receive. Two residents spoken to regarding their care plan were not aware that they had one. A variety of risk assessments are completed by staff. This is to ensure that any risks that are taken by residents can be done in a safe way where possible. Grace Lodge Nursing Home DS0000059144.V311397.R01.S.doc Version 5.2 Page 10 Records and discussion with residents showed that a variety of health workers visit the home to assist with residents care. These are people such as dentists, opticians and dieticians. A number of records for residents who had wounds were sampled. 3 of these records were unclear. Nursing staff had been putting various dressings on wounds but there was no indication of who had prescribed these dressings. One nurse had recorded that a wound was ‘slightly septic’ on a number of occasions, however the manager was not sure what was meant by this phrase and what the nurse had done to address the problem. Other records were just recorded as ‘dressing renewed’, with no explanation as to what the wound had been dressed with. The home need to be consistent with how they record wound care. Records need to reflect the exact state of the wound and the type of dressing that is applied in order for clear records to be maintained. Medication storage areas and records were checked for both units at the home. During the homes random inspection, in July 2006, serious failings were highlighted with regard to practices in medication administration. The home has addressed this problem and improved practices, especially with regard to recording if medications have been given, however further improvements are still needed to ensure the safety of residents. 4 residents at the home are prescribed a supplement to put in drinks to thicken it up. This is to reduce the risk of chocking. Medication records to show that this supplement had been given had not been completed for 3 of the residents. The other residents records showed that she only received 3 drinks per day. On discussion with the manager, this appeared not to be the case and it was thought that staff had not recorded every time a drink had been given. It was recommended that the home start using a separate chart to record when this supplement is given and that all staff are made aware of its importance. On the upper floor, 4 residents had not been given medication as it had been prescribed. 2 residents also had handwritten medication records that hadn’t been double signed. On the lower floor, 1 resident had not been given medication as prescribed. These practices leave residents at risk and need to be addressed by the manager and staff involved. On both floors a number of blood bottles, urine testing strips and blood glucose testing strips were found to be out of date. This could have an effect on the reliability of tests that are carried out at the home. The manager was made aware of this during the inspection. Residents spoken with during the inspection felt that they were treated well. Comments were made such as “ its nice here” and “ I am well cared for”. Staff were observed maintaining residents dignity and addressing them in a kind and courteous way. Grace Lodge Nursing Home DS0000059144.V311397.R01.S.doc Version 5.2 Page 11 Grace Lodge Nursing Home DS0000059144.V311397.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. 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. Activities are varied and suit the needs of individuals. Residents enjoy a flexible lifestyle and are supported to make choices. Meals are balanced and varied, however staff need to ensure residents who need help eating receive it. EVIDENCE: The home has an activity organiser who works 34 hours per week and who ensures that the planed activities are carried out. Residents know what is on offer on a daily basis and a weekly plan is available around the home for them to read. Residents were able to name some of the activities they join in with as “bingo”, “quizzes” and “keep fit class”. They also stated they like the activities that are on offer and felt that it kept them busy. Other residents stated that they did not join in with activities, but that this was their own choice. The home has an open visiting policy, where visitors can come into the home at any time. Staff confirmed that visitors are welcome in the communal areas of the home or to use the residents bedroom if they agree. Staff and residents confirmed that they are able to make choices on a daily basis. There is no specific time to get up or go to bed and no one is forced to join in with anything that they don’t want to do. Residents commented, “ I Grace Lodge Nursing Home DS0000059144.V311397.R01.S.doc Version 5.2 Page 13 wouldn’t want to be anywhere else” and “ I couldn’t be in a better place than this”. The home has smoking and non-smoking areas for residents to sit. Residents are able to choice which of these areas they prefer. The home has a rotating menu programme. This means that the menu changes from week to week and provides residents with a varied and flexible diet. Menus are displayed for residents to look at their options, however the residents on the upper floor were not sure of what their choices were as the menu is only displayed downstairs. Staff were observed to be offering regular drinks to residents, which the residents enjoyed. Lunch was observed in the dining room on the ground floor. Residents were given roast beef, vegetables and gravy. A number of residents were noted to not be able to cut up their meat, and were leaving it to one side as a result. Staff were busy taking meals to residents who prefer to eat in their own rooms. One resident commented, “I don’t like this, when I don’t like meals I get a sandwich”, another commented, “the food is nice here”. Staff need to be alert to which residents need extra support at this busy time. Grace Lodge Nursing Home DS0000059144.V311397.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. 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. Complaints are dealt with well at the home. Staff are made aware of the responsibilities in looking after residents and are all checked to ensure they are suitable to work with the residents at the home. EVIDENCE: The home received a random inspection as a result of a complaint made directly to CSCI. This inspection was carried out unannounced on 28th July 2006. Following the visit a number of requirements were made to the home. These requirements were then checked during this inspection. The home has a clear and accessible complaints policy. Residents spoken to were able to tell the inspector how and whom they could make a complaint to. 3 complaints had been made at the home since the last full inspection. Records showed that these had been dealt with correctly and in a timely way. The home has a copy of the local adult protection policy and some staff have received training on this subject. Staff files checked showed that all staff had received a police check before starting work at the home. This ensures that they are suitable to work with vulnerable adults. Checks are also completed on registered nurses, to ensure they are holding the correct qualifications to care for residents. Grace Lodge Nursing Home DS0000059144.V311397.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some of the decoration and furniture at the home is tired and needs replacing. The home needs to review the layout of the upper lounge area to create a more homely space for residents to live. EVIDENCE: A full tour of the home was carried out as part of the inspection. Whilst sitting in the dining room at lunchtime, it was noted that the chairs and tables were dirty with pieces of old food. Chairs and tables were tired and need of replacement. The lounge and dining area on the upper floor was also in need of updating. Chairs were all different colours and made with plastic coverings. This did not create a homely atmosphere for the residents to sit. The seating area is very small and is very much in the style of a waiting room. Discussion took place with the manager to look at partitioning this area off, to create a separate area from the dining room that would be more like a lounge. Residents sitting in this area commented that they didn’t like sitting there and that they didn’t enjoy Grace Lodge Nursing Home DS0000059144.V311397.R01.S.doc Version 5.2 Page 16 looking out onto dining tables and chairs all day. The provider needs to give careful consideration to how to improve this area. A maintenance and decoration plan needs to be implemented and forwarded to the inspector. This needs to address all areas of the home and the replacement of décor and furniture that has been at the home since it opened some years ago. This is to ensure that residents can live in a pleasant and homely environment. A selection of bedrooms was checked. These areas were pleasant and had been made homely by residents by bringing in items from home such as photos and pictures. Residents spoken with in their bedrooms were satisfied with the standard of accommodation. The home has a policy in place on infection control. Staff spoken with were aware of this policy and how it is used at the home. During the tour of the home 3 bathrooms were noted to have soap dispensers that were empty. The manager needs to ensure that this is addressed. Grace Lodge Nursing Home DS0000059144.V311397.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. 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 feel well cared for by staff. Staff are well trained and work well as a team. The manager needs to ensure that staffing levels are kept under review to ensure safety needs are met at all times. EVIDENCE: The home staffing rota shows that there is always a trained nurse on duty. Accident records at the home showed that there is an increase in the number of falls at the time of shift change at night. Duty rotas show that at this time there are 3 care staff upstairs, 2 downstairs and a trained nurse. At this time the nurse is doing the medication round and care staff are starting supper. One the night before the inspection, records show that 3 residents fell. The home manager needs to consider where staff are placed at this time and consider employing an extra member of care staff around this busy time. Accidents need to be audited regarding this pattern of falls. Residents spoken to about how things are managed at the home around 8pm stated, “ there are not enough staff” and “ no one comes in to the lounge until much later”. Staff training records were sampled and showed staff had recently attended training on food safety, first aid, diabetes care and fire safety. Staff interviewed felt that they were given good amounts of training that assisted them in their work. Staff also confirmed that they had been given an induction by the home and that they had job descriptions and contracts of employment. Grace Lodge Nursing Home DS0000059144.V311397.R01.S.doc Version 5.2 Page 18 Staff files sampled showed that the home had taken up references for staff to ensure they were suitable to work at the home. Residnets spoken with stated staff were “caring”, “very kind” and “jolly”. Residents stated that staff made them feel secure at the home and that they were able to help them when they needed it. Staff spoken with stated they enjoyed working at the home and felt that they worked well as a team. One member of staff described working at the home as “ really good fun”. Grace Lodge Nursing Home DS0000059144.V311397.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. 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 is competent and qualified to run the home. She monitors quality of the home on a regular basis. The recording of residents money needs to be improved to ensure the residents remain protected. EVIDENCE: The home manager is a qualified nurse who also holds a specialist management qualification. She has worked at the home for several years and is registered with the Commission for Social Care Inspection. Staff and residents spoke highly of the manager stating she was “approachable”, “ easy going” and “fair”. The home manager is responsible for monitoring the quality of the service offered at the home. Surveys are sent out to residents and families on a 6 monthly basis. This allows people to give their views on what it is like to live at Grace Lodge Nursing Home DS0000059144.V311397.R01.S.doc Version 5.2 Page 20 the home. The home used to hold residents meetings, however due to poor attendance these were stopped. Residents stated that they could approach any of the staff if they wanted to make an improvement or suggestion. The home currently holds pocket monies for 11 residents. Records showed that family members collect this and sign to say they have done so. One resident who had her money case tracked by the inspectors showed that she receives her money directly. The resident had not signed to say that she was given the money. This was discussed with the manager, as a system must be put in place to ensure that all monies can be clearly accounted for to protect the residents. Records sent to the inspector and records seen during the site visit showed that all health and safety checks are being carried out at the home. Staff receive regular updated on fire drills and accident records comprehensive. Health and safety training is given to staff on a regular basis to ensure they can protect the residents from harm. Grace Lodge Nursing Home DS0000059144.V311397.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 2 8 2 9 2 10 X 11 X 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 2 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 2 X X 3 Grace Lodge Nursing Home DS0000059144.V311397.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES 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 OP8 Regulation 12(1) Requirement Timescale for action 31/12/06 2 OP9 13(2) 3. OP19 23 The registered person must ensure that wound charts are completed correctly to ensure that it is clear as to what dressing had been applied, why this has been done and to the status of the wound. The registered person must 01/12/06 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medications at the care home. Remains outstanding from previous inspection report The registered person must 01/02/07 produce a maintenance and decoration plan to address how areas of the home are to be updated and made into a more homely environment. The dining room tables and chairs to the ground floor dining room must be cleaned. 4 OP35 17 The registered person must ensure that the recording of financial transactions are reviewed and secure. This is to DS0000059144.V311397.R01.S.doc 01/12/06 Grace Lodge Nursing Home Version 5.2 Page 23 ensure residents are protected from potential abuse. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP15 Good Practice Recommendations The manager may wish to consider implementing a drinks chart for those residents who have supplement or thickened drinks. The manager may wish to locate a menu board on the upper floor of the home to ensure all residents are aware of meal choices. Staff also need to be aware of residents who need assistance in cutting up food. The manager may wish to carefully consider the lay out of the upper lounge area and the atmosphere created by the furniture/décor in this area. The manager may wish to ensure that all soap dispensers are kept full at all times The manager may wish to audit accidents and monitor trends in falls at the home. 3 4 5 OP19 OP26 OP38 Grace Lodge Nursing Home DS0000059144.V311397.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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