Inspection on 03/01/07 for Hamelin

This inspection was carried out on 3rd January 2007.

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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hamelin 13/12/05

Hamelin 15/06/05

Hamelin 15/12/04

Hamelin 27/07/04

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

CARE HOME ADULTS 18-65 Hamelin Farewell Road Totnes Devon TQ9 5LT Lead Inspector Graham Thomas Unannounced Inspection 3 January 2007 09:15 rd Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 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 Hamelin DS0000003714.V314664.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 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. Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hamelin Address Farewell Road Totnes Devon TQ9 5LT 01803 868971 01803 868396 enquiries@comae.org.uk 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) Mr Simeon James Antony George Ramsden The Very Rev Archpriest Benedict Ramsden, Katherine H L Finnigan, Mrs Lilah Ramsden Miss Shelley Barreto-Pereira Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th December 2005 Brief Description of the Service: Since the last inspection the accommodation at Hamelin has been reorganised and a bedroom has been added. Hamelin is now registered to provide care and support for up to six people with mental health needs. The home is located in a residential area close to the town of Totnes where all public amenities are to be found. This is one of a number of homes in the South Hams and Plymouth areas owned by the Community of St. Anthony and Elias which for ease of reference will be referred to as the Community throughout this report. Service users are provided with a well-developed activities programme including arts, crafts and outdoor activities. This is staffed by skilled specialists. Support is provided to access ordinary community facilities and engage in personal development through work and education. The current fees range from £1507 to £1950 per week. Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Registered Manager provided information about the home before the inspector visited. Four staff and one service user returned written comments to the inspector. The Inspector spent six hours at the home. During this visit, he spoke with five service users, five staff and the Registered Manager. He looked at care plans, staff files and other records. He also looked around the home and examined the way medicines were used. After the visit, the Inspector spoke with a relative, a Community Psychiatric Nurse and the Community’s Head of Care and Finance Officer. What the service does well: Hamelin is a comfortable and homely place to live. People choose how they want their rooms to look. The Community makes sure that Hamelin can meet a person’s needs before they move in. When they have moved in, they have a clear plan that is written down. Staff help service users to make choices and become more independent. There in excellent activities programme for service users. This includes art, craft, music and many outdoor activities. One service user said “There’s load of stuff going on here all the time!” People are helped to improve their education and skills. There is support for them to make choices about the way they want to live. Staff help and support service users to get any treatment they need. There is good support for people when they are distressed. One service user said “the staff are very supportive when I feel down”. Staff listen to service users’ concerns and make sure they are protected from abuse. Before employing staff, the Community makes sure they are safe to be with service users. They get training to be able to give service users the support they need. The Manager runs the home well for the service users’ benefit. She understands what is needed to support staff and make sure service users get what they need. She makes sure the home is a safe place for service users Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 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 Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 and 3: Quality in this outcome area is good. Prospective service users can feel confident that Hamelin will meet their needs and aspirations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection one additional service user has been admitted to the home. This service user was transferred from another of the Community’s homes. The service user had been able to visit Hamelin prior to moving and felt that, ultimately it was a good move. The Inspector had some concerns as to whether the move had been conducted with sufficient consultation and choice for the service user. These concerns were discussed with the Registered Manager and the Community’s Head of Care. Following these discussions, the Inspector was satisfied that the move was in the best interests of the service user and had resulted in a good outcome. Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9. Quality in this outcome area is good. Service users can feel confident that they will receive the support they need to achieve their goals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All the service users had an individual plan. In addition, a detailed daily record was kept which had clear links to the various elements of the plan. The plans focussed clearly on goals and covered areas of social, family and health and psychological needs. Each had been regularly reviewed and signed by the service user. Discussion with service users showed that they were aware of the contents of their plans and that the goals in the plans were being pursued. A Community Psychiatric Nurse commented that the reviews were regular, professional and that reports for the reviews were well-presented. The plans and daily records showed clearly how service users had been supported to reach decisions over issues such as family contact, education and leisure activities. This was confirmed in discussion with the service users and staff. Restrictions on freedoms and choices were set out in the plans and understood by the service users with whom the Inspector spoke. There was also evidence as to how increasing independence was being promoted. For Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 Page 10 example, one service user was working towards managing their own medication. Others were taking trips into the local community with reduced support from staff. One plan detailed how a service user was to be supported in managing day-to-day finances. Each of the service users’ plans contained detailed assessments of risk for both activities and the home environment. These showed that service users were supported to take risks appropriate to their individual needs and interests. For example, the home’s activity plan includes canoeing and surfing. These activities had been risk assessed to take account of the individual’s skills as well as seasonal variations of risk. Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15, 16 and 17. Quality in this outcome area is excellent. There is excellent support for service users at Hamlin to pursue their chosen lifestyles. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Community has a very well developed programme of activities which are co-ordinated and run by skilled professionals. These include arts, crafts, music tuition, and a range of outdoor activities. The residents of Hamelin have access to all these activities. On the afternoon of the inspection, a small group of service users went on a weekly visit to a sports centre where they enjoy badminton squash and cricket. Another service user spoke with the Inspector about how tuition provided by the Community was helping her to maintain a long-standing interest in music. One service user commented enthusiastically “There’s load of stuff going on here all the time!” Activities for specific individuals were also being supported. One service user spoke of attending a horticultural course and took justified pride in achieving an A grade in an AS level course. Another had become interested in cooking and was planning to cook a meal the following evening. Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 Page 12 Service users spoke of regular trips into the nearby town for shopping and leisure. One small group went to the local supermarket during the morning of the inspection to buy food for lunch. Religious and spiritual beliefs were acknowledged and respected. For example, the Inspector spoke with one service user about his regular attendance at a local spiritual group. Records showed that service users had been encouraged to maintain contact with their friends and families. This was achieved by making and receiving visits and telephone calls. One service user was staying with his family at the time of the inspection. Another had spent substantial time at home over the Christmas period. Most service users have mobile phones. However the home does have a phone available for service users in the hallway. The Registered Manager stated that the office phone could be used by service users who wanted more privacy. The rights and responsibilities of service users were well understood by staff and service users. Staff addressed service users in an informal but respectful manner. There was considerable interaction between staff and service users during the inspection. This was all positive and supportive. Individual decisions as to whether to participate in activities were being respected. Service users rooms were clearly identified as their private space. Each room was fitted with a lock to which service users had been offered a key. House “rules” on smoking, alcohol and drugs were understood by service users. The Inspector joined service users and staff for a lunchtime meal. This was taken in the kitchen / dining area. The atmosphere was informal and sociable with much interaction between staff and service users. The meal had been planned in the morning by staff and service users who had been shopping for the ingredients. One service user had recently become vegetarian and had chosen an alternative to the meat content of the meal. Discussion with staff and service users confirmed that service users are routinely involved in the planning, purchase and preparation of meals in the home. Care plans contained details of particular dietary needs. Menus showed a varied and nutritious diet. The menus recorded what service user had actually eaten and included reviews conducted by the Registered Manager. Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20: Quality in this outcome area is good. Service users can feel confident that they will receive good personal and healthcare support at Hamelin. However, improvements are needed to the systems for giving medicines to make sure they are completely safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussion with staff, service users and examination of the care plans showed that service users were receiving effective support in personal and social development, maintaining contacts with families and maintaining their physical and psychological health. Service users commented very favourably on the individual support they received from staff. One service user commented “The staff are great and I really value my place here”. Another stated “The staff are very supportive when I feel down”. A relative stated that she felt the care was very good and that some of the staff were “fantastic”. The care plans showed that all service users had access to both routine and specialist mental health care. On the morning of the inspection, two service users attended the GP’s surgery. One of the service users was receiving routine testing whilst the other was consulting the doctor about a physical ailment. Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 Page 14 All service users are encouraged to be physically active. The Community’s activities programme provides a variety of ways to achieve this aim. At the time of the inspection, none of the service users was administering their own medication. However, it was planned that two service users should begin to do so as part of a programme of increasing independence. Medicines records for three service users were scrutinised. The medicines administered had been signed for. Some medicines were labelled “as directed”. It is recommended that specific directions should be sought from the prescribing GP in order to reduce the possibility of error. Several medicines were prescribed on an “as required” basis. There was no specific guidance in place for staff concerning the use of these medicines. Such guidance is important so that there is a clear understanding of how the medicine should be used. The guidance should state the specific circumstances in which the medication is to be given and the maximum dose to be administered in a given period. Training for staff in medication was discussed with the Manager and staff. All staff receive awareness training as part of the Community’s induction. Those staff who are to administer medicines are trained by senior staff who observe their practice until they have achieved competence. A review of the home’s accident / incident sheets showed a number of errors in medication over the past three months. Appropriate action had been taken on each occasion. However, it is recommended that the Registered Manager should review the administration procedures to ascertain whether these errors can be reduced. The Registered Manager stated that no controlled drugs were in use at the time of the inspection. A professionally approved list of homely remedies was seen by the Inspector. Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good Service users can feel confident that their concerns will be listened to and acted upon. They can be assured that staff will protect them from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear complaints procedure which was available to service users. The Registered Manager stated that no complaints had been received since the last inspection. None had been received by the Commission. In discussion with the Inspector, service users felt that the staff listened to them and acted on their views. During the inspection staff treated service users with the utmost respect and were supportive, open and approachable. Procedures were in place to protect vulnerable adults from abuse. Training records showed that staff receive training in this subject as part of their induction. A specific issue was discussed with the Community’s Head of Care which demonstrated a robust approach to protecting service users from potential abuse. Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 25 and 30: Quality in this outcome area is good. The home provides a sufficiently, homely clean and safe environment for its residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During this inspection, the Inspector toured the accommodation and inspected all but two of the service users’ rooms. Hamelin is in a quiet residential area within walking distance from the nearby town of Totnes. The building has been extended and substantially modified over a period of years. This includes recent modification to provide an extra bedroom. The accommodation is on three levels. The front entrance is on the lower ground floor where there is a large laundry room. Stairs lead to the next floor which is level with the rear garden. On this level there are five service users’ rooms, a shower room, a lounge, activities room, kitchen, dining area and office accommodation. At the next level there is a service users’ room and two bathrooms. There is also staff sleeping in accommodation at this level. Since the last inspection, work on the exterior decoration had been completed. The kitchen had been substantially refurbished. During the inspection routine Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 Page 17 maintenance was being carried out by the Community’s maintenance personnel. The shower room was due for refurbishment. Records showed that routine safety checks had been carried out including, for example, personal electrical appliances. Risk assessments had been produced for each service user in relation to risks around the home. All areas were comfortably furnished and decorated in a domestic style. Individual rooms reflected the tastes and personalities of their occupants. They contained many personal items, ornaments, photographs and in some cases furniture belonging to the service user. One room had a number of trailing leads with extension sockets which could present a safety hazard. This was discussed with the Registered Manager who was aware of the issue and had identified possible solutions to the problem. Appropriate measures were in place to control infection. The home was adequately clean on inspection. Hand basins near each of the three toilets were supplied with liquid soap and towels. The home’s laundry had cleanable walls and impermeable flooring. The washing machine had a hot wash cycle. A new tumble dryer had recently been installed. Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 and 35: Quality in this outcome area is good. Service users are well supported by competent staff who are able to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection there were four staff on duty with the Registered Manager. This group included both women and men with a variety of experience. The rota showed that this level of staffing was typical. The Inspector examined the files of the two most recently recruited staff and spoke with all the staff. Staff files and discussion with the newly recruited staff revealed a sound recruitment procedure. This included, in each case, formal application, interview, two references and criminal records checks. Prospective staff are given the opportunity of a “taster day”. This includes time spent in the home with service users who are then able to feed back their view of the person to those responsible for recruitment. The newly recruited staff were receiving or had received the Community’s two-part induction. This covers a range of topics including for example, subjects specific to mental health, health and safety topics and medication awareness. Each staff member had a training file of which an example was seen. Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 Page 19 Of the current eight staff, two hold a National Vocational Qualification in care at level two or above. One was a qualified Art Therapist. In discussion the longer-standing staff members described ongoing training in topics such as deescalation, fire safety and first aid. This was confirmed in the home’s records. All the staff with whom the Inspector spoke were able to describe clearly their roles and responsibilities. The good feedback received by the Inspector from service users suggests that the staff group is competent at supporting adults with mental health needs. Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42: Quality in this outcome area is good. Service users at Hamelin benefit from a generally well managed home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager of Hamelin was Registered with the Commission in April 2006. She has completed a National Vocational Qualification in care at level 4. At the time of the inspection she was close to completing the Registered Managers Award. Discussion with the Registered Manager on a number of topics demonstrated that she had a clear understanding of her responsibilities in relation to, for example, training, staff supervision, record keeping and the home’s maintenance. Her competence in managing the home effectively is reflected in the outcomes for service users described in the previous sections of this report. A system of monitoring the quality of the service provided is being developed at the corporate level. An annual development plan concerning administrative systems was seen. However, quality monitoring systems remain under Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 Page 21 development and do not yet adequately reflect the views of service users and others concerned with the home. Monthly visits to the home by the Registered Provider are required by regulation. Records of these visits have been sent to the Commission. They have not, however, occurred at the required monthly intervals. The Inspector discussed training with staff and examined training records. These confirmed that staff receive training in health and safety topics such as first aid, fire safety and food hygiene. Health and safety records in the home showed evidence of routine checks and maintenance such as electrical equipment testing and gas safety checks. Risk assessments were seen for each service user in respect of risks around the home. Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 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 X 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 2 X X 3 X Hamelin DS0000003714.V314664.R01.S.doc Version 5.2 Page 23 No 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 YA39 Regulation 26 Requirement The Registered Provider must visit the home at least once per month in accordance with the provisions of Regulation 26 of the Care Homes Regulations 2001 Timescale for action 03/02/07 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 YA20 YA20 Good Practice Recommendations Where medication is received into the home labelled “as directed”, specific instruction concerning its use preferably in writing, should be sought from the prescribing GP. Where medication is prescribed “as required”, specific guidance should be in place concerning its use. This should identify the specific circumstances in which the medication is to be given and the maximum dose in a given period. The Registered Manager should review and monitor medication errors to ascertain whether practice needs to be changed or further training is needed. The quality assurance system should be fully developed to incorporate the views of service users and other stakeholders. DS0000003714.V314664.R01.S.doc Version 5.2 Page 24 3 4 YA20 YA39 Hamelin Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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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