Inspection on 05/07/05 for Harrington Cottage

This inspection was carried out on 5th July 2005.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Harrington Cottage 14/05/07

Harrington Cottage 23/10/06

Harrington Cottage 06/02/06

Harrington Cottage 24/01/05

Harrington Cottage 05/07/04

Harrington Cottage 19/11/03

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Harrington Cottage Forge Hill Aldington Ashford, Kent TN25 7DT Lead Inspector Lois Tozer Unannounced 5 July 2005 9:30 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 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 Stationary 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. Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Harrington Cottage Address Forge Hill, Aldington, Ashford, Kent, TN25 7DT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01233 720814 Canterbury Oast Trust Claire Anne Harman Care Home only 6 Category(ies) of Learning Disability x 6 registration, with number of places Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24/01/05 Brief Description of the Service: Harrington Cottage is registered to provide accommodation, personal care and support to six people who have a learning disability. A large cottage, set in its own extensive grounds, the home is set well back from the road and is approximately 20 minutes walk from the village shop and 15 minutes from the local pub. It is owned and operated by The Canterbury Oast Trust (C.O.T.), a charitable organisation and is managed by Miss Claire Harman. Overlooking Romney Marsh, the house is homely and comfatable. Communal facilities consist of a good size dining room (that is used as a staff sleep over area at night) and a large lounge, with TV, music and computer. The garden is well maintained and a new patio and seating area is being developed to the rear of the house. The kitchen (which also houses the washing machine) are fully accessible. All bedrooms are registered for single occupancy. The office area is of sufficient size to contain all documentation, medication and offer a 2nd staff sleep in bed. WC, shower and bathrooms are situated on the 1st floor, with a separate WC on the ground floor. Access into the wider community relies on the homes transport (the bus service is reported as infrequent) so there are two dedicated vehicles provided for communal use. A computer and art classroom is situated in the grounds . Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory unannounced inspection took place on 18th July 2005 between 9.45am and 2.30pm. There are currently six people living at the home, four residents were happy to give feedback to help with the inspection process. All either said or indicated that they were very happy living at Harrington Cottage. Two residents said they were off on their holidays with staff this year, and two small groups were going. A resident confirmed that holiday groups had been chosen individually. Paperwork seen included individual support plans, risk assessments; medication and administration documents; staff recruitment details and files, training details, duty rota, and menu. The house is a pleasant, well-presented abode set in extensive grounds. Landscaping work to the side and rear of the house has been taking place with residents input. Work is planned to replace the kitchen and the bathroom suite in the near future, but as yet, no firm date has been set. External work to a chimneybreast and surrounding is outstanding, and would benefit from being attended to before the foul weather sets in. There is a high level of activities available to residents and the range of choice for activities outside of the home is extensive and well supported both financially and by staff availability. Comments expressing the suitability of the home’s services were made clear by a resident as follows; ‘I considered moving, but staff have helped me get over my problems, I am pleased with my Pathways course, I am doing well here and I have a good key worker, who I like a lot’. ‘Yep, looking forward to holiday’ (whilst handing over some work that had taken place on the internet to discover more about the holiday destination). ‘I and [my boyfriend] go to the pub up the road, we are going to a disco tonight’. A resident said, without prompt, that he was proud to live at the home and that staff really made efforts to help residents, so they didn’t miss out, giving an example of efforts made to make sure a planned trip still took place when a staff member fell ill. What the service does well: The home is clearly run with the inclusion of residents in many aspects of everyday life. There is a very high level of educational and practical work experience opportunities available to everyone. Each person has an individually tailored day plan that they are happy with. Care and support plans have been re-written and are specific to individual needs. People are encouraged to speak up and tell staff how they feel and what they want. Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 Page 6 Through residents meetings, residents are fully involved in the running of the home and are helped to plan daily things like menus and events such as holidays. 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. Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 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 standard(s) 1, 2, 3, 4, 5 The service user guide is full of valuable information to aid prospective service users to decide if the home is suitable for them. The assessment process has not been used for many years, but the past procedures have been robust. Past prospective residents have had opportunities to ‘test drive’ the home. Individual written contracts state the terms and conditions of residency in a manner that can be understood by service users. EVIDENCE: A very informative statement of purpose and service user guide has been developed and contains all the information a prospective resident requires to make a decision if the home can meet their needs. Minor adjustments to acknowledge the recent change in manager need to take place. All new service users would undergo a full needs assessment prior to a placement being considered, and documentation previously seen demonstrated that this covers the range of this standard. It is recommended that the manager use the assessment tool with current residents to re-assess needs and to practice assessment skills to develop the individual plans further. A recent piece of work on contracts has provided each individual with an easy to read and understand statement of their terms and conditions of residency, using symbols and pictures where this aids understanding. Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9, 10 Although the service user plans have been recently updated and improved to be more specific, a greater level of opportunity for personal development through decision-making and participation in day-to-day matters would be beneficial. Risk management is well assessed in most areas but is absent in one important area. Information is stored in a safe and secure way. EVIDENCE: Two service user plans were read through, these were comprehensive in offering information to staff to give continuity of support and care in all aspects of individual’s life. Where extra support is required to practice skills, for example, participating in kitchen duties, a goal plan with a task analysis (to give the individual continuity of support) would be beneficial. Of additional benefit would be the demonstrated consultation that the decisions made in the plan were done so with the involvement of the residents themselves. The use of a person centred planning approach may be of benefit, and would be more easily understood by several residents. Through observation and discussion with staff, it was clear that service users are supported to practice life skills, however it was said that during college term time, some opportunities are curtailed due to time factors. Combining domestic duties and resident support within the shift planning may prompt greater creativity in time management during busy spells. Risk assessments were in place for most events, however Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 Page 10 service users have new bank accounts with ‘chip & pin’ facility, and the vulnerability of this has not been assessed, some people being unable to keep their pin secret. A requirement to assess and remedy this situation has been made. Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16, 17 Resident’s personal development opportunities are offered frequently, but some lapses occur during ‘term time’. All residents have opportunities participate in educational and occupational activities that they enjoy. Although the home is situated in a rural location, regular trips into the village and wider community are facilitated. A range of leisure activities chosen by residents is available on a regular basis. Residents are supported to maintain close family connections and have relationships. Some residents are fully involved with meal preparation on a regular basis, this would be beneficial for all interested service users. EVIDENCE: A resident was seen working in the kitchen with staff and appeared to be happy with the opportunities. Staff were careful to allow the individual to take natural breaks and then encourage rejoining the activity. Staff said that they really enjoy getting helping residents get involved with running their own home, but this can be difficult in ‘term time’, when time is not on anyone’s side! A discussion about creative shift planning, and staggered lunch preparation, took place, which may offer greater engagement opportunities and solve some time management problems. Such planning should increase Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 Page 12 the inclusion of all residents in the daily routines of the home. Although the individual plans have improved, regular consultation to develop service user skills must take place; this could be achieved through a person centred plan approach. All residents have chosen a comprehensive educational or work experience schedule, which is reviewed regularly. Staff support all residents get out into the community, and one resident said that he was dropped off at the train station, so living in the countryside was not a problem to him! Every resident has a holiday booked this year, with four people choosing to go away in September, and a further two in November. The home supports all residents to keep in touch with their wide network of friends and family. Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 Documented personal support would benefit from demonstrated service user consultation. Some elements of personal support risk assessment may be undignified. Each individual has access to a range of health care professionals; all health care needs are addressed swiftly. Medication is generally well managed, however some minor shortfalls were seen. EVIDENCE: Documented personal support was generally written to emphasise the individuals’ involvement in the task. Some areas that could be developed were discussed, such as jobs attributed to staff could be carried out by residents with prompts, guidance and support. A personal support requirement had been risk assessed to protect staff from possible accusations, but appeared not to fully consider maintenance of dignity for the individual concerned. A review of the plan is required, and a more appropriate solution may be available. Healthcare is well supported, staff document visits and outcomes to healthcare professionals and take action as required. Residents said that they choose who will help them for personal care and for anything to do with healthcare visits. Medication was generally well managed, with all of the requirements made in the January 2005 inspection being met. Minor shortfalls that require addressing are; storage of staff medication in the service medication cupboard; storage of external medication needs to be kept separate from internal meds and accountability for paracetamol purchased by the home for service user use. Two recommendations were made, this being the reason for the use of Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 Page 14 prescribed medication and the common side effects be included on the individual header sheets and that the in-house competency assessment is dated and signed off by both the manager and staff. Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 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 standard(s) Neither standard was inspected, but there have been no complaints since the last inspection. EVIDENCE: Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 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 standard(s) 24, 25, 26, 27, 28, 29, 30 The home is comfortable, homely, and safe, but external decoration remains outstanding. Bedrooms are highly personalised and are enjoyed by the individuals. Shared space meets all the resident’s needs, is well maintained, and enjoyed by all. Adaptations that have been assessed as necessary for physical movement have been implemented, but further assessment may be of benefit to retain the level of service user involvement in kitchen activities. Improvements in both bathrooms and kitchen have been identified as required; plans are in place to address these. EVIDENCE: The house is very much liked by the residents, who enjoy the communal space, garden, and patio area. A resident was proud to show off the new shingle borders around the house and a tomato plant that they were watering. No parts of the home are restricted to residents. All bedrooms are registered for single occupancy; all residents giving feedback said they liked their rooms very much. The TV lounge is large and offers an area for using the computer freely. Staff benefit from one dedicated facility to sleep in but use the dining room (sofa bed) to accommodate the second person. This is not a problem for residents, one advising that the lounge was always free for use. Internally, the home is very well maintained and is due to have a kitchen refurbishment in the Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 Page 17 near future. Quotes for bathroom refurbishment have recently been passed to the board of trustees for approval and a new shower cubicle was due to be fitted shortly after this inspection. Decoration to the chimneybreast and wall to the front of the premises has been an ongoing requirement, but no start date has, so far, been arranged. A commencement date has been required, as it is important that this work is carried out before the winter months create further problems. All facilities are clean and hygienic. Adaptations have been installed to assist movement around the home, however some access to the kitchen is limited due to the risk from scalding for one individual. It is strongly recommended that, where possible, adaptations be used to empower individuals as their physical health changes, by use of, for example, a ‘safety kettle tipper’. Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36 Staff job descriptions would benefit from review to reflect the modernised aims and objectives of the home and the organisation. Staff are competent, effective and have many qualities to offer the resident group, but would benefit from a change in shift planning to meet all the residents needs when time is short. Many staff hold NVQ qualifications and all have received a wide range of training to meet residents needs. Staff benefit from regular supervision support. EVIDENCE: Several staff files seen contained all the relevant information to show that the recruitment procedure was robust. Many staff hold NVQ 2 or above, several are just completing their qualification. In both conversation and indirect observation of staff, a high level of competence, skill, and commitment was evident, with staff including residents in every available aspect of home life. A staff member said that it was easier to get people involved with the running of the home when there was no college, as time was tight in ‘term time’. This is understandable, however, may be able to be improved by combining what is seen as ‘staff duties’ into the shift planner to increase the level of service user participation. Practicing being actively involved in all tasks, alongside staff, as equals, may lead to a more flexible approach of inclusion when things get busy again in the autumn. The job description is adequate, however does not appear to have been reviewed for many years. It is recommended that this is Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 Page 19 reviewed centrally in light of the many and varied changes that have taken place in the modernisation of supporting people. Staff have regular, planned, supervisions, and although in very recent months these have slipped in frequency, the manager has been available daily and has planned all future meetings. Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, The home is run with the best interests of the service users in mind. The ethos of the home was commended by a visitor. EVIDENCE: The manager, Claire Harman, has recently achieved registration and has the NVQ level 4 registered managers award. Additionally, she is also an assessor for NVQ and has had a great deal of experience working with people who have learning disabilities. The residents and staff were very complementary about the manager, a resident said that they ‘got on very well’ and two gave the ‘thumbs up’ sign when asked if they were happy with the way things were being managed. One visiting relative of a service user said that the manager was ‘marvellous, conscientious, and capable’. All requirements that were in the manager’s power to act upon, from the last inspection, have been met. Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 3 3 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 2 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 2 3 2 3 Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Harrington Cottage Score 2 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x x x x H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 Page 22 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 4, 5 Requirement Resubmit the statement of purpose and service user guide when updated with new manager information. Service user plan be developed in consultation with the individual & presented in an understandable format. Must identify the strengths & needs and show what support will be put in place to promote greater independence and maintain skills. Risk assess service user access to money using the ‘chip & pin’ facility, taking action to remedy if required. Review risk assessment for personal care support, to increase dignity where possible. In reference to the Royal Pharmacutical Society of GB guidelines; Cease storing staff medication in the service user medicaion store. Storage of external medication to be kept separate from internal meds Accountability for paracetamol purchased by the home for service user use to be improved. Timescale for action 01/12/05 2. YA6, YA18 12 (3, 4) 14; 15; 18 (1, a) 01/12/05 3. YA9, YA23 13 (4,b) 01/09/05 4. 5. YA9, YA18 YA20 12 (4,a) 13 (2) 01/09/05 01/09/05 Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 Page 23 6. YA24 23 (2,b) (Outstanding requirement) Advise CSCI the date for external decoration to commence. 01/08/05 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 YA7, YA8, YA11, YA16 YA20 Good Practice Recommendations Shift plan to combine domestic duties to link in to service user support, giving regular opportunities for residents to work alongside staff in all aspects of running the home. Reason for the use of medication and the common side effects be included on the individual header sheets. The in-house competency assessment is dated and signed off by both the manager and staff stating competent or not competent. Obtain information in respect of adaptations and equipement that will help retain service user skills, autonomy, self asteem and participation. Staff job description is reviewed to reflect the modern approach to supporting people. 3. 4. YA29 YA31 Harrington Cottage H56-H05 S23434 Harrington Cottage V234590 180705 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford, Kent TN23 1HU 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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