Inspection on 01/07/05 for Hartford Hey

This inspection was carried out on 1st 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 but made no statutory requirements on the home.

Other inspections for this house

Hartford Hey 07/08/07

Hartford Hey 28/11/06

Hartford Hey 27/06/06

Hartford Hey 01/11/05

Hartford Hey 09/11/04

Hartford Hey 02/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Hartford Hey Manorial Road South Parkgate South Wirral CH64 6US Lead Inspector Maureen Brown Unannounced 1 July 2005 10:30 st 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 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. Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Hartford Hey Address Manorial Road South Parkgate South Wirral Cheshire CH64 6US 01513364671 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) Hartford Hey Limited/Mr D S Rowland Mrs Jeanette Faland Care Home 28 Category(ies) of Old Age, not falling within any other category registration, with number 28 of places Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 9th November 2004 Brief Description of the Service: Hartford Hey is a residential care home providing personal care and accommodation for up to 28 older people. It is a family run private business. The home is located in a residential area of Parkgate on the Wirral, near to the river Dee estuary. The home is within walking distance of shops, public houses and other community facilities. There are adequate car parking facilities available. Hartford Hey is two large older style semi-detached houses converted into one. Service user accommodation is on three floors, with access to all floors by a passenger lift or the stairs. There is a newer single storey extension to the rear of the property. There are 22 single and 3 double bedrooms, twelve of which have en-suite facilities. The remaining bedrooms have wash hand basins fitted. The home has extensive patio and garden areas. Some of the bedrooms of the ground floor extension have direct access to the gardens via patio doors. Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out during 1st July. The total time on site was six hours. The inspector spent an hour planning the inspection by reviewing previous inspection reports and the service history. The inspection included a tour of the home, inspection of records and discussions with twenty-five residents, the deputy manager, care assistants, cook, domestic assistants, and relatives and friends. Nineteen out of thirty-eight standards were assessed and thirteen were met and six were partially met. Feedback from this inspection was given to the deputy manager at the end of the inspection. What the service does well: What has improved since the last inspection? New laminate flooring had been provided in the hallway. Staff said that it was easier to keep clean and residents commented, “it looked nice”. One resident’s bedroom had been redecorated and a new en-suite fitted since the previous inspection. The resident was happy with the décor and new en-suite. Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 Page 6 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. Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3 & 4 Sufficient information is provided for residents to make a decision about moving into the home. A brief assessment of need is carried, but not fully recorded, to ensure that the home can meet the residents’ needs. EVIDENCE: The statement of purpose and service users guide were produced in individual folders. They included information about the facilities, services provided, fees, terms and conditions of residence and the service user guide had a summary of a previous inspection report. Both these documents were well presented and easy to read. Residents and relatives confirmed that they had seen both these documents. It was recommended that a full copy of the latest inspection report be made available and appropriate wording in the service users guide used to reflect this. (See recommendation No 1). Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 Page 9 Within the statement of purpose the category of the home needs amending and details of the Commission for Social Care Inspection should replace the National Care Standards Commission details. (See recommendation No 2). A sample of three care plans from current residents and one prospective resident were examined. The information available for the prospective resident who was due to arrive on this day was insufficient. There was no preassessment documentation produced by the home and no information had been obtained from other professionals. Pre assessment documentation must be available and show that the home can meet residents’ needs. Also other professional information must be obtained. (See requirement No 1). This requirement remains outstanding from the previous inspection report. Residents and relatives confirmed that they had visited the home prior to admission and staff said that admissions were planned. Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 & 9 The residents’ health, personal and social care needs are met by the staff team who enable them to maintain their privacy and dignity. EVIDENCE: A sample of three residents’ care records was seen during this inspection. These were presented in individual folders. Each contained very basic information covering some areas of personal care, one resident had risk assessments for falls and moving and handling, one resident had a visiting professionals sheet and all the residents had copies of the daily report sheets. The care plans were not drawn up in consultation with the residents and family, nor were they reviewed on a monthly basis. The residents did not sign their care plans to show that they agreed with the contents. Requirements were made regarding all the above issues. Daily record sheets seen showed day-to-day activities of each resident. They were written clearly, easy to follow and were signed by carers. Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 Page 11 Details of residents’ wishes with regard to dying and death were not recorded. These should be recorded and kept in a separate file. Information regarding residents’ weights was not recorded. Medication records examined showed that this was recorded and administered appropriately. Medication was kept secure, however, controlled drugs were not stored in line with current regulations. It is recommended as good practice that controlled drugs are signed and witnessed by two members of staff. The deputy manager produced a copy of the British National Formulary, which was dated 1996. It was recommended that a more up to date copy be obtained. It was also recommended that the Royal Pharmaceutical Society book entitled “ The Administration and Control of Medicines in Care Homes and Children’s Services” be obtained. These reference books should be obtained and used by staff for reference and guidance purposes. The manager said staff that administer medication had started a booklet with the pharmacist that would lead to certificated training, however this training had lapsed. It is recommended that this be completed or other training be sought. During discussions with the residents it was said “the care was very good” and “the residents were well looked after” and also “the home had a lovely atmosphere”. Other comments included “the food is good” and one resident said “their privacy and dignity was respected by the staff”. Relatives spoken to said “the home has a good name locally” and “he was very happy with the care given to his mother” and “the staff approach was excellent” and also “they were kept informed of changes in the residents health needs”. A number of requirements and recommendations have been made. (See requirements 2 – 5 and recommendations 3 – 8). Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 Residents’ were able to take part in a range of activities of their choosing. Personal and family relationships were encouraged by the home and the staff team supported people with this. Residents’ dietary needs were well catered for with a balanced and varied selection of food that met peoples’ tastes and choices. EVIDENCE: Some of the residents’ plans reflected the range of activities undertaken which included reading, bingo, hairdressing, hymn songs, manicures, arts and crafts and watching television. Residents said they particularly enjoyed reading the paper or chatting to other residents in the mornings and participating in activities or watching television during the afternoons. One of the lounges was used as a quiet lounge for people wanting this facility. The deputy manager said that religious services take place within the home, the local Roman Catholic Priest visits fortnightly and the Church of England Vicar visits monthly. Both would visit as required as well. Some residents spoken to said they had enjoyed the church service that had taken place the day before this inspection. Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 Page 13 Visits from family and friends were noted throughout the day and these were recorded in the case notes. Residents shared with the inspector the contact they had with family members and said they could choose to see visitors within their own room or in the lounges or dining area. Relatives said that they were always made very welcome by the staff and were offered refreshments. They said that they could visit their family in the privacy of their own bedroom, in one of the lounges or the dining room. The menu was displayed on the board in the hallway. The menus reflected peoples’ personal choices. Special diets were catered for such as diabetic and low fat meals. The main meal of the day was observed being served and it was hot, appetising and well presented. The inspector tasted this meal of fish, new potatoes, peas and parsley sauce, which was well cooked and served hot. An alternative was available. During the meal it was observed that staff assisted residents as necessary in a friendly and unobtrusive manner. After the meal residents said that “the meal was lovely” and that “you wouldn’t get better anywhere else”. Fridge, freezer and hot food temperatures were recorded and seen by the inspector. The kitchen was maintained in a clean and tidy condition. Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Residents and relatives were satisfied with the support they received from the manager and staff. EVIDENCE: The policy on complaints was seen and included timescales for any complaint made and information about whom else could be contacted for example the Commission for Social Care Inspection. All relevant paperwork was available if a complaint is received. The Commission received a complaint about the home on 3rd March 2005 and this remains unresolved. Residents and relatives confirmed that they were aware of the complaints procedure and to whom they would direct their complaint. Residents and relatives were confident that any complaint would be dealt with swiftly. One relative also said “he has never made a complaint as this is a very good home”. Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 The home provides a clean and comfortable environment for the people to live in. EVIDENCE: The home was furnished in a domestic style with additional equipment such as grab rails, raised toilet seats and hoists provided as necessary to meet the residents’ needs. An acceptable standard of décor was evident throughout. One bedroom had been recently redecorated and new en-suite fitted. The bedrooms were all light and airy and had personal possessions and mementos belonging to the residents. The radiators that residents might come into contact with did not have low surface temperatures or had not been provided with protective guards. (See requirement No 6). The heating and lighting was sufficient throughout the home. The grounds were well maintained and extensive. They were secure and plants in hanging baskets were placed around the seating areas. Residents Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 Page 16 said that it was nice to sit out in the good weather and staff confirmed that the seating area was used in the better weather. The home was clean, tidy and free from any unpleasant smells. The home had a separate laundry room, which was clean and tidy. Cleaning materials were stored appropriately and basic information on hazardous materials was kept and accessible to the staff. Staff stated they were aware of this file and that chemicals must not be mixed with other chemicals. Random samples of hot water temperatures were taken in residents’ bedrooms. These were well above 43 degrees centigrade, which is the agreed acceptable guideline. The recorded temperatures were between 53 – 56 degrees. The deputy manager said this had been risk assessed and hot water notices had been provided by every hot water tap. It was also said that residents were able to identify when water was too hot for them. It is recommended that this be risk assessed and appropriate documentation kept in each residents care plan. As this is a risk to residents safety, the home should be taking steps to reduce the water temperature to a safe level. (See requirement No 8). Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 The manager provided clear leadership. Care plans were not well maintained. Other records were maintained in a satisfactory manner. Staff received support to enable them to meet residents’ needs. EVIDENCE: At the time of this inspection the agreed staffing levels were met. A recorded staff rota confirmed this. The owner, registered manager, cook, domestic staff, laundry staff and maintenance people support the care staff in the care of the residents. The staff team was well established and the team had a range of life experiences and training. The deputy manager said three care staff had obtained NVQ level II in care and that two staff were currently undertaking NVQ level II in care. A recommendation was made regarding 50 of staff obtaining NVQ level II in care. (See recommendation No 10). Staff on duty confirmed they had completed NVQ training in care and an induction process within the home. Relatives spoken to said the staff worked in a caring manner. Residents and relatives confirmed that the care given was very good and that “the staff approach was excellent”. Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 Page 18 It has been detailed previously in this report that care plans were not well maintained. Daily records about residents were well written and accurate. Policies and procedures seen were appropriate to the home. The deputy manager said that staff files were now up to date following a requirement in the previous inspection report. However, documentary evidence to support this was not available at this time. The deputy manager said that an induction programme was used at the home. Staff confirmed that they had undertaken an induction process. This should be reviewed in line with the specification from Skills for Care, which was formally the TOPPS organisation. (See recommendation No 11). Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36 & 37 The manager is competent, experienced and able to meet the homes stated purpose aims and objectives. Staff received support to enable them to meet residents’ needs. EVIDENCE: The manager had the In-service Course in Social Care (ICSC) and NVQ level III D32 Assessors Award. It is recommended that the manager undertake NVQ level IV in Care and Management. (See recommendation No 12). The deputy manager said that the manager was considering the Registered Managers Award. All policies and procedures seen were up to date and accurate. These were kept secure within the home. Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 Page 20 Residents and relatives said that they felt the home was well run and that the manager and staff were very welcoming and friendly. This was confirmed during the inspection. Relatives said that the staff worked in a very friendly manner. Observed day-to-day supervision of staff was good and the staff team confirmed they were supported by the manager and the senior staff in their delivery of care to residents. The staff said that formal supervision was conducted on a regular basis and records were kept. Supervision records were kept in a locked cupboard with staff files, in the office. Access to this was not available at this inspection because the manager was not on duty and she was the only person with keys to this cupboard. Fire alarm tests were being undertaken on a weekly basis and records kept. Emergency lighting tests were also being carried out on a monthly basis with records kept. However, the fire risk assessment was only partially completed and staff had not received training in fire awareness. In the Statement of Purpose and Function it states that fire awareness training for staff will be undertaken every six months. (See requirement No 7). Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 2 x x 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 x 15 3 COMPLAINTS AND PROTECTION 3 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 Standard No 16 17 18 Score 3 x x 3 x x x x 3 2 x Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 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 3 Regulation 14 Requirement Timescale for action 30.08.05 2. 7 15 3. 7 13 4. 8 12 The registered person must produce a pre assessment document to show the home can meet residents’ needs. Also other professional information must be obtained. (Outstanding requirement timescale of 31.12.04 was not met). The registered person must 30.08.05 ensure that full information is avialalbe to the staff team with regard to residents care needs, which must be completed with residents input and they must have the opportunity to sign the care plan. (Outstanding requirment timescale of 31.1.05 was not met). The registered person must 30.08.05 ensure that risk assessments are carried out and documented with regard to falls, moving and handling and any other percieved risk. (Outstanding requirment timescale of 31.1.05 was not met). The registered person must 30.08.05 ensure that a record is kept of all F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 Hartford Hey Page 23 5. 9 13 6. 26 13 7. 37 23 8. 26 13 visits made by and to other professionals. The registered person must ensure that controlled drugs are stored in line with current regulations. The registered person must ensure that risk assesments of the radiators that residents. might come into contact are undertaken and if required are fitted with protective guards. The registered person must undertake a full fire risk assessment and provide six monlthly training in fire awareness for staff members in line with the Statement of Purpose and Function. the registered person must take steps to reduce the temperature of the water to acceptable levels to prevent the risk of accidents to serivce users. 30.08.05 30.08.05 30.08.05 30.08.05 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. Refer to Standard 1 Good Practice Recommendations The registered person should ensure that a full copy of the latest inspection report be made available to residents, relatives and other interested people. appropriate wording in the service users guide used to reflect this. The registered person should ensure that in the statement of purpose the category of the home needs amending and details of the Commission for Social Care Inspection should replace the National Care Standards Commission details. The registered person should ensure that details are kept of residents wishes with regard to dying and death. The registered person should ensure that details are kept of residents weights. The registered person should ensure that controlled drugs are signed and witnessed by two members of staff. F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 Page 24 2. 1 3. 4. 5. 7 7 9 Hartford Hey 6. 7. 9 9 8. 9. 10. 11. 12. 9 The registered person should ensure that a more up to date copy of the British National Formulary be obtained. The registered person should ensure obtain a copy of the Royal Pharmaceutical Society book entitled “ The Administration and Control of Medicines in Care Homes and Children’s Services”. The registered person should ensure that staff that administer medication recieve certificated training in the safe handling and administration of medication. The registered person should ensure that 50 of care staff obtain NVQ level II in care. The registered person should ensure that the induction programme is reviewed in line with the specification from Skills for Care which was formally the TOPPS organisation. The registered person should ensure that a plan is produced to show how the registered manager will obtain NVQ level IV in Care and Management. 28 30 31 Hartford Hey F51 F01 S6593 Hartford Hey V235056 010705 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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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