Inspection on 04/05/05 for Heyhead House

This inspection was carried out on 4th May 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

Heyhead House 04/10/06

Heyhead House 07/02/06

Heyhead House 16/12/04

Heyhead House 25/05/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Heyhead House 1 Trinity Close Brierfield Lancs BB9 5ED Lead Inspector Julie Playfer Unannounced 4 May 2005 9.15 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. Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Heyhead House Address 1 Trinity Close Brierfield Lancs BB9 5ED 01282 617902 01282 690649 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) Mr Shaun Martin Brelsford Mrs Amanda Jane Brelsford Care Home 8 LD Category(ies) of Learning Disability registration, with number of places Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is staffed in accordance with the below and a maximum of one wheelchair user to be accommodated. Waking Day 7.30 am - 10.00 pm Care Staff - 2 staff 8.00 am - 9.30 am 1 staff 9.30 am - 4.00 pm 2 staff 4.00 pm - 10 pm At weekends or whenevery there are more than 6 service users at home 2 care staff should be on duty at all times. Night time - Care staff 2 staff sleeping in Date of last inspection 16 December 2004 Brief Description of the Service: Heyhead House is registered with Commission for Social Care Inspection to provide accommodation and personal care for eight adults (aged 18-65 years) with a Learning Disability. The home is a purpose built single storey building, providing accommodation in eight single rooms, two of which have an ensuite facility, comprising of a toilet and hand wash basin. The shared space is provided in a lounge and dining room. The home is located approximatley half a mile from Brierfield town centre. There is a garden and patio area surrounding the property and small car park at the front of the building. The staffing levels form part of the conditions of registration. Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first unannounced inspection of 2005 and took place over one day. At the time there were 8 residents living in the home. The inspector met 6 of the people living in the house, spoke to the owner (registered person) and staff on duty, looked at written information including records and had a tour of the premises. What the service does well: What has improved since the last inspection? Since the last inspection the registered person had provided the residents with information (as part of the service users guide) about advocacy schemes in the area. The registered person had also updated the procedure used to employ staff to include new aspects of the law. Staff had received training to ensure residents were protected from bad working practices and training on Equal Opportunities and Disability Awareness. Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 Stage 4.doc Version 1.30 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. Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 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 Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 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 - 5 The admission procedure was well managed and ensured a proper assessment of needs had been carried out and that any new residents had the opportunity to experience life in the home. The written contract clearly set out the terms and conditions of living in the home. Improvements need to be made to the presentation of the service users guide to ensure it is readily understood by the residents and they have an awareness of the services and facilities available in the home. EVIDENCE: Written information about the home in the form of a statement of purpose and service users guide was available for service users. The service users guide had been distributed to all residents. However, one resident spoken to found the guide confusing and could not recall the staff explaining the document. One resident had been admitted to the home since the last inspection, it was evident from the case file that this person’s needs had been assessed by a social worker and the registered person had a copy of the assessment. Following admission further assessments had been carried out. Written documentation indicated the new resident visited the home for a series of introductory visits prior to moving into the home, which included an overnight stay. All residents had been issued with a written contract/statement of terms and conditions, which had been appended to their service users guide. Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 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) 6-9 There was no clear care planning system in place to adequately provide staff with the detailed information they need to ensure all the residents needs are met. Without clearly documented risk management strategies, the residents continued to be at risk and there was the potential for an inconsistent response to the identified hazards. Relationships within the home were good and residents were able to participate in all aspects of life in the home. EVIDENCE: The residents had an individual plan on their case file. However, the plans did not reflect all the residents assessed needs in terms of their health and welfare and therefore did not incorporate clear instructions to staff on how these needs were to be met. The daily care files contained out of date information, which was confusing. One staff member spoken to was unable to locate the current care plan in the file for one service user, due to the amount of information present in the file. Later discussion with staff suggested that needs were being addressed even though the care plans lacked detail. This approach is dependent on staff memory and good verbal communication systems. Residents are at risk of not having their needs met if such systems break down. Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 Stage 4.doc Version 1.30 Page 10 Risks had been identified and assessed, however, the assessments did not incorporate risk management strategies and hence there was no evidence to demonstrate action had been taken to minimise risk to residents. During discussion with residents, they confirmed they were consulted and were able to participate in life in the home. As such the residents contributed to general household tasks, which included cooking and cleaning. A rota of “jobs” for instance washing up, was displayed in the kitchen to ensure the distribution of tasks was equitable. Residents were supported to manage their finances and all received their personal allowance and Disability Living Allowance. One resident spoke about using the local shop to buy magazines and items of her choice. Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 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 -17 Residents were provided with good opportunities to engage in a wide range of appropriate activities and were supported to use community facilities. The residents maintained strong links with their families and enjoyed positive relationships within the home. Arrangements were in place to ensure the residents participated in the life of the home and their rights were respected. EVIDENCE: The residents spoken to said they enjoyed attending college and found their courses interesting. The residents attended different courses in line with their interests, which gave them the opportunity to meet people outside the home environment. The residents also enjoyed using leisure facilities in the local area, which included the pub, cinema and restaurants. One resident spoke about going to a nearby church and one resident reported she liked to go into Burnley town centre to shop for clothes. Families and friends were able to visit the home at any time and some residents enjoyed regular visits to their parent’s house. These relationships Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 Stage 4.doc Version 1.30 Page 12 were supported by the registered person and staff and transport was provided as necessary, in order to facilitate the visits. The residents said the routines in the house were flexible and were designed around their arrangements for the day. As such, there were different routines at the weekend. The menu was compiled on a weekly basis and residents were able to contribute to this process. There was a choice of meal and residents were able to participate in the preparing, cooking and serving of food. Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 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 - 20 The residents’ healthcare and emotional needs were not detailed in their care plans; such shortfalls could therefore result in the residents’ needs not being met. Since the residents were not aware of their care plan, it was not evident that personal support was delivered in a way which they preferred and required. To safeguard the residents some practices and record keeping in respect to medication must be improved. EVIDENCE: Care records demonstrated that residents received appropriate personal support. However, there was no written evidence to indicate the residents had participated in the care planning process and when asked the residents couldn’t recall discussing their care plan with their keyworker. The care plans lacked detail and did not reflect all assessed needs. It was therefore not possible to ascertain whether the residents’ emotional health needs had been addressed and were being met. Appropriate policies and procedures were in place to manage medication in the home. However, it was evident that the medication administration record of some residents did not correspond exactly to the prescription label and there was an instance where staff were not administering medication in line with the prescriber’s instructions. There was also no record of the receipt of medication into the home. Staff training in respect of medication was mostly informal in Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 Stage 4.doc Version 1.30 Page 14 house training and was therefore not accredited. Some staff had completed a course with a local pharmacist, however, there was no evidence to indicate this training was accredited. Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 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) 22 and 23 Systems were in place to ensure residents were listened to and any concerns were acted upon. Appropriate policies and procedures and staff training were in place to respond to any allegations or suspicions of abuse. EVIDENCE: The complaints procedure was included in the service users guide and was displayed in the hallway. A pictorial version of the procedure was also available. The registered person had received two complaints since the last inspection. Both complaints had been investigated and resolved. A record had been kept of the complaints, the investigation and the outcomes. However, given the nature of the complaints, the registered person should have informed the Commission of the concerns raised and the action taken in response to the complaints. Residents were listened to and consulted as part of daily practice and regular resident meetings were held in the home. From examination of the minutes it was evident that a wide variety of topics were discussed including forthcoming holidays and activities. There was an appropriate procedure for responding to any suspicions or allegations of abuse. Staff had also received in-house training on the protection of vulnerable adults, which included a video and questionnaire. Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 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- 30 The residents were able to personalise their bedrooms and create an individual space suitable for their needs. Improvements must be made in certain areas of the home to ensure the residents live in a homely, comfortable and safe environment. EVIDENCE: Heyhead House is a purpose built property, providing accommodation for eight residents. All bedrooms are single occupancy. Communal space is provided in a lounge and dining room. There is also space in the kitchen to eat meals. There are the necessary number of toilets and bathrooms and one assisted shower. The bedrooms are all at ground floor level have been decorated according to the personal preferences of the residents. One resident said she had chosen the colours used to decorate the room. Access for one resident who uses a wheelchair is provided by a ramp to the front door. A number of areas require attention. These include the garden, which was very overgrown at the time of the inspection; noticeable cracks around the door Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 Stage 4.doc Version 1.30 Page 17 frames in some of the rooms and general decoration in some of the bedrooms. In addition the fabric on the lounge suite is badly worn in several places and the foam was clearly visible. The condition of the suite could therefore present a significant hazard in the event of fire. There is insufficient seating in the main living room. The registered persons should investigate ways this situation can be improved, to ensure the space is welcoming and comfortable for all residents who wish to sit in the lounge. The two pieces of wood secured in the corridor outside the shower room present a tripping hazard to residents. Also one of the screws was protruding from the surface and was a risk to a resident who walks down the corridor in bare feet. Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 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 -36 The procedures for the recruitment of staff were not robust and must be improved to ensure protection for the people living in the home. Satisfactory arrangements are in place for the induction of staff. However, the systems in place to supervise the staff should be improved to ensure the staff are well supported. EVIDENCE: Since the previous inspection four new members of staff have commenced work in the home. The staff had completed an application form and had attended an interview with the registered person. Appropriate police checks had been carried out. However, there were shortfalls identified in the recruitment procedure, which included gaps in employment histories, one reference received after the person started work in the home and missing documentary evidence of qualifications. Staff had been issued with a job description and contracts of employment following a probationary period of six months. Staff had a good understanding of their roles. There was evidence on the staff files to indicate staff had completed an in house induction and “Skills for Care” (formerly TOPSS) induction within six weeks of employment. Staff had been supplied with a staff handbook, Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 Stage 4.doc Version 1.30 Page 19 containing pertinent policies and procedures. A training and development plan and individual training assessments and profiles were seen. At the time of the inspection 3 members of staff had completed NVQ level 2. The staff received supervision, but had not had six supervision sessions in the last year. Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 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- 43 With the lack of quality monitoring systems it is not possible for the service to demonstrate it is meeting the needs of the service users. Staff enjoyed positive relationships with the residents and the home had a friendly atmosphere. EVIDENCE: The registered provider undertakes day to day management of the home. The registered provider has significant experience of running a home and has the relevant qualifications. There were systems in place to brief staff, including staff meetings. There had been two staff meetings during 2005. Relationships within the home were positive and the staff spoke about the residents with respect. The home had recently been reaccredited for the Investors in People Award. Whilst the registered person maintained an audit of the care plans and the environment, an annual development plan based on continuous self monitoring Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 Stage 4.doc Version 1.30 Page 21 had not been developed. Satisfaction surveys had been distributed to residents and their relatives, however, the results of the questionnaires had not been collated or published. There was a full set of policies and procedures, which had been signed and dated by the registered person. Documentation was seen during the inspection in relation to health and safety and it was clear gas and electrical systems were serviced at regular intervals. To minimise the risk of scalding, the water system was fitted with a central lockable valve. There were individual preset valves fitted to baths. The registered person stated an assessment had been undertaken of all windows and reported window restrictors were not necessary. There was appropriate insurance cover in place against the loss or damage to the assets of the business and business interruption costs up to a minimum of £5 million. There was no financial plan available. Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 Stage 4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 3 1 3 1 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score 3 2 3 1 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Heyhead House Score 3 2 1 x Standard No 37 38 39 40 41 42 43 Score 3 3 1 3 2 3 2 F57 F07 S9634 Heyhead Hs V224825 4.5.05 Stage 4.doc Version 1.30 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 5 Requirement The presentation of the service users guide must be improved to ensure the information is readily accessible to residents. Following full consultation with the residents the registered person must ensure the care plans set out the residents needs in respect of their health and welfare and include details of how these needs will be met. The risk assessments must include the action to be taken in order to minimise the identified risk. A record of all medication received into the home must be maintained. Timescale for action 30th June 2005 30th June 2005 2. 6, 19 15 3. 9 13 15th June 2005 Immediate and ongoing from the date of inspection. Immediate and ongoing from the date of inspection. Immediate and ongoing from the Page 24 4. 20 13 5. 20 13 The medication administration record must be accurate and correspond exactly to the prescription label. All medication must be administered in line with the prescribers instructions. F57 F07 S9634 Heyhead Hs V224825 4.5.05 Stage 4.doc 6. 20 13 Heyhead House Version 1.30 7. 22 37 The Commission must be informed of any allegations of misconduct by a member of staff. The lounge suite must be recovered in a fabric which meets fire regulations or be replaced. Cracks in the plaster work around door frames must be repaired and bedrooms painted as necessary. The two pieces of wood must be removed from the corridor to minimise the risks to residents health and safety. The garden at the rear of the property must be appropriately maintained. Sufficient seating must be provided in the living room for all residents wishing to use this room. All records and documentation relating to the recruitment of new staff must be collated and maintained at all times. Staff must receive supervision six times a year. 8. 24 16 date of inspection. Immediate and ongoing from the date of inspection 30th June 2005 30th June 2005 Immediate 9. 26 23 10. 26 13 11. 12. 28 28 23 16 Immediate 30th June 2005 Immediate and ongoing from the date of inspection. Immediate and ongoing from the date of inspection. 31 July 2005 13. 34 18 14. 36 18 15. 39 24 There must be continuous selfmonitoring, using an objective, consistently obtained and reviewed verifiable method (preferably a professionally recognised quality assurance system) involving residents and an internal audit takes place annually. (Previous timescale of F57 F07 S9634 Heyhead Hs V224825 4.5.05 Stage 4.doc Heyhead House Version 1.30 Page 25 15 February 2005 - not met). 16. 39 24 An annual development plan must be produced, which is based on a systematic cycle of planning, action and review reflecting aims and outcomes for residents. All records must be maintained in line with the Care Home Regulations 2001. 31 July 2005 17. 41 17, 19 Immediate and ongoing from the date of inspection. 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. 3. 4. 5. 6. Refer to Standard 1 20 20 32 39 43 Good Practice Recommendations Residents should be given the opportunity to sign their care plan to indicate their agreement and participation. All staff medication training should be accredited. All transcribing from prescription labels to the medication administration record should be signed and witnessed by two members of staff. 50 of the care staff should achieve a National Vocational Qualification level 2 in care by 2005. The results from satisfaction surveys should be collated and published and made available to the residents, their representatives and other interested parties. The registered person should devise a financial plan. Heyhead House F57 F07 S9634 Heyhead Hs V224825 4.5.05 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection Unit 4 Petre Road Clayton-le-Moors Accrington BB5 5JB 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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