CARE HOMES FOR OLDER PEOPLE
Highbury House Nursing Home Steyning Road Rottingdean Brighton East Sussex BN2 7GA Lead Inspector
Elizabeth Dudley Key Unannounced Inspection 21st September 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Highbury House Nursing Home Address Steyning Road Rottingdean Brighton East Sussex BN2 7GA 01273-309447 01273 307527 naomi.highbury@virgin.net Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Zeenat Nanji Tasneem Osman Benitha Siziba Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Service users should be aged sixty-five (65) years or over on admission The service can provide up to thirty (30) nursing places and twelve (12) personal care places The maximum number of service users to be accommodated is thirty (30) That no more than four (4) service users who are terminally ill can be resident in the home at any one time. This is to include service users who are already resident within the home and become terminally ill 13th June 2006 Date of last inspection Brief Description of the Service: Highbury House provides accommodation with nursing for up to 30 older people, it may also accommodate 12 older people who need only personal care and assistance. The Primary Care Trust has a contract with the home to provide continuing care. Situated in Rottingdean, all rooms have pleasant views, some with a sea view and there are well-maintained gardens which are accessible to service users who use wheelchairs. Highbury House provides a pleasant environment and one which service users are encouraged to treat as home’. Public transport passes within walking distance of the home and there is restricted parking in the area of the home, however unrestricted parking is available in roads around the home. The South East Registration Team is currently looking at conditions imposed on the certificates of registration in care homes as part of the Modernising Registration Agenda; therefore the conditions of registration may be changed or reduced in the future. Then fees currently charged are in a range of £450-£700 depending on both the residents’ needs and the room to be occupied. There are charges for extra services such as hairdressing, chiropody, toiletries and newspapers. Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on the 21st September 2007 over a period of seven hours and was facilitated by the owner and the deputy manager. Prior to the inspection ten questionnaires had been sent out to residents at the home, ten to visitors and two to health care professionals. Six relatives or representatives of residents, five residents and one health care professional responded. Comments made were generally good, one comment card said that although communication about major issues was good, minor issues were not always discussed until broached by the visitor, whilst another stated that the ‘staff are always helpful, menus look varied and interesting and we enjoy the activities and outings’. During the inspection a tour of the home took place, staff, visitors and residents were spoken with and a selection of documentation which included care plans and medication charts, staff recruitment files and training records, and health and safety documentation was examined. What the service does well:
The home provides nursing and personal care for up to 30 older people, there is a contract with the Primary Care Trust to provide continuing care to those people who are requiring end of life care and have other complex nursing needs but the home is also admits residents from the general community who require nursing or personal care. In order to meet the varying needs of the residents the management of the home ensures that staff receive a sound knowledge and clinical practice base through regular training and updating on existing experience and skills. Some registered nurses have completed the Liverpool care pathway training (A tool which ensures that terminally ill residents are kept free from pain as soon as this becomes necessary) and the Gold Standards Framework (a framework which aims for excellence in terminal care) and care assistants are being trained in this by the registered nurses. Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 6 The views of residents and relatives are gained by the provider meeting with them and holding meetings on an eight to ten week frequency, and these are followed by staff meetings in order that the staff can be apprised of any changes that may occur as a result of comments made. The provider stated that joint meetings are held at times to enable residents and their visitors to discuss matters with the staff. Questionnaires relevant to different areas of service in the home are sent out on a three monthly basis and responses inform the service offered. The Annual Quality Assurance Assessment which is an overview of the home required by the CSCI from the manager, was returned by the required time, and had been completed to a high standard, enabling the CSCI to gain an accurate view of what was happening in the home and any constraints to the plans and improvements that the manager is trying to achieve. Health and social care professionals have made positive comments about the home over the past year and there was evidence in the home that they are called in to give help and advice as required. A varied programme of activities is in place, which includes outings and functions in the home, and on the day of the inspection residents were very enthusiastic over activities taking place in the lounge. The home does not employ an activities person but the ratio of staff on duty, to the amount of residents, allows some staff to initiate the activities in the afternoons. Residents who preferred to stay in their rooms said that ‘ staff come in and talk to me’, ‘ staff are really friendly and you don’t feel on your own’. The home has had fourteen concerns since the last inspection and these were all relatively minor issues, the complaints record showed that the provider has responded in writing to all of these and has monitored the issues to ensure that there is no repetition. Residents and visitors spoken with said that they were comfortable with raising a concern, as they knew they would be addressed in a professional and thorough manner. What has improved since the last inspection?
At the previous inspection staff and residents raised concerns regarding the presentation and variety of food, especially where this concerned residents who were on special diets, and the owner stated that this would be addressed. Staff stated that much improvement had taken place and generally this was maintained. Cleanliness in the home has improved with all areas looking very clean and tidy. Redecoration in some resident’s accommodation has taken place, and the front garden has been redesigned and provides wheelchair access. The manager has addressed the duty rota to ensure that a senior care assistant is always on duty with the registered nurse after four in the afternoon, this was in response to comments raised at the last inspection
Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 7 where visitors and some residents said that there was a lack of supervision of staff in the late afternoon. The kitchen has been awarded four stars by the Environmental Health Authority. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6 People who use the service experience good quality outcomes in this area Residents are admitted to the home following assessment by a qualified person to ensure that the home can meet their needs and expectations. Sufficient information is provided by the home to enable the resident to determine whether they wish to live at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose and service user guide are available for all residents and visitors to the home, this has been reviewed recently and meets the regulations. All service users have a copy of the service user guide. The home is in the process of compiling a new service user guide and statement of purpose.
Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 10 Each resident or their representative receive a copy of the terms and conditions which includes all the information as required by the National Minimum Standards. Comprehensive assessments are usually undertaken by the manager, or a registered nurse, to determine whether the home can meet the prospective residents expectations and needs. The majority of the preadmission assessments were thorough and identified all the health, personal, psychological and social needs of the resident and were in sufficient depth to form the basis of the care plan. Discussions were held with the provider regarding one assessment, which had not been carried out by a registered nurse, and the implications of this assessment, which lacked sufficient information to inform the care planning process or to inform the admitting staff of important elements of care required on admission. The provider has given assurances that this will not reoccur. The manager should ensure that following assessment the prospective resident is informed in writing about whether the home can meet their needs and can offer them a place. The provider stated that this will be done in the future. Residents or their representatives can visit the home prior to admission and a four-week trial period is in operation. The home also admits residents under the continuing care programme and has completed appropriate training to ensure that the complex needs of these residents can be met. Residents are admitted for respite care but not for intermediate care. Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 People who use the service experience excellent quality outcomes in this area. Care plans give clear instructions for care to be given to meet the assessed needs of the residents; they are regularly reviewed and offer a person centred approach to the care. Practices in administration of medication fully safeguard the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection six (20 ) of the care plans were examined. These showed evidence of person centred care planning which addressed the health, personal, psychological and social needs of the resident and identified the actions to be taken to meet these needs. They had been reviewed regularly and in the most part formed in consultation with the resident.
Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 12 The home accesses the relevant specialist health care professionals and ensures that registered nurses update their practice knowledge on a regular basis. Registered nurses and care assistants were well informed about the care that was required for individual residents in the home. Pressure relieving equipment is provided and the wound care nurse accessed as required. One care plan did not identify when treatment was concluded and this was discussed with the registered nurse. Residents spoken with, comment cards received and observations at inspection, showed that residents were treated with respect, dignity and as individuals. It was seen that the administration, recording and auditing of medications met the National Minimum Standards and associated regulations and safeguarded the residents. The home has just obtained a home office licence relevant to the controlled drugs that are required routinely in the care of the terminally ill resident under the Liverpool Care pathway. The home admits residents under the continuing care programme and by the nature of this, accepts residents with complex needs and who are at the end of their life. Staff receive on going training to enable them to care for these residents and letters were seen in the home thanking staff for their care. The manager has completed the study for the ‘Gold Standards Framework’ and ‘Liverpool care pathway’, both of these tools are benchmarks of good practice in promoting pain control and care of the resident who has a terminal condition. Other registered nurses in the home are either undertaking this course of study or have completed it and are training the care staff in giving the appropriate care. Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15. People who use the service experience good quality outcomes in this area. Residents are able to make choices in how they wish to spend their day and there are opportunities for participation in activities and outings. A choice of menu ensures that residents benefit from a nutritious and varied diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents were seen being very enthusiastic over a horse racing game in the lounge and there is an activities programme in place, which is displayed in the lounge. This includes outings and activities taking place within the home, visitors and residents spoke of how much they enjoyed the activities and outings, those residents who remain in their rooms say that staff come in and talk to them when they have time. The community care bus is hired on a regular basis to ensure as many residents as possible are able to go on the outings.
Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 14 The residents spoken with said that they had choice in the times they went to bed and woke in the morning and in other activities of daily living, and this was evidenced in the care plans. Ministers of religion visit the home and there is an open visiting policy. Visitors spoken with, said that the care was good and that they were very satisfied both with the care and were made aware of any concerns. One comment card from visitors said that communication over small matters could be improved. Staff and residents said that the standard of meals are much improved and that choices are available to those who have pureed meals. Three choices of meals were available and three choices of dessert. The food appeared appetising and residents said that they were enjoying the food provided. Comments from residents about the food were: ‘the food is lovely and plenty of it. I think I’ve put on lots of weight’, ‘Lovely here, food smashing.’ ‘Food all right most of the time’. Residents can have snacks or hot drinks when they wish and meals are served in a pleasant dining room. Care staff were seen assisting residents in an empathetic and relaxed manner and engaging them in conversation Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area Residents and visitors to the home are able to take their complaints to the management and be sure that they are dealt with in a transparent and professional manner. Staff are aware of their responsibilities in safeguarding residents in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints policy accessible to both visitors and residents. There have been 14 complaints over the past year of which all have been wholly or partially substantiated. These were all relatively minor complaints around domestic matters in the home. These complaints were all substantiated or partially substantiated by the provider and responded to in writing. The provider states that she encourages complaints and prefers them to come to her so that she is aware of, and can deal with them. There have been no adult protection issues in the home and all staff have received training in the safeguarding of the residents in the home. Residents spoken with said that they often see the owner and know that any complaints they may have, will be dealt with in a thorough and professional manner by both provider and manager.
Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 16 Residents and visitors spoken with said that they were comfortable in taking complaints to the provider or manager and knew that these would be dealt with in a professional manner. Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 21,22,23,24,25,26 People who use the service experience good quality outcomes in this area. Residents benefit from a homely, clean and well maintained home. A large garden, which is laid out with variety of plants and bird tables placed in areas, which can be viewed from the residents’ windows, add to residents’ enjoyment of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Redecoration has taken place in many areas in the home and new curtains and carpets in several rooms in the home, the front garden has been redesigned and the back garden is well maintained with bird feeders and small patio areas throughout. There are plans to make a large patio to make it easier for
Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 18 residents to enjoy the garden. Communal indoor space consists of a large lounge, a small quiet seating area and a dining room. Resident’s accommodation is comfortable and homely and residents are encouraged to bring in their own personal possessions. Rooms have lockable doors and residents are given a key if they would prefer to have one providing their risk assessments show that they are able. Lockable drawers are provided for personal possessions. Rooms above ground floor have window restrictors and there was evidence of radiator guards and the maintenance person carries out regular monitoring of the hot water delivered to residents’ outlets. Records showed that these were within recommended parameters. With the exception of one room, resident’s rooms have an ensuite facility consisting of a washbasin and wc. Bathrooms throughout the home are clean and general bathrooms have assisted bathing facilities with one assisted shower room. The home is clean and free from odours and the kitchen has received four stars from environmental health. Staff undertaken infection control training and policies relating to this are in place. Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People who use the service experience good quality outcomes in this area. Staff are employed in sufficient numbers to ensure the care and expectations of the residents are met. The home invests in the training of staff to enable them to meet the complex needs of the residents admitted to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rota and conversations with staff showed that there are sufficient staff to meet the needs of the residents, with staff saying that extra staff are brought in if the dependency of the residents require this. Concerns previously voiced about lack of supervision of staff after 4pm by some relatives of residents have been addressed by the inclusion of senior care staff on this shift. Care staff are supported by catering, ancillary, maintenance and administrative staff.
Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 20 Twenty members of staff (54 ) have the National Vocational Qualification level 2 or 3 in care, with a further six members of staff in the process of undertaking this. Staff receive a recognised induction training on commencement of duties, this is either the recognised induction training which forms the first part of the National Vocational Qualification in care, of if they have already gained this qualification then the home’s own induction package is undertaken. Registered nurses undertake a local induction. The staff receive additional training which includes mandatory training, courses relevant to the care of the residents, including extended practice such as venepuncture for the registered nurses and continuing training on the Liverpool care pathway and gold standards framework. A robust recruitment system is in place and the four personnel files examined included all documentation as required by the regulations. Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36,37 People who use the service experience excellent quality outcomes in this area Residents, relatives and staff views are obtained at regular intervals and used to inform the service offered by the home to ensure that it meets residents’ expectations. Residents and staff are safeguarded by continuous attention to health and safety and staff training throughout the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is a registered nurse (level 1) and has the Registered Managers Award and is registered with the CSCI. She has managed the home for two years and previously worked as a registered nurse in the home. A deputy manager and administrator support her.
Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 22 The ethos in the home is good; relative and residents meetings take place every eight to ten weeks and staff meetings within the same timescales. Minutes of these meetings were seen and it was evident that the manager and provider encourage staff and residents to make their views known and act upon them. Questionnaires, usually based on specific topics in the home such as catering, are sent to relatives and residents at three monthly intervals and the home has a ‘ service user representative’ who is a relative of a resident and she makes any concerns that residents or relatives express known to the provider. The Annual Quality Assurance Assessment required by the CSCI on an annual basis which indicates to the CSCI what is occurring in the home, the plans for the home and what the manager sees as improvement or barriers to improvement, was informative and gave a clear and accurate picture of what was happening in the home. The home does not act as appointee for any resident but has personal money for safekeeping, records were seen to be accurate and in order. The home has a business plan and this was seen at the inspection, public liability insurance is in place. Staff receive supervision at intervals directed by the National Minimum Standards and monthly visits by the provider take place and were seen at the inspection. The Annual Quality Assurance Assessment stated that regular servicing of utilities and equipment has taken place. All staff have received the necessary fire, manual handling and those that require it food hygiene training. Some staff have had first aid training. There is a fire risk assessment in place and doors have self-closures, which are activated by the fire alarm Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 4 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 x 18 3 3 3 3 3 x 3 3 3 STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 4 3 3 3 3 3 Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Highbury House Nursing Home DS0000013999.V348145.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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