CARE HOME ADULTS 18-65
Higher Morris Farm 595 Preston Road Clayton Le Woods Lancashire PR6 7EB Lead Inspector
Val Turley Unannounced Inspection 6th September 2006 09:30 Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Higher Morris Farm Address 595 Preston Road Clayton Le Woods Lancashire PR6 7EB 01772 324515 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) Progress Adult Services Limited Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The home is registered for a maximum of up to 5 service users to include: Up to 5 service users in the category LD (Learning Disability). The service should, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines, which may be issued through the Commission for Social Care Inspection. 23rd January 2006 Date of last inspection Brief Description of the Service: Higher Morris Farm is one of the three homes operated by Progress Adult Services Ltd, which is a company caring for young adults whose severe learning disabilities are compounded by severe challenging behaviour. The service aims to provide an individualised, integrated service within which, communication therapy and high quality care, combine to reduce challenging behaviour and reinforce and maintain positive changes. The home is a detached property with a large enclosed secure garden to the rear, and parking area to the front and side of the property. The home offers accommodation to five young adults who each have their own bedroom. There are two bedrooms located on the ground floor, which are adjacent to a bathroom. On the first floor there are three bedrooms with one service user having sole use of an adjacent bathroom. The remaining two rooms having access to a second bathroom also on the first floor. In addition, the home has three lounges over the two floors, a dining room, kitchen, and two staff offices/sleeping accommodation and bath/toilet facilities. The outbuildings provide an activity room for the use of one of the young adults and a laundry in another. Fees for the home range from £113,000 to £134,00 per year with additional charges for any extra staffing. Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The key inspection of a service takes place over a period of time and involves gathering and analysing written information. A site visit was also made to the home as part of the inspection process and this involved discussion, where possible, with young adults living at the home, discussion with and observation of the staff working there, an examination of records, policies and procedures and a tour of the premises. A questionnaire was completed by the acting manager prior to the site visit and comment cards had been completed and received from two parents and a GP. These all provided information that was included in the report. As part of the inspection, the inspector used “case tracking” as a means of assessing some of the National Minimum Standards. This process allowed the inspector to focus one of the young adults living at the home. Records relating to that individual were inspected. As the young adult had communication difficulties, discussion with him was not possible, but discussion did take place with the management team and the staff who supported the young adult. What the service does well:
The home provided a pleasant, clean, comfortable and homely environment for the young adults who lived there and the staff team who worked there. The home was well maintained and decorated. The homes pre-admission process is thorough and detailed and gives the prospective service user, their representative and the home an opportunity to determine whether a placement at the home is suitable or not. The care and support provided for the young adults is carefully planned and reviewed regularly to ensure that their needs are being met as appropriately as possible. Staff were provided with clear written guidance as to how they should support the young adults and discussion with them indicated that they were fully aware of their responsibilities. The home had links with the local advocacy agency, which was able to provide support as necessary. The young adults were supported to become involved in a range of community and home based activities. Both the homes own transport and public transport was utilised to enable the young adults to pursue their own interests and hobbies. The activities that the young people were involved in influenced the number of staff that were on duty at any one time to help ensure that any activities were undertaken safely and that the young adults were adequately supported. The home was very pro-active in supporting the young adults to maintain contact with their families and friends and the home was looking at how they could improve the contact they had with families to ensure that they were kept informed of the progress that the young adults made and the activities that they were involved in.
Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 6 The daily routines within the home were flexible and relaxed enabling the young adults to make their own choices and decisions as far as possible taking into account any limitations put in place through the risk assessment process. Staff were observed to speak appropriately with the young adults and to included them in conversation. Wherever possible the young adults were encouraged and supported to become involved in household tasks and duties especially in relation to their own bedrooms. The home catered for specific diets and the individual likes and dislikes of each of the young adults. Eating arrangements were flexible to meet the needs of the service users. The individual health needs of each of the service users had been identified and the home ensured that their health needs were met. The home had a good working relationship with health professionals. Medication was managed well and the home were actively working to review their management of medication and to make improvements if necessary. The homes policies and procedures relating to the Protection of Vulnerable Adults had recently been updated and these contained all of the necessary detail. Training in this area had been provided for the majority of staff. The homes complaints procedure was clear and parents reported that they knew how to make a complaint. One of the young adults was also aware of how to do this. The young adults monies were managed appropriately with the home about to implement new procedures with a view to minimising the possibilities of any errors being made in respect of its management. The staff working at the home had the skills and knowledge to provided an appropriate service for the young adults living there. There were a range of training opportunities on offer and the staff were supported to take advantage of these. The recruitment process was thorough and ensured that the necessary checks were undertaken prior to the member of staff starting work in the home. The staff team were very supportive of each other. The home had a number of quality assurance checks in place to help ensure that the home was run appropriately and efficiently. All of its policies and procedures had recently been reviewed and updated. Its equipment and systems were appropriately maintained and serviced. What has improved since the last inspection? Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 7 The home had improved upon its recruitment procedures and had ensured that it had undertaken all of the necessary checks prior to the member of staff commencing work in the home. The acting manager had submitted an application to the Commission for Social Care Inspection to become the registered manager. The home had involved the services of a company providing psychological guidance and support to work with the company to ensure that strategies implemented to manage challenging behaviour are appropriate. 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. Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 9 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 the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre-admission process was in sufficient detail to ensure that prospective young adults supports needs are fully assessed before admission. EVIDENCE: There had been no new admissions since the previous inspection. Evidence from previous inspections have indicated that the pre-admission process is thorough and detailed and gives the prospective service user, their representative and the home an opportunity to determine whether a placement at the home is suitable or not. Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 10 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 the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a positive and effective approach to meeting the individual support needs of the young adults. EVIDENCE: The care and support provided for one of the young adults was tracked. The care plan gave detailed information regarding the young adults support needs and provided staff with guidance as to how the support should be provided. It included details regarding communication strategies, the management of risk and challenging behaviour, family contact details, and personal care and emotional support needs. The plan was regularly reviewed with care planning meetings being held monthly. The home had contact with the local advocacy service and one of their representatives was able to provide input into the care planning process when necessary. A formal review of the care plan had recently taken place. The plan included details of how best to support the young adult to make decisions as well as any restrictions that needed to be implemented in order to avoid self-harm and harm to others. Discussion with support staff and the management team indicated the staff team as a whole were very much aware
Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 11 of the needs of the young adult and that the care and support they provided corresponded to that identified within the care plan. The home was in the early stages of implementing person centred planning with the young adults who lived at the home. It was anticipated that this would help to identify with greater certainty and in more detail the preferred routines and most successful strategies for supporting each of the young adults and would enable the staff team to provide the most appropriate care and support. Discussion with one of the young adults confirmed that the staff team had a good knowledge of their individual support needs and that their individual needs were being met. It was recommended that the home research the possibility of the young adults participating in a local independent self-advocacy group, where this is appropriate. Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The support staff encouraged the young adults to make decisions and choices in their daily lives and supported them in these, taking into account any health and safety issues. EVIDENCE: The care of one of the young adults was tracked. The care plan, daily record sheets and discussion with members of staff confirmed that they were encouraged and supported to get involved in a range of activities that were enjoyed by and benefited the young adult. These activities included attendance at college, shopping, cooking, walking, visits to the gym as well a having time to relax and spend time alone. The staff team were also planning ahead and researching the possibility of appropriate work experience placements. The home made good use of its own transport and of public transport to enable the young adults to pursue their own interests and hobbies. One of the young adults was able to talk about the activities he was supported to become involved in. His bedroom was decorated to reflect his interests and hobbies. Discussion with the staff at the home indicated that the activities that the young people were involved in, influenced the number of staff that were on
Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 13 duty at any one time to help ensure that any activities were undertaken safely and that the young adults were adequately supported. The home was very pro-active in supporting the young adults to maintain contact with their families and friends. Documentation, discussion with one of the young adults and with staff confirmed that the home worked hard to ensure that this contact was maintained appropriately. Information provided by families had indicated that there was a need to look at how they should be kept informed of the progress the young adults made and the activities they had participated in. The home was actively looking at the possibility of providing this information on a monthly basis for those families who wished to receive it. The daily routines within the home were flexible and relaxed enabling the young adults to make their own choices and decisions as far as possible taking into account any limitations put in place through the risk assessment process. Staff were observed to speak appropriately with the young adults and to included them in conversation. Wherever possible the young adults were encouraged and supported to become involved in household tasks and duties especially in relation to their own bedrooms. Each of the young adults in the home had their own specific needs, likes and dislikes in relation to food. The home had a four-week menu, which took these different needs into account. Specific diets were catered for and eating arrangements were flexible to meet the needs of the service users. Care plans and discussion with both staff and one of the service users indicated that these needs, likes and dislikes were acknowledged and respected. Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had procedures in place to assess the health needs of the young adults they supported and worked appropriately and sensitively to ensure that their health needs were met. EVIDENCE: The care plan examined contained specific details of the young adults preferred daily routines and personal care support needs. The information was comprehensive and discussion with support staff indicated that they were fully aware of these preferences and needs. The health needs of the young adult were identified within the care plan and again discussion with staff indicated that they were aware of these. The young adult had received an annual health check through the GP and there was evidence that support was provided to attend out patient appointments and other health appointments. The young adult had a health action plan in place and this together with their health file enabled staff to monitor their health needs easily. A comment card received from a GP indicated that the home a positive working relationship with the GP. Accredited training in the administration of medication was in the process of being provided. The intention was to review the homes procedures once this training had taken place and to make any improvements that were necessary. Procedures in the home were observed to be good and the home had a number
Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 15 of check and audits in place to help ensure that medication in the home was managed well. Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some improvements could be made to ensure that the service users were protected as far as possible specifically in relation to the management of some challenging behaviour. EVIDENCE: The home had recently updated all of its policies and procedures. The policies and procedures in relation to the Protection of Vulnerable Adults contained all of the necessary detail and the training matrix indicated that most staff had received training in this area. The policy dealing with complaints contained all of the necessary detail. Those parents who had completed comment cards stated that they knew how to make a complaint should they need to and one of the young adults reported that he knew how to make a complaint. The staff at the home had received training in the management of challenging behaviour and positive handling and there were clear guidelines in place for each of the young adults. These strategies must be agreed, if possible, by the company now providing psychological guidance and support. This involvement would help ensure that the approaches used are the most appropriate for the individual young adults. Some clarification was needed regarding the occasional use of one strategy, to manage challenging behaviour. It was agreed at the time of the site visit that this would be examined separately in greater detail to ensure that the strategy used was appropriate. The homes policy and procedure on the management of the young adults monies kept at the home was under review and new procedures were about to be implemented with a view to minimising the possibilities of any errors being made in respect of its management.
Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean and comfortable and provided a pleasant and safe environment for both the young adults and support staff. EVIDENCE: The home was clean, well decorated and homely, providing a pleasant and safe environment for both the young adults and the support staff. Any repairs and maintenance were attended to quickly by the company’s maintenance team. Since the previous inspection much of the home had been redecorated, a new kitchen had been installed and two WC’s had been replaced. The laundry was situated outside of the home. This was well equipped and was sufficient to meet the needs of the service users. Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a robust recruitment process and provided staff with good training opportunities with a view to protecting the young adults as far as possible. EVIDENCE: Observation of and discussion with the staff working at the home indicated that they had the skills and knowledge to provide an appropriate service for the young adults living there. The training matrix indicated that the staff team had received a range of training, giving them the skills necessary to work at the home. All new staff received induction training within the first two weeks of their employment by the company. The home were continuing to work towards 50 of the staff team achieve a nationally recognised qualification in care. The recruitment documentation in relation to three members of staff was examined. This indicated that the home had robust procedures with staff being selected carefully with all of the necessary checks having been undertaken. This ensured as far as possible the safety and protection of the service user in terms of the recruitment procedure. Discussion with some of the staff on the day of the site visit and observation of them indicated that the staff team working at the home were very supportive of each other. Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally well managed and there is a willingness to work towards improving the service. Some improvements should be made to ensure that the health and safety of both the young adults and the staff is maintained. EVIDENCE: Standard 37 could not be assessed, as the home did not have a registered manager in post. However the acting manager of the home had submitted his application to the Commission for Social Care Inspection to become the registered manager. He had also started to work towards his registered managers award. The home had a number of quality assurance checks and audits in place undertaken by the manager and the senior staff at the home. In addition the quality assurance officer undertook monthly monitoring visits to the home. Both of these approaches helped ensure that the home was run efficiently and appropriately. There was also an annual development plan in place for the home. The homes policies and procedures had been recently reviewed and
Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 20 updated were necessary. Surveys of the views of families and involved social care professionals had been undertaken and it was recommended that the views of involved health professionals should also be sought. The home had achieved the Investors in People Award which is a quality assurance award accredited by an outside body and was considering working towards the Investors in Excellence Award. The homes systems and equipment were appropriately serviced and maintained. There was evidence that food hygiene, first aid and health and safety training were provided. There were some ambiguities in relation to the link between the fire risk assessment, the fire policy and fire training. The company must ensure that these ambiguities are resolved and that staff are clear in respect of their responsibilities. Additionally the company should be clear with regard to its provision of manual handling training and whether this training needed to be provided. Accident reports were maintained and were filed in accordance with the data protection act. Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X X X 2 X X 2 X Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA23 Regulation 13(4)(c) Requirement The psychology service must be requested to become involved in any decisions regarding the management of challenging behaviour and the use of physical intervention strategies. The fire policy, risk assessments and training must be reviewed. Timescale for action 30/09/06 2. YA42 23(4) 30/09/06 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. Refer to Standard YA7 YA32 YA39 YA42 Good Practice Recommendations The possibility of service users participating in independent self-advocacy groups should be explored. The home should continue to work towards 50 of its staff achieve a relevant qualification in care. The views of Health professionals should be sought as part of the homes quality assurance audits. The home should review its provision of manual handling training. Higher Morris Farm DS0000005967.V303684.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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