Inspection on 12/01/09 for Highfield House

This inspection was carried out on 12th January 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Highfield House 23/01/07

Highfield House 13/02/06

Highfield House 08/11/05

Highfield House 29/03/05

Highfield House 19/10/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Highfield House High Street Castle Cary Somerset BA7 7AN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Poole     Date: 1 2 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Highfield House High Street Castle Cary Somerset BA7 7AN 01963350697 01963350697 highfieldhouse@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): MRS PHILIPPA GRACE BIDDLECOMBE,Mr Stephen John Biddlecombe Name of registered manager (if applicable) Mr Stephen John Biddlecombe Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Highfield House provides residential services for 22 people over the age of 65. Mr and Mrs Biddlecombe own, and have managed the home since 1988. The home is located in the main street of Castle Cary, close to all the towns amenities. Nearby larger towns include Taunton and Yeovil. There is a rail station on the outskirts of Castle Cary with a main line to London. The home consists of a period main house to which extensions have been built at later dates. Accommodation is on two floors. There is a passenger lift and a stair lift. All bedrooms are for single occupancy and all have washing facilities. Fifteen bedrooms have en-suite toilets. The home has a number of communal rooms, a conservatory and large, attractive gardens with level access. Fee at the home range from 480 pounds to 580 pounds per week. Care Homes for Older People Page 4 of 28 care home 22 Over 65 22 0 Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commissions Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are:- excellent, good, adequate and poor. The inspection was carried out over a one day period. During this time we, the Commission, were able to talk with people living and working at the home, meet with a visiting relative, observe care practices, view records and tour the building. Care Homes for Older People Page 6 of 28 We were given unrestricted access to all areas of the home and all records requested were made available. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was completed and forwarded to the Commission. This was completed to a high standard and gave clear details about the home, its recent achievements and plans for future improvements. 9 people living at the home and 4 members of staff completed questionnaires before the inspection. One relative provided written feedback about the home. Some of the comments and findings from the questionnaires have been incorporated into this report. The following is a brief summary of the inspection findings and should be read in conjunction with the whole of the report What the care home does well: What has improved since the last inspection? What they could do better: People living at the home were very satisfied with the care that they received and could not think of anything that the home could do better. On touring the building it was noted that at least two wardrobes were not secured and Care Homes for Older People Page 8 of 28 posed a risk of toppling forward and causing injury to someone living or working at the home. Assurances were given by the management that this would be addressed without delay. Care plans seen gave very personal details about peoples needs and daily routines. However one seen would benefit from being expanded upon to ensure that staff have clear guidance about how to assist someone with specific physical healthcare needs. The manager also needs to ensure that there is clear documentation to evidence that the recruitment practices are robust and minimise the risks of abuse to people living at the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wishing to move into Highfield House have their needs assessed and are able to spend time at the home before deciding to move in. People are supplied with adequate information about the home before they move in. Intermediate care is not provided. Evidence: Anyone wishing to move to Highfield House has their needs assessed by the manager and is able to spend time at the home before deciding to move in. This ensures that the home meets the persons expectations and that the staff have the skills to meet the persons needs. Copies of pre admission assessments were seen in personal files. People spoken with during the inspection said that they had visited the home with Care Homes for Older People Page 11 of 28 Evidence: family members before deciding to move in. One person said that they had originally come to the home for a short stay which gave them time to get to know the home, the staff and other people living there. Everyone who stays receives a contract which states that the first month is a trial period for both the home and the new resident. The home has produced a statement of purpose, a service user guide and a brochure which give clear details about the home, including what is covered by the basic fee. Everyone who completed a questionnaire prior to this inspection answered YES to the question Did you receive enough information about the home before you moved in so you could decide if it was the right place for you? Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are very personal to the individual and set out preferred routines as well as physical needs. The privacy of people living at the home is respected by the staff who support them. Evidence: Everyone living at the home has a care plan setting out their needs, preferences and daily routines. 4 care plans were viewed at this inspection. All gave adequate information to ensure that people received care in their chosen manner. All demonstrated that people living at the home had been involved in their creation and review. One care plan seen did not give clear instructions to enable staff to assist the person to manage a medical condition and this was discussed during the inspection. 9 people living at the home completed questionnaires before the inspection 8 answered ALWAYS to the questions Do you receive the care and support that you need? and Do you receive the medical support you need? 1 person answered USUALLY. Care Homes for Older People Page 13 of 28 Evidence: Assessments in respect of falls, nutrition and skin care had been carried and these are regularly reviewed to ensure that people receive appropriate support. Individual weights are recorded and these showed that everyone living at the home is maintaining a stable weight. Currently weights are recorded in a communal book and it is suggested that these are recorded as part of each individuals care plan. Everyone asked said that they had access to healthcare professionals according to their individual need. One person said that staff always contacted a doctor or nurse if they were unwell and checked on them regularly to see if there was anything they needed or wanted. One relative spoken with during the inspection said that the home were pro-active in meeting health care needs and kept families well informed. Another relative, who provided written comments wrote The standard of medical care can not be faulted. Throughout the inspection it was observed that staff treated people living at the home with kindness and respect. People said that they were able to spend time in communal areas or in their personal rooms and privacy was always respected. Staff were seen knocking on bedroom doors and waiting to be invited in before entering. The majority of people living at the home have telephones in their bedrooms, other people are able to use the office phone where they can make calls in private. Lockable storage facilities are provided in each bedroom to enable people to lock away private or valuable items. The home uses a Monitored Dosage System for medication and there is appropriate storage facilities, including facilities to store medicines that require refrigeration and controlled drugs. All staff who administer medication have received specific training to promote good practice. Medication Administration Records were viewed. All medication was correctly signed for when entering the home or being administered, giving a clear audit trail. Controlled drugs seen correlated with records held. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are no strict routines in the home and people are able to choose how they spend their time. There are organised activities for people who wish to take part. There is a good variety of food for people to choose from. Evidence: There are no strict routines in the home and people are able to choose what time they get up, when they go to bed and how they spend their day. People spoken with during the inspection said that they are free to spend time in communal areas or in their personal rooms. Everyone said that they continued to make decisions and felt that they remained in control of their day to day lives. Some people said that they went to local shops on a regular basis and everyone said that they could have visitors at anytime. Many people said that Highfield House was home and that they were very much encouraged to treat it as their home. One visitor said Care Homes for Older People Page 15 of 28 Evidence: that they were always made welcome and people living at the home said that visitors were always provided with refreshments. There are various organised activities which people said that they could choose to join in with if they wished. Activities include gentle exercise classes, scrabble, quizzes and visiting entertainers. There is a regular church service at the home and people are able to attend local churches if they wish. Staff demonstrated a good knowledge of the people living at the home and their hobbies and interests. There is a very relaxed atmosphere in the home. Many people said that they enjoyed the company of other people and liked to spend time socialising. On the day of the inspection people were offered sherry in the lounge before lunch and spent time chatting together. People living at the home were very complimentary about the food. One person said there is a good choice of food another said meals are excellent and varied. There is a four week menu that offers people a choice at each meal. People said that if they did not like anything on the menu then they were offered an alternative of their choice. People are able to choose where they eat their meals, some people eat in the dining room and others prefer to eat in their personal rooms. The inspector was invited to have lunch with people living at the home, the meal was well presented and tasty. There was a pleasant relaxed atmosphere and meals are obviously treated as a social occasion. It was noted that the kitchen was well stocked with good quality food products. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are comfortable to raise any concerns or worries with staff or management. Everyone living at the home has unrestricted access to their personal rooms and all communal areas. Evidence: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. The complaints procedure is clearly displayed in the home and is within the service user guide. Everyone who completed a questionnaire said that they knew how to make a complaint. All staff answered YES to the question Do you know what to do if a service user or their advocate has concerns about the home? Everyone spoken with during the inspection said that they would be comfortable to raise any concerns or worries with the management or a member of staff. One person said that if there was anything that they were not totally satisfied with You just ask and it will be put right immediately. Care Homes for Older People Page 17 of 28 Evidence: No complaints have been received by the home or the Commission for Social Care Inspection since the last inspection. Staff undertake training in issues of abuse as part of their National Vocational Qualifications (NVQ) and the Annual Quality Assurance Assessment states that there are plans for further training in this subject in the coming 12 months. It was noted that people living at the home had unrestricted access to their personal rooms and all communal areas at all times. One staff file seen did not clearly evidence that appropriate checks had been carried out before the person began work. However assurances were given that this was a recording error and all staff spoken with and those who completed questionnaires said that they had undergone appropriate checks before they began work. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Highfield House provides a very comfortable, homely environment for the people who live there. Standards of cleanliness are excellent. Evidence: The home is a large town house located in the centre of Castle Cary. It is within easy walking distance of shops and other local amenities. All areas are fitted with a fire detection and call bell system. There is a programme of ongoing refurbishment and redecoration which ensures that all areas are decorated and furnished to a very high standard. Communal areas of the home consist of a large lounge, a dining room and a conservatory which gives access to the garden. There is also a spacious hallway with comfortable seating. Personal accommodation is set over two floors with a passenger lift between. Stair lifts have been fitted to small flights of stairs to ensure that all rooms are accessible to Care Homes for Older People Page 19 of 28 Evidence: people with all levels of mobility. Other aids and adaptations have been put in place to enable people to maintain independence where possible. These include hand rails in hallways, assisted bathing and showering facilities and raised toilets. People are able to bring personal possessions with them including small items of furniture, pictures and ornaments. All bedrooms seen during the inspection were personal to the individual and had a homely domestic feel. Everyone spoken with was very happy with their personal room and two people said that they had been given the opportunity to move to a larger room when one had become available. It was noted that in at least two bedrooms the wardrobes had not been secured to the wall and could potentially topple forward causing injury to people living and working at the home. Assurances were given during the inspection that these would be secured without delay. Some bedrooms have en suite toilet facilities and all have wash hand basins. There are ample toilets and bathroom facilities for communal use. There is a laundry sited in an outbuilding to the rear of the property, this is fully equipped to meet the needs of the people who live at the home. Throughout the home there are hand washing facilities and protective clothing is supplied to promote good infection control practices. Since the last inspection the heating system has been upgraded to ensure that the home is kept comfortably warm even in extremely cold weather. Everyone who completed a questionnaire answered ALWAYS to the question Is the home clean and fresh? One person wrote The home is always spotless. At the time of the inspection all areas of the home were warm, immaculately clean and fresh. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are supported by a well motivated staff team. Recruitment records do not always give clear evidence of a robust recruitment procedure, which minimises the risks of abuse to people living at the home. Evidence: The home employs 16 care staff 15 (94 ) have a National Vocational Qualification (NVQ) in care at level 2 or above. The home also employs 12 ancillary staff to ensure that the care staff are solely responsible for meeting the care needs of the people who live at the home. Since the last inspection the home has changed their handover procedures to ensure that ancillary staff, as well as care staff, share information. Everyone asked felt that there was very good communication in the home. There is a stable staff team and staff spoken with during the inspection, and those who completed questionnaires, said that it was a very happy place to work. All felt that they were well supported in their roles. Staff observed during the inspection were well motivated and demonstrated a good knowledge of individuals living at the home. Care Homes for Older People Page 21 of 28 Evidence: All new staff complete a comprehensive induction programme and there opportunities for ongoing training. All staff have regular supervision and these sessions showed that training needs are discussed. All 4 staff who questionnaire said that they received training relevant to their job. Staff during the inspection said that the management support them to attend interests them and is appropriate to their role. are records of completed a spoken with training that People living at the home were very complimentary about the staff who assisted them. Comments included Staff are fantastic, they do anything you ask and could not be kinder, the carers are always very supportive and helpful and staff are marvellous. 4 recruitment files were viewed. Three files gave evidence of a robust recruitment procedure which included obtaining written references and carrying out an enhanced Criminal Records Bureau (CRB) check. In one file it appeared that the person began work before two written references and appropriate checks had been received by the home. Assurances were given that the person only begun their induction training at this time and did not carry out care duties within the home. The home need to ensure that personal files give evidence that appropriate checks are in place before new staff begin work. All 4 staff who completed a questionnaire answered YES to the question Did your employer carry out checks, such as CRB and references, before you started work? Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is effectively managed taking account of the views of people living and working there. There are systems in place to monitor the quality of care and a commitment to ongoing improvements. Evidence: The home has been owned by the same providers, Mr and Mrs Biddlecombe, for over 20 years. Mr Biddlecombe is registered with CSCI as manager but management responsibilities are shared by the couple, with Mrs Biddlecombe taking the lead role in day to day care management. In addition to the managers there is an experienced deputy and a group of senior carers. This gives clear lines of responsibility within the home and ensures that there is always a senior member of staff on duty to give guidance and support to less Care Homes for Older People Page 23 of 28 Evidence: experienced staff. The management team are very visible in the home and demonstrated a good knowledge of the people who live and work there. They keep their practice up to date by regular training and networking with other professionals. Everyone asked said that all members of the management team were very approachable and everyone felt that they could make suggestions and share their opinions about the day to day running of the home. The home do not act as a power of attorney of financial appointee for anyone at the home. They do hold small amounts of money for safe keeping for a small number of people. Clear records are kept of these monies and records seen correlated with amounts held. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was completed and sent to the Commission. The document was completed to a very high standard and showed a commitment to ongoing improvement within the home. The management monitor the quality of the service provided by sending out annual satisfaction questionnaires and holding meetings for people living and working at the home. Results of surveys are collated and the results are used to influence any changes in the home. Collated results of the last survey were seen and these showed a high level of satisfaction in all areas. People spoken with during the inspection said that the managers and staff regularly discussed their care with them to ensure that they were happy with the service and facilities within the home. The building is maintained to a high standard. All areas are fitted with a fire detection system which is regularly tested. To promote good health and safety practices within the home all staff receive regular training in fire safety, food hygiene, manual handling, first aid and infection control. All equipment in the home is kept in good condition and serviced regularly by outside contractors. Any accidents in the home are recorded and the managers view all accident records to ensure that appropriate action is taken to minimise risks to people living and working at the home. It was noted that some wardrobes in personal rooms had not been secured to the wall and posed a risk of toppling forward causing injury to people living and working at the home. The manager gave assurances during the inspection that this matter would be Care Homes for Older People Page 24 of 28 Evidence: addressed without delay. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 13 (4) The manager must ensure that all wardrobes and other large items of furniture are secured. To prevent them toppling forward and causing injury to people living and working at the home. 30/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 8 The home should ensure that care plans give clear instructions to enable staff to fully support people with physical health needs. The home should up date the complaints procedure to ensure that it gives correct contact details for the Commission for Social Care Inspection. The manager should ensure that recruitment records clearly demonstrate that steps have been taken to minimise the risks of abuse to people living at the home. 2 16 3 29 Care Homes for Older People Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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