CARE HOMES FOR OLDER PEOPLE
Hill House Elstree Hill South Elstree Hertfordshire WD6 3DE Lead Inspector
Mr Tom Cooper Unannounced Inspection 24th October 2005 4:00 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 Hill House DS0000019427.V259536.R01.S.doc Version 5.0 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. Hill House DS0000019427.V259536.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Hill House Address Elstree Hill South Elstree Hertfordshire WD6 3DE 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) 0208 236 0036 0208 236 0944 BUPA Care Homes Limited Care Home 76 Category(ies) of Old age, not falling within any other category registration, with number (59), Physical disability (17) of places Hill House DS0000019427.V259536.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. This home may accommodate 53 older people who require general nursing care. This home may accommodate 6 older people who require personal care. This home may accommodate 17 people (aged 18-65 years) with physical disability who require personal care. 7th April 2005 Date of last inspection Brief Description of the Service: Hill House is a care home situated in the village of Elstree, which offers nursing and residential care to elderly people and residential care to young adults with physical disabilities. The building is a period building with modern additions. All rooms are in excess of the National Minimum Standards for Older People. In the two areas used for the young adults the rooms also meet National Minimum Standards for Young Adults with additional space now available in the ground floor therapy room and the bedrooms are large enough to count towards the day space standard. All rooms have en-suite facilities and there are a variety of day rooms throughout the building. Hill House is situated in a convenient location for links with motorways and routes to London. There are small shops, a post office and a GP surgery nearby. The home has extensive grounds to the rear and off road car parking facilities to the front of the building. Hill House DS0000019427.V259536.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second inspection for the year 2005/6 under the National Minimum Standards for Care Homes for Older People and the Care Homes Regulations 2001, the last having occurred on 7th April 2005. Hill House is one of several BUPA Care Homes establishments in Hertfordshire and is registered to accommodate a maximum of 76 elderly people including 17 young adults with a physical disability who require nursing and social care. This unannounced inspection was conducted on a weekday in the late afternoon and evening. Discussions were held with service users, the manager, deputy manager, the activities coordinator, other staff on duty including a night care assistant and a visiting relative of one of the residents. Documentation examined included six service users’ care plans, medication records, complaints records and activities records. The inspection indicated the home was providing a service that residents appreciated, with caring and knowledgeable staff. Opportunities are available for service users to lead reasonably stimulating lifestyles as they choose. What the service does well:
All service users spoken with said that they were satisfied with the quality of care received and felt that the staff were competent, knew their particular needs well and respected their dignity and privacy. Observations of staff at work reinforced these views. Staff and residents obviously enjoyed excellent relationships, especially in the younger adults unit, where staff clearly knew the individual requirements of the various service users very well. All service users consulted praised the food provided and one said that it had been the quality of the food experienced on a short stay that had persuaded him to choose Hill House as his permanent home. The BUPA complaints system operated by the manager had produced timely responses to a small number of complaints received at the home since the last inspection. Complaints documentation examined included details of investigations and any actions taken in consequence, therefore complainants can have confidence that their views will be taken seriously and remedial action implemented as necessary. A comprehensive assessment of needs is undertaken prior to any potential resident being offered a place. Service users’ needs were well documented in the care plans seen. These provided detailed information on each individual
Hill House DS0000019427.V259536.R01.S.doc Version 5.0 Page 6 across the range of physical, social and emotional areas, with clear instructions to staff on how to proceed. The plans seen had been audited by the deputy manager and monitored through a review system, involving the service user, relatives and other professionals where appropriate. The level and variety of social and recreational activities for the older people are good, primarily organised by the very enthusiastic activities coordinator. In-house activities for the younger adults are also good and several reported enjoying their lives in the home with the strong support of staff. The premises are well maintained following extensive redecoration in most areas including bedrooms, and although the building is old it has been successfully adapted to provide a suitable environment for people with restricted mobility. Bedrooms are spacious and corridors are wide, with gentle ramping between floor areas of varying heights. Specialist equipment is provided and maintained as necessary. There are numerous communal areas providing ample recreational space, all in good condition apart from the younger adults lounge, which was due for redecoration shortly after the inspection. Staffing levels are satisfactory and a good number of qualified nurses are always available during the day and night. All staff members receive mandatory training, which staff members appear to appreciate. Although recruitment records were not examined on this occasion, it has previously been established that the home operates a robust recruitment process that protects residents from harm. The manager is experienced and competent to manage the home effectively. A generally high standard of record keeping was found in the areas checked. What has improved since the last inspection?
Monthly review notes in the care plans examined contained a good level of details as to the current status of the individuals concerned and the ongoing actions required. Some progress has been made in promoting NVQ qualifications for staff, as recommended in the last inspection report, with two staff having started the NVQ2 course. The upgrading and redecorating works had continued in recent months and were nearing completion, with some rooms in the younger adults unit due to be improved soon. The younger adults spoken with were looking forward to the redecoration of the currently very drab lounge. On touring the building the new paintwork, wallpaper and flooring had produced smart and homely appearance. Hill House DS0000019427.V259536.R01.S.doc Version 5.0 Page 7 The activities coordinator has expanded the range of leisure pursuits, entertainments and fundraising activities, producing more opportunities for service users. 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. Hill House DS0000019427.V259536.R01.S.doc Version 5.0 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 Hill House DS0000019427.V259536.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Information is available in the home’s statement of purpose and service user’s guide to enable prospective residents to make an informed choice about the home. Each service user has a written contract of occupancy. All admissions are subject to a pre-admission assessment. Senior Staff determine whether the home can meet the individual’s needs. Prospective service users are given appropriate details and the opportunity to visit the home and meet with staff members and other residents. EVIDENCE: The home has a statement of purpose and service user’s guide that contain the required information that enables prospective service users to make an informed decision about whether the home will be suitable for them.
Hill House DS0000019427.V259536.R01.S.doc Version 5.0 Page 10 Contracts of occupancy and comprehensive pre-admission assessments were present in service users’ files seen. The original assessment is used as the basis of the initial care plan. Staff and residents spoken with confirmed that prospective residents and the social worker where appropriate, normally visit the home prior to admission. They would spend time looking around, speaking to other service users and a meal is offered. All service users are admitted on a trial basis for mutual assessment. A meeting is held at the end of the trial period with the service user, relatives and social worker (where applicable) and if all are agreed a permanent place is offered. Hill House DS0000019427.V259536.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Service users’ needs and requirements, including health and personal care are identified and recorded in individual care plans that are regularly monitored and reviewed. Staff monitor service users’ condition and act as appropriate to maintain their welfare and health. The home operates sound procedures for the safe handling and administration of medication that ensure the well being of service users. Service users feel that staff treat them with respect and promote their privacy. Staff are aware of the need to maintain service users’ dignity. EVIDENCE: Six care plans examined contained comprehensive information on the medical, physical and personal care needs of service users. Risk assessments were in place for key areas such as pressure care, moving and handling and falls. Special factors such as nutrition and diet, and the individual levels of staff assistance required for mobility, eating and communication were considered
Hill House DS0000019427.V259536.R01.S.doc Version 5.0 Page 12 with the actions agreed to meet the needs identified noted. Personal preferences were also detailed. All examples seen had been regularly updated by the nursing staff and audited by the deputy manager, who had made formal suggestions to improve the quality of the information recorded. An interesting feature of the care plan format was the life story sheet which gave space for the noting of relevant personal information invaluable to give insight into the individual as a human being. The records demonstrated that the care management of pressure sores was well documented, with progress clearly noted. Staff monitor the progress of individuals and a fair standard of entries was found in the daily records as well as a reasonable level of detail in review documents. Individual service users seen during the inspection looked well cared for and were well presented physically, with tidy hair and fingernails and were wearing well laundered clothing. Medication is securely stored in locked cabinets. The Nomad weekly cassette system is used. Records checked were generally satisfactory, with all medication entering the home recorded and consistent records of administration on the MAR sheets. However some bottles and packets of medication not in the Nomad cassettes did not have the dates of opening recorded, which should always be done. Also two gaps were noted on MAR sheets without an explanation of the non-compliance with the GP’s prescription and no code letter used. The nurse on duty was able to explain the circumstances of each situation satisfactorily but a recommendation has been made to use the appropriate code letters and write explanations on the MAR sheets in all such situations. All service users consulted felt that staff were knowledgeable and treated them with respect. They confirmed that staff knocked and waited at their bedroom doors to be invited in and the inspector observed this in practice. Medical examination and treatment are carried out in private. Hill House DS0000019427.V259536.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Service users are able to enjoy a stimulating lifestyle by taking advantage of the frequent and varied range of activities available, coordinated by the activities coordinator. However the younger adults’ opportunities for off-site activities are restricted due to lack of minibus drivers and this must be addressed. Service users are able to have visitors and can maintain contact with friends and relatives. However, some of the younger adults feel cut off from some friends due to the withdrawal of a former day centre facility. Staff support service users to make decisions for themselves and retain control over their lives. Service users enjoy the food provided and have reasonable choices available in respect of where and what to eat. Special dietary requirements are detailed in care plans. EVIDENCE: Six care plans viewed detailed identified social, cultural, religious and recreational needs, and in the main, these were being addressed. Service users spoken to expressed general satisfaction in this area. The home employs
Hill House DS0000019427.V259536.R01.S.doc Version 5.0 Page 14 an enthusiastic activities coordinator who, in consultation with service users, has organised a broad range of stimulating recreational and leisure activities for residents to enjoy as they choose. In recent months these have included a Monday art class, trips out to the London Eye, crafts, cinema club, quizzes, bingo, board games, social events such as birthday parties, barbeques, a garden party, an in-house shop, beautician sessions and performances by outside entertainers. Also a 2006 calendar had been produced in conjunction with BUPA’s marketing department. Service users reported that there was no pressure to participate and they could opt in or out as they chose. Staff recognise that some individuals prefer to spend time in the quiet of their own rooms and some were doing so during the inspection. The imaginative activities provided benefit all service users. However, the clearly expressed desire of some of the younger adults to spend more time out of the home had been thwarted by a lack of drivers at the home able to drive the minibus. Five younger adults said this lack of external opportunity had compounded the previous loss of places at a local day centre. This aspect of life in the home must be addressed by the manager to ensure adequate stimulation for the younger adults affected (see requirements). Staff, service users, and visiting relatives confirmed that visitors are always welcome in the home. Residents are able to entertain their visitors in private and also choose whom they see and do not see. Some service users are able to go out to visit their relatives and friends. Service users can exercise personal autonomy and choice, not only in respect of activities but also in having personal possessions around them and gaining access to their personal records. All service users spoken with said that the food provided in the home of good quality, wholesome and varied. Alternative dishes were always available for residents who did not fancy the official choices. The evening meal provided during the inspection looked appetising and well balanced. Hill House DS0000019427.V259536.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Service users are confident that any complaints they make will be listened to by staff and taken seriously by the manager and responded to appropriately in a reasonable timescale. The home has robust procedures for responding to allegations or evidence of abuse, which promote the safety and protection of service users. However all staff should be given adult protection training to ensure that they understand the relevant issues and procedures. EVIDENCE: The home’s policy and procedures on complaints are available and accessible to all staff members. The manager demonstrated a good understanding of the procedures and ensuring that any complaint is dealt with quickly and satisfactorily. Information regarding how to make a complaint is also included in the statement of purpose and service users’ guide. Service users spoken with reported that they had no wish to complain but felt confident to raise any concern or complaint they might have about the services they receive. The complaints record indicated that there had been four complaints made to the home since the last inspection in April 2005. Documents on file indicated that each had been dealt with and responded to quickly, with any resulting action taken explained to the complainant. The home has comprehensive procedures on the protection of vulnerable adults, which include forwarding the names of unsuitable staff for inclusion on the Protection of Vulnerable Adult Register. The “Whistle Blowing” policy is
Hill House DS0000019427.V259536.R01.S.doc Version 5.0 Page 16 also available to the staff team. Staff members spoken with demonstrated some understanding of the above procedures. Evidently some staff members have received training on the protection of service users, a subject also included in their NVQ assessment. However, other staff members spoken to including a member of the night team felt that they would benefit from training on this subject (see recommendations). Hill House DS0000019427.V259536.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 The premises are safe and well maintained, providing a pleasant environment suitable for the needs of people with restricted mobility. Adequate communal spaces are provided in all areas. The home also provides individual accommodation for each service user in single bedrooms that meet the minimum space standards and are suitably equipped and furnished to assure comfort and privacy. Heating, lighting and ventilation are adequate, providing a safe and warm environment for service users. Care should be taken to maintain hot water temperatures in bathrooms within safe limits. The home is kept clean and tidy and free from unpleasant odours. Hill House DS0000019427.V259536.R01.S.doc Version 5.0 Page 18 EVIDENCE: The building, although old, is suitable for the use of the service users. With wide corridors, gentle ramping in places and large bedrooms. A passenger lift serves the first floor. The home employs a maintenance supervisor and a programme of planned maintenance is followed. The numerous and spacious communal areas and bedrooms are decorated and furnished in attractive domestic colour schemes designed to promote a smart yet homely appearance. Much carpeting and hard flooring has been replaced, which service users said they appreciated. The Manager said that the final phase of the current upgrading work would be completed in the next few weeks. Several younger adults said that they were looking forward to the redecoration of their rather shabby lounge. Furniture and fittings are of a good standard and bedrooms viewed are comfortable and residents have introduced personal items of furniture, pictures and ornaments. Adequate numbers of suitably equipped toilets and bathrooms are provided. Service users spoken with praised the standard of the premises and seemed to appreciate the overall quality of the environment. The large grounds were not inspected but are evidently accessible and well tended and are much used by residents in fair weather. A high standard of cleanliness was evident in all areas viewed, with no unpleasant smells detected anywhere. No health and safety hazards were noted. Liquid soap and paper towels are provided in areas where personal care is carried out and in high-risk areas such as the laundry. Staff members are conversant with infection control procedures. Suitable special equipment such as hoists, and pressure aids is provided according to individual needs. All equipment checked had been serviced within the last year. All nursing patients have adjustable beds. Staff spoken with demonstrated a good understanding of the principles of infection control and adequate supplies of protective clothing and gloves were available. Hill House DS0000019427.V259536.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Staffing numbers and deployment of staff at Hill House are adequate on both the day and night shifts with sufficient qualified nurses provided to ensure that service users’ needs can be met. EVIDENCE: Staff duty rotas were not inspected on this occasion however observation of the situation in the home and discussions with staff on duty supported the conclusion that the care staffing levels were adequate on both the day and night shifts. One night care assistant said that he felt hard pressed on some shifts, especially if the service users with dementia were presenting difficult behaviour. However the trained nurses felt that staff generally coped well. Sufficient ancillary staff are provided to manage catering, laundry and housekeeping duties. Staff recruitment records were not inspected however it has previously been established that the home has robust procedures that safeguard the interests and safety of service users. All staff spoken with said they liked working at the home and praised the management support and supervision received. Hill House DS0000019427.V259536.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 37 & 38 The management of the home remains satisfactory. The manager is well qualified and experienced in care management. Comprehensive policies and procedures ensure that the health, safety and welfare of service users and staff are safeguarded. Records viewed, in particular service users’ care plans, were maintained in good order. Hill House appears to be a safe home for residents to live in, with equipment serviced regularly and staff receiving mandatory training as necessary. EVIDENCE: The manager is a registered nurse with the Certificate in Management Studies and several years experience in the residential care field. There are clear lines
Hill House DS0000019427.V259536.R01.S.doc Version 5.0 Page 21 of accountability within the home and the senior staff team evidently work closely together to provide leadership to the rest of the team. As indicated above, staff said they felt well supported and rated teamwork and communications within the team as good. Although training records were not checked on this occasion, staff on duty indicated that they received specific training to promote safe working practices (first aid, moving and handling, fire safety etc). Hazardous substances such as disinfectant and cleaning materials are stored in locked cupboards. Up to date risk assessments are in place. All equipment checked had been serviced within the last year. The lift was in good working order. Hill House DS0000019427.V259536.R01.S.doc Version 5.0 Page 22 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 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 X 29 X 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X 3 3 Hill House DS0000019427.V259536.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 OP12 Regulation 16 (2) (m) Requirement The level of outdoor activities for the younger service users must be improved, in order to provide an adequate level of stimulation for their development and general well being. Timescale for action 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Code letters should be used and explanations should always be written on MAR sheets of any apparent noncompliances with the GP’s prescription. Dates of opening should be recorded on bottles and packets of medicine not in the Nomad boxes. All staff should receive training in the protection of vulnerable adults, especially members of the night team. The remaining premises upgrading work should be completed. Hot water delivered in bathrooms should be kept within safe temperature limits i.e. close to 43 degrees centigrade. 2. 3. 4. OP18 OP19 OP25 Hill House DS0000019427.V259536.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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