CARE HOMES FOR OLDER PEOPLE
Hollow Oak Nursing Home Haverthwaite Ulverston Cumbria LA12 8AD Lead Inspector
Marian Whittam Unannounced Inspection 17th October 2006 09:00 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 Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hollow Oak Nursing Home Address Haverthwaite Ulverston Cumbria LA12 8AD 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) 015395 31246 015395 30202 Hollow Oak Nursing Home Limited Mrs Angela Peachey King Care Home 27 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (27) of places Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 27 service users to include: - up to 27 service users in the category of OP (Old age, not falling within any other category) - up to 4 service users in the category of DE(E) (Dementia over 65 years of age) Date of last inspection 31st January 2006 Brief Description of the Service: Hollow Oak is a care home providing nursing care for 27 older people, four of whom may have dementia. Hollow Oak is well established and the current owner has been in charge for the last twenty-four years. The home is in the South Lakeland village of Haverthwaite, close to the market town of Ulverston and has good road access via the A590. The home is in a period house over three floors, which has been adapted to its current use and residents live on two of the floors. The floors used by residents have a passenger lift but two bedrooms in the older part of the home are reached by a short flight of stairs. The bedrooms in the home vary in size and layout and are individually decorated in keeping with the homes period style and they retain many original features. The home has a large entrance area that is also used as a lounge and informal seating area, there is also another lounge and a lounge/dining room and a small conservatory for service users. Outside there are large, well kept gardens to the side and rear of the home and these are accessible to residents and have appropriate seating. There is a car park to the front of the building for visitors and staff. There are good views over the gardens and surrounding countryside from the communal rooms and many of the bedrooms. Fees payable at the home are up to £525.00 a week as at 17th October 2006. There are additional charges for hairdressing and private chiropody. The home makes information about its services available through its service user guide and statement of purpose. These are available from the home. Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key unannounced inspection took place on 17th October 2006. Two inspectors did the inspection and looked around the home and spoke with the manager, residents, visitors to the home and with staff members. Staff recruitment records, training records, medication handling records and care plans were examined and a selection of records required by regulation. The provider provided information about the home and its services, asked for by the Commission for Social Care Inspection (CSCI), before the inspection took place. Before the visit information was also gathered on the service from records of previous visits, notifications and other regulatory activity. Questionnaires from residents and relatives about the service, provided by CSCI, were returned before the inspection took place and also provided information about their experiences of the home. What the service does well:
Residents spoken to like living in the home and spoke highly of the management and staff and the care and support they receive from them, especially the close involvement of the owner and his family in the daily life of the home. Residents spoken with felt the manager and staff worked hard in the home for them and that they “ listened” and were always available to talk to. Residents commented on how friendly the home is and the kindness of the staff and owner. The environment is relaxed and homely and one resident said they felt they had “the best care possible”. Attention is paid to detail in resident’s private rooms and in their decoration. The home is well maintained and the rooms clean and it is the home’s policy to fully redecorate a bedroom before a new resident moves into it. The home has a stable, well supported staff team and staff morale is good with staff saying what a good working environment they have. The home maintains a high standard of catering with the majority of food home made, reflecting residents preferences and choice. Efforts are made to ensure residents are offered a varied and nutritious menu with fresh fruit and vegetables available each day and meat from local suppliers. Residents and visitors spoke well of the home baking and the cakes at tea time. The home has good working relationships with the local doctors and district nursing service and residents have medical reviews to monitor their wellbeing. The home provides a comfortable and homely atmosphere for residents and many of the residents say they especially enjoy the home’s gardens, tending them and watching the wild birds that come to feed there. The management responds positively to the inspection process and keeps the Commission for Social Care Inspection (CSCI) informed of problems and
Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 6 changes and seeks advice in a timely way. The owner is open to advice in looking for ways to improve the home for residents. What has improved since the last inspection? What they could do better:
The home has established recruitment procedures reflecting equal opportunities. However at this visit there were no records of the Criminal record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks within the home for 2 new members of staff, despite having applied for these. The home has been experiencing increasing difficulties in their dealings with the Criminal Record Bureau (CRB) and must now find a reliable method of ensuring these checks are done promptly via some other umbrella agency to fully safeguard residents. The home informed the Commission for Social Care Inspection (CSCI) of this problem as it arose and how it proposed to manage it to reduce any risk to the residents. The home supports care and nursing staff in training and professional development that improves care to residents. it should continue to improve this by continuing to develop its NVQ training to achieve 50 of care staff with this qualification. Medication practices, the storage of medicines and their handling is of a good standard. However to further promote good practice the home needs to make sure they have a safe system for identification of residents for medicines administration. Also it is good practice when doctors make change to the medicines doses that they sign this. If this is not possible any changes written by hand on the chart by nursing staff should be checked and signed by a second person for accuracy. Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 7 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. Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre admission assessments done by the home are detailed to ensure individual needs will be met on admission. EVIDENCE: The home’s admission process includes a pre admission assessment of individual needs for residents before and at admission to the home. There are four to six week trial periods for new residents, during which time the homes assessment is continued to see that needs are being met. Information is gathered from other agencies and where appropriate a social services management plan is obtained and held on file for information. All prospective residents and their families are invited and encouraged to visit the home prior to admission. This gives them an opportunity to assess the quality and suitability of the home. One relative commented on how, when looking at prospective homes, they called in to have a look around without an appointment, and were welcomed
Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 10 and shown around the home by staff who were happy to answer their questions. Where appropriate families, other specialised care agencies and professionals are being involved in providing information on the health and personal needs to be met for residents. Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a care planning and assessment system in place to provide information for staff to meet resident’s individual health, personal and social care needs. EVIDENCE: All residents have a plan of care and personal and clinical risk assessments in place that are reviewed and updated. These have been developed and improved further since the last inspection to make them clearer and more consistent. Clinical guidance is in place for specific nursing needs. Wound care and management plans are more detailed now and reviewed and evaluated regularly. They provide clear instruction and monitoring for staff. There is evidence from speaking with residents and from their care plans that residents are involved in making choices about their care. Residents confirmed that their opinions are sought about their personal care and life in the home generally. Residents and their relatives say they feel privacy and dignity is respected and promoted. One visitor said they have “absolute confidence in the staff” to take care of their relative. They said they felt they could “relax now” and “know their relative is being well cared for”.
Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 12 Resident’s health care needs and reviews are being promptly attended to and the home works well with other agencies and health professionals to meet identified needs. Medication practices, the storage of medicines and their handling is of a good standard. The home keeps records of medicines it receives and returns and now has arrangements in place for disposal through a licensed contractor. However the home needs to make sure they have a safe system for identification of residents for medicines administration. Also it is good practice when doctors make change to the medicines charts that they sign this. If this is not possible any changes written by hand on the chart by nursing staff should be checked and signed by a second person for accuracy. Observation during the inspection, records of care planning and conversations with residents and relatives suggests that residents are treated very much as individuals with their dignity, independence and choice promoted by staff. One resident, following a risk assessment and with monitoring, looks after some of their own medicines to promote their own independence. Some residents spoken with have lived in the home some time, one said it “ is my home now and Mr H makes it homely”. Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides social and leisure activities within the home and outside and there is variety and choice in the food on offer to residents. EVIDENCE: All of the residents spoken with like the food provided, some said it was “excellent” and another that they were “very satisfied with all the meals”. Residents say that the cook, who comes round each day, to ask them about what they want to eat, offers them a choice of meals. If they do not want what is on the main menu they can have something else. One resident said, “ I have only to say and they will get me what I want”. All spoken with agree there is a choice of food each day and that there is plenty to eat and drink and that they enjoy their meals. The menus and records of food served show a varied and nutritious diet that catered for special dietary needs. The lunchtime meal was well presented and assistance was given discreetly to residents who needed it. Some residents chose to eat in their bedrooms, others in the dining room. Residents and relatives commented on the high standard of home baking and the afternoon teas residents have. They also commented positively on and the care taken with food at seasonal events such as the buffets put on over
Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 14 Christmas and at the Christmas party and festivities and birthdays during the year. The home provides some regular activities and organised social and religious events. Residents talked about the musical entertainments provided from outside and within the local community and the home’s annual fete when the home is open to meet the local community. Staff help residents with individual and group activities and support them with their individual interests and in obtaining materials and items they need to follow their interests. Some residents said that they preferred to follow their own interests and spend time in their rooms reading, knitting, one liked to spend time in the garden potting plants and watching the birds. Some say they go out with their families and friends. Relatives spoken with said they could attend social events and were made welcome in the home by staff. One relative said they were “impressed by how much time the staff spend with residents, not just giving care”. Residents say that they can come and go as they please and see whom they want to. The home had its own mini bus transport for residents. Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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 home has a complaints system that residents and relatives have confidence in and there are procedures in place to protect residents. EVIDENCE: The home has a complaints procedure that is displayed in the home and complaints received are logged for investigation and the outcomes and actions taken are recorded. Residents and relatives spoken with are confident that the manager and the owner will deal with any complaints or suggestions they make. They say that the manager and owner are around most days and “make a point of speaking to us”. Both residents and relatives spoken with are aware how to make a complaint, although one resident did say that, “this is never necessary”. There are procedures in place to protect vulnerable adults from abuse and for whistle blowing including multi agency guidance and these were available for staff in the home. Matron is due to attend a training course on adult protection run by social services and can then give this training to all staff to update the previous training. Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 16 The home does not deal with any resident’s personal finances or hold money on their behalf. All expenses are invoiced to residents and/or their representatives. Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment in the home is, clean, warm and homely with a good standard of decoration, regular maintenance and refurbishment to give residents a safe and comfortable home. EVIDENCE: The home is well maintained with regular, planned maintenance and a good standard of décor throughout that provides a clean, tidy and homely environment for residents. Residents and relatives spoken with say that the home is always “clean” and “fresh”. The lounge and dining areas are comfortable and well furnished with good lighting. Outside the large gardens are attractive, well kept and have seating for residents. Residents say that they use the garden a lot in the summer months, and enjoy it, especially when the fete is held. Some residents assist in planting and potting flowers out in the garden as they have an interest in gardening that they want to continue.
Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 18 Resident’s bedrooms seen by the inspector have a good standard of décor and furnishings. Some bedrooms were in the process of being redecorated and carpeted as the rooms have been recently vacated. It is the home’s policy to redecorate all bedrooms before a new resident comes to live in it. Many residents have brought into their rooms personal possessions and items of importance to them. This helps make the bedrooms more personal and homely for the residents living there. The home has policies and procedures for infection control. The laundry facilities are basic but satisfactory and there are systems in place to test water temperatures. There is a sluice and disinfector on the two floors away from resident areas. There is a range of equipment, nursing beds, moving and handling equipment and adaptations in the home to help residents make the most of their independence and to get about the home. Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient nursing and care staff on duty day and night to meet resident’s needs. There are recruitment procedures in place but these must improve to fully safeguard residents. EVIDENCE: Staff rotas and observation of staff deployment during the visit indicate that the home has a stable staff group providing continuity of care for residents. There is very little staff turnover. There are enough staff on duty to provide adequate nursing and care during the day and night and more staff at handover periods. Staff spoken with enjoy their work and morale among the staff team is good. Staff say they feel supported and valued in their work by the owner and senior staff. One staff member said, “It feels like one big family”. All staff spoken with felt that if they had any problems in their work the Matron and the owners would act quickly. Records of supervision indicate that this is the case. Residents and visiting relatives said that the home has a friendly atmosphere staff and management. One relative commented that staff are, “100 committed to the residents”. The home does not use agency staff. The home has recruitment procedures reflecting equal opportunities. However there are no records of the Criminal record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks within the home for 2 new members of staff. The home has been experiencing difficulties in their dealings with the Criminal
Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 20 Record Bureau (CRB) and must find a reliable method of ensuring these checks are done promptly via some other umbrella agency to fully safeguard residents. The home informed the Commission for Social care Inspection (CSCI) of the difficulty as it arose and how it is managing to reduce any risk to residents. All other recruitment checks and induction are in place. Identification numbers with the Nursing and Midwifery Council (NMC) for registered nurses are being checked periodically to make sure nursing staff remain on the register. Records are kept of training attended by staff including inductions taking place in the home. NVQ level 2 training is underway and established for care staff and needs to continue to be developed to achieve the required 50 level of care staff. Staff spoken with felt they are being supported to achieve this and other qualifications and are well motivated to take on training. Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures are in place to safeguard resident’s financial interests and promote their health, welfare and safety. EVIDENCE: Although the home does not have regular residents meetings there is evidence from survey responses, speaking to residents and visitors that they feel their opinions are valued and affect the way things are done in the home. Residents comment that they see and speak to either the Matron or the owner on a daily basis and one said, “I can discuss anything I want”. Visitors in the home commented that they felt welcome and could be part of social events if they wanted. Satisfaction surveys are in use annually and reviews of procedures to promote quality monitoring. Audits are being carried out, by the nursing staff on the care plans, to promote consistently and identify any gaps in care.
Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 22 The provider and Matron are clear about their roles and responsibilities and have good relationships with nursing staff, care staff and residents and relatives. Residents made positive comments about the staff and management team. One resident said, “ We all get on a treat.” Comments from staff indicate a supportive working environment where staff feel valued and get satisfaction from their work. Records and servicing contracts indicate that the home has systems, training and practices to promote resident health and safety. Records show that servicing and maintenance of equipment is being done as needed. Staff have been given appropriate training on moving and handling and this is due to be updated as part of the training programme. Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 3 3 X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 3. Standard OP29 Regulation 19 (4) Schedule 2 Requirement CRB and POVA checks must be obtained by the home for the staff identified at inspection. Evidence must be sent to CSCI. Timescale for action 13/11/06 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. Refer to Standard OP9 Good Practice Recommendations It is good practice when doctors make changes to the medicines records that they sign them. If this is not possible any changes written by hand on the chart by nursing staff should be checked and signed by a second person for accuracy. The home should implement a system for identification of residents for safer medicines administration The home should continue to develop its NVQ training to achieve 50 of care staff with this qualification. 2. 3. OP9 OP28 Hollow Oak Nursing Home DS0000050483.V309969.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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