Inspection on 07/03/07 for Hope House

This inspection was carried out on 7th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hope House 09/03/09

Hope House 26/01/06

Hope House 03/08/05

Hope House 24/01/05

Hope House 09/06/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Hope House No 1 Hope House Wainwright Way, Grange Farm Kesgrave Ipswich Suffolk IP5 2XG Lead Inspector Tina Burns Unannounced Inspection 7th March 2007 10:15a Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hope House Address 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) No 1 Hope House Wainwright Way, Grange Farm Kesgrave Ipswich Suffolk IP5 2XG 01473 612198 01473 611782 hope.house@optua.org.uk Rethink Disability Mrs Judith Carol Williams Care Home 4 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home only accomodates young people who have both a learning disability and a physical disability. The home only accomodates young people in the following age range 16-25 years. 26th January 2006 Date of last inspection Brief Description of the Service: Hope House registered as a care home for younger adults in March 2002 and provides residential care for four young people with profound / multiple physical and learning disabilities. Although the care is provided by the charitable organisation Optua (formerly known as Rethink Disability) the property is owned and maintained by Orbit Housing Association. Hope House is situated at the end of a cul-de-sac in Kesgrave, Ipswich, close to shops, services, and facilities. It is purpose built with all accommodation on the ground floor. It has its own minibus for transport purposes, and there are local bus services within walking distance of the home. Each service user is provided with a private well-equipped single bedroom and en-suite facilities are shared between two service users of the same gender. The home has been designed, furnished and equipped for young people with physical disabilities, based on specialist advice. It has ceiling tracking, hoisting equipment, and specialist bathroom and toilet facilities designed to meet the needs of people with physical disabilities. Hope House is small, accessible, and homely in appearance. Communal areas are open plan and include a kitchen, dining area, lounge and conservatory. There is also a small sensory room and ball pool. At the time of inspection fees were £1620.51 per week. Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which focused on the core standards relating to care homes for young adults. The inspection was undertaken on a weekday and took place over approximately five hours. The report has been written using accumulated evidence gathered prior to and during the inspection. The inspection process included examination of a range of documents including two staff records, two residents care plans and a range of policies, procedures and health and safety records. The inspector also toured the premises, spoke with care workers on duty and met two service users. Information was also gathered from the homes pre inspection questionnaire, three service user survey’s (completed by service users representatives) and four relative’s/visitor’s comment cards. At the time of inspection the registered manager was on a temporary secondment to another post within the organisation and the acting manager was on annual leave. However, the Divisional Manager and Deputy Divisional Manager visited the home during the afternoon and contributed to the inspection process, further more, staff on duty (support workers) were extremely helpful and co-operative through out the day. What the service does well: What has improved since the last inspection? There were no specific areas identified for development at the previous inspection and no requirements or recommendations were made. Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 & 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can expect the home to have a good understanding of their needs and preferences. EVIDENCE: All four of the home’s service users had lived at Hope House since it opened in 2002; consequently there were no pre admission assessments examined on this occasion. However, records seen confirmed that the home consistently reviews service users needs in partnership with their relatives/representatives and other professionals, such as social workers, occupational therapists and physiotherapists. Observations made on the day of inspection, staff spoken with and feedback from service users relatives confirmed that support workers had a good understanding of service users needs, likes/dislikes and preferences. Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can expect to have a person centred care plan in place, however they cannot be certain that they will be appropriately safeguarded from risks. EVIDENCE: Records examined evidenced that service users had care plans in place that included guidelines for staff in terms of the action required to meet basic and complex needs such as communication, mobility, eating and drinking and personal hygiene. The plans seen were person-centred and set out how specialised needs would be met including detailed, individualised procedures for service users that were at risk from self-harm. Records included good evidence of reviews and consultation with service users and/or their families and appropriate specialist professionals in the development of the care plans. Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 10 Feedback from service users relatives, records seen and staff spoken with confirmed that, due to the complexity of the service users needs the home works closely with their relatives regarding decisions about their daily lives. Records seen and observations made during the inspection indicated that support workers had got to know service users well, were aware of their likes/dislikes and preferences and were ‘tuned in to’ individual’s non-verbal communication such as body language, signs or gestures and facial expressions. Care plans examined included a range of individual risk assessments, such as moving and handling, use of wheelchairs and indoor/outdoor mobility. However, the risk assessment seen regarding PEG feeds was not suitably detailed and had not been signed and agreed by the service users representatives or appropriate professionals. Discussion with senior managers during the inspection also confirmed that risk assessments had not been undertaken for the three service users with bedsides in place. Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can expect their daily routines and activities to be based around their personal needs and preferences. EVIDENCE: Records seen, feedback from relatives and observations on the day of inspection evidenced that the home was committed to providing a wide range of appropriate and stimulating activities within the home and the wider community. Each Service User had an individual, person-centred activity plan that had been developed in consultation with the service user and/or their relatives with their needs, wishes and interests in mind. Community activities were accessed by both public transport and the homes adapted minibus and included outings such as a trip to the coast, a walk in the park, bowling, shopping, swimming, horse riding and trampolineing. Activities and facilities enjoyed within the home included use of the sensory room and ball pool, art and craft activities, cooking, musical instruments and the sensory garden. Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 12 There was also evidence that service users were appropriately supported to have an annual holiday away from the home. Overall there was a good range of 1-1 activities taking place in addition to shared and group activities. Records seen, feedback from relatives and discussion with staff confirmed that service users are supported to maintain links with their families and friends. Care plans in place indicated that service users are involved, as much as possible in the daily routines of the home. There was also a suitable menu in place and staff seemed to have a good understanding of service users dietary needs, likes and dislikes and had incorporated these into the menu. Staff had received specialist training to assist those service users requiring assistance with artificial feeding. Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can expect to receive appropriate personal and healthcare support. Further more they are safeguarded by medication procedures in place. EVIDENCE: Discussion with staff, examination of records and observations made during the inspection indicated that staff worked hard to provide support to individuals in the way that they prefer and require. Staff spoken with had a good understanding of service users needs and had learnt to recognise their moods and gestures and adapted support accordingly. Care plans examined detailed action to be taken to meet personal care needs; feedback from relatives confirmed that overall the personal support provided was of a good standard. Records examined included details about the service user’s health needs and there was good evidence that the home worked closely with their relatives and a wide range of health professionals including GP’s, Community Nurses, Physio Therapists, Occupational Therapists, Dentists and Dieticians to ensure that service users health needs were met. Overall records seen evidenced that the home generally monitored service users health well although one care plan Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 14 examined included a weight chart that stated the service user must be weighed weekly but their weight had only been recorded periodically. However, discussion with staff indicated that the service users weight no longer required monitoring on a weekly basis. Medication records included a summary of the “do’s and don’ts” of medication administration, guidelines to be followed in the event of an error, a record of staff signatures and individual’s photographs. Medication administration records (MAR sheets) were appropriately signed, dated and complete. Staff guidelines stated, “before giving medication you must have had medication training, been signed off as being competent following supervision and be familiar with the “Optua Policy”. Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is committed to protecting service users from abuse. Further more service users and their representatives can expect the home to listen to and take their complaints seriously. EVIDENCE: The home had an appropriate complaints procedure in place and on display in the entrance to the home. Records seen and the pre inspection questionnaire submitted indicated that there had been no complaints made in the previous twelve months. Feedback from service users / relative’s surveys indicated that they knew how to complain and who to approach if they were unhappy. Comments received included “ Hope House is wonderful, the staff are brilliant, no complaints at all”, “They go out of their way to help and improve” and “If they (complaints) should arise they are brought to the attention of the management or raised at assessments or parents meetings”. Discussion with staff on duty and training records examined indicated that care workers received appropriate training in the protection of vulnerable adults. The divisional manager advised that the organisation had adopted and worked within the framework of the Suffolk Inter Agency Policy and Procedures for the Protection of Vulnerable Adults. Although the home had not made any adult protection referrals in the past twelve months there was good evidence that individual Physical Intervention (Restraint) protocols had been agreed at “Best Interest Meetings” attended by Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 16 the service users relatives and a group of appropriate multi disciplinary professionals. The protocols in place were clear and thorough and aimed to eliminate or minimise the need for physical intervention. However, the documentation in service users records did not include the names or signatures of any of those attending. The Divisional Manager agreed to ensure that the protocol in place was signed and agreed by the service users relatives and representatives from the “Best Interest Meetings”. Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can expect to live in a clean and comfortable environment. Furthermore, they can expect to have a room of their own that reflects their needs and interests. EVIDENCE: Hope House is a purpose-built ground floor unit of accommodation, situated at the end of a cul-de-sac in Kesgrave, Ipswich. The property is owned by Orbit Housing Association who retains responsibility for repairs, maintenance, and upkeep of the premises. The home has been designed, furnished and equipped for young people with physical disabilities, based on specialist advice. There is ceiling tracking, hoisting equipment, and bathroom and toilet facilities designed to meet the needs of people with disabilities. The home was fully accessible and communal areas included an open plan lounge, dining room and kitchen, a small ball pool, a sensory/relaxation room and a conservatory. There was also a small office that ‘doubled up’ as a staff sleeping in room. Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 18 Service users had private, well-equipped bedrooms with en-suite facilities that were shared by two service users of the same gender in adjoining rooms. All bedrooms were individually decorated and furnished, and personalised with service users belongings. Moving and handling equipment was in place and had been serviced and maintained in safe working order. Overall the home seemed generally well maintained although individual’s bedrooms had not been redecorated since the home opened and needed some attention. Staff on duty advised that it was the homes intention to decorate the bedrooms while the service users are away on their next holiday so that any disruption is kept to a minimum. Appropriate laundry facilities were in place including an industrial washing machine and tumble dryer; disposable aprons and gloves, liquid soap and paper towels were readily available for staff use. Staff on duty confirmed that in addition to providing care and support to service users they were responsible for doing the laundry, cleaning the home and preparing the meals. To their credit all areas seen on the day of inspection were clean, hygienic and odour free. Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can expect to have their needs met by a committed, well trained and competent team of staff. Further more they are safeguarded by thorough and robust recruitment procedures. EVIDENCE: On the day of inspection staff were observed interacting positively with service users. Conversation with those on duty at the time indicated that they were motivated and committed, had a good understanding of service users needs and had appropriate skills and experience to undertake the job. Discussion with staff and training records examined evidenced that staff received appropriate training including a comprehensive induction programme, Food Hygiene, First Aid, Medication, Manual Handling, Health, Safety and Fire, Protection of Vulnerable Adults. The homes pre inspection questionnaire indicated that more than fifty percent of staff had NVQ qualifications. Observations during the inspection, discussion with staff on duty and examination of the rota evidenced that there was a minimum of three staff on duty each shift with the exception of nights when there was one waking support worker on duty and another sleeping-in and on call. Two out of the Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 20 four relatives that returned surveys felt that there were not always sufficient numbers of staff on duty but all four were satisfied with the overall care provided. Staff spoken with during the inspection were enthusiastic, knowledgeable and motivated in their jobs. Comments included “we are happy with the staffing levels” and “everything is done with the clients interests at heart” and “this is a good place to work”. Staff records examined included application forms, written references and evidence of health screening, Criminal Record Bureau checks, face-to-face interviews and verification of personal identity. Records seen and discussion with staff also confirmed that they received regular planned 1-1 supervisions. Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 & 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, safety and welfare of service users are promoted and protected. EVIDENCE: At the time of inspection Judy Williams, the home’s Registered Manager, had been ‘seconded’ to an alternative role within the organisation but continued to take responsibility for the overall management of Hope House. The inspector was advised that she continued to spend a minimum of one day a week at the home to support the deputy manager who had taken on additional responsibilities and was acting manager in her absence. The organisations divisional manager and deputy divisional manager supported the registered manager and deputy manager in their roles. Feedback from staff and relatives indicated that the management team was approachable, effective and well regarded. Hope House DS0000028573.V332484.R01.S.doc Version 5.2 Page 22 Quality Assurance procedures in place included monthly visits undertaken by the area manager, relatives meetings, joint advisory group meetings and service user reviews. The home works within the framework of Optua’s policies and procedures. These were available in the office on the day of inspection and easily accessible to staff. The homes health and safety records were examined and found to be thorough and up to date and included evidence that a wide range of daily, weekly and monthly safety checks are undertaken. These included fire equipment tests/inspections, fridge/freezer temperatures, COSHH checks, manual handling equipment and water temperature checks. A record of incidents and accidents was not available at the home. The divisional manager advised that the homes completed accident reports were forwarded to their office and not held at the home. Hope House DS0000028573.V332484.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 3 X 2 X Hope House DS0000028573.V332484.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. 1 Standard YA9 Regulation 12(1)(b) 12(4) 12(1)(b) 12(4) 12 Schedules 3&4 Requirement The registered person must ensure that there are appropriate risk assessments in place for the use of bedsides. The registered person must ensure that risk assessments in place for PEG feeding are appropriately detailed. The registered person must ensure that the home has a record of all incidents and accidents. Timescale for action 31/03/07 2 YA9 31/03/07 3 YA42 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA19 YA23 Good Practice Recommendations Records used for monitoring service users weight should be appropriately maintained, kept up to date and accurate. The registered person should ensure that the names of everyone attending “Best Interest Meetings” are documented and the Physical Intervention Guidelines in place are dated, signed and agreed by appropriate professionals and the service users representatives. DS0000028573.V332484.R01.S.doc Version 5.2 Page 25 Hope House Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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