Inspection on 22/02/07 for Ivelhurst Nursing Home

This inspection was carried out on 22nd February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ivelhurst Nursing Home 20/07/07

Ivelhurst Nursing Home 06/10/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Ivelhurst Nursing Home Ivelhurst Nursing Home 27 Preston Road Yeovil Somerset BA21 3AD Lead Inspector Shelagh Laver Unannounced Inspection 22nd February 2007 10:00 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 Ivelhurst Nursing Home DS0000066074.V330329.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. Ivelhurst Nursing Home DS0000066074.V330329.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ivelhurst Nursing Home Address Ivelhurst Nursing Home 27 Preston Road Yeovil Somerset BA21 3AD 01935 426777 01935 415777 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) Ivelhurst Nursing Home Ltd Position Vacant Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Ivelhurst Nursing Home DS0000066074.V330329.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Elderly persons of either sex, not less than 60 years, who require general nursing care Up to two persons, of either sex, between the ages of 50-60 years, who require general nursing care 6th October 2006 Date of last key inspection Brief Description of the Service: Ivelhurst is a well established care home providing both personal and nursing care for older people. The home can also provide nursing care to up to two younger people. The home was purchased in January 1988 by the current owners. There are arrangements to provide care for service users funded by both social and health services. It became a registered company in March 2006. The responsible individual for the company is Mrs Ada White who is also company director. Six new rooms were commissioned in 2006 and fitted and furnished to a high standard. Ivelhurst is a large traditional building situated in a residential area in Yeovil. The home provides nursing for up to 34 service users and at least one trained nurse is always on duty. The accommodation consists of a large lounge that leads to a paved area and two smaller communal areas . There are seven rooms in the old building that have en-suites. All six single bedrooms in the extention have en-suites. Ivelhurst Nursing Home DS0000066074.V330329.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last key inspection of Ivelhurst took place on the 6th October 2006, a random inspection to monitor progress was carried out on the 5th January 2007. At this random inspection a concern raised by the Primary Care Trust was investigated. Requirements were made with regard to the assessment and prevention of pressure` damage and the importance of care documentation. This inspection was carried out over a 6.5 Hour period by two inspectors. The inspectors were given unrestricted access to all areas of the home, were able to speak with staff, service users and relatives and view care practices. All documentation requested was made available. There is currently no registered manager at the home but the newly appointed manager Cheryl Stratton and providers Mr and Mrs White were available throughout the day. At the time of this inspection there were 27 people living at the home. The home has experienced a period of change and uncertainty. It is hoped that the appointment of the current manager will bring this to a close as she addresses the issues related to care planning and some care practices. It was evident at this inspection that considerable improvements had been made in some areas. The report identifies those areas where further action is required. The providers are supporting substantial redecoration and up-grading of the home environment. What the service does well: As the inspectors observed care practices they noted that interactions between staff and service users was kind and respectful. People being nursed in bed appeared clean and comfortable. Relatives spoken to stated that they were happy with the care provided and that they were always made welcome in the home. Service users stated that they enjoyed the food and received ample portions. The inspectors saw that drinks were available throughout the day. The home was generally clean and tidy. Ivelhurst Nursing Home DS0000066074.V330329.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: At the last inspection a requirement was made to ensure that care plans were fully reflective of service users needs and gave clear guidance to staff to maintain and promote good health. Although the care plan format has been changed those seen by the inspectors still did not give clear guidance or cover all areas. Many areas of need highlighted in assessments were not covered by care plans. There was no evidence that service users had been involved in the creation of care plans and no records of any individual choices, preferences or routines. There were some instances where evidence suggested that care was not being carried out in a consistent manner. This related to incomplete records regarding assisting service user to change position to minimise the risk of pressure damage. Ivelhurst Nursing Home DS0000066074.V330329.R01.S.doc Version 5.2 Page 7 There are limited opportunities for service users to pursue hobbies or take part in stimulating social activities. Currently there are 5 shared rooms at the home but no evidence to suggest that people had made a positive choice to share with another service user and no assessments of compatibility. Some issues relating to privacy and dignity were raised with the manager. 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. Ivelhurst Nursing Home DS0000066074.V330329.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 Ivelhurst Nursing Home DS0000066074.V330329.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The pre admission assessments carried out by the home focus on physical needs and do not take account of the wishes or expectations of the prospective service user. EVIDENCE: A senior member of staff from the home sees and assesses all prospective service users prior to a place being offered at Ivelhurst. The inspector viewed two pre admission assessments and noted that they focused on physical health issues. There was no evidence to suggest that the prospective service user had been involved in the process and their views and expectations were not recorded. Ivelhurst Nursing Home DS0000066074.V330329.R01.S.doc Version 5.2 Page 10 In addition to the assessments carried out by the home copies of fuller assessments undertaken by professionals outside the home had been obtained. The inspectors were concerned that some needs identified in the full assessments had not been incorporated into the care plan once the person moved to the home. It was therefore unclear if the home were able to meet all the identified needs. One persons assessment stated that they were registered blind but there was no acknowledge of this in the care plan and no guidance for staff to assist this person to settle into the home. Two relatives spoken to during the inspection stated that they had been able to visit the home and meet staff before deciding it was the right place for their relative. Ivelhurst Nursing Home DS0000066074.V330329.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is no evidence of service user involvement in the creation of care plans. Care plans do not give clear guidelines to assist staff in meeting the needs of service users in a consistent manner. Medication Administration Records give evidence of good practice. EVIDENCE: Since the last inspection the home has introduced a new care plan format. This format has sections for the identified need, the action to be taken to meet the need and the desired outcome. The inspectors viewed three care plans in detail. Needs identified related to physical needs and there was no social or psychological needs identified. As Ivelhurst Nursing Home DS0000066074.V330329.R01.S.doc Version 5.2 Page 12 previously stated not all needs identified in the full assessment had been transferred onto the care plans. For example one assessment stated that the person was at high risk of pressure damage and required specialist equipment. There was no care plan in respect of this and no guidance for staff to follow to prevent pressure damage. One care plan seen in respect of a service user with pressure damage was not specific in it actions to be taken to minimise the risks of further damage. One Nutrition care plan stated “Insulin dependant diabetic, check blood sugar” There was no information regarding the person’s normal blood sugar range. There were instructions for what to do if the person became hypoglycaemic but no signs and symptoms for staff to be aware of. The printed format for a diabetic care plan was included in the file but had not been completed in respect of this service user. Another care plan seen, contained plans of care, with only the need and desired outcome completed. As previously stated the care plan in respect of a person who was registered blind gave no information to enable staff to assist this person to orientate themselves around the home or maintain a degree of independence. There was no evidence that service users had been involved in the creation of the care plan and no recording relating to individual wishes or preferred routines. One care plan seen contained a comprehensive social assessment that had been completed by a relative, but none of the information had been incorporated into the plan of care. Whilst touring the building the inspectors met with some service users who were being nursed in bed. All appeared comfortable and clean. There were turn charts and fluid records in the rooms of these service users. Charts indicated that regular fluid and food was offered. Records of turns were incomplete with two instances noticed when there was no record of staff assisting service users to change position for several hours. There are adequate storage facilities for medication. Trained nurses administer all medication and the majority have received training from the dispensing pharmacist. Medication Administration Records (MARs) were correctly signed and gave evidence of good practice in this area. Some issues relating to privacy and dignity were raised with the manager and providers during the inspection. Ivelhurst Nursing Home DS0000066074.V330329.R01.S.doc Version 5.2 Page 13 There are currently five shared rooms at the home and although screening is provided some carers stated that it is often difficult to maintain privacy and dignity when assisting with intimate personal care in these rooms. The home must consider service users privacy and dignity at all times. For example using a service users room as a temporary store is not acceptable. Interactions between staff and service users, however, was observed to be friendly and respectful. Ivelhurst Nursing Home DS0000066074.V330329.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Visitors are made welcome at the home at anytime. There are limited opportunities for service users to pursue hobbies or take part in stimulating social activities. There are sufficient balanced meals available. EVIDENCE: Staff spoken to gave evidence that service users get up and go to bed at their preferred times. All communal areas are located on the ground floor meaning they can be accessed by all service users. There are two lounges and a dining room. Most people appeared to spend their day in the main lounge or in their personal rooms. Ivelhurst Nursing Home DS0000066074.V330329.R01.S.doc Version 5.2 Page 15 An activities worker is employed but there were no activities taking place on the day of the inspection. There were posters for outside entertainers that had been arranged for the home. There appeared to be limited social stimulation for service users. Care plans do not contain records of service users preferences, likes or hobbies unless social assessments have been completed by relatives. The manager of the home is aware of the need to improve social stimulation and is currently looking at ways to make the day more meaningful and stimulating for service users. Two service users told the inspectors that it often felt like a long day, as they had nothing to do. Since the last inspection there have been great improvements in the mealtime experience for service users. The main dining room has been re instated meaning that service users now move from their chairs in the lounge and eat sat at tables. There is a choice food at each meal. Service users spoken to were aware of the choice but the menu is not prominently displayed. The inspectors were invited to have lunch at the home. The food was well cooked with fresh vegetables. Service users asked were all happy with the quality of the food. Visitors spoken to during the inspection stated that they were able to visit at anytime and were always made welcome. Ivelhurst Nursing Home DS0000066074.V330329.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 16 and 18 were inspected and met at the inspection carried out on the 6th October 2006. They have not been inspected on this occasion. EVIDENCE: Ivelhurst Nursing Home DS0000066074.V330329.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally clean and tidy. The quality of service users accommodation is variable but there is evidence of up dating. EVIDENCE: The home is a large older style 3 storey building that has been extended over the years. Service user accommodation is set over two floors with a passenger lift between. The top floor is used by staff and includes the managers and providers offices. Ivelhurst Nursing Home DS0000066074.V330329.R01.S.doc Version 5.2 Page 18 All areas of the home are fitted with a fire detection and call bell system. There are three main communal areas, a large lounge with small dining area, a dining room and quiet lounge. Service user accommodation is variable. The newest extension to the home has 6 spacious bedrooms with en-suite facilities and two large wet rooms. In the older part of the home there are a further 18 bedrooms, 5 of which are for shared occupancy. All shared rooms are fitted with curtain screens to promote privacy. 13 of the 24 rooms have en suite facilities. There is no documentation or evidence that the people sharing rooms have made a positive choice to share and staff were unable to state how the compatibility of service users was assessed. Records in one file relating to a service user who was sharing a room stated that they were so disturbed during the night that the other occupant was moved in the early hours of the morning. The home has a programme of redecoration and since the last inspection many areas have been repainted and re-carpeted. One bedroom seen by the inspector was in need of redecoration. Some of the preparatory work had been started but the service users had not been given the opportunity to move out whilst the work was in progress. Various aids and adaptations have been fitted around the home to promote independence, these include assisted bathing and showering facilities, raised toilets, grab rails and a passenger lift. The position of housekeeper has been created since the last inspection. This worker has responsibility for the cleanliness of the home and supervises all other domestic staff. All areas seen by the inspectors were adequately clean. The homes main laundry is located in a separate building and was not viewed on this occasion. Appropriate hand-washing facilities are located throughout the home. Ivelhurst Nursing Home DS0000066074.V330329.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate numbers of nursing and care staff are on duty. 26 of care staff currently hold a National Vocational Qualification in care. The homes recruitment practices protect service users if fully adhered to. There is a plan in place to provide training for staff. EVIDENCE: Since the last key inspection a new manager and deputy manager have been appointed meaning that many changes are occurring in the home. There are adequate numbers of staff on duty throughout the day and night. During the day there are two trained nurses and between 4 and 6 care staff on duty. Overnight there is one trained nurse and two carers. Staff spoken to felt that there was good communication between all staff and that generally people worked as a team. 6 of the 23 care staff have a National Vocational Qualification (NVQ) in care at level 2 or above. Another 6 members of staff are working towards this qualification. Ivelhurst Nursing Home DS0000066074.V330329.R01.S.doc Version 5.2 Page 20 The inspectors viewed the recruitment files of three newly appointed members of staff. One had only one written reference but there was evidence that a telephone reference had been obtained. All contained enhanced Criminal Bureau Checks (CRBs) and evidence that new staff had been checked against the Protection Of Vulnerable Adults (POVA) register before commencing work. Ivelhurst Nursing Home DS0000066074.V330329.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 36 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is currently no registered manager. The newly appointed manager has begun to identify areas of concern and look at ways to improve care at the home. EVIDENCE: The new manager Cheryl Stratton, has been in post for three months. She has substantial experience of home management. Ivelhurst Nursing Home DS0000066074.V330329.R01.S.doc Version 5.2 Page 22 It was evident throughout the day and that areas of weakness are being addressed. There procedures in place to improve the quality of care offered. The owners of the home, Mr and Mrs White, are at the home daily and were also available during the inspection. Staff felt that the new manager was open and approachable. She was able to demonstrate a good knowledge of staff and service users. The manager is planning to carry out appraisals with staff before implementing a programme of formal supervision for all staff. A new deputy has been appointed who will work alongside staff offering ongoing supervision and support. The inspectors viewed a sample of records relating to health and safety issues. The fire log shows in-house tests take place regularly on alarms and emergency lighting. The system was serviced by outside contractors in October 2006. 14 staff took part in a fire drill earlier this month and 17 staff received formal training in fire safety in last October, further training is booked for staff later this month. Portable electrical appliances and lifting equipment is regularly checked and serviced by outside contractors. Some staff felt that they would benefit from further training in Moving and Handling. Ivelhurst Nursing Home DS0000066074.V330329.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 2 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x 3 3 3 3 2 2 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X X 2 X 3 Ivelhurst Nursing Home DS0000066074.V330329.R01.S.doc Version 5.2 Page 24 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 OP7 Regulation 15(2) Requirement Care planning must reflect comprehensively the care and health needs of service users and must include clear instructions for care and robust reviews of service users needs. (Requirement carried over from previous inspection.) The manager must ensure that staff are supervised as part of normal management process in a way that ensures nursing and care staff carry out their roles effectively in delivering nursing care. (Requirement carried over from previous inspection.) The manager must ensure that service users have the risk of developing pressure areas assessed and appropriate intervention planned, implemented and monitored. (Requirement carried over from previous inspection.) Records kept of care provided DS0000066074.V330329.R01.S.doc Timescale for action 01/04/07 2. OP36 18(2) 01/05/07 3. OP8 12(1) 01/04/07 4. OP37 17(1)a 01/04/07 Page 25 Ivelhurst Nursing Home Version 5.2 5. OP7 15(2) [c] 12 (3) 12 (4)[a] 6. OP10 7. OP12 16 (2)[m] are up to date and in good order. (Schedule 3(k) (Requirement carried over from previous inspection.) The registered person must 01/04/07 ensure that service users are consulted about the contents of their care plan. The registered person must 01/04/07 ensure that the home is conducted in a way that respects the privacy and dignity of service users. The registered person must 01/04/07 ensure that service users are consulted about their social interests and that social activities are provided for all service users. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP12 OP15 OP23 OP28 Good Practice Recommendations The activities co-ordinator should receive support to access training and resources in order to further develop the social provision in the home. The menu in the home should be prominently displayed. Double rooms should only be shared by service users who make a positive choice to do so. 50 of care staff should have a National Vocational Qualification in care at level 2 or above. Ivelhurst Nursing Home DS0000066074.V330329.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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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