Inspection on 30/10/07 for Kingsley Nursing Home

This inspection was carried out on 30th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Kingsley Nursing Home 14/10/08

Kingsley Nursing Home 03/10/06

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Kingsley Nursing Home 18 - 20 Kingsley Road Northampton Northants NN2 7BL Lead Inspector Irene Miller Unannounced Inspection 09:15 30 October 2007 th 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 Kingsley Nursing Home DS0000067790.V348372.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. Kingsley Nursing Home DS0000067790.V348372.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingsley Nursing Home Address 18 - 20 Kingsley Road Northampton Northants NN2 7BL 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) 01604 712411 01604 711199 Carehome32@aol.com Hollyberry Care Limited Mrs Linda Frances Kench Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25), of places Physical disability over 65 years of age (25) Kingsley Nursing Home DS0000067790.V348372.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Hollyberry Care Limited is registered to provide personal care at Kingsley Road Nursing Home for both male and female service users who fall within the following categories :Dementia - over 65 years of age DE(E) 25 Physical Disability - over 65 years of age PD(E) 25 Old age not falling into any other category (OP) 25 To admit into Kingsley Road Nuring Home the person named in variation number V38033 who falls within category MD Kingsley Road Nursing Home is registered to accommodate a maximum of 25 service users 3rd October 2006 2. 3. Date of last inspection Brief Description of the Service: Kingsley Nursing Home is a private nursing home and is registered to accommodate up to 25 older people, within the categories of registration Kingsley Nursing Home can provide care for people living with dementia-related conditions, and people with a physical disability. Kingsley Nursing Home is a large Victorian house situated in central Northampton opposite the racecourse, local shopping and leisure amenities are close by and the home has good access to local transport facilities. There are six single bedrooms with en-suite facilities and nine shared bedrooms without en-suite facilities. On the ground floor there is two lounges and one dining room. A central lift provides access to the first floor, and ramps and grab rails are fitted internally and externally around the property to assist people with limited physical mobility. To the rear of the property there is a pleasant garden and a private parking area. Fees range from £465.00 to £500.00 per week. The homes statement of purpose and service user guide are made available to prospective residents and their representatives, these documents set out the aims and objectives of the home and provides clear information on the range of services available within the home. Kingsley Nursing Home DS0000067790.V348372.R01.S.doc Version 5.2 Page 5 Kingsley Nursing Home DS0000067790.V348372.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is based upon outcomes for Service Users and their views of the service provided. This visit was unannounced and focused on ‘key standards’ under the National Minimum Standards and the Care Standards Act 2000 for homes providing care for older people. The care needs of three people living at the home were looked at in depth this involved looking through written information available on their care, such as the care plans (a care plan sets out how the home aims to meet the individual service users personal, healthcare, social and spiritual needs). Time was spent with the people living in the home, during which time the views on the quality of care of the service users were sought and discussion took place with the staff and visitors that were present. Some of the service users were unable to comment on their care therefore observations of staff and service users interactions were made with an aim to establish if service users were satisfied living at the home. Sample checks were carried out on the homes policies and procedures and records in relation to staff recruitment, complaints, and general maintenance and upkeep of the facility were viewed. Prior to the visit the Commission for Social Care Inspection sent out to the home the Annual Quality Assurance Assessment (AQAA) for the home to self assess their performance, the AQAA was returned to the Commission for Social Care Inspection prior to this visit taking place and provided information on the homes management and administration, processes. The registered manager Mrs Linda Kench was not available at the home on the day of the visit, however the registered provider Mrs Donnella Robinson was available. What the service does well: The registered manager operates an open door policy, and there are effective management systems in place to ensure that the day-to-day needs of the residents are met with professionalism, the staff are trained and competent in their roles and responsibilities. Kingsley Nursing Home DS0000067790.V348372.R01.S.doc Version 5.2 Page 7 Prospective residents are invited to visit the home and full assessments of care needs are carried out prior to them moving in. Following admission a trial period of one month takes place, after which a full review of the care is conducted to ensure that the home can continue meet the needs and the expectations of the new resident. The information contained with the care plans enables the staff to provide person centred individualised care. Arrangements are in place for outside therapists to provide activities such as music and movement and reminiscence therapy, to stimulate the mind and body. The home takes all concerns/complaints seriously there was records that demonstrated that the registered manager had listened to and acted upon all concerns /complaints that had been brought to her attention. The staff team are provided with a full and varied training programme and are skilled within their roles to ensure that the needs of the residents can be fully met. There is a high commitment to ongoing staff training and learning and development. The staff recruitment procedure ensures that staff only takes up employment at the home once clearance has been obtained through the Protection of Vulnerable Register (POVA), the Criminal Records Bureau (CRB) and for staff taking up Nursing positions clearance through the Nursing and Midwifery Council (NMC) and two suitable references having been obtained. Residents live in a home that is clean, comfortable and well maintained. What has improved since the last inspection? What they could do better: Kingsley Nursing Home DS0000067790.V348372.R01.S.doc Version 5.2 Page 8 The risk assessments for the use of bedside rails (cot sides) were generic and not specific to the bed occupant, the home is advised to use the medical devices agency Safe Use of Bedside Rails publication to assist in formulating individualised risk assessments. 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. Kingsley Nursing Home DS0000067790.V348372.R01.S.doc Version 5.2 Page 9 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 Kingsley Nursing Home DS0000067790.V348372.R01.S.doc Version 5.2 Page 10 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): Standard 3 (standard 6 is not applicable to this service) Quality in this outcome area is good. Full pre assessments are carried out on the health, social and emotional care needs of prospective residents this is to ensure that the home can fully meet the needs and expectations of prospective residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans viewed included pre assessment documentation that identified the level of care required by each resident and how their physical, social and emotional needs were to be met. The homes statement of purpose and service user guide are made available to prospective residents and their representatives, these documents set out the aims and objectives of the home and provides clear information on the range of services available within the home. Kingsley Nursing Home DS0000067790.V348372.R01.S.doc Version 5.2 Page 11 Prospective residents are invited to visit the home prior to moving in and following admission a trial period of one month takes place, after which a full review of the care is conducted to ensure that the home can continue meet the needs and the expectations of the new resident. Kingsley Nursing Home DS0000067790.V348372.R01.S.doc Version 5.2 Page 12 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): Standards 7,8,9 & 10 Quality in this outcome area is good. The home aims to meet the physical and emotional needs and expectations of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Within the care plans viewed there was information on the individual physical and emotional needs of residents, such as assessments on nutrition, pressure area care, continence management and the individual likes and dislikes in terms of social activities hobbies and interests. There were records of the care plans being regularly reviewed and amended as and when changes in the health status of the residents had occurred to ensure that needs were continually being met. Time was spent with the staff during the early morning handover and the information shared between staff during this period demonstrated that staff were fully aware of the importance of monitoring residents individual health Kingsley Nursing Home DS0000067790.V348372.R01.S.doc Version 5.2 Page 13 care, areas discussed included the preventative treatment of pressure sores and wound management, nutrition and fluid intake and observations of individual residents moods. Many of the residents living at the home require a high input of clinical nursing skills and information was available within the care plans for residents who required this level of care. Information was available on health care monitoring, such as pressure ulcer prevention and management, artificial (PEG) feed systems (Percutanious Endoscopic Gastronomy Feeds). There were records of residents having contact with their general practitioner and other healthcare professionals, such as dietician, community psychiatric nurse (CPN), speech and language therapist and community physiotherapist. The nursing staff employed at the home hold the responsibility for the administration of residents medication, and on sample checking the medication storage and administration records they were seen to be in good order and medication that was no longer in use was disposed of appropriately through a licensed waste disposal company. On speaking with the nursing staff it was apparent that they had a thorough knowledge of the individual needs of the residents in relation to their medication needs. The nursing and care staff were observed to care for the residents with compassion and respect and residents and visitors spoken with during the visit were complimentary of the staff. Kingsley Nursing Home DS0000067790.V348372.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): Standards 12,13,14 & 15 Quality in this outcome area is good. Opportunities are made available for people living at the home to engage in their preferred social, cultural, recreational and occupational activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Arrangements were in place for activity specialists to provide weekly therapeutic activities with the aim of stimulating the mind and body, these involved music and movement, physical exercises and reminiscence discussions. The visiting times are flexible and due to the location of the home access to the local community is manageable, relatives/visitors are encouraged to remain involved in the care of the resident in terms of outings social events some offering a helping hand over meal times. On the day of the visit one of the residents had been out with their son to the local pub, and another relative said that her mother often visits her brothers allotment and likes feeding the Kingsley Nursing Home DS0000067790.V348372.R01.S.doc Version 5.2 Page 15 ducks. All of the visitors spoken with during the visit praised the staff for the care they provided and were observed chatting with the staff. For residents who are unable to access the community due to failing health, arrangements were in place to ensure that they receive one to one attention from the staff. Therapeutic activities provided included massage, hand manicures and foot care, and other activities included crosswords, daily newspapers, TV and radio programmes. In discussion with staff they said that they were in the process of setting up more one to one sensory activities for people with advanced dementia with the aim of to keying into the persons sense of smell, touch, sight and hearing. The home produces a monthly newsletter for residents and families called ‘In Touch’ . The most recent newsletter was seen that covered topics such as Halloween, thanking those who had contributed in fund raising events, dates for the diary informing residents families and friends of up and coming events. There was an article called resident focus that welcomed new residents into the home and with the residents permission gave a little write up on where the resident was born where they lived, their previous occupations, hobbies and interests. Representatives from the local churches visit the home and for residents that wish to receive Holy Communion this is made available. The menus seen contained a variety of meals and vegetarian, pureed or special diets to meet the residents healthcare or cultural needs can be accommodated by the home. Residents who required additional nutritional support had the support and advise of a dietician available. The kitchen was seen to be clean and tidy and food hygiene safety systems were in place to prevent cross contamination of foods. Kingsley Nursing Home DS0000067790.V348372.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): Standards 16 & 18 Quality in this outcome area is excellent. Residents can be assured that any complaints or concerns that they may have will be listened to and acted upon and the residents right to confidentiality is respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is made available to all residents and their representatives, and there is a copy of the procedure on display within the entrance lobby of the home. Records were available of all concerns/complaints that had been brought to the attention of the registered manager and there were records of the action that had been taken to resolve the concerns/complaints. Since the last inspection visit the Commission for Social Care Inspection (CSCI) had not received any complaints about the home. There was a detailed in house staff training programme on Safeguarding Adults and information on the Mental Capacity Act 2005 codes of practice, to ensure that all staff were fully aware of their responsibilities of recognising and reporting any abuse and to ensure that residents are promoted to exercise their human rights. Kingsley Nursing Home DS0000067790.V348372.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): Standards 19 & 26 Quality in this outcome area is good. Resident live in a home that is clean, comfortable and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A limited tour of the building was conducted and bedrooms seen were personalised, with items such as personal items of furniture and smaller possessions such as photos, plants and ornaments, shared bedrooms viewed had privacy screens available. There was moving and handling equipment available to ensure that residents with limited mobility were moved safely. There was pressure relieving equipment and specialist chairs/seating in use. Kingsley Nursing Home DS0000067790.V348372.R01.S.doc Version 5.2 Page 18 The home was clean and free from unpleasant odours; systems were in place for the prevention of cross infection. Systems were in place for the disposal of clinical waste, sharps, and medication returns, and records were retained by the home. Information gained from the Annual Quality Assurance Assessment (AQAA) indicated that a routine maintenance schedule was in place and that safety checks are carried out on the fire, water, gas, heating and electrical systems. The external of the home appeared well maintained and the garden looked pleasant and well kept. Kingsley Nursing Home DS0000067790.V348372.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): Standards 27,28,29 & 30 Quality in this outcome area is excellent. The staff team are provided with a full and varied training programme and are skilled within their roles to ensure that the needs of the residents can be fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing levels on the day of inspection were sufficient to meet the needs of the current residents. A registered nurse leads each shift, morning and afternoon and at night one registered nurse and two care staff care for residents. Records of staff training seen demonstrated that the homes management are committed to ensuring that all staff are provided with a full and varied training programme which ensures that staff have the skills to perform their duties within their respective nursing and caring roles. Training was based upon the Skills for Care Common Induction Programme, there was a full and varied training programme in place, covering areas such as fire safety, moving and handling, health and safety, infection control, first aid, food hygiene safeguarding adults, and the mental capacity act 2005. Kingsley Nursing Home DS0000067790.V348372.R01.S.doc Version 5.2 Page 20 Service user led vocational training included dementia care, and advanced dementia care; some staff had achieved an NVQ level 2 in dementia care. In addition training had been provided on illnesses such as Parkinson’s disease, diabetes and nutrition for the elderly. An enthusiastic training co-ordinator is employed at the home that holds qualifications in training and development and is a qualified National Vocational Qualification (NVQ) assessor. The training co-ordinator has the responsibility for the planning and implementation of all mandatory and vocational training needs. Each member of staff has an individual training portfolio to evidence all of the training courses they have attended. There were records of all training that had been provided and future training courses that had been booked. Registered nurses employed at the home are provided with training specific to their professional nursing development, records were seen of staff having attended training courses on the safe administration of medication, pressure ulcer awareness, tissue viability and wound care. Some staff had attended a two-day course on bereavement counselling skills. The home has exceeded the National Minimum Standard ratio of 50 of staff being trained to National Vocational Qualification level 2. Three staff recruitment files were sample checked which evidenced that robust staff recruitment procedures were followed. It was confirmed through the records available that staff commences employment at the home once clearance has been obtained through the Protection of Vulnerable Register (POVA), the Criminal Records Bureau (CRB) and for staff taking up Nursing positions clearance through the Nursing and Midwifery Council (NMC) and that two suitable references have been obtained. Kingsley Nursing Home DS0000067790.V348372.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): Standards 31,33,35 & 38 Quality in this outcome area is good. Resident’s benefit from living in a home where their views are listened to and acted upon and which promotes their health safety and welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager was not available at the home on the day of the visit, however through having effective management systems in place the day-today needs of the residents were met with professionalism, this was due to the dedication of the staff who are trained and competent in their roles and responsibilities. Kingsley Nursing Home DS0000067790.V348372.R01.S.doc Version 5.2 Page 22 The registered nurse on duty was observed to provide support to care staff and to have a good rapport with residents and visitors. The home operates an open door policy and it was observed that in the absence of the registered manager that this philosophy was continued The nursing and care staff were observed during the morning handover to communicate well with each other ensuring that information was exchanged on each of the residents changing needs. The care plans informed staff of the individual residents health and personal, social and emotional needs and risk assessments were in place that identified potential hazards to the individual. However for residents at risk of falling out of bed and who required the use of bedside rails the risk assessments were generic and not specific to the bed occupant. There was a copy of the medical devices agency safety poster on the use of bedside rails (cot sides) on display and the home is advised to use the Medical Devices Agency ‘Safe Use of Bedside Rails’ publication to assist in formulating individualised risk assessments. Regular one to one staff supervision and takes place and general staff meetings take place. The views of service users and their representatives are sought through residents meetings and more formally through quarterly satisfaction surveys. Cash held on behalf of residents was sample checked and the records of cash deposited and withdrawn were all in order. The registered provider has regular contact with the home and supports the registered manager in providing a high quality service for the residents living within the home. Kingsley Nursing Home DS0000067790.V348372.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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 4 17 X 18 4 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Kingsley Nursing Home DS0000067790.V348372.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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Kingsley Nursing Home DS0000067790.V348372.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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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