CARE HOMES FOR OLDER PEOPLE
Kington St Michael Residential Home 81 Kington St Michael Chippenham Wiltshire SN14 6JB Lead Inspector
Elaine Barber Unannounced Inspection 20th December 2005 10:40 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 Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Kington St Michael Residential Home Address 81 Kington St Michael Chippenham Wiltshire SN14 6JB 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) 01249 750737 Mr Jitendra Kumar Singh Tirbhowan Mrs Sashtee Teelucksingh-Tirbhowan Mrs Sashtee Teelucksingh-Tirbhowan Care Home 9 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (9), Old age, not falling within any other of places category (9) Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Only the two named male service users in the category DE referred to the in the application dated 3rd November 2005 maybe accommodated in the home. O nce these service users reach the age of 65 the service user category DE will not longer apply. 2nd August 2005 Date of last inspection Brief Description of the Service: The home is situated in the village of Kington St Michael in a large building, parts of which date back to 1660. The home is registered for older people, older people who have had a diagnosis of dementia and two named people under the age of 65 who have dementia. The home is adjacent to the pub and the village provides many amenities. The home is owned and run by independent providers, Mr and Mrs Tirbhowan. During the waking day there is a minimum of two staff who are involved in cooking and cleaning as well as care. Two staff sleep in at night. There is a set of steps from the pavement to the front door although there is level access to the rear of the property. All the bedrooms are single accommodation and have en-suite facilities save one, which has its own nearby private toilet. On the ground floor there is a large sitting room, separate dining room, kitchen, toilet, laundry facilities, one of the bedrooms and an office. The first floor is accessed by two sets of stairs, one with a stairlift. To the rear of the home there is a garden with a large level patio. Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection and preparation took seven hours. The inspector talked to seven people, who lived in the home, four members of staff and the proprietor, read records, including personal notes and medication records, and looked at the accommodation. What the service does well:
A new assessment and care planning format had been introduced. Each person’s needs were fully assessed and their health, personal and social care needs were set out in their individual plans to ensure that their needs would be met. People were registered with the local GP and saw other health professionals such as the optician, podiatrist, and dentist. They also had access to specialists. Their health care needs were being met. Medication was appropriately stored and recorded. A monitored dosage system was used and all staff had received training about medication. People were protected by the home’s policies and procedures for dealing with medicines. People had opportunities to exercise choice and control over their lives. They could go out unaccompanied if they chose and were able. People had independent arrangements to manage their finances and managed small amounts of cash themselves. They had their own furniture and personal possessions in their rooms. People had a wholesome appealing and balanced diet served in pleasant surroundings at times convenient to them. Three meals a day were served and drinks and snacks were available throughout the day. There was a varied menu and special diets were catered for. Meals were attractively presented in the dining room and people said that they enjoyed the food. People were protected from abuse through the procedures for reporting allegations of abuse and staff training about prevention from abuse. All areas of the home were kept clean and free from odours. The laundry arrangements were satisfactory. The home was clean, pleasant and hygienic apart from the floor to the laundry room. Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 6 There were two members of staff on duty at all times during the day and two staff sleeping in at night. Several staff had worked in the home for many years and were familiar with people’s needs. Three staff had a National Vocational Qualification level two and one had an NVQ level 3. People’s needs were met by the numbers and skill mix of staff, and people benefited from staff who were qualified. The manager had a registered mental nursing qualification and was undertaking management training. People lived in a home run and managed by a person who was fit to be in charge and of good character. The manager had introduced a quality assurance process and had conducted a survey of people’s views and views of their relatives. The proprietors were introducing changes based on these views to ensure that the home was run in people’s best interests. There were independent arrangements for managing people’s money to ensure that people’s financial interests were safeguarded. What has improved since the last inspection? What they could do better:
Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 7 The registered persons need to compile a report from the service user survey and provide a copy to the Commission and the service users in order to develop their quality assurance system. All the care plans could be improved by including the outcomes that people want from living in the home, to ensure that these outcomes are achieved. Several improvements need to be made to the health and safety measures. These include taking the temperature of the bath water using a bath thermometer before a person has a bath or shower. It would also be good practice to record these temperatures to demonstrate due diligence. The radiator surfaces and windows must be made safe subject to risk assessment of each person’s ability to manage their own safety. The hot water also needs to be regulated and the worn carpet on the stairs in one of the resident’s living accommodation needs to be made safe. The safety issues around the use of an electrical socket in one of the bedrooms need to be addressed. These measures will reduce hazards to people’s safety. In order to comply with the regulations the registered person must inform the Commission without delay of the death of a service user including the circumstances of their death and any serious injury to a service user. The floor of the laundry room could be made more hygienic and easy to clean by replacing the carpet with an impermeable flooring material. The proprietors had identified that the general surroundings and ambiance of the home could be improved and planned to redecorate the shared areas and replace the carpet. 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. Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Each person’s needs were assessed to ensure that these needs would be met. EVIDENCE: The records of three people were read. Two had community care assessments before they moved into the home and one had a care programme including assessment information. Each person also had a new care plan. There was a requirement at the previous inspection that assessments must include all health care needs including dental needs. A new care plan format had been introduced which included assessment of needs and the plan to meet the needs. The format covered all areas of need identified in this standard including health care needs and dental needs. Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 People’s health, personal and social care needs were set out in their individual plans to ensure that their needs would be met. Their health care needs were being met. People were protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Three people had new style care plans including action to meet all the needs identified in standard 3.3. There was a requirement from the previous inspection that care plans must include action to address all aspects of personal, social and health care needs including dental care, social interests, hobbies, leisure activities, religious and cultural needs and people must be involved in developing their care plans, sign them and be given a copy. This had been addressed. All these needs were included in the new style plans. These also included a box to tick to confirm that the person agreed with their plan and all had signed their plans.
Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 11 There was also a recommendation at the previous inspection that plans should include the outcomes that a person wanted to achieve from living in the home. The person who had moved in recently had a separate sheet in their notes, which identified the aims, objectives and outcomes that they wished to achieve. The plans of the other two people did not include their aims, objectives and outcomes. The plans were reviewed once a month. Each person also had a manual handling care plan. The care plans included the support that people needed with health care. They also identified that staff were supporting people to manage their own personal and oral care when able including washing, dressing and cleaning teeth. Advice was sought from the district nurse when people were at risk of developing pressure sores. Treatment, specialist equipment and continence aids were also provided by the district nurse. The community psychiatric nurse monitored people’s psychological and mental health. People had opportunities for physical activity and could go for walks. Their nutritional needs were identified in the personal notes and their weight was recorded. People were registered with the local GP. There was a recommendation at the previous inspection that all visits to health care professionals should be recorded in the personal notes. This had been addressed and records of appointments with the GP, dentist, optician, chiropodist, district nurse and community psychiatric nurse were recorded in the personal notes. There was a medication policy. The home used a monitored dosage system, which was kept secure in a locked cupboard. No one administered their own medication. There were records of all medication received into the home, administered and returned to the pharmacist. No controlled medication was prescribed. A locked cash box was kept in the medication cupboard in the event of controlled drugs being prescribed. Should this happen a double locked metal drugs cupboard with controlled drugs section must be provided. The manager sought advice about medication from the pharmacist. The GP monitored people’s medication. The staff had received training about medication with Swindon College. There was a requirement at the previous inspection that all written changes to the administration records when a new prescription was issued must be dated and signed and the directions from the GP must be included. This had been addressed and all these details were included. Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14, 15 People had opportunities to exercise choice and control over their lives. People had a wholesome appealing and balanced diet served in pleasant surroundings at times convenient to them. EVIDENCE: People could go out unaccompanied if they chose and were able. People had independent arrangements to manage their finances. Some people’s money was managed by their family and some by solicitors. People managed small amounts of cash independently. Some people had brought items of furniture into their rooms and everyone had brought personal possessions. The proprietor reported that people were aware that they could access their own records and one person had requested access to their records in order to find a phone number. People were offered three full meals a day; breakfast, lunch and supper. Breakfast was flexible and people had this in their rooms. Lunch was around 12 noon and supper was at 5-30pm and drinks were served throughout the day. There was a further drink and snack at 8-30 pm. Two people also took sandwiches to their rooms in the evening. There was a fixed menu but staff and the people who lived in the home said that an alternative was offered if
Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 13 someone did not like the meal. Lunch was well presented and hot. People said that they enjoyed their meals and were observed enjoying their lunch. Nutritional needs were assessed and recorded. Special diets could be catered for, including diabetic. The menu showed that a varied and balanced diet was being served. People said that staff asked what meals they liked and included everyone’s preferences in the menu. The dining room table was attractively laid and people had individual napkins. Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 People were protected from abuse. EVIDENCE: The registered person reported that a recommendation from the previous inspection that each person should be made aware of the complaints procedure and how to make a complaint had been addressed. He stated that he and the manager talked to people in residents’ meetings and explained about how to make a complaint. There was a policy about abuse, a copy of the Swindon and Wiltshire Protection of Vulnerable Adults Procedure and a copy of the ‘No Secrets’ booklet. There had been no allegations of abuse to record and no staff had been found to be unsuitable to work with vulnerable adults. Two members of staff reported that all staff had received training about prevention of abuse. Staff also reported that they do not handle any money on behalf of people. The registered person stated that relatives or solicitors manage money on behalf of people. They give small amounts of cash to the manager who hands it to the person concerned. There were records of these transactions. The people managed these small amounts of cash themselves. Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 The home is clean, pleasant and hygienic apart from the floor to the laundry room. EVIDENCE: The accommodation was clean and free from odours. The washing machine was sited in a small room in the rear corridor. Laundry was not carried through areas where food is stored, cooked or eaten. There were no hand washing facilities in this room but there was a hand wash basin in the toilet next to it. The walls of the laundry area were painted and easily cleanable. There was carpet on the floor, which was not impermeable or easy to clean if there were spillages. A tumble drier was in the airing cupboard upstairs. There were infection control guidelines. The washing machine had a pre-wash facility and a high temperature programme to meet disinfection standards. People’s clothes were labelled to ensure that their clothes were returned to them. The staff also said that they knew which clothes belonged to each
Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 16 person apart from rare occasions when relatives brought in a new item of clothing and did not inform them. Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 People’s needs were met by the numbers, and skill mix of staff. People benefited from staff who were qualified and familiar with their needs. EVIDENCE: The rota showed that there were two staff on duty at all times and two staff sleeping in. The staff had a multi-purpose role and were involved in meal preparation, cleaning and laundry as well as care. Four members of staff had worked in the home for several years and were familiar with people’s needs. Over 50 of the staff had an appropriate qualification. Three of the seven staff had achieved National Vocational Qualification level 2, one had NVQ Level 3 and was working towards Level 4. Two staff were working towards NVQ Level 3. Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 People lived in a home run and managed by a person who was fit to be in charge and of good character. The home was run in people’s best interests. People’s financial interests were safeguarded. The health, safety and welfare of service users and staff was not promoted and protected. EVIDENCE: The registered manager had a Registered Mental Nursing qualification and was updating her knowledge and skills by undertaking a management course. Through her qualification and experience she was familiar with conditions and diseases associated with old age. There were clear lines of accountability between the manager and the staff.
Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 19 The manager had undertaken a service user survey within the last six months. The survey showed a high level of satisfaction with the care provided. The results of this survey had not been forwarded to the Commission. The views of relatives had also been sought. The registered person stated that he and the manager planned to improve the environment by decorating and replacing the carpet. As a result of the survey the home had obtained Freeview in order to give people a wider choice of television programmes. Staff do not manage money on behalf of people. The registered person reported that people’s finances were managed by their families or their solicitor. The family representative handed small amounts of cash to the manager to give to people who looked after the cash themselves. Appropriate records were kept of these transactions. There was a health and safety policy identifying how the home would comply with relevant legislation. There was a general risk assessment in relation to safe working practices. There were arrangements for the training of staff in moving and handling, fire safety, first aid, food hygiene and health and safety There were COSHH assessments, equipment was regularly serviced, the electrical wiring had been checked and portable appliances were tested annually. There was a fire risk assessment and records of fire safety checks. The environmental health officer had visited in June 2005 and was satisfied with the arrangements in relation to food hygiene. The boilers had recently been replaced. The central heating system was working much more efficiently. However the hot water temperature had also increased. The temperature of the water in the downstairs toilet was too hot to tolerate. The staff reported that they tested the temperature of the bath water with their hands before assisting people to bathe. A bath thermometer would provide a more accurate reading. There were no thermostatic controls on taps. The registered person reported that the plumber was expected to return to regulate the water temperature. The surfaces of radiators in the bedrooms were very hot. There was a risk assessment about radiators and people’s ability to monitor their own safety dated 2nd August 2003. Some people had since left the home and the needs of others had changed so this needs to be reviewed urgently. The radiators in the communal areas were covered but not those in the bedrooms. Windows were not fitted with restrictors and there were no risk assessments in relation to the safety of windows. The registered person stated that they did not accommodate people who would be at risk from unrestricted windows and this would be indentified in their original risk assessment. However several people had lived in the home some years and their needs had changed so the risks need to be reassessed. Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 20 One person had a bedroom and an adjoining sitting room accessed by three stairs. The carpet on these stairs was worn and must be repaired or replaced to ensure this person’s safety. In another bedroom an electric heater, with a time switch, and a television were plugged into a single electric socket through an adaptor. The safety of this practice should be checked with an electrician. Accidents were recorded. A previous resident had fallen down the back stairs and fractured their hip. This was recorded in the accident book but had not been reported to RIDDOR or to the CSCI. There had also been a death of a resident and this had not been reported to CSCI either. Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 21 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 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 1 Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 22 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 OP33 Regulation 24(2) Requirement Timescale for action 14/02/06 2. OP38 13(4)c The registered persons must compile a report from the service user survey and provide a copy to the Commission and the service users. The temperature of the bath 20/12/05 water must be taken using a bath thermometer before a person has a bath or shower. The risk assessment in relation to radiator surfaces and people’s safety must be reviewed and where indicated radiators must be covered. Risk assessments must be conducted in relation to the safety of unrestricted windows and where indicated restrictors must be fitted. A design solution must be put in place to ensure that hot water is delivered to the taps at a temperature close to 43 degrees centigrade. The worn carpet on the stairs in one of the resident’s living accommodation must be made safe.
DS0000028153.V269593.R01.S.doc 3. OP38 13 (4) c 14/02/06 4. OP38 13 (4) c 14/02/06 5. OP38 13 (4) a & b 14/02/06 6. OP38 13 (4) a & b 14/02/06 Kington St Michael Residential Home Version 5.0 Page 23 7. OP38 13 (4) a & b 8. OP38 37 (1) a & c In the bedroom where an electric 20/12/05 heater, with a time switch, and a television were plugged into a single electric socket through an adaptor, the safety of this practice must be reviewed. The registered person must 20/12/05 inform the Commission without delay of the death of a service user including the circumstances of their death and of any serious injury to a service user. 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. Refer to Standard OP7 OP26 OP38 Good Practice Recommendations It would be good practice for all care plans to include the outcomes that they wished to achieve from living in the home. The floor of the laundry room could be made more hygienic and easy to clean by replacing the carpet with an impermeable flooring material. It would be good practice to record the temperature of the bath water before a person bathes to demonstrate due diligence. Kington St Michael Residential Home DS0000028153.V269593.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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