CARE HOMES FOR OLDER PEOPLE
Lindisfarne Nursing Home Kepier Chare Crawcrook Ryton Tyne & Wear NE40 4TS Lead Inspector
Ian Armstrong Key Unannounced Inspection 9:45 7th August 2006 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 Lindisfarne Nursing Home DS0000018174.V299587.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. Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Lindisfarne Nursing Home Address Kepier Chare Crawcrook Ryton Tyne & Wear NE40 4TS 0191 413 7081 0191 413 7308 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) Gainford Care Homes Limited Eileen Bellas Care Home 61 Category(ies) of Dementia - over 65 years of age (61), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (61) Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Of the 61 rooms registered, one of two rooms without en-suite facilities (room 36) to be used as short stay/emergency respite only. 11th October 2005 Date of last inspection Brief Description of the Service: Lindisfarne Nursing Home is a two-storey purpose built home providing nursing care and personal care to people suffering from mental illness and dementia. The home is situated in the centre of Crawcrook and close to local shops, park and other facilities, and is on a main bus route. All bedrooms are single and the majority are en-suite, and all the necessary services and facilities are provided including an emergency call system and bathrooms and toilets that are suitable for physically frail or disabled people. There is a passenger lift to take residents and visitors between floors. A choice of lounges is also available. Easy access into and around the Home is available and corridors and doors widths are wide to allow access for wheelchair users. The home has extensive and pleasant gardens and a safe area for residents to sit outside. On the day of the inspection there was 61 residents in occupation 11 males and 50 females. Fees in the home range from £365 to £533. Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 1 day and was unannounced. Time was spent talking with residents, relatives and staff and observing practices in the home. A sample of records that the home must keep was looked at before and during the inspection. This included, pre and post admission assessments, care plans, resident financial records, medication records and staff files. A tour of the premises was carried out to check that the facilities available are suitable for the people who live there and repairs on the property are carried out. Views of residents and their families were also sought before the inspection via a questionnaire. Some of the comments made are reflected in the report. What the service does well: What has improved since the last inspection?
An activities co-ordinator has been appointed for 40 hours each week. The post holder has begun to develop life history profiles for all of the residents from which she intends to develop individual social care plans. The manager intends to appoint another post holder for a further 30 hours each week. Two minibuses are now available at the home for residents to go out on trips or to taxi to and from events. Training for staff continues to improve. Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 6 What they could do better:
Care plans are currently inadequate, two out of six resident care records randomly sampled had no care plans written. In all six there was no social care plans, two had no mental health care plans. Many of the records were not dated and signed. Information in assessments must be used to develop care plans. Daily records need to be written and be linked to the care plans. Good care plans are essential to meet resident’s assessed needs. Menus don’t state all meals provided including, breakfast and suppertime meals and vegetables offered each day. Menus also don’t mention what type of sandwich fillings are on offer. There was a tray of covered sandwiches in the refrigerator which weren’t dated and signed to show when they were prepared. Menus used at present do not reflect the range and choice of food available for residents and therefore, limits residents ability to make choices at mealtimes. The cook doesn’t meet with residents and relatives to identify individual food likes, dislikes and this might help residents to speak up about how they feel about the meals. In-house fire instructions to staff must be clear so that staff understand what is expected of them by the Fire Brigade. Fire safety checks must also comply with the frequency stated. The records currently are unsatisfactory and could affect the safety of residents and staff. Regulation 26 visits by the Registered Provider or their representative must take place monthly and a written report of these visits must be kept in the home. These visits must be carried out to ensure that the services provided for residents are satisfactory. Supervision (or one to one sessions) for all staff must take place at least every two months. The records of these sessions showed that these are not held very often. This may affect the way that staff carry out their day to day job as the sessions can be used to identify where staff need further training to learn a new skill or brush up on an old one. Staff and relative meetings don’t take place regularly. If held regularly these meetings can provide a chance for the home to give residents and relatives information, and collect the views from residents/relatives about how the service can be further improved. The company doesn’t currently send out relative questionnaires to seek their views about the service. This should be done at least twice each year and the information should link into the home’s quality assurance system and again look at how to improve the service. A hard backed book is not in place to record the weekly checks of the aspirator. These checks are needed to ensure that the aspirator is working in the case of emergency use and could affect resident safety if proper procedures are not in place.
Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 7 More staff need to be approved to drive the home’s minibuses to allow more resident trips out to occur. The weekly activities programme does not offer much choice of to people living at the home to keep up existing interests, or take part in activities. Six resident bedrooms to the side of the home have little natural light due to overgrown trees, which need to be pruned. 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. Lindisfarne Nursing Home DS0000018174.V299587.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 Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6. Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Good pre-admission assessments are generally achieved which, means that identified needs can be planned for and met by the home. The home does not provide intermediate care. EVIDENCE: Six residents’ pre-admission assessment documents were examined. All of these records were well completed. However, not all of the information in the assessments was linked to the care plans. For example, social information about the person, their likes/dislikes, interests/hobbies etc. before moving into the home, are not being used to formulate a social care plan. This may mean that resident’s social needs are not met and care is focused solely on physical aspects of care. Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 10 Relatives spoken to said that the home had provided them with an information pack that listed the homes services, facilities, philosophy of care and complaints policy. They said the information provided was good and helped them in making their decision about admission to the home. A relative spoken to said ‘’ if I had a complaint I would go to the manager and I know it would be dealt with’’. Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, & 10. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The standard of care planning was generally poor with little detail to guide staff how to deliver the right care. This may affect the quality of care delivered to residents. Access to healthcare professionals is good resulting in resident’s health care needs being fully met. Robust medication policies and procedures are in place to safeguard residents. Appropriate safeguards are in place where residents are encouraged to be responsible for their own medication. Residents are treated with respect and their right to privacy is upheld. EVIDENCE: The care of six residents was tracked and showed that in two cases no care plans had been written. However, all six of the records had no social care plans to guide staff about meeting resident’s social care needs. And although the
Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 12 home’s registration is predominantly for people with dementia type illnesses two records of the cases had no mental health care plans in place. Care records were not kept up to date and this was obvious as a number of these records were not dated and signed. Daily recordings were not present in two of the files, which makes tracking any care given to residents difficult and shows that care plans are not used as a working tool, or to aid communication between staff. There was little evidence to support any direct involvement/ consultation between residents, or their relatives in developing the care plans. It is vital to encourage involvement from the resident about the care they wish to receive and where they are unable to involve the family, as they offer a great source of information about the person prior to moving into a care home. This helps with the planning of care and particularly where someone has dementia, provides insight into who the person was before they developed the condition. It also helps carers to understand the behaviour of the person with dementia, which may relate to past behaviour and help the home better meet their mental health needs. Case files showed that other healthcare professionals visit regularly and provide a range of support to residents. There is a system for the effective management of medications in place, which promotes safer working practices. Medication records belonging to two residents were satisfactory and showed that stocks balance and procedures are followed properly. Facilities for the storage of medications is ample and was kept clean and tidy. However, the home currently has no weekly record of any checks made of the aspirator for use in emergency situations. Staff were attentive and pleasant with residents and relatives said residents are treated with respect ‘’staff are kind and caring’’. Residents were comfortable and ease with staff and their dignity is promoted by staff. Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Residents lifestyle choices and preferences are not adequately recorded with the care planning system. This means that individual social, cultural, religious and other needs may not be identified and met appropriately met. Residents have good contact with the local community and are encouraged to maintain contact with family/friends/representatives as they wish. This helps people to remain part of the local community and keep links alive. Residents lack control in some aspects of their lives this limits their choice and autonomy. Residents generally receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Menus however, do not reflect the range and choice of food available to the residents, limiting their ability to make informed choice at mealtimes. Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 14 EVIDENCE: The weekly activities programme needs to show a greater variety of events taking place than those at present. The home has the use of two mini buses however, there is only one approved driver. Therefore, this restricts the number of outings for residents. More home staff need to be approved to drive the minibuses to facilitate more residents trips out. An activities co-ordinator has been appointed who works 40 hours each week and this individual has started to record life histories for all the residents with the intention of developing individual social care plans. A second post of 30 hours each week for activities is also soon to be appointed. A number of visitors came and went during the day as there is an open visiting policy. Relatives said they were made welcome by the home’s staff and confirmed that they could visit at any time. During the lunchtime meal tablecloths and placemats were is use. Staff were attentive to residents and gave residents help where this was needed. This was carried out discreetly and sensitively and according to the individual’s level of need. The meal consisted of beef and chips, or mince and dumplings, and the food was nicely presented. Dining areas are well furnished and decorated. However, menus don’t show which vegetables are on offer for each main meal including, breakfast and suppertime meals. In addition, sandwiches fillings were not specified, thereby limiting choice at mealtimes. Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, & 18. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Robust complaints procedures are in place with effective timescales for response. As a result residents and their relatives / friends are confident that their complaints will be listened to, taken seriously and acted upon. A comprehensive and effective Safeguarding Adults procedure is in place to protect residents from risk of harm. EVIDENCE: A complaints procedure is displayed in the Home and is also available in the Service Users Guide, which gives information about how to and whom complaints can be made to. Those residents who were able to express their views, and relatives who were spoken with, were confident about who they could make complaints to and that they would be dealt with appropriately. There have been no new complaints since the last inspection. The Home’s policy and procedure on Safeguarding Adults remains in place and is comprehensive on its content. Staff spoken to were able to describe the procedure they would follow if they were concerned about residents being placed at risk of harm or abuse and showed that they were aware of the correct procedure to follow. Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24 & 26. Quality in this outcome area is generally good. This judgement has been made from evidence gathered both during and before the visit to this service. The standard of accommodation and maintenance is good, and facilities are appropriate to the needs of the current population. This ensures that a safe and suitable environment is available for residents. Residents live in safe, comfortable bedrooms with their own possessions around them. The home is clean, pleasant and hygienic. EVIDENCE: The home is being well maintained, communal and bedroom areas are well decorated and clean. Resident bedrooms showed much evidence of personal possessions. Six resident bedrooms to the side of the home however have
Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 17 little, or no natural light due to a screen of trees. Dining rooms are congenial settings for meals. The laundry was clean and tidy all equipment was in good working order. COSHH information was on display. The kitchen area was inspected and this was also was clean and tidy. Although menus don’t show the variety of food on offer, store rooms in the kitchen were well stocked. However, some covered sandwiches in the refrigerator were not dated and signed as to when they were prepared. Cleanliness levels throughout the home were very good and help to maintain good control of infection. Staff said they enjoy good relationships with the residents and both were at ease with each other. Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. The numbers and skill mix of staff meets Service users’ needs. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The numbers and skill mix of staff adeqaute to meet residents needs of current residents. Recruitment and selection policy and proecdures are robust and ensure that residents are not placed at risk of harm by carrying out appropriate checks on staff before beginning employment. Staff are trained and competent to do their jobs and this improves the quality of life for residents where staff are knowledgeable about individual needs. EVIDENCE: Duty rosters show the levels of staff being deployed in the home each day; am - 3 Qualified and 12 care staff, pm - 3 Qualified and 12 care staff, night duty - 2 Qualified and 6 care staff with the manager working supernumary hours. The service is run over two floors and therefore, the ratio of staff to residents is currently is approximately 1:4, and is adequate to meet the current needs of residents.
Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 19 Three staff recruitment files sampled had all the necessary checks needed in place. However, there no job descriptions were available in the files. Each member of staff must be given a copy of their job descriptions so that they are aware of their roles and responsibilities in line with their work. Staff training files showed that good levels of training for staff members are being achieved. Certificates of statutory training were in evidence. Client centred training courses had been achieved in those files seen. Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 20 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. The home’s record keeping, policies and procedures safeguard service users’ rights and best interests. 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. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Residents 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 her responsibilities fully. The home is generally run in the best interests of resident. Systems used to safeguard resident’s finances are robust and therefore, their financial interests are safeguarded. Recording is clear and easy to audit. The health, safety and welfare of residents and staff are generally promoted and protected. EVIDENCE:
Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 21 The Home’s manager is a very experienced Registered Mental Nurse and has been in charge of the home for over three years. She has recently completed the Registered Manager award. Relative and staff meetings are held, with agendas set before the meeting and minutes taken to record any discussion and action points. However, the meetings are not held regularly and if so, would help to enable better communication and inform how improvements to the service could be made. Relative questionnaires are sent out each year, but twice yearly would be more beneficial to seek views about the services provided. Regulation 26 visits by the Registered provider are carried out, reports of these visits are appropriately recorded. However, the last recorded visit was in May of this year and these visits need to be carried out each month. Resident’s financial records showed evidence of regular expenditures are recorded with two staff signatures for all transactions. A number of money balances were checked and were correct. There is appropriate recording of staff supervision. However, these are infrequent and may mean that areas for improvement and development for staff are not quickly identified and rectified. The fire logbook shows that fire equipment checks are not being carried out as required. Fire alarm checks need to be weekly. In-house fire instructions to staff are not being carried out at the required levels. The Home’s accident book, not all entries had recorded outcomes. Health and Safety check certificates for the Home were satisfactory. Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 22 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 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 23 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. Requirement Care plans must be written for all residents based on their assessed needs. Particular attention must be given to addressing mental health and social care needs. In-house fire instructions to staff must be carried out to levels specified by the Fire Brigade. Fire equipment checks must also be completed to the specified frequency. The Registered person or their representative must visit the home each month and a report of these visits must be written. The Registered manager must ensure a system is in place for all staff to receive supervision at least six times each year. Trees to the side of the home must be pruned to allow natural light into the resident bedrooms. Menus must include breakfast and suppertime meals. Vegetables need to be stated for
DS0000018174.V299587.R01.S.doc Timescale for action 31/10/06 2. OP38 23.4©(v) &(d) 31/08/06 3. OP33 26.3 31/08/06 4. OP36 18.2 30/08/06 5. 6. OP19 OP15 23.2(b) 16.2(i) 30/08/06 30/08/06 Lindisfarne Nursing Home Version 5.2 Page 24 meals each day. Sandwich ingredients must be specified. 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. 5. 6. 7. Refer to Standard OP33 OP32 OP12 OP15 OP12 OP38 OP9 Good Practice Recommendations Relative questionnaires should be sent out twice yearly to seek views on services provided. Staff and relative meetings should be held more frequently. The weekly activities programme needs to be amended to provide a better variety of events for the residents. The homes cook should meet with residents and relatives to identify individual food likes and dislikes so these can be better met. More staff in the home need to be approved to drive the minibuses to allow residents more trips out. All entries in the Accident book should have recorded outcomes. A hard backed book be obtained for the recording of weekly aspirator checks. Lindisfarne Nursing Home DS0000018174.V299587.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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