Inspection on 03/04/07 for Loose Court

This inspection was carried out on 3rd April 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

Loose Court 26/04/10

Loose Court 23/02/10

Loose Court 19/11/09

Loose Court 18/03/08

Loose Court 27/10/05

Loose Court 03/05/05

Loose Court 15/12/04

Loose Court 18/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Loose Court Loose Court Rushmead Drive Maidstone Kent ME15 9UD Lead Inspector Lynnette Gajjar Key Unannounced Inspection 3rd April 2007 9:20 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 Loose Court DS0000023872.V334445.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. Loose Court DS0000023872.V334445.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Loose Court Address Loose Court Rushmead Drive Maidstone Kent ME15 9UD 01622 747406 01622 749948 debbiecarson@btconnect.com 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) Jewel Homes Limited Mrs Debra Carson Care Home 39 Category(ies) of Dementia - over 65 years of age (39) registration, with number of places Loose Court DS0000023872.V334445.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care is restricted to provide older person residential care to 7 persons not diagnosed with dementia. 27th October 2005 Date of last inspection Brief Description of the Service: Loose Court was a domestic house until 1982, when it changed to a care home for the elderly. The house has had purpose built extensions. The accommodation comprises of two lounges and integral conservatory, a library/snoozlem room and dining area. There are 39 bedrooms of which 31 are for single occupancy and 4 are twinned rooms. There is a lift to access the first floor bedrooms, as well as stairs for those more ambulant. Some internal/external doors have keypad locks for the security and safety of residents. The home has a small-enclosed garden. The care home is currently registered as a residential care home for 39 Dementia- over 65 years. With a condition restricted to 7 persons who care is Older Person not falling into any other category. The home’s directors and manager have expressed and evidenced a high commitment to residents’ involvement in any changes to the care home and to provide the support, environment and trained staff in order to meet the care needs of their residents. The home is run by a registered manager with the support of the welfare officer, senior carers, carers, kitchen, domestic, administration and maintenance staff and 2 part-time leisure therapists. The home is approximately 50 yards from the main Loose Road where local bus services are available to the town centre of Maidstone approximately 4 miles away, where there are two main line railway stations. Loose Court’s current fee range is £401.26 to £590.00 per week. Additional charges are made for Hairdressing £7.20, Chiropody £12.00, one to one escorts £7.50 per hour, personal toiletries and newspapers vary pending on personal choices. A copy of the last inspection report can be seen in the main hallway of the home. Loose Court DS0000023872.V334445.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was key unannounced inspection. The visit lasted from 09.20am until 17:20pm. The home currently has 37 residents and is running with two vacancies. The visit was spent talking directly with residents privately and collectively, visiting relatives, care and ancillary staff, senior carers and deputy manager. The registered manager was on annual leave. Due to the nature of the service, it is difficult to reliably incorporate accurate reflections of the residents in the report. Some judgements about quality of life and choices were taken from direct conversation with residents and observation followed by discussion with care staff and relatives. Additional information was obtained through receipt of the manager’s preinspection questionnaire, a partial tour of the premises and conducting a case tracking exercise, by reading the files and care plans of the two residents and one senior staff and one ancillary staff, as well as some policies and records maintained by the home. Documentation was on the whole in good order and some recommendations from the previous inspection were ongoing subject to planning permission and contractors being confirmed. The welfare officer has retired and a senior carer has been promoted to deputy manager in the past few weeks. The registered manager has resigned but will remain in post until a new manager has been recruited. Residents and staff have adapted to this change of management with considerable ease. Questionnaires feedback was also received from a further 9 relatives/carers, 2 residents, 2 GP and care manager. Overall relatives and professionals are very satisfied with the service received. Some comments received: “My mother is a changed lady. She is so happy, looks good. All staff at Loose Court looks after all these ladies the same as my mother. It is a very happy home and all meals are perfect. You cannot fault anything. They have all peace of mind & feel relaxed. It always looks bright, fresh and clean. You could not want more from a home.” “Loose Court is in my opinion an extremely well run home and my mother is very happy there. I am extremely happy that my mother is there.” Loose Court DS0000023872.V334445.R01.S.doc Version 5.2 Page 6 “ Having looked at 16 homes in and around Maidstone, I considered this residential home to be one of the best, both from the care aspect and pleasant environment, and I had no hesitation in deciding this to be suitable for my mother.” “They provide a complete service that provides the best possible situation for my mother that she requires, and gives me a tremendous peace of mind.” “Every aspect of cleanliness with in the home is excellent. This includes the residents themselves, their clothes, their own rooms, the linen and the building together with fixtures and fittings. The home maintains a regular timetable where meals, medication and other activities are carried out knowing the routine assists those visiting to choose quiet times and helps to avoid some of the confusion where time is concerned for the residents. Security within the building is very good/high.” What the service does well: What has improved since the last inspection? The home continues with the refurbishment programme to provide a high standard of accommodation. Working closely with residents to ensure a good and personal standard of care. Maidstone Planning Dept has agreed further planning permission for additional toilets off the integral conservatory, new clinical/medication room and separate access to the laundry room that does not require laundry to be carried through the dining area. Loose Court DS0000023872.V334445.R01.S.doc Version 5.2 Page 7 Internal alternation to the entrance hall is in place with reception staff from 9.30-4pm. Further staff have completed or commenced their NVQ 2 or 3 in care, building on their experience and personal competencies in supporting older people. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Loose Court DS0000023872.V334445.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 Loose Court DS0000023872.V334445.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their families are assured of detailed assessment of their care needs and as to the suitability of Loose Court in meeting these. EVIDENCE: The home undertakes full pre-admission assessments before offering a visit to the home. This enables staff and residents to get a clearer understanding of the services offered and if the home is able to meet their care needs. Further development of understanding of dementia care for care staff has enabled this process to be simplified and welcoming. The home does not provide intermediate care. Loose Court DS0000023872.V334445.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual health, social care needs and personal choices are well supported through discussion, and informed decision-making. Residents are treated with genuine respect and dignity by care staff. EVIDENCE: Two individual care plans were tracked. Staff maintain care plans to ensure personal, consistent, safe care and support is given. These can be developed further with individual information particularly in relation to social interaction and personal preferences. Much of which, staff were verbally able to share with the inspector. Risk assessments format are simple, detailed and easy to follow, offering a good baseline for guidelines to promote individual independence through minimised risk. Photographs are in the process of being transferred to the new care plan files. Records are stored securely. “Appear to understand the individual needs if the resident.” Loose Court DS0000023872.V334445.R01.S.doc Version 5.2 Page 11 The health and personal care needs of residents are well supported with regular contact with specialists and external professionals. District nurse visiting today expressed satisfaction with the open and good communication with care staff and working together to address the care required for residents. “Outbreak of a stomach complaint early 2007 was well monitored and kept under control, a credit to all the staff concerned.” Interaction between residents / relatives and staff is good showing genuine respect, friendship and appropriate familiarity with each other. Safe medication practice is in place with regular monitoring and auditing by the deputy manager. Residents and staff would benefit from more detailed guidelines of what PRN medication is given for and specific triggers or indicators for administration, particularly for those who may be more confused. Medication storage will be greatly improved with the planned new clinical/ medication room. Loose Court DS0000023872.V334445.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are given encouragement and support to make choices about aspects of their daily lives, including a range of local social and recreational interests. EVIDENCE: Continued support from staff enables individuals to access local amenities and surrounding area including shopping, walks, and trips out. Resident’s families are in regular contact, with an open door visiting policy. A steady flow of visitors was observed throughout the day with fondness and familiarity with staff. From those spoken with and in response to questionnaires there is a high regard from families towards the staff team and care provided. Residents are supported to visit or meet relatives outside the home. “I feel that the staff at Loose Court take a constant interest in the well being of residents and are particularly good at providing a varied and stimulating series of activities. I am most pleased that they don’t allow residents to simply sit around the room for hours without some stimulating input as in some Loose Court DS0000023872.V334445.R01.S.doc Version 5.2 Page 13 homes I have visited.” All feedback cards received from relative stated they were satisfied with the overall care given. The home has a leisure therapist, spending time from 2-4pm and 6-9pm in supporting residents in leisure activities both in groups and individually. The home has purchased a number of leisure activities / games promoted by the Alzheimer’s Association. Themed nights are popular. Residents today engaged in decorating Easter eggs and playing skittles. Residents also continue to comment on how good the ‘music man’ who comes every fortnight to entertain them. A number of residents chose not to join in planned activities today but sat reading newspapers, snoozing or chatting to each other. Others were engaged in responsibilities of laying tables for meal times, polishing cutlery and being involved in the daily routines of the home. “The meals I have seen look attractive and appetising” Residents were observed to be stimulated and comfortable in their home. Loose Court DS0000023872.V334445.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable those living and visiting the home to raise concerns or complaints with staff. However not all relatives were familiar with this process. Protection from abuse is promoted through staff training and understanding of actions they may need to take. EVIDENCE: Copies of the complaint procedure are available in the home in formats easily understood by those living there, but also given to relatives at the time of admission. All questionnaires indicated they were aware of the procedure if required to make a complaint. “The procedure is set out in the contract. There is a complaint form enclosed.” Due to the nature of the service and those living here, using this system can be limiting. Residents were able to indicated through discussion, who they would talk to if they were unhappy about something talking fondly about the deputy manager and her kindness to listen. Residents can also rely on others such as relative/ advocates to identify concerns and raise them on their behalf. The home has not received any formal complaints since the last inspection. Loose Court DS0000023872.V334445.R01.S.doc Version 5.2 Page 15 Staff spoken with continue to showed a good understanding of how to protect and prevent abuse, including reporting under the latest local procedures. There are no current adult protection alerts relating to this home. Loose Court DS0000023872.V334445.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a warm, nicely decorated, safe and clean home, which will be enhanced further with facilities being installed later this year. EVIDENCE: The home continues to be presented to good standard of hygiene and cleanliness. The snoozlem room continues to be successful. Security keypads have been installed to minimise the risk of residents entering stairwells, external doors and rooms holding equipment and chemicals. The deputy manager detailed proposals to start the final part of building work to include a separate entrance to laundry room, larger medication storage room and additional toilets of the communal conservatory. Planning permission has been approved. Minor areas were identified during this visit but in hand with the manager to be fully addressed by the maintenance staff. “I feel there are too few toilets (plus facilities) in the main living area.” Loose Court DS0000023872.V334445.R01.S.doc Version 5.2 Page 17 “ Cleanliness is a priority, there are never any unpleasant odours when visiting” The internal courtyard garden has been completed, with special safety surface installed to this area. For further independence and to minimise the risk of falls, immediate exploration of the raised doorframe (off the conservatory external doorway) should be undertaken, grab rails to slopping ramp exits particularly for those with limited mobility and reliant on Zimmer frames or wheelchairs. Advice from an occupational therapist would assist in maximising independence and safety in use of the garden. A laundry service is available on site for residents clothing. External contractors undertake all linen laundry care. One comment received about what the home could do better was; “Perhaps more care with personal clothing of residents. The lady who cares for this side is pleasant and has an enormous responsibility, carrying out her duties to the best of her ability.” Loose Court DS0000023872.V334445.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from the support of a confident and skilled staff team. Resulting in good morale and enthusiasm to improve the service users whole quality of life. EVIDENCE: The home continues to encourage and support care staff to completed their NVQ 2 and 3 in care. The home currently has 43 of care staff holding NVQ 2 or 3 in Care. All staff has undertaken a thorough and comprehensive recruitment and induction programme including all core training. Detailed training matrix is in place. Staffing have undertaken basic training in dementia care but feel that they would benefit from further workshops and training to enhance the support and care given. Staff feel supported by the deputy manager and registered manager. Care staff spoken with and directly observed evidenced clear and good understanding of different individual care needs. There are clear roles and responsibilities to enable a smooth and efficient service being delivered, with good communication between staff. Loose Court DS0000023872.V334445.R01.S.doc Version 5.2 Page 19 Residents reacted fondly towards individual staff and their help. Staff were seen to support individuals with dignity but with respectful two-way familiarity. Rosters are covered with various short shift patterns to cover key areas of the day. Most staff are part-time enabling annual leave and sickness to be covered by familiar regular staff increasing their hours for that period. Offering consistent care and support. Feedback from relatives included; “Credit to A**** and M****, carers who really care for the residents. I feel happy and confident when they are on duty that my mother in law receives the best care possible. We were very sorry to hear that G**** has left, this lady held the care home together.” “The care staff are excellent and approachable to visitors. They are also friendly and helpful.” Loose Court DS0000023872.V334445.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. 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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents living here have their personal preferences, support and care needs encouraged through the managers open leadership and the promotion of a safe home and working environment. EVIDENCE: The registered manager has worked with this service user group for a number of years and has completed NVQ 4 in Care and Management. The manager has just resigned from their post and recruitment is currently in hand. The manager will remain in post until a successful candidate is appointed. The manager also has responsible individual responsibility for other homes within the organisation. The welfare officer has retired and senior carer has been promoted to deputy manager. Loose Court DS0000023872.V334445.R01.S.doc Version 5.2 Page 21 Residents and staff expressed a high regard for their management approach to the home. Residents continue to feel the registered manager and deputy manager are approachable and staff said they felt well supported. Regular quality assurance questionnaires are circulated to residents and relatives. The deputy manager demonstrated through discussion and practice, a very clear understanding of the needs of current residents and current issues. Good financial systems are in place to protect and assist residents with personal monies held by the home. The home does not act as appointee for any residents. Relatives or power of attorneys manages this. Monitoring health and safety in the home is to a good standard. Minor areas were identified and undertaken before the inspection had concluded. Equipment is serviced as required to maintain a safe home and facilities. Risk assessments are completed for individuals and staff activities in the home and care duties. Staff evidenced a clear understanding of accident/incident reporting. Loose Court DS0000023872.V334445.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 3 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 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 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 4 X 4 X 3 X X 3 Loose Court DS0000023872.V334445.R01.S.doc Version 5.2 Page 23 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. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended that care plans are developed further to detail residents using PRN medication with clear guidance to triggers to look for, to indicate how much PRN Medication is required particularly for those who are easily confused. It is recommended the commission pharmacy inspectors prior to any work commencing view the plans for new medication storage for advice and approval. Ongoing from the last inspection, this is proposed to address in the homes extension and refurbishment plans now approved by Maidstone Planning Dept. 3. OP19 It is recommended that raised doorframes leading to the garden are risk assessed and the access made safe for residents (using highlighters or flushing floor to frame). DS0000023872.V334445.R01.S.doc Version 5.2 Page 24 2. OP9 Loose Court 4. OP26 It is recommended that the laundry area have access that is not through dining area. Before final work commences on laundry access, consideration should be given to consultation with the Health Protection Unit for advice on effective clean and dirty area management of laundries in care homes. Ongoing from the last inspection, this is proposed to address in the homes extension and refurbishment plans now approved by Maidstone Planning Dept 5. OP28 Further formal training and workshops into aspects of dementia care would assist staff in developing further skills and a better understanding of supporting those with dementia. Serious consideration should be given in reviewing current environmental risk assessments in relation to COSHH regulations for general cleaning product storage, as wells as personal toiletry storage to be lockable and minimise risk of residents accessing products that may be harmful to them if used other than directed by the manufacturer. 6. OP38 Loose Court DS0000023872.V334445.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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