Inspection on 04/12/08 for Mapleholme

This inspection was carried out on 4th December 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mapleholme 17/12/07

Mapleholme 30/10/06

Mapleholme 09/02/06

Mapleholme 27/01/05

Mapleholme 03/06/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Mapleholme Beckwith Street Birkenhead Wirral Cheshire CH41 3JP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Diane Sharrock     Date: 0 4 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Mapleholme Beckwith Street Birkenhead Wirral Cheshire CH41 3JP 01516661250 01516661298 boboswald@wirral.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Metropolitan Borough of Wirral Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category of service only Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 23 Date of last inspection Brief description of the care home Mapleholme is one of several services managed by Wirral metropolitan Borough council. Mapleholme provides respite care to young adults with learning disabilities who are in the age range of 18 to 65. All accomodation is provided in single bedrooms. The accomodation is provided over 2 floors and is wheelchair accessible with a number of adaptations throughout the building. The service is situated in the Birkenhead are of the Wirral. It is close to the town centre and easily accessible by public transport. Wirral metropolitan borough council also operates a day service for adults at the same building. This is staffed separately however the manager is responsible for both Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 23 Brief description of the care home services. The manager is Mr Bob Oswald who is currently in the process of applying for registration with the commission social care inspection. The current weekly fees are from 69.55 pounds to 360.64 pounds. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that people that use the service receive an adequate outcome. This unannounced visit took place on the 4th December 2008 over a period of 5 hours.This was carried out with the help of the manager and the staff on duty. We gathered information for this inspection in a number of ways. Case tracking was used as part of the visit to the service. This involves looking at the support and care a person gets from the staff including their care plans, medication, money and their living conditions, we also spent time meeting both staff and residents. Care Homes for Adults (18-65 years) Page 6 of 30 Inspections involve measuring a number of standards considered as important by the commission. Records that we looked at, staff and resident comments and observations made during our visit have also been used as evidence for this report. The manager completed a questionaire we sent before our visit. The information from this was used by us to plan this visit and in writing this report. The document was completed and was returned to the commission before this visit took place. A selection of comment cards were also sent before the inspection and we left some more to offer people further opportunity to give their opinions. What the care home does well: What has improved since the last inspection? What they could do better: The way in which one persons money is managed is not always clear. This procedure must be reviewed so that all money managed is safely recorded and is clear in acting in the best interets of the guests. Staff must be provided with up to date training to make sure they are updated in their practice and able to safely and appropriately support the guests. Updated training must include load management, safeguarding, food hygiene, medicine administration and learning disability. All staff must be provided with at least 5 days paid training per year to make sure they are up to date with current good practice to support all of the guests. Care Homes for Adults (18-65 years) Page 8 of 30 Care plans must be up to date and give the necessary information to show how their needs will be met including communication and behavioural needs and social care and support. Activities must be developed and planned with all guests so that their needs and requests can be met and they can be given enough information to show each person how they can enjoy their respite break. To plan and display weekly activties plans with new guests so that their needs and requests can be taken in to account when planning activites during their stay especially when they are on days off from their day service. Guest should be consulted about what activities they would like to do during their stay and be given updated care plans showing how they will be supported with their social needs This will show how guests are supported in fulfilling their social needs and enhance their quality of life. To produce a development plan for Mapleholme and consult and include the staff and guests regarding the future and development of their service. The service must have a maintenance and renewal programme and include guests and staff in the planning and development of Mapleholme. A review of the facilities should look at how the environment can be developed to provide facilities for younger adults which are more homely and personalised. To remove any notices from areas that guests access and live in. All guests must be provided with any necessary equipment to help them live comfortable at Mapleholme. To make sure the service has provisions and procedures to follow regarding emergency respite so that these placements receive appropriate support to move to more suitable long term placements. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information is given to anyone thinking about staying at the service for respite. This makes sure that the service is the right place for the person to stay and that their needs can be met. Evidence: Good information is given to any new prospective guest including the option of having a trial visit to the service which happened recently. This makes sure that Mapleholme is the right place for the person to stay at and and that their needs can be met. The only isue discussed around admissions is about the service accepting emergency respite. This has and can result in some people staying longer at the respite service as a care home placement rather than a weeks break. This is not always in the best interest of the person being placed as their long term needs are not always being met. The manager has developed a service user guide and a statement of purpose which are available to anyone including any prospective guest. The guide includes good levels of information on the purpose of the service and the facilities on offer and Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: includes visual pictures which may help some people understand the information given and its also offered in an audio format. The guide lets people know that the service offers respite to younger adults and it also offers emergency respite. We looked at a selection of pre admission information for new guests which helped the staff to identify if the service can meet a persons needs. The details also include updated information from families and the care manager. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are not always detailed enough to show people how their needs and personal goals will be met or supported while at Mapleholme. Evidence: Individual care plans were available for each of the guests we looked at two of them. The care plans have been reviewed and developed following the previous inspection visit and show regular reviews are carried out by staff each time a guest comes to stay at Mapleholme. The plans gave some information to show how their personal care and support would be met. However some care plans did not have enough information to show how they would be supported with their behaviour or communication, especially for one person who can use makaton but this wasnt noted in their care plan. Although staff were fully knowledgeable about this persons needs and could explain how they supported this person with communicating their needs. The records showed that information provided by care managers had not been transferred over to the guests care plan ,especially in describing how they should be supported with their Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: communication needs while at Mapleholme. Some of the plans provided staff with guidance and were appropriate instructions as to the support guests required. We chatted generally to some of the guests and staff during our visit. Most comments made were quite positive. Some comments included, all staff have been here a long while and know the guests well In discussions with staff they were able to explain the way in which people staying at Mapleholme make decisions and how they are able to decide for themselves, for example staff support people what they choose to do while at the service. Staff were knowledgeable about the needs of the guests and knew how to meet their needs. Staff were observed to be respectful and seemed to have a good rapport with each of the guests. Some of the services policies and procedures have been developed to make them more user friendly for some people who may like the use of pictures to describe a policy. eg the complaints procedure has been developed to include pictures to describe its procedures. Each bedroom and area of the home had access to a nurse cord so people could contact the staff whenever they needed assistance. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Guests do not always have their social needs supported or documented in their care plans to show how they could be helped to live a lifestyle of their choice. Evidence: The manager explained that alot of people who book in to stay at Mapleholme would be supported to continue with their visits to day centres. During our visit the service had just 12 people staying for respite with most people at their day centre during the day leaving just 2 people at the service who we met. There was no published or planned activity programme and one guest said they were bored and was only able to watch television. Discussions with staff, residents and in looking at records, it showed that the people staying at Mapleholme do not always receive the support they need to get out and Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: about regularly in their local community. For example one person said they would have liked to have gone out more while staying at the service especially in wanting to go to the pub and their care plan gave no details as to how they would be supported socially in doing what they suggested. An activities file showed that staff do try to plan social events and also carry out risk assessments to help make activities as safe as possible. These records showed that there had been four trips in November including, shopping in Birkenhead, fireworks, the cinema and a trip to a burger bar. Records of meals served in the service showed that a variety of meals are served in order to offer people as much choice as possible. The dining rooms were basic in design and bare in decor although clean and tidy. Some staff notices were seen displayed in the kitchen areas which did not help to make a homely environment. Throughout the service there are various day areas with plenty of day space for everyone to use. Relatives, service users and staff have regular meetings to discuss the running of the service. We looked at these records which showed good discussions on everything keeping everyone informed and included in the developments of their service. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People coming to stay at Mapleholme are supported with their health care. Evidence: We looked at the care records of 2 people and they showed that they are supported in accessing health care services during their stay if it was needed, especially the doctor and care managers. General observations showed that staff are respectful towards the people who use the service and promote the persons dignity at all times. Staff were aware of the support each person needed and had a good rapport and knowledge base of each person. We looked at the storage and procedures of managing medications at the service and they were found to be well maintained and safely managed. Care Homes for Adults (18-65 years) Page 17 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are adequately protected by the homes procedure for responding to concerns and complaints. Evidence: Information about how to raise a concern or complaint is made available to the people staying at Mapleholme. This is good practice as it helps to increase the opportunities for people using the service now and in the future to have a better understanding of the ways in which they can raise concerns. The service help to manage small amounts of money for each person who comes to stay at Mapleholme. These records were detailed and accurately maintained. We discussed how the financial procedures were carried out and how they were maintained to help safe guard the financial affairs of each persons. However one persons finances was still stored at social services head office and staff did not have any information to give regarding how and were this persons money was stored. Some of the staff we chatted to described various training that they had attended including, complaints and safeguarding and abuse awareness however in looking at training records it was noted that some staff had not received this training or update to these subjects for quite a few years. Care Homes for Adults (18-65 years) Page 18 of 30 Care Homes for Adults (18-65 years) Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Mapleholme is clean and tidy and provides a safe and adequate environment for people to live in. Evidence: The service is divided into 3 units which are accessible to each other. Each unit has its own lounge and kitchen area which provides basic facilities. All bedrooms are single and there are various sizes some larger than others. Generally the home is decorated to an adequate standard. As mentioned at the previous inspection the are areas of wear and tear and some furnishings are worn and some areas like corridors, kitchens, toilets and bathrooms are basic and bare in decor. The manager advised at the previous visit that the unit didnt have a maintenance and renewal programme which has resulted in an environment which is basic in facility and does not always look homely or offer a younger persons design or comfort in some areas. We found that the service had alot of equipment and adaptations such as adapted taps and electric beds that would help with the care and support a person needed. However some basic equipment such as, one person had a low level bed that was too small for them and needed replacing to make sure they were comfortable at all times while at the service. During our visit the manager rectified this problem by ordering a new bed Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: to be delivered the following week. Care Homes for Adults (18-65 years) Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Guests are supported and protected by the services recruitment and selection procedures. Evidence: Records showed that before anyone is appointed to work at Mapleholme respite service a series of checks are carried out. These include obtaining written references and checking with the criminal records bureau (CRB). These checks help to make sure the people staying there are safe and that staff are suitable to support guests. Staff explained they mainly have long standing members of staff and rarely have new staff which showed the stability of the current staff team. Observation of staff and discussions with them indicate that the staff know the needs of the guests well and know their likes and dislikes. It was evident they had a good understanding of how to support guests and how to make sure their needs are met and their individuality respected and catered for. We spoke with staff and looked at staff training records which showed what training had been provided. Some staff were up to date. However some staff had not received mandatory training and updates. Staff need updated training to help keep them up to date in their practices and help to appropriately support guests. Some training records Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: showed that staff still needed training updates in safeguarding, medications, food hygiene, load management and learning disabilities. Care Homes for Adults (18-65 years) Page 23 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service benefit from a well managed respite service. Evidence: The manager meets with both the residents and staff on a regular basis and the minutes of these meetings shows good communication keeping everyone up to date and included with the developments of the home. The manager is currently going through the process of applying for registration with the commission. there is a clear management structure at the service however staff explained that due to long term leave they currently have 2 co ordinators which has led to some reorganization of workloads. The service is visited on a regular basis by a representative of the organization. These visits form part of the quality assurance process and form an opinion on the standard of care and support provided. These visits are also a requirement of the care home regulations and a report has to be produced to show evidence of these checks. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: Records and certificates showed that regular checks are carried out on the building and equipment. This includes checking electrical appliances, the gas supply These checks help to make sure that the environment is well managed and is a safe place to live and work in. Care Homes for Adults (18-65 years) Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 9 15 The registered persons must 03/02/2008 ensure that there is a clear record to indicate that care plans and risk assessments have been reviewed and the information in these documents has been updated. Care Homes for Adults (18-65 years) Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Care plans must be clear in 18/02/2009 describing the support needed to meet each persons needs including how to support a person with their communication,and behaviour. This will make it clear as to how people will be supported with all of their needs during their stay at the service. 2 14 16 Guest should be consulted 22/01/2009 about what activities they would like to do during their stay and be given updated care plans showing how they will be supported with their social needs. This will show how guests are supported in fulfilling their social needs and enhance their quality of life. Care Homes for Adults (18-65 years) Page 27 of 30 3 23 20 Each person must have clear 22/01/2009 and transparent financial assessments to show how their finances are managed. This will help to show how their funds are safeguarded. 4 32 18 Staff must have support in 18/02/2009 being updated with mandatory training including safeguarding, medication, food hygiene, load management, learning disabilities. This will make sure that staff have the necessary information and skills to appropriately support people during their stay at Mapleholme. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 To make sure the service has provisions and procedures to follow regarding emergency respite so that these placements receive appropriate support to move to more suitable long term placements. To plan and display weekly activties plans with new guests so that their needs and requests can be taken in to account when planning activites during their stay especially when they are on days off from their day service. All staff must have updated training on safeguarding so they are fully aware of policies and procedures to make sure people are protected. The service must have a maintenance and renewal programme and include guests and staff in the planning and development of Mapleholme. A review of the facilities should look at how the environment can be developed to provide facilities for younger adults which are more homely and personalised. To remove any notices from areas that 2 14 3 23 4 24 Care Homes for Adults (18-65 years) Page 28 of 30 guests access and live in. All guests must be provided with any necessary equipment to help them live comfortable at Mapleholme including comfortable and appropriate beds. 5 32 All staff must be provided with at least 5 days paid training per year to make sure they are up to date with current good practice to support all of the guests. To produce a development plan for Mapleholme and consult and include the staff and guests regarding the future and development of their service. 6 39 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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