CARE HOME ADULTS 18-65
Meadow & Ivy Cottages 39-40 Bentinck Crescent Pegswood Morpeth Northumberland NE61 6SX Lead Inspector
Janine Smith Key Unannounced Inspection 26th July 2006 09:50 Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 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 Meadow & Ivy Cottages DS0000000610.V295358.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 Adults 18-65. 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. Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Meadow & Ivy Cottages Address 39-40 Bentinck Crescent Pegswood Morpeth Northumberland NE61 6SX 01670 511776 01670 511776 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) www.c-i-c.co.uk. Community Integrated Care Mrs Elizabeth Jane Costelloe Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 4 residents may also have a physical disability 2 residents may also be over the age of 65 Date of last inspection 19th January 2006 Brief Description of the Service: Meadow and Ivy Cottages provides a home for up to seven adults with a learning disability who need residential care. Some of the residents also have physical disabilities. Nursing care is not provided. The fees are £723 per week. The building has the appearance of two modern semi-detached bungalows. A corridor links the bungalows internally. The design of the house is in keeping with other houses on the estate and is close to local facilities, such as the health centre and transport networks. Each bungalow has a lounge, dining kitchen and bathroom and toilet facilities. Residents can use the shared facilities in either house. The house is surrounded by large, maintained gardens, which have a summerhouse, paved areas for sitting and are easily accessible. Residents also have a mini-bus. Information about the service, including inspection reports, are readily available. Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection started at 9.50 am on 26th July 2006 and took seven hours. The home had not been given advance warning. There were 7 residents living in the home. A tour of the premises was made, including the bedrooms. The systems for the storage, handling and administration of medication were looked at, as well as the system for handling residents’ money. A sample of records about the residents and staff were also examined. The seven residents were spoken to as well as the Manager and three of the staff. What the service does well:
The Registered Manager and her team are committed to ensuring that the residents have a good quality of life. People living here are encouraged and supported to enjoy facilities in the community and at home. Staff were aware of each residents’ needs and how their care should be provided. Some residents cannot communicate verbally, but the staff team understood the other ways in which they expressed their views and consulted them for their opinions and wishes. Each resident has a regular programme of activities that they participate in. These are individualised and vary according to their interests. A resident spoke about the bowls she enjoys playing. During the inspection, some went on an outing, others enjoyed spending time with staff or time alone listening to music or watching television. The routines in the home are based on the wishes and needs of the people who live there. For example, one resident enjoys staying up late and sleeping late in the morning. The atmosphere in the home was very cheerful and happy. The standard of decoration, furnishing and equipment is high. Bedrooms were pleasant and comfortable and reflected the personality of each resident. The home was very clean and protective clothing was available to the staff team. 60 of the staff team have now achieved a National Vocational Qualification at Level 2 or above and evidence of this was seen on a sample of staff files examined. The files also showed that staff have opportunities to do other relevant training, such as ‘communication and listening skills’ and ‘understanding challenging behaviour’. Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 5. Standard 2 was not applicable. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Standard 2 was not assessed as all of the residents have lived at the home since it was opened several years ago. Contracts are in place, which explain the terms and conditions applying to the home. EVIDENCE: Three care files were examined and contracts were found in place on each. Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. 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 care planning arrangements ensure residents’ needs and wishes are understood and met. The residents are supported to make decisions about their lives and how they spend their time. Staff take appropriate action to reduce the risk of harm occurring to anyone, whilst ensuring that the residents live fulfilling lives. EVIDENCE: Three care records were examined. These were very detailed and up to date and provided the staff team with the information they need about each resident’s needs and wishes for their care. Individualised procedures were in place for residents, where particular risks had been identified. Staff were aware of each residents’ needs and how their care should be provided. Some residents cannot communicate verbally, but the staff team understood the other ways in which they expressed their views.
Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 10 The staff respected resident’s choices about how they spent their time and with whom. The staff could provide examples of how they give choices to residents day to day. Any risks arising from residents’ day to day lives have been identified and strategies put in place to reduce the risk of any harm occurring to residents or anyone else. Consultation has taken place with relevant specialists where appropriate. Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15, 16 and 17. 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 staff help residents to participate in a range of fulfilling activities, which provide them with enjoyment and give them opportunities to meet and spend time with other people outside the home. Routines in the home are centred on the needs and wishes of the residents. Residents are provided with nutritious and varied meals, which they enjoyed. EVIDENCE: Each resident has a regular programme of activities that they participate in. These are individualised and vary according to their interests and age. For example, one resident regularly attends an Adult Training Centre, some attend an Over 55 club, two residents regularly play bowls, some attend ‘snoozelum’ sessions or craft sessions at venues outside of the home. Residents regularly go for walks or outings with the staff. Some residents assist with baking sessions in the home and enjoys visits by a Music Therapist.
Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 12 One resident has their own transport, others can use the home’s minibus. There are regular outings to local places of interest and residents often have lunch or a snack when on outings. Recently staff have assisted some residents to use a new bus service, which has enabled them to visit Newcastle City Centre and other towns in Northumberland. A resident spoke about the bowls she enjoys playing. One also had photographs, from when they attended the wedding of a member of staff. Residents can move around the building as they wish and choose who they wish to spend time with. During the inspection, some went on an outing, others enjoyed spending time with staff or time alone listening to music or watching television. The routines in the home are based on the wishes and needs of the people who live there. One resident enjoys staying up late and sleeping late in the morning. The atmosphere in the home was cheerful and happy. Residents are supported to keep in contact with their families. Some residents go out to visit their families, other are welcomed to the home. The staff follow menu plans which offered nutritious and varied meals. There is a separate menu plan in place for each part of the home. A support worker said that alternatives were readily available if any resident did not want any menu item. The inspector had lunch with some residents, who were having a tasty soup followed by rice pudding. They looked like they enjoyed the food. In the evening, residents were offered a roast chicken dinner with Yorkshire pudding and vegetables. Staff gave support to those residents who needed it, and respected residents’ wishes to eat alone or with others. Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents are supported in a way that meets their needs and wishes. The health needs of residents are well met, apart from monitoring of their weight, which is being done infrequently. The systems for the handling and administration of medication were sound. However, not all the medication is stored appropriately. EVIDENCE: Staff were seen providing care to residents in a sensitive and respectful manner. Residents are encouraged to choose their own clothes. All were well dressed and attention had been paid to their appearance. Times for getting up/going to bed are flexible and take account of residents’ individual preferences. Specialist equipment has been obtained for residents where appropriate, following assessment by specialists, such as Occupational Therapists. Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 14 Inspection of care records and discussion with the Manager showed that residents’ have regular health care checks and contact with specialists as needed. Residents were being weighed infrequently. One, who has a low body weight, had been weighed twice in 2005, and once to date in 2006. This is due to a lack of suitable equipment in the home. A random sample of medication records and the system for storage and handling medication was looked at and found to be appropriate, other than some medications were being stored in a locked cupboard used to store other items, such as cleaning substances and files. A new carer confirmed that training is given in handling medications and evidence of training was seen on staff records. A resident has diabetes. The Community Nurse has delegated responsibility for carrying out blood glucose monitoring tests to the staff, who have been trained by the Manager. The training is not documented as thoroughly as it should be. Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Staff know and understand how each resident communicates their feelings, which helps ensure that any concerns they have are acted upon. The Manager and staff have good knowledge of adult protection issues, which helps protect residents from abuse. EVIDENCE: The Manager stated that no complaints have been received since the last inspection. The complaints procedure is produced in a pictorial form for each resident and is available on audio tape. The Manager described how she endeavours to create a culture within the home to encourage residents to make clear their feelings and wishes. Some residents have difficulties communicating verbally, but discussions with staff showed that they were well informed about how residents communicate non-verbally and how they indicate if they are not happy about something. Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 16 The Manager said most of the staff have received training in adult protection. Evidence of this training was seen within staff records. A member of staff spoken to during the inspection showed an understanding of the issues and was very clear about the action she would take if she had any concerns. Staff help residents with their finances by holding money on their behalf and making withdrawals from their bank accounts. Records are kept of transactions and there are audit procedures in place. A check was made of the cash amount held for one resident, which tallied with the record held. Receipts were kept for purchases made on residents’ behalf. Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 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 home is designed to meet the needs of people with learning and physical disabilities and fits in well with other houses in the neighbourhood, providing residents with an attractive and homely place to live. It is well maintained and clean, providing a safe place for people to live. EVIDENCE: The home was toured and found to very well maintained, clean and comfortable. The standard of decoration, furnishing and equipment is high. There are an appropriate number of bathrooms and toilets. Hoists and other special equipment has been provided to meet the needs of residents, following assessment by appropriate specialists. Bedrooms were pleasant and comfortable and reflected the personality of each resident. The home was very clean and protective clothing was available to the staff team.
Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. 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 number and type of staff on duty throughout the day and night is sufficient to meet the needs of residents. The organisation provides a good range of training to staff, although LDAF induction training should be more timely. There are weaknesses in the vetting procedures, which places residents at potential risk. EVIDENCE: Four staff were on duty from 8 am to 3 pm, and then four more from 3 pm to 10 pm. The rota and staff confirmed that it was normal practice to have four staff between these periods and that one member of staff slept in overnight to assist a waking member of staff if necessary. A carer said that the staff levels were good, giving them time to spend with residents. The Manager works as part of the care staff team, which limits the amount of time she has for management duties. Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 19 The Manager confirmed that 60 of the staff team have now achieved a National Vocational Qualification at Level 2 or above and evidence of this was seen on a sample of staff files examined. The files also showed that staff have opportunities to do other relevant training, such as ‘communication and listening skills’ and ‘understanding challenging behaviour’. The Manager said she had spent a lot of time with new staff, ensuring that they understood the needs of residents and how they communicate and that staff were aware of good practice. The benefits of this were apparent, as a recently recruited member of staff was well informed about the residents. There was evidence that new staff have been given basic induction training, however there have been delays in providing Learning Disability Framework Training (LDAF) due to courses being unavailable at the local college. This means that some new staff will not receive this training within the six months timescale set out in Standard 35.3. Three staff records were examined. Written references had been obtained from previous employers and the Protection of Vulnerable Adults List checked before the new staff were employed. Due to staffing difficulties, the organisation has employed some staff before a full Criminal Records Bureau Disclosure (CRB) had been obtained. These staff were being supervised at all times, until such time as the CRB was obtained. However, one CRB remained outstanding after almost six months, which is an unacceptably long time. When applicants are interviewed, a checklist is kept of the interview findings. There was a lack of evidence gaps in one employee’s job history had been explored before they were employed. Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 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 Manager provides clear leadership, which ensures that the home is well run and the staff team are fully aware of their roles and responsibilities. The organisation regularly reviews its performance. However, this would be more meaningful, if the results of surveys of service users and other stakeholders about the performance of this home, were made available to them and the Manager. There is a thorough approach to health and safety, which ensures that the home provides a safe environment for residents and staff. Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 21 EVIDENCE: There was evidence that the home is run well by the Registered Manager, Mrs Liz Costelloe. She stated that she has recently completed the Registered Manager’s Award and expects to receive the certificate for this training shortly. CIC carry out a quality assurance survey of its service users, staff, and other stakeholders on an annual basis. The company then produce a report of the overall findings, which is also available on the internet. Examination of the report showed that high satisfaction ratings had been achieved in a number of areas, however the report does not give any information as to whether any respondents were dissatisfied with any aspect of the service provided. Neither is feedback given to each respective Home on the results of the survey, which means that the Manager does not know if there are any areas of the service, which need to be improved. The service is visited monthly by a senior Manager who checks the quality of the service being provided, which is a regulatory requirement. The Manager also carries out health and safety audits monthly. CIC has a training programme in place to ensure that the staff are given training in moving and handling skills, fire safety, first aid and infection control. Evidence of the training was seen on a sample of staff files examined. Training was being arranged for staff needing updates or who had not yet done the required training. Evidence of maintenance and servicing of essential equipment in the home was seen. The electrical wiring system has recently been inspected and some work to improve this is required. The entries in the fire log book showed that routine checks on the fire safety systems are made and staff are given training. No health and safety hazards were seen during this inspection. Meadow & Ivy Cottages DS0000000610.V295358.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 Adults 18-65 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 X 2 X 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 x Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? 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 YA19 Regulation 12(1) Requirement Obtain appropriate weighing scales so that residents can be weighed at home at least monthly. All medication must be stored in an appropriate secure cupboard, which is not used for the storage of other non-clinical items. The outstanding Enhanced Criminal Records Bureau Disclosure must be obtained in respect of the member of staff employed nearly six months ago. The organisation must ensure that Disclosures are obtained promptly if staff are to be employed. A full employment history, together with a satisfactory written explanation of any gaps in employment, must be kept for each person managing or working at the home. Confirm that the works identified as necessary in the report of the recent Periodic Inspection of the Electrical Wiring system have been carried out and are satisfactory.
DS0000000610.V295358.R01.S.doc Timescale for action 31/10/06 2. YA20 13(2) 31/10/06 3. YA34 19 31/10/06 4. YA42 13(4)(a) 23(2)(b) 31/10/06 Meadow & Ivy Cottages Version 5.2 Page 24 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 YA20 Good Practice Recommendations The training of staff in caring for diabetic residents should be thoroughly documented to show that they have been trained and are competent to carry out the practical aspects of :checking blood glucose levels and testing urine sample and understand the relevance of the outcomes of these tests and any action to take. Awareness of specific complications that diabetes may give rise to. Provide bereavement training for staff. (Outstanding from previous inspection.) The Registered Manager should endeavour to ensure that LDAF training is provided to new inexperienced staff in accordance with the timescales set out in Standard 35.3. The Registered Manager should provide CSCI with copies of certificates of NVQ Level 4 in Care and the Registered Manager Qualification when these are available. The results of surveys of service users and other stakeholders about the performance of this home, should be made available to them and the Manager. 2. 3. 3. YA21 YA35 YA37 4. YA39 Meadow & Ivy Cottages DS0000000610.V295358.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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