Inspection on 21/12/05 for Medihands Healthcare (2)

This inspection was carried out on 21st December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Medihands Healthcare (2) 17/10/06

Medihands Healthcare (2) 28/10/05

Medihands Healthcare (2) 21/03/05

Medihands Healthcare (2) 09/12/04

Medihands Healthcare (2) 28/02/04

Medihands Healthcare (2) 30/10/03

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Medihands Healthcare (2) 2 Westbury Road New Malden Surrey KT3 5BE Lead Inspector David Pennells Unannounced Inspection 15:00 21 December 2005 st Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 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 Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Medihands Healthcare (2) Address 2 Westbury Road New Malden Surrey KT3 5BE 020 8404 4108 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) Mrs Jayashree Sawmynaden Mrs Jayashree Sawmynaden Care Home 3 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (3) of places Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28/10/05 Brief Description of the Service: 2, Westbury Road is owned and managed by Mrs Sawmynaden – being part of a group of homes in this area (‘Medihands Care Services’). The owner / manager is well organised in supporting the needs of both service users and staff. She is also the owner/manager of another small unit a couple of roads away, and the proprietor of a larger home for people with mental health needs and also a care home for older people. This is a small care home for three people, situated in a pleasant residential area not far from New Malden High Street, on a busy main road close to local amenities and shops. The house is in keeping with the neighbouring properties and is not identifiable as a ‘home’. The home provides long term care for a small number (three maximum) of people with enduring mental illness. The home aims to support service users in becoming independent through providing such support to each individual. Accommodation comprises a bedroom for each of the three service users, with a bathroom and toilet upstairs, and the lounge/diner, a conservatory, toilet and kitchen are provided on the ground floor. There is a small rear garden with a patio. The accommodation is of generally good quality. Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted over a period of just over three hours, during which time the inspector was able to meet the staff member on duty, with all three of the service users, and the proprietor and her husband – who came to the home part-way through the inspection. The ground floor communal areas of the home were again inspected – as at the last inspection, but service users bedrooms were not seen on this shorter visit – the inspector relying on self-reporting. The inspector was again able to review the outcomes from requirements and recommendations from the last inspection visit, and also to inspect essential documentation relating to the home – ensuring that the conduct of the home was safe for both service users and staff. The inspector is grateful to the service users and staff for their welcome and hospitality during the visit. The inspector spent a good time talking to all three service users in private – as well as alongside the proprietors – and was able to ascertain that all three service users were generally very satisfied with the service received and keen to praise both the staff on duty at the home and the proprietor for her attention to their needs. What the service does well: What has improved since the last inspection? Training – to an accredited level - has been given to all care staff concerning the administration of medication. This course was arranged through the Boots the Chemist pharmacy adviser. The house continues to be well kept, generally, and was warm and comfortable on the day of the inspector’s visit. All three of the service users reported a general consensus of happiness at the home – reporting that is was meeting their needs, both individually and collectively. Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 Page 6 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. Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 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 Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 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): 2. Service users can expect their needs and aspirations to be clearly assessed and expressed in both the comprehensive assessments undertaken through the care programme approach, and by the home seeking to underpin these plans through their own care planning. EVIDENCE: The population of the home was the same as at the last three inspection visits; one service user has been resident at the home since 1994, the other two arriving in November 2002 and January 2003. All standards were previously inspected in the previous (2004/05) cycle of inspections and found ‘met’ at these previous visits. On this occasion, the home was able to evidence that regular reviews are held during which time service users are interviewed and their plans for the future and also preferences and comments about the service are taken on board. The Community Mental Health Team is conveniently situated only a short walk away from the house at Roselands Resource Centre - and service users are therefore in constant contact (even by workers just ‘dropping in’ when necessary) with professional input. There is a positive working relationship between the mental health care professionals and the home. Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 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): None directly inspected on this visit. The home maintains care plans and assessment documents designed to ensure that the needs of individual service users are realistically met in a focused and individual way. Service users can be assured that their rights to individuality and selfexpression are protected, whilst acknowledging the community aspect of living at the home. Consultation and sharing of information will involve, and take into account, the wishes and aspirations of the single service user as an individual, as well as being a member of the home’s community. Service users can be assured that risk-taking will be an integral part of the support / protection plans put in place by the home and the placing authority. EVIDENCE: These standards were not inspected this time and the inspector had no reason from what he observed /learned on this visit that the situation had changed from the previous time’s visit. The above judgement statements were formulated after the inspection of Key standards 6-9 on the last visit and are repeated here for information. Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 Page 10 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): 15. Service users can be assured that the home provides opportunities for them to engage in activities both within and outside the home, and to adopt a lifestyle suited to their individual needs and preferences, whilst respecting a service user’s own choices and decision-making. Service users are encouraged to develop and maintain personal relationships – with both family members and friends – through the home offering encouragement, advice, support and appropriate guidance on ‘boundaries’. Service users can expect to be provided with nutritious and wholesome food from the home’s menu, acknowledging the right to their own stated choice. EVIDENCE: All the above standards - but standard 15 - were examined at the last inspection visit – and found generally ‘met’. A recommendation was made, which is discussed further below, under standard 17. The first and third judgement statements cover the findings of the last inspection visit – which the inspector believes to be the ongoing case at this Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 Page 11 visit. The middle paragraph states the case finding standard 15 to also be ‘met’. It was clear from discussion with service users that relationships with families and friends are positively encouraged by the home. With the exception of spending the entire night at the home, visitors are welcomed at the home and service users confirmed that they may spend times with their friends either in the communal space of the home (with the remaining service users’ agreement) or in their own private bedroom space. Personal relationships are also encouraged, the service users stating that personal friends are accepted and encouraged at the home. Relationships with families / parents are also strengthened through the service users visiting them at their respective homes; one service user travels to Leicester, one to Hampton and one to near Heathrow to maintain and sustain these important connections. An issue raised as a recommendation in the last inspection report again arises at this point; whilst the general standard of food provided at the home is appreciated and declared to be of a good general standard, service users also express a wish to have a higher level of choice in such issues as the choice of bread provided at the home; the ‘white sliced’ bread (observed again in the refrigerator) was not liked by the service users interviewed. The inspector recommends that the manager and staff ensure that the mechanism agreed (this time immediately declared by the proprietor) of having a ‘float’ of cash available to buy fresh brown bread - ensuring that the preferred foodstuffs are provided at the home - is carried through this time. A suggestion by service users that the home makes available tins of soup or ‘cup-a-soups’ is also made a recommendation – to ensure that this practical suggestion (especially for the colder winter months) is carried to fruition. Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 Page 12 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): 20. Service users can be assured that their personal, health care and emotional / mental health needs will be recognised and met by the home’s daily service input - and through longer-term monitoring, assessment and care plan programming in conjunction with the mental health team professionals. The systems adopted by the home regarding the storage, administration, and disposal of medication ensure the safety and consistent treatment and support for each service user, according to their individual needs. EVIDENCE: The first three of the above standards were previously inspected and the judgement statements covers these again and also reflects the spot checking of medication storage and records – which were all found to be in order on the day of the inspection visit. Medication was stored, ordered and disposed of according to the set written house procedures. Photos were present on Medication Administration Record sheets. Details concerning ‘prn’ medication (‘when required’) were noted to be full in detail to support staff when having to decide if a discretionary dose was appropriate. Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 Page 13 Staff members have received training in the administration and handling of drugs - and are supervised by the manager until assessed as generally proficient. The proprietor has recently accessed accredited staff training by Boots – the supplying pharmacist. The Consultant Pharmacist visits the ‘Medihands’ homes and inspects the systems from time to time. All three of the service users interviewed were vociferous with the strength of opinion that indicated that they felt they were appropriately placed and that the home – and implicitly the care provided - was ‘right’ for them at present. Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 Page 14 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): None inspected this time. Service users can be confident that their comments and complaints are responded to, with appropriate action being taken in a timely fashion. The home provides support to service users to ensure that they are protected from harm and any form of abuse. EVIDENCE: The above judgement statements are reiterated from the last inspection report, where both standards were found ‘met’. The inspector had no reason to suspect that the situation in this regard had changed over the past three months. Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 Page 15 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): None fully inspected at this visit. Service users can expect to live in a clean, warm and comfortable environment - designed to meet their individual needs - and providing adequate services and domestic facilities. Service users can be assured that, generally, the home is maintained as a safe environment, in which they may live without unnecessary risk or danger. EVIDENCE: The above judgement statements were written in October 2005 at the previous visit (when all standards were found ‘met’) and - the inspector this time seeing the public areas in full, and checking with users about their private space - is happy to state that the premises continue to be well maintained and safe. The home is ideally situated, just off a principal road leading to Kingston, within a short walk of local shops, other amenities and public transport. The premises again appeared to provide a comfortable & homely environment for all service users. There is a good standard of decoration throughout the home, with the furniture and fittings being of good quality. The home has access to maintenance staff, ensuring all repairs can be dealt with swiftly. Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 Page 16 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): 35. Service users can be assured that they will be supported at all times by staff who are trained and competent in their work, staff being provided in sufficient numbers to meet service user’s identified needs. Service users can expect to be provided a service that ensures their safety and protection from abuse through thorough recruitment processes, and ongoing staff support arrangements. Service users can expect to be served by adequately training staff membersthough the deficit in First Aid training could compromise the service users’ safety and best interests. EVIDENCE: The first two judgement statements above cover the key standards 32 & 34 which were covered at the last inspection. The third paragraph covers the exploration of the key issue (previously raised) of staff training (Standard 35) raised in regard, especially, to First Aid. Discussion again revealed that four of the six staff members working at the home are undertaking NVQ training in care - so that the home will exceed the target of a minimum of 50 care staff being trained soon after the end of 2005. Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 Page 17 It is hoped and strongly recommended that that all staff working at the home will be at least thus qualified - if not to a level higher than Level 2 - as they are working independently on their own initiative at the home, on a generally unsupervised basis, except when Mrs Sawmynaden - as manager - is also at the house. The duty roster again confirmed that there is one staff member on duty at all times at the home and one staff member sleeps-in at night. The manager’s time is shared with the other Medihands 3-bedded home (“Medihands Villa”) nearby. Three staff members have First Aid training – there is a need (and it is a regulatory requirement) to ensure that all staff members working at the home have a First Aid qualification – as they will, without doubt, find themselves at some point working independently at the home and needing to call upon such skills in an emergency situation. The home was yet to arrange training in this discipline at the time of the inspection visit, however a day or two after the visit, the inspector was informed that training sessions had been booked for staff members early in the new year 2006. The inspector again observed that the proprietor continues to be very much ‘hands-on’, providing additional support and guidance to service users and also to staff. Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 Page 18 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): 39 & 40. The home generally operates systems to ensure service users benefit from a well-run and safe environment. Service users can be assured that their welfare, health and safety is safeguarded through the home’s adherence to appropriate guidance and regulations concerning best safety practice. Service users can be confident that their opinions and views underpin the majority of actions and developments undertaken by the home; service users can be confident that their opinions will be heard. Service users can be assured that generally their rights and interests are well served and protected through the home’s approach to record keeping, policies & procedures, and through the day-to-day conduct of the home. EVIDENCE: The above first and last judgement statements cover the key standards, 37 and 42 which were both inspected and found generally well met at the last inspection visit. The central statement is related to standard 39 –which was inspected at this visit. Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 Page 19 The proprietor / manager – who manages a second ‘small home’ nearby - is almost always available to the home, if any problems arise. On the day of the inspection, the manager had been called at the inspector’s arrival, and she was at the home within a few minutes. She has many years’ experience working with this client group and showed good insight into relevant issues. Service users expressed their confidence in receiving a positive reaction from any discussion, formal or informal, with the proprietor. One service user – with the other two present - summed up this feeling by stating: “Mrs Sammy is always willing to listen if we have a problem and we immediately come together and discuss it – I have done the minutes, or Mrs Sammy does them. Service users also confirmed that they have routine ‘Residents meetings’ and that minutes are taken of these events. The inspector has also been shown a format devised by the proprietor for surveying service users, their relatives and professional carers; this was currently being implemented. ‘Policies and procedure’ sets are now held in each ‘Medihands’ home, as each is a separately registered care home. All policies and procedures held must, however, be dated and signed by the proprietor - to ensure that staff members are reading the most up-to-date document, and also using the documents specifically sanctioned by the proprietor. This issue was a requirement outstanding from the last two inspection visits; the proprietor again admitted that work had not been completed on this aspect yet. A recommendation about ensuring that all staff had experienced a fire drill in the houses they work in (they can move from one small home from time to time to ‘help out’) is reiterated – purely as one staff member was found not to have undertaken a drill at those premises yet. Again, as staff members are left on their own at these addresses, it is important that more-than-robust induction (including a fire practice / drill) is arranged for each staff member as soon as possible. Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X 2 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Medihands Healthcare (2) Score X X 3 X Standard No 37 38 39 40 41 42 43 Score X X 3 2 X X X DS0000013435.V273421.R01.S.doc Version 5.0 Page 21 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 YA35 Regulation 13(4) Requirement First Aid training must be provided to all staff members who work at the home – as they will, without doubt, find themselves working independently at the home - and need to call upon such skills in an accident emergency. Timescale of 01/03/06 yet to be met; the proprietors have booked some courses for staff early in the new year. All policies and procedures held must be dated and signed by the proprietor, to ensure that staff are reading the most up-to-date document – and are also using the documents specifically sanctioned by the proprietor. Previous timescales of 30/04/05 & 20/12/05 not due to be met. Timescale for action 01/03/06 2. YA40 17 & 18(1) 28/02/06 Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 Page 22 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 YA17 Good Practice Recommendations That service users be consulted more closely with regard to their preferred foodstuffs, such as providing brown or wholemeal bread rather than the ‘white sliced’ observed in the fridge at the home on the day of the visit. That snacks such as tins of soup or ‘cup-a-soups’ be made available for service users – especially throughout the colder months. All care staff should be trained minimally to NVQ level 2 in care by 2005; the home should aim to train staff at 2, Westbury Road to a higher level, due to their need to operate autonomously. The manager of the home should evidence her competency against the NVQ Level 4 Registered Manager’s Award framework – this competency evidence should be in place by the end of December 2005, or supplementary training be committed to, by this date. Fire drills should be conducted sufficiently frequently to ensure that all staff members have undergone such training on a minimally yearly basis. 2. YA17 3. YA32 4. YA37 5. YA40 Medihands Healthcare (2) DS0000013435.V273421.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 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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