Inspection on 10/01/06 for Morton House

This inspection was carried out on 10th January 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Morton House 30/05/07

Morton House 07/08/06

Morton House 21/07/05

Morton House 26/03/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Morton House The National Society For Epilepsy Chesham Lane Chalfont St Peter Gerrards Cross Bucks SL9 0RJ Lead Inspector Barbara Mulligan Unannounced Inspection 10th January 2006 13:30 DS0000023000.V277683.R01.S.doc Version 5.1 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 DS0000023000.V277683.R01.S.doc Version 5.1 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. DS0000023000.V277683.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Morton House Address 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) The National Society For Epilepsy Chesham Lane Chalfont St Peter Gerrards Cross Bucks SL9 0RJ 01494 601300 01494 871927 jo.yates@epilepsynse.org.uk martineau@epilepsynse.org.uk The National Society for Epilepsy Johanne Hazel Yates Care Home 17 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places DS0000023000.V277683.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 17 residents, some of whom may have a physical disability, learning disability. 21st July 2005 Date of last inspection Brief Description of the Service: The National Society for Epilepsy is an independent registered charity that is administered by a Board of Governors who oversee the running of the Chalfont Centre. The centre is located on a large rural site on the edge of the village of Chalfont St Peter. It consists of residential houses, a supported living project, a number of workshops and sites for daytime activities, an assessment unit which is an NHS provision, and additional services including a chapel, a restaurant central kitchens and laundry, a small shop run by service users, administrative buildings and staff accommodation. Morton House is one of the residential houses and is situated centrally on the site. The house is surrounded by attractive, open, grassy areas. It has no private garden of its own but a small area at the front with benches and tubs of flowers. The home is a two storey building and access to the upper floor is by stairs or passenger lift. All rooms are single accommodation and there is a small kitchen, a bright and spacious dining and living room. There is access to public transport and this is used by service users living in the home. The home provides double bedroom accommodation on request, presently providing for one married couple. DS0000023000.V277683.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 11th January 2006 at 13.30pm on a Tuesday afternoon. The visit consisted of discussions with care staff, and records, policies and procedures were also examined. Support worker Leszek Jastrzebiecpelczynski assisted the inspector during the visit to the home. The inspection officer was Barbara Mulligan. What the service does well: What has improved since the last inspection? What they could do better: DS0000023000.V277683.R01.S.doc Version 5.1 Page 6 Care plans were observed to be detailed and contain an action plan to ensure care needs are met. However, several night care plans were completed illegibly and were not dated. It is a requirement of the report that all documentation is completed legibly, accurately and is up to date. The inspector observed two occasions where service users were having difficulties making themselves understood by care staff. On both occasions this was resolved by the housekeeper. It is recommended that there are staff on duty at all times who can communicate effectively with service users in their first language including sign; and have skills in other communication methods relevant to service users needs. During discussion with the assisting support worker he stated that he had not received fire training during his sixteen months in post. The support worker did not know where training records were kept so staff training was difficult to assess. The inspector requests the registered manager to forward to the Commission evidence of all staff training undertaken in the last twelve months. Staff are unable to produce any evidence of Quality Assurance practices undertaken in the home and it is a requirement of the report that the home ensures an effective quality assurance system is in place to measure success in achieving the aims and objectives of the home. 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. DS0000023000.V277683.R01.S.doc Version 5.1 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 DS0000023000.V277683.R01.S.doc Version 5.1 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): Standard 1 was not assessed due to the Statement of Purpose and Service Users Guide being unavailable for inspection. EVIDENCE: The homes Statement of Purpose and Service Users Guide were not available for inspection purposes and the inspector requests that an up to date copy of both documents are sent to the Commission. DS0000023000.V277683.R01.S.doc Version 5.1 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, 8 and 9. Not all care planning documentation is legible and does not ensure service users’ rights and best interests are safeguarded. Service users make decisions about their lives, with assistance and communication support, that allows them to influence their lifestyle and how the home is run. Support staff enable service users to make decisions in relation to their own lives, providing information, assistance and support to maintain their independence. Risk assessments are in place that outline individual vulnerabilities and which contain control measures that enable service users to live their lives as independently as possible. DS0000023000.V277683.R01.S.doc Version 5.1 Page 10 EVIDENCE: A random selection of care plans were looked at during the inspection. Care planning documentation has been reviewed and improved upon. The care plans looked at cover communication, mobility, personal hygiene needs, health care needs, religious needs, social life (off the centre) and social life (on the centre) and family contacts. Care plans were observed to be detailed and contain an action plan to ensure care needs are met. However, several night care plans were completed illegibly and were not dated. It is a requirement of the report that all documentation is completed legibly, accurately and is up to date. Service users have a choice of menu each day, and are supported to make individual choices. Service user meetings take place 2-3 times a month. At the time of the inspection there were no service users who were being supported by an advocate. Each individual is assessed regarding money management and staff offer informal training if required. The inspector observed the financial assessments. Numeracy training is available on site and this is a six-week course. Service users are informally involved in decision-making regarding the home. They are invited to a “Any questions asked” forum where service users are invited to raise concerns and ask questions. Policies and procedures are not in a service user-friendly format. However the complaints procedure is available in picture format and this is also available in the Statement of Purpose and the Service Users Guide. Risk assessments are in place and up to date. These are completed for transportation, smoking, use of stairs and self-medication and road awareness. There is an absence policy regarding unexplained absences by service users and this was dated 1994. DS0000023000.V277683.R01.S.doc Version 5.1 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): 11, 12, 13, 14, 15, 16 and 17 Care planning documentation demonstrates that service users have opportunities for personal development and independence training. Service users are able to access a wide range of amenities which meet their social, leisure and spiritual needs. Service users engage in appropriate activities inside and outside of the home, allowing individuals to pursue their own interests and hobbies. Links with the local community are good which support and enrich service users social and educational opportunities. Staff support service users to maintain family links and friendships inside and outside the home. Service users rights are respected and the daily routines of the home promote individual choice and freedom of movement. The dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. DS0000023000.V277683.R01.S.doc Version 5.1 Page 12 EVIDENCE: Several service users attend the local college where they undertake training in social skills, community participation and social development courses. Service users have opportunities to maintain and develop social, emotional, communication and independent living skills through training carried out with the homes staff and day services staff. Service users are supported to continue with activities engaged in prior to entering the home. On site there is a sheltered workshop called CAPS where service users are offered employment opportunities. There is also a printing workshop, computer courses and an Internet Café which is available to service users if they wish to access them. Benefits are paid into a safe keeping account and service users do not go to the post office to cash their own benefits. Service users access local pubs, shops, the cinema and local restaurants. On the day of the inspection many service users were out attending places of work. Day services on site offer trips out every day to libraries, supermarkets and shops and the home provides supported trips as well. The National Society for Epilepsy has a pool of transport and the home can access this. Service users also access taxis and one service user has accessed dial a ride. The home encourages service users to vote. All service users are registered to vote but not many take advantage of this. Televisions, videos and music centres were observed around the home and in service users own rooms. All service users choose to enjoy an annual holiday. Family and friends of service users are welcomed into the home. The home operates an open house policy and there are no restrictions on visiting. Service users can see visitors in the privacy of their own rooms or there is a quiet room available. Service users have a key to their own bedrooms if they wish. Locks can be over ridden from outside by the staff. Mail is delivered to the home and then distributed to the service users. If they require help to read or understand their mail then the staff will support them. Care staff were observed interacting with service users and this was done with respect. However there were communication difficulties observed between some staff and service users. The registered manager needs to ensure that there are staff on duty at all times who can effectively communicate with service users and this is a recommendation of the report. DS0000023000.V277683.R01.S.doc Version 5.1 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, 20 and 21. Service users’ needs are outlined within their individual plans, ensuring that the manner in which they are supported and cared for by staff is appropriate and promotes their preferences. The physical, emotional and health care needs of service users are well met with evidence of good multi disciplinary working taking place on a regular basis. The systems for the administration of medication are well managed, protecting service users and ensuring their medication needs are met. There are good policies/procedures in place to ensure that the ageing, illness and death of a service user will be handled with respect and as the individual would wish. EVIDENCE: DS0000023000.V277683.R01.S.doc Version 5.1 Page 14 Moving and Handling assessments are in place for service users. Service users are able to retire to bed and rise whenever they chose to do so. Other activities are flexible, although it can be difficult to arrange mealtimes around service users activities due to the fact that the meals arrive from a central kitchen. The home operates a key-worker system. Service users are given support to choose their own clothes, hairstyles and make up. Key-workers will take service users to shop for their own clothes and other personal items. There is evidence of services users likes and dislikes and preferences, contacts with advocates, family, friends and relevant professionals outside of the home. Personal Care needs of service users are recorded in care plans. There are adapted baths and grab rails around the home. There is a psychologist on site who can be accessed to monitor the mental health needs of service users. Service users are supported and facilitated to manage their own healthcare where practicable. Service users at Morton House are registered with a G.P. who is community based, but has a clinic at The National Society for Epilepsy on a weekly basis. Service users undertake regular dental and optical health checks. Hearing checks are accessed via the service users G.P. Visits to the home from healthcare professionals take place in the service users bedrooms. Staff provide support to service users needing to attend outpatient and other appointments. A teaching programme for the self-administration of medication is practised in the home and service users are on different levels of the programme. At the time of the inspection approximately seven service users who are on this programme. There are consent forms for medication and risk assessments are in place. Medication is received by the home monthly, from the pharmacy on site. Returns are completed by senior staff and records looked at demonstrate that these are completed accurately. Each service user has a purple chart for anti epileptic medication and a green chart for other prescribed medications. All charts observed contain a photograph of each service user for identification purposes. All medicines are stored appropriately. The home do not handle controlled medication. Staff undertake training in the administration of medication. Training includes medication awareness and medication management. The pharmacist and the clinical tutor supply training. Following training, staff are required to complete twelve supervised medication rounds in a period of three months. Then each individual is assessed using a National Society for Epilepsy drug assessment, and this includes a written exercise. There is a bereavement counsellor on site and this is available for both service users and care staff if it is required. There are policies and procedures in place regarding Care of the Dying. There were not observed during the inspection. The new care plans allow for recording service users wishes regarding their last DS0000023000.V277683.R01.S.doc Version 5.1 Page 15 wishes. The home will be supported to enable service users to receive treatment and care to die in the home if that is their wish and unless there was a medical reason for an alternative setting. DS0000023000.V277683.R01.S.doc Version 5.1 Page 16 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): 23 Vulnerable adults are protected through a range of policies and procedures which means that their intrinsic human rights are protected. EVIDENCE: There are policies and procedures in for the Protection of Vulnerable Adults, and this includes definitions of abuse and how to deal with allegations made against staff and strangers. Policies were observed regarding whistle blowing and challenging behaviour and/or aggression in the workplace. The inspector was unable to assess if care staff have received up to date POVA training as the support worker assisting with the inspection was unable to locate records regarding staff training. The inspector requests evidence that all care staff have received up to date POVA training. The homes policies and procedures regarding service users money and financial affairs ensures service users have access to their money, valuables and safe storage of valuables. Valuables are stored in the homes safe but service users tend to keep their valuables in their own rooms, which are lockable and all service users have their own keys. DS0000023000.V277683.R01.S.doc Version 5.1 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): These standards were not assessed during this inspection. EVIDENCE: DS0000023000.V277683.R01.S.doc Version 5.1 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): 31, 32, 35 and36 Service users benefit from clarity of staff roles and responsibilities. ensuring that their care and support needs are appropriately and effectively met. The staff team have the competencies and qualities required to meet service users needs. Service users benefit from a staff team who are mostly up-to-date with their training, however, some updating of training is needed to ensure that staff are competent to do their jobs. Service users benefit from having staff who are supervised and whose performance is appraised regularly. EVIDENCE: DS0000023000.V277683.R01.S.doc Version 5.1 Page 19 Staff are aware of the organisations policies and procedures and understand how their work, and that of other staff, promotes the main aims of the home. This is achieved through staff meetings and supervision sessions. There is evidence in service users plans of care and through discussions held with staff that individual needs are met, with particular attention to gender, age, culture and personal interests. At the time of the inspection there were no care staff under the age of eighteen. Staff are aware of their limitations and, when questioned, were able to give examples of how and when to involve someone else, with more specific expertise in the care of service users. During discussion with the assisting support worker he stated that he had not received fire training during his sixteen months in post. The support worker did not know where training records were kept so staff training was difficult to assess. The inspector requests the registered manager to forward to the Commission evidence of all staff training undertaken in the last twelve months. Discussions held with staff confirm that formal staff supervision is carried out regularly. Each staff member should have an annual appraisal. However this was difficult to assess as staff spoken to appeared confused between annual appraisals and supervision. There is a grievance and disciplinary procedure and all staff are given copies of these. Suitable protocols are in place for dealing with physical aggression towards staff and training is provided. DS0000023000.V277683.R01.S.doc Version 5.1 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, 38, 39 and 43. The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. The management approach of the home creates an open, positive and inclusive atmosphere. The unit do not regularly review aspects of its performance through a programme of self-review and consultations, which include seeking the views of service users, staff and relatives. The overall management of the home ensures the effectiveness, financial viability and accountability of the home. EVIDENCE: DS0000023000.V277683.R01.S.doc Version 5.1 Page 21 The manager has been in post as manager at Morton House for approx three years. Prior to this she was a deputy at a Supported Living project within the national Society for Epilepsy. The registered manager is in the process of completing her a registered managers award. The registered manager has the overall responsibility for ensuring the homes written aims and objectives are achieved, the homes budget is properly managed, policies and procedures are implemented, certificates are displayed and that the home complies with the Care Standards Regulations. The home has a complaints procedure in place and a whistle blowing policy, which enable staff and service users to voice concerns and affect the way in which the service is delivered. The homes aims and objectives are included in the Service Users Guide. Service users can voice their concerns via service users meetings, individual key worker meetings and by using the organisations complaints procedure. Discussions held with staff confirmed that the manager was approachable and that staff felt able to raise any concerns they may have. Families, friends and representatives of service users are invited to reviews if the service users wish and so are any health care specialists involved in the care of service users. At the time of the inspection service user reviews take place annually. Staff are unable to produce any evidence of Quality Assurance practices undertaken in the home and it is a requirement of the report that the home ensures an effective quality assurance system is in place to measure success in achieving the aims and objectives of the home. It was evident from the homes policy and procedure manual that policies, procedures and practices need to be updated regularly in light of changing legislation and of good practice advice from the Department of Health, local authorities and specialist/professional organisations. There was evidence to show that these were in the process of being updated. The inspector observed insurance certificates on display in the home. The organisations business and financial plan was not available for inspection. DS0000023000.V277683.R01.S.doc Version 5.1 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 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 3 32 3 33 X 34 X 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 2 x X X 3 DS0000023000.V277683.R01.S.doc Version 5.1 Page 23 No 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 1 Regulation 6 Requirement The registered manager is required to ensure that up to date copies of the Statement of Purpose and the Service Users Guide are sent to Commission. The registered manager is required to ensure Care Plans are completed legibly, accurately and up to date. The registered manager is required to send to the Commission evidence that care staff have undertaken POVA training within the last twelve months. The registered manager is required to send to the Commission evidence of all training undertaken by care staff within the last twelve months. The registered manager is required to ensure that an effective Quality Assurance system is implemented. Timescale for action 28/02/06 2 6 15 28/02/06 3 23 13 28/02/06 4 35 18 28/02/06 5 39 12 30/08/06 DS0000023000.V277683.R01.S.doc Version 5.1 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 33 Good Practice Recommendations It is recommended that there are staff on duty at all times who can communicate effectively with service users in their first language including sign; and have skills in other communication methods relevant to service users needs. DS0000023000.V277683.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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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