CARE HOMES FOR OLDER PEOPLE
Nora Chase House 50 Valentines Road Ilford Essex IG1 4SA Lead Inspector
Stanley Phipps Unannounced Inspection 1st December 2005 12:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Nora Chase House DS0000025919.V269421.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nora Chase House DS0000025919.V269421.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Nora Chase House Address 50 Valentines Road Ilford Essex IG1 4SA 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) 020 8518 0336 020 8554 9129 Mrs Mary Louise Crosdale Mrs Mary Louise Crosdale Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places Nora Chase House DS0000025919.V269421.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30th August 2005 Brief Description of the Service: Norah Chase House is registered as a care home for ten (10) older people. It is owned and run by the Proprietor/Manager – Mrs Mary Crossdale since it opened in 1985. Although Mrs Crossdale is a registered nurse, nursing is not provided on the premises, except that which is provided by the district nurses. The aims of the home are to offer high standards of care in a homely atmosphere. There are six single rooms and two double rooms on the ground and first floor, currently accommodating six service users. Therefore, all service users currently have their own room and do not share. Sharing rooms in future will only be because of positive choice. There is no lift and most of the service users are mobile and self-caring.There is a main lounge, which is separate from the dining area, but no separate quiet room for service users to see visitors. There is a back garden which service users use when it is less cold and within the last year, a conservatory has been built to the rear of the building. The conservatory although providing a good alternative communal option is only accessible via the kitchen and/or a fire exit that leads down the side and into the rear garden. The home is near Valentines Park with reasonably close access to public transport and the centre of Ilford. Nora Chase House DS0000025919.V269421.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place in just over three hours and was unannounced. It was aimed at monitoring the overall progress of the service and meet with service users. At the time of the visit the registered manager was on leave and the home the deputy manager had the responsibility for managing the service in her absence. The inspection found that the service was relatively stable and had shown some improvements since the last visit in August 2005. The building works had been completed and service users were now using the conservatory, which was attractively laid out. An assessment of the policy and procedure file, staffing recruitment records, menus and service user case records took place. This was followed by formal interviews with; one care-staff, the deputy manager and one service user. Informal discussions were held with other service users and a tour of the premises took place. At the time of the visit, a formal application for providing dementia care in the home had not been received by the Commission, despite confirmation by the deputy manager that the building works had been completed. The inspection found that there remain a small number of requirements that have been repeated. Although this marks an improvement in the registered person’s compliance with the national minimum standards and it’s associated requirements, it is imperative that full compliance is achieved without delay. As stated in previous reports, a continued failing to meet repeated requirements may adversely impact on the welfare of service users. It is for this reason and that of achieving compliance that the Commission would initiate statutory enforcement action against the registered provider. What the service does well:
Service users at Norah Chase Lodge enjoy comfortable living in the home, which according to them is safe and warm. They are always in praise of the care staff they described as ‘always taking good care of their needs’. According to one service user the home ensures that they get a personal service and this is possible because it is relatively small and staff are always on hand to support them, when needed. Service users benefit from the care provided and usually thrive for a considerable period of time in the home, for example there are service users in the home for well over ten years. It is true to say that service users enjoy a Nora Chase House DS0000025919.V269421.R01.S.doc Version 5.0 Page 6 relatively long life at Norah Chase and this is a credit to the management and staff of the home. They are encouraged to live life to the full in line with their needs, interests and abilities for e.g. one service user enjoys visiting the pub on some days around lunchtime and he is encouraged to so do. Another enjoys going to a day centre and this is also encouraged. The home is also good at promoting service user’s independence and all service users are very well presented on every occasion that the home is visited. Part of maintaining their awareness in keeping updated with events in the world involves ensuring that newspapers both national and local are made available to them. As a consequence, the registered manager has provided reading lamps for service users individually, in areas of the main lounge that is preferable to them. Service users also indicated that they are usually well informed about what is happening in the home and is consulted on matters affecting them e.g. constructing the conservatory and being not only aware that the manager was away, but also when she was due back. This is positive and gives them a feeling of inclusion. What has improved since the last inspection?
There was evidence that risk assessments were in place for all service users and they were updated (21/10/05) reflecting the needs of service users and this was improvement since the last visit. The medication policy at Norah Chase Lodge now makes reference to the handling of spillages and this should benefit all staff working in the home. It would also by extension, result in safer environment being maintained for the service users living there. An access to information policy is in place so that service users wishing to access information have clear guidelines on how to so do. Staff spoken to, were also aware of the policy. At the time of the construction of the conservatory, a new area has been created where staff could write up their daily case notes as well as update each other on the changes on each shift. This area also houses the policies and procedures and was previously the area used for laundering purposes. During the time of compiling this report, the registered manager provided a letter by way of fax to the Commission’s offices from her accountant indicating that Norah Chase Lodge is a financially viable service. This is reassuring not only to the Commission but also and more importantly to the service users and/or their relatives. Nora Chase House DS0000025919.V269421.R01.S.doc Version 5.0 Page 7 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.
Nora Chase House DS0000025919.V269421.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nora Chase House DS0000025919.V269421.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (2,4,6) All service users are issued with a statement of terms and conditions once they are admitted to the home. In this way they are made aware of the obligations of the registered manager in meeting their needs, which are assessed prior to their admission. Intermediate is not provided at Norah Chase Lodge. EVIDENCE: A random sample of service user files bore evidence that service users were issued with a statement of terms and conditions outlining the facilities and services offered by the home. It also sets out the obligations of the registered manager and the service user and is essentially a contractual agreement, which is signed off by the manager and the service user or his/her representative. Prior to admission service users have a detailed assessment of their needs carried out. This is to ensure that they could be met by the home as specified in the statement of purpose. All service users currently in the home were in no doubt that their needs are adequately met. This is confirmed also by the fact that, in their annual review held with the placement commissioners they remained satisfied that Norah Chase Lodge was provide adequate care and support for its service users. A random sample of service user plans indicated
Nora Chase House DS0000025919.V269421.R01.S.doc Version 5.0 Page 10 that identified needs were generally met and this included needs met outside the home e.g. the local GP. It was slightly disconcerting that the weight of one service user could not be monitored because a special scale is required. The deputy indicated that they never had a need to weigh the service user, as there was never a concern that would lead them to so do. However it would be difficult to accurately monitor the deterioration of this service user, should she develop a problem where her weight unaffected. It is therefore recommended that the registered manager explore with the local GP as to how a baseline weight, which one would take in an annual health check – could be obtained. Norah Chase Lodge does not offer intermediate care and if a decision were taken to so do, then changes would have to be made to the environment, staffing and policies and procedures to pursue such an undertaking. Nora Chase House DS0000025919.V269421.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (7,9,10,11) Service users are assured that their needs are not only adequately provided for, but also pertinently recorded at Norah Chase Lodge. They benefit from having their privacy preserved along with being treated with respect on a daily basis. Improved protocols around medication, ensures that their health and safety is maintained. EVIDENCE: The health, personal and social care needs of service users was documented for each service user in their individual plan. This was enhanced by updating risk assessments for all service users and linking it to the service user plan. It now means that service users goals are identified and managed, ensuring that risks are kept to a minimum. This is a positive outcome for all concerned. The administration of medicines in the home remained generally safe, however guidance is now available to all staff with regards to dealing with spillages. This would also ensure a safe environment for both service users and staff. The deputy manager gave an undertaking that all staff would be taken through the guidance to ensure the application of it. From interviews held with service users they were consistent in making it clear that staff treat them with the utmost respect. Examples given included: staff
Nora Chase House DS0000025919.V269421.R01.S.doc Version 5.0 Page 12 addressing them by their preferred names, staff routinely knocking on their doors prior to entering their bedrooms and the staff supporting and encouraging them to open their own mail. Staff was also observed providing support to service users in a private manner. All service users spoken to were pleased with this. There is a policy on death and dying in the home and it was clear that the wishes of service users and their relatives are respected at such a time. The home had lost a service user in since the last inspection and service users spoke of the kindness of the manager and staff in handling this. They expressed that the service user had a nice send off and that they were all given opportunities to pay their respects, which they really appreciated. They also indicated that occasionally they are supported to reflect upon and reminisce on the memories in the life of the deceased. Service users described this as ‘comforting’. Nora Chase House DS0000025919.V269421.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (14) At Norah Chase Lodge all service users have opportunities to choose and make decisions affecting their lives. This gives them a sense of involvement and fulfilment. EVIDENCE: Service users are encouraged to make choices in all areas of their lives, most of which are documented in their individual service user plans. This is extended to the meals they eat, the activities they participate in, entertainment pursuits and what they wear. This is not exhaustive and all service users take part in planning their care. It was also noted that a policy is now in place to enable service users to access information held on them should they need to and this is an improvement from the last inspection. Staff play an active part in enabling service users to take control of their lives and one example of this is where each service user take turns in opening their front door. In so doing they are supported to carry out their safety checks prior to allowing individuals into the home. Service users spoke to enjoy this responsibility and as such agreed to do it in turns on different days. Another good example of service users determining and taking control of their lives involves the case of one service user’s choice in visiting the local pub for a drink at lunchtime. This choice has a positive impact on the welfare of the service user and as such is encouraged.
Nora Chase House DS0000025919.V269421.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (17) Staff ensure the promotion of service users’ rights by providing appropriate support and information to them at all times. This is so that they could make informed decisions about their life. EVIDENCE: There was evidence to confirm that service users were encouraged to take part in the civic process e.g. voting at both the local and national elections. For those wishing to take part, staff work closely with them to ensure that they either visit the local polling station or use the postal voting option. Participation in this varies from service user to service user. It was disclosed that candidates at times visit the home and speak with service users personally. Service users and staff spoken to informed that this gives the service users a sense of importance and is carried out in a friendly manner. At the time of the visit, none of the service users had independent advocates and this was down to choice as they had a preference for their family members taking care of such matters. One service user commented ‘my brother takes care of all my affairs and though he is getting on – is doing a good job. The manager is aware of the entitlements of service users and she works closely with social workers when required to ensure that service users receive their entitlements. Where necessary staff also obtain appropriate advice in relation to service users benefits. Nora Chase House DS0000025919.V269421.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (20,22,23) At Norah Chase Lodge service users could generally, safely access both the internal and external facilities of the home. However a risk assessment and clearance the local fire department is required to ensure the safe access of the new conservatory. Service users bedrooms are safe and suit their needs. EVIDENCE: Prior to the development of a conservatory in 2005, Norah Chase Lodge provided safe access to all parts of the home for the benefit of the service users living there. This included the rear garden which was mostly used in the spring and summer seasons. However a new conservatory had been added with the main access as the kitchen, which is relatively small in scale. Alternative access is provided through a fire exit used for the benefit of a service user currently using a wheelchair. Given the fact that the conservatory offers a great communal alternative, it is anticipated that this would increase the traffic through the kitchen significantly. As such, the registered person was required to carry out a risk assessment relating to this issue along with obtaining the local fire authority’s approval of using the fire exit as a thoroughfare. This had not been complied with, as the
Nora Chase House DS0000025919.V269421.R01.S.doc Version 5.0 Page 16 manager intimated that the door had been approved for use in this way, years ago, prior to building the conservatory. She could not present written evidence of this and ventured to so do some time in the future as she was in the process of dealing with a personal crisis. The requirement would therefore be repeated. From speaking with service users and being offered opportunities to visit their bedrooms, it was clear that the individual bedrooms suited their needs. One of the service users on the ground floor is a wheelchair user and she manages quite well in her bedroom. The natural light and fresh air benefits derived from her bedroom window however, is now filtered through the newly built conservatory. She insisted that she was happy with the arrangement as she enjoys using the conservatory. She also made it clear that she was consulted on how it would affect her, prior to its development and subsequently agreed for the construction of the conservatory to go ahead. According to the service user, matters of privacy were non-existent, as she could draw her curtains whenever she wanted more privacy. This was evidence of service user choice and/or empowerment and is positive. Nora Chase House DS0000025919.V269421.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (28,29) Service users are generally safe living at Norah Chase Lodge, however improvement in the recruitment practice of the home and the provision of regular formal supervision is required to ensure their continued safety. EVIDENCE: It was clear from previous inspections that service users are safe living at Norah Chase Lodge and this could be evidenced by the non-existence of adult protection activity in the home, the low levels of incidents/accidents in the home and the limited number of complaints on record- from relatives and stakeholders about the service. However from looking at the staffing records it was clear that they were not receiving regular formal supervision. Whilst it is acknowledged that they receive informal supervision; dedicated time to offer support, looking at care philosophy and practice and identifying professional training and development is most effective when recorded. This would enhance the quality of service provision for the benefit of the service user group. From assessing the recruitment process of the most recently appointed staff, it was conclusive that the practice was unsafe and not in line with national and regulatory guidance. This failing compromises the safety and protection of service users. Some of the failings included; no evidence that a Criminal Records Bureau Check conducted prior to appointing the staff, the absence of a file for the most recently recruited staff and the absence of recent photographs for staff working in the home. This must be addressed as a matter of urgency to ensure that service users are protected at all times. In this case they were clearly not for the reasons given above. This practice needs to improve.
Nora Chase House DS0000025919.V269421.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (31,33,34,37,38) Norah Chase Lodge is a well run home that is generally geared towards service the promotion of service users’ interests. More could be done however, to enhance the quality of the service. This could be achieved through, the production of an annual development plan and improving the quality of the records held in the home, as required by Regulation. EVIDENCE: Service users and staff expressed their satisfaction with the registered managers. They are of the view that she is approachable have their interests at heart and leads by example. Mrs Crossdale has managed the home from its inception and that has been well over twenty years. Most service users have been living in the home for considerable periods and according to them – ‘we are well looked after’. It is true to conclude that she discharges her responsibility with some authority as she is quite knowledgeable about the needs of the service user group as well diseases associated with the elderly. However, she could improve her service by working more effectively with the
Nora Chase House DS0000025919.V269421.R01.S.doc Version 5.0 Page 19 Commission in complying with the National Minimum Standards for Older Persons. There is evidence throughout the home to indicate that she has the welfare of service users at heart e.g. developing more communal space (conservatory) for them. She has acquired the views of service users, staff and relatives, however this information has not been published and/or integrated into an annual development plan for the home. This has been an area that has been the subject of a repeated failing and needs to be acted upon. In discussion with her she was of the view that her development work could be seen, by looking around the home and while this may be so, the relevant standard (NMS 33) requires more than this. The registered manager has provided evidence from her accountant to confirm that the business is financially viable and this has been a reassuring revelation to service users, their relatives, staff and the Commission. This also represented an improvement in complying with National Minimum Standards (NMS34). Since the last inspection the home’s policies and procedures have improved in line with regulation and this would benefit service users and staff. However the home’s record keeping did not improve as required by the last inspection and two examples of this included the fact that the recruitment file for one member of staff could not be located and recent photographs were not on file for staff. The relevant requirement would be therefore repeated. Health and Safety in the home was generally satisfactory as key procedures and appropriate records were in place to promote this. It remains outstanding as stated earlier, for the registered manager to conduct a risk assessment on accessing the conservatory via the kitchen and acquiring clearance from the local fire department with regard to using the side fire door as a thoroughfare to access the conservatory. Nora Chase House DS0000025919.V269421.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 Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X X 2 X 3 3 X X X STAFFING Standard No Score 27 X 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 3 X X 2 3 Nora Chase House DS0000025919.V269421.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES 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 OP28 Regulation Requirement The registered manager is required to ensure that care staff receive formal supervision at least every two months. The registered manager/proprietor must be able to demonstrate that she operates a thorough recruitment procedure based on equal opportunities to ensure the protection of service users. All necessary information must be obtained in order to assess the fitness of staff and appropriate records kept. (This is a previously made requirement). The registered person is required to a) conduct a risk assessment on the accessing the newly built conservatory and b) consult with the local fire department with regard to the use of the fire exit as access to the conservatory. (this was previously made requirement). The proprietor/manager must establish an annual development plan for the home and effective
DS0000025919.V269421.R01.S.doc Timescale for action 31/03/06 2 OP29 19 15/02/06 3 OP20 23 31/03/06 4 OP33 24 31/03/05 Nora Chase House Version 5.0 Page 22 5 OP37 17 Schedules (3 & 4) quality monitoring systems to ensure that the home meets all aspects of Standard 33 and the Regulations (Care Homes2001). The result of any review must be made available to service users and the Commission. (This is a previously made requirement). All statutory records listed in Schedules 3&4 of the care Homes Regulations 2001 must be kept in the home, including a record of all staff employed in the home with all the information required by the schedules. (This is a previously made requirement). 31/03/06 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 2 Refer to Standard OP31 OP4 Good Practice Recommendations The registered manager should act on all requirements made, in a timely manner. The registered manager should explore with the GP how best to acquire a baseline weight for service user Ms. W. Nora Chase House DS0000025919.V269421.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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