Inspection on 08/05/06 for Northfields

This inspection was carried out on 8th May 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Northfields 16/12/05

Northfields 29/06/05

Northfields 29/09/04

Similar services:

Pemdale

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

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

CARE HOME ADULTS 18-65 Northfields 49a Northfields West Earlham Norwich Norfolk NR4 7ES Lead Inspector Mrs Lella Andrews Unannounced Inspection 8th May 2006 01:15 Northfields DS0000027527.V294403.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 Northfields DS0000027527.V294403.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. Northfields DS0000027527.V294403.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Northfields Address 49a Northfields West Earlham Norwich Norfolk NR4 7ES 01603 458865 01603 458969 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) Elizabeth Fitzroy Support Mrs Jane Grant Care Home 7 Category(ies) of Learning disability over 65 years of age (7) registration, with number of places Northfields DS0000027527.V294403.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Up to seven (7) Service Users who have a learning disability and are over the age of 65 years may be accommodated. The total number of Service Users accommodated not to exceed 7. Date of last inspection 16th December 2005 Brief Description of the Service: Northfields is a detached, purpose built, chalet style house that is run as a residential care home providing accommodation and care for up to seven older people with learning and physical disabilities. The home is operated as two units within the home, has a shaft lift to the first floor and has seven single bedrooms all containing a washbasin of which one is upstairs and six downstairs. Each unit has a communal lounge, dining room, kitchen, adapted bathroom and toilet and there is a patio area and well-kept garden to the rear of the property and parking to the front. The home is sited in the middle of a residential area on the outskirts of the city of Norwich and is near local shops and healthcare facilities. Northfields DS0000027527.V294403.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection was unannounced and took place between 1.15pm and 5.15pm with a follow-up visit to look at records on the 11th May 2006. The deputy manager was present on the first day and the Manager present on the second day of the Inspection. The new Manager started working at the Home approximately three months ago when the previous Manager moved to another role within the organisation. The new Manager is currently applying to become registered with the Commission. The Inspector spoke to residents and staff, was shown around the accommodation and inspected records. Completed comment cards were received from all seven residents, some of whom had received assistance to complete them. These indicated that all of the residents feel that they are well cared for and that they know who they can speak to if they are unhappy about something. The comment cards mainly contained positive responses to the questions about the Home. The question that contained the most negative response was that which asked about whether the residents have a lot of things to do. Additional comments about what is good about the Home included: “..the food, going out, the people, its comfortable…” There were very few additional comments about what might not be so good about the Home but did include “..the noise, shouting…” which refers to one of the residents. Comment cards were also received from four relatives and a health professional. These all contained positive comments about the care that is provided. What the service does well: The staff work hard to support the residents to make their own choices about issues affecting their lives. This includes regular house meetings, regular reviews of care plans and the involvement of residents in the recruitment of staff. The staff are enthusiastic, kind and respectful when supporting the residents. The staff receive good support and training which enables them to carry out their roles effectively. Northfields DS0000027527.V294403.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Northfields DS0000027527.V294403.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 Northfields DS0000027527.V294403.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): 2 Quality in this outcome group is good. Appropriate assessment information is gathered prior to a resident moving to the Home. EVIDENCE: No residents have been admitted to the Home for over a year but the records seen show that appropriate assessments are undertaken prior to anyone moving into the Home. The Manager is aware of the organisations assessment procedure. Northfields DS0000027527.V294403.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 Quality in this outcome group is good. The care plans include detailed information which enable staff to meet individual needs. Residents are consulted on and participate in all aspects of life in the home. EVIDENCE: Two of the care plans were seen and these contain detailed information about a range of issues affecting the individuals. The care plans contain information about the residents likes and dislikes which is particularly useful for those residents who have some difficulties with verbal communication. The comment cards indicate that five of the residents know that they have a care plan, however, one of the residents who had stated “no” to this question in the comment card was aware of the care plan when speaking to the Inspector but had not known what it was called. The residents have a keyworker and those who spoke to the Inspector know who this is. The care Northfields DS0000027527.V294403.R01.S.doc Version 5.1 Page 10 plans contain evidence of regular reviews of the care plans and a record of any discussions with keyworkers about their care. The staff are aware of the content of the care plans and of the process for reviewing them. It is recommended that the section of the care plan that is used on a daily basis as a working document is kept either in the residents room or in the communal areas so that the staff and resident have easier access to them. Staff described the process that is currently taking place for each of the residents to develop their own Person Centred Plan. This is a positive step as it puts the resident at the centre of the care planning process and involves them more fully. Keyworkers are currently talking to the residents about their wishes for funeral arrangements and this will be included within the care plans as required in the previous report. The care plans contain evidence of detailed risk assessments having been undertaken for each of the residents. Staff are aware of these and of the risk assessment process that takes place within the Home. Residents are encouraged to make their own decisions wherever possible. Staff were heard to offer choices to residents about a range of daily living issues such as choice of drink, where to spend their time, what to have for dinner. The care plans show evidence that keyworkers discuss more serious issues with the residents and that a record is kept of the outcomes. The residents are encouraged to join in with the house meetings that take place on a regular basis. The minutes from the staff meetings are shared at this meeting (and vice versa) so that the residents are kept informed of wider issues. The minutes of these meetings show that action is taken to address any suggestions and comments that the residents make at the house meeting and that explanations are provided when this is not possible. Six of the comment cards stated that the residents are able to take part in meetings to discuss what is good and what can be changed. Recently, advocates have been introduced to two of the residents. Two of the residents represent the group at the Tenants Forum run by the organisation. Northfields DS0000027527.V294403.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): 12, 13, 14, 15, 16 and 17 Quality in this outcome group is adequate. Staff work hard to ensure that the residents can take part in a range of education/leisure pursuits but recent staffing difficulties have made this difficult recently. The resident’s rights and responsibilities are recognised and respected. Residents enjoy their mealtimes and are offered a choice. EVIDENCE: The care plans contain information about the range of educational and leisure interests that the residents take part in. Some residents are supported by the Community Support Team (Social Services) to access activities but the majority of activities that the residents take part in require staff from the Home to provide support. Northfields DS0000027527.V294403.R01.S.doc Version 5.1 Page 12 Staff have worked hard to continue to support residents to access community facilities and take part in the activities that they enjoy but staffing difficulties over the last four months have sometimes made this difficult. Staff and residents told the Inspector that residents have not always been able to go out as much as they would like. Only two of the comment cards stated that the resident has lots of things to do, with one answering “no” and the other four answering “sometimes”. Three of the relatives comment cards stated that there is enough staff with one not having answered the question. However, the Manager and deputy manager have recently recruited new staff and it is expected that the situation will shortly improve and that the residents will again be supported to go out a lot more. Residents told the Inspector about the arrangements in place to enable them to maintain contact with family and friends. They said that they are able to have visitors to the Home whenever they wish to. The relatives comment cards all state that they are made to feel welcome at the Home and that they can visit their relative in private if they wish to. The staff are clear that the routines of the home should be arranged around the needs of the residents. Recent staffing difficulties have meant that this has not always been possible but they gave examples of how they have tried to ensure that this happens as much as possible. This situation is expected to improve with the recruitment of new staff. Staff were seen to knock on doors prior to entering and when, on one occasion, the resident refused the staff entry they did not enter the bedroom. Two of the comment cards stated that the resident has a key to their room. Staff are aware of the reasons why some residents do not have a key but it is recommended that this risk assessment is recorded within the care plan. Residents were seen to move freely around the Home and are able to choose where they wish to spend their time. Staff were heard to offer residents choices about the drinks and the evening meal. Different meals were prepared to ensure that the resident was able to have what they had asked for. The care plans contain detailed information about the nutritional needs of the residents and there is evidence of liaison with health professionals such as the dietician. This is particularly important for some of the residents who have difficulty with eating/drinking. The staff are aware of the individual needs. Six of the comment cards stated that the residents have a choice of what to eat with one stating that this happens “sometimes”. Northfields DS0000027527.V294403.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 and 20 Quality in this outcome group is adequate. Residents receive personal support in the way that they prefer. Resident’s health care needs are assessed and met but there have been recent errors in the administration of medication, which reduces the protection provided to the residents. EVIDENCE: Residents said that they receive good support from the staff and that they are kind and helpful. The Inspector observed relaxed, respectful relationships between the staff and the residents with lots of communication between everyone present in the house. Five of the comment cards state that the staff treat the residents well with two stating that this happens “sometimes”. All seven comment cards state that the residents feel well cared for. Residents said that they have the choice about when to go to bed and when to get up. Staff gave examples of how they ensure that the residents choices with regard to daily issues are respected. Northfields DS0000027527.V294403.R01.S.doc Version 5.1 Page 14 The staff group include both male and female staff. The care plans for the female residents contain a statement signed by the resident to confirm whether they are happy to have personal care provided by male staff or not. The care plans contain detailed assessments and information about the residents individual health care needs. There is evidence of the involvement of other health professionals. The residents are over the age of 65 and have the additional health needs related to becoming older as well as other health needs. Staff are aware of how to meet these needs. The comment card completed by the GP states that the staff demonstrate a clear understanding of the needs of the residents and that the staff communicate and work in partnership with the GP practice. Risk assessments are carried out with regard to whether the resident is able to look after their own medication. One of the residents is able to do this and the staff explained the process, which provides suitable safeguards. The Inspector was shown the medication storage system and staff explained the process for ordering and administering medication. Appropriate records are kept and staff receive appropriate training which should provide suitable protection for the residents. However, since December 2005 the Commission has been notified of three medication errors which clearly reduces the protection. The management team of the Home dealt with the situations appropriately and the members of staff involved are not able to administer medication until they have received additional training. Northfields DS0000027527.V294403.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome group is good. Residents feel that their views are listened to and acted on. All staff need to receive training about the protection of vulnerable adults to improve the protection provided to the residents. EVIDENCE: As previously mentioned in this report the Home has a variety of ways in which the views of the residents are sought and there is evidence that action is taken to address issues which arise. All seven comment cards stated that the residents know who to tell if they are unhappy about something. Residents told the Inspector that they would tell staff if they were not happy about something and one gave an example of a situation that had been addressed satisfactorily. There is currently a situation in the Home which three of the residents told the Inspector that they are not happy about and which was also mentioned on two of the comment cards. One of the residents has developed dementia and makes a lot of noise throughout the day. The noise can be heard throughout both sides of the Home and on the first floor also. The staff work hard to support both the individual and the other residents but there is a need for the Manager to continually monitor this situation to ensure that the other residents are not suffering from this constant noise. Northfields DS0000027527.V294403.R01.S.doc Version 5.1 Page 16 The relatives comment cards stated that they had not had to make any complaints. The GP comment card stated that he had not received any complaints about the Home. The policies and procedures of the Home all aim to protect the residents from any form of harm. Not all of the current staff have received protection of vulnerable adults training and it is required that they do so. Northfields DS0000027527.V294403.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): 24, 29 and 30 Quality in this outcome group is good. The standard of the environment is mostly good with some small areas needing attention. Residents have the specialist equipment that they need. EVIDENCE: The Inspector was shown around the communal areas of the Home and two of the residents were happy to show their bedrooms too. The Home is purpose built with the two sides of the building providing separate accommodation for a group of three and four residents. The building is light and on the whole is decorated and furnished in a homely and comfortable style. There are some areas which would benefit from redecoration. The previous report required that the carpets receive deep cleaning or are replaced. This has not taken place yet but the Inspector was shown the quotes that have been obtained for this work to take place. This requirement is repeated in this report. Northfields DS0000027527.V294403.R01.S.doc Version 5.1 Page 18 The Home has specialist equipment such as hoists, large bathrooms and baths with hoists to meet the needs of the residents. Records show that the equipment receives regular servicing and maintenance. The Home has suitable laundry facilities with arrangements in place for infection control. Northfields DS0000027527.V294403.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome group is good. Staff are competent and provide a good standard of care. They receive appropriate training and support to carry out their roles. EVIDENCE: Residents said that they feel that they are well cared for. The comment cards support this, as previously detailed in this report. Staff are aware of their own roles and responsibilities and that of others within the team. Staff have a good understanding of the needs of the residents. The Inspector saw a selection of recruitment records and these contained the necessary checks on the candidates and evidence of appropriate recruitment procedures having been followed. Two of the residents are regularly involved in interviewing candidates and their views are considered seriously as part of the recruitment process. The Home meets the standard of having 50 of staffing trained to the level of NVQ Level 2. Staff receive effective induction within the Home and also a two week formal induction at the organisations regional office which includes information about the organisation, policies and procedures and basic training. Northfields DS0000027527.V294403.R01.S.doc Version 5.1 Page 20 A member of staff said that their current induction is appropriate to their role and that they are receiving good support from the whole staff team. Staff receive training in mandatory subjects such as fire safety, moving and handling, food hygiene and first aid. A requirement has already been made with regard to POVA training. Training has also been provided with regard to dementia, lone working, positive communication and other issues relating to the needs of the residents. The Manager has a system in place to ensure that staff attend updates for all necessary training. Staff said that they feel well supported by each other and by the Manager and deputy manager. Regular staff meetings take place and formal supervision is carried out by the Manager and deputy manager. Staff said that they feel confident in speaking to either of the management team and that issues are addressed. Northfields DS0000027527.V294403.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome group is good. The Manager is competent to manage the Home. The views of the residents underpin the review of the service. The health and safety of the residents and staff are protected. EVIDENCE: The Manager has only been in post for approximately three months but staff feel that she has a good understanding of the needs of the residents and that she provides the staff team with good support. The Manager is currently working to complete the NVQ Level 4 and also undertakes other relevant training as appropriate. The Manager is supported by a competent deputy Manager. Northfields DS0000027527.V294403.R01.S.doc Version 5.1 Page 22 As previously mentioned in this report the Home has a variety of ways in which the views of the residents are obtained and used to review and change the way in which the service is provided. In addition, the organisation also uses REACH standards in which a different standard is looked at on a monthly basis. The records relating to this were seen and provide detailed, interesting results which show that the residents have been central to the process. It is required that the different formats for reviewing the quality of the service are brought together in an annual quality assurance report with a copy being provided to the Commission. The Inspector saw a selection of records that show that the health and safety of the residents and staff are given a high priority and that action is taken to rectify any areas of concern that are highlighted. Maintenance and servicing records were seen for the equipment in use in the Home. The Home has a member of staff responsible for health and safety issues and they are also the representative on the organisations health and safety forum. Northfields DS0000027527.V294403.R01.S.doc Version 5.1 Page 23 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 3 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 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 2 X X 3 X Northfields DS0000027527.V294403.R01.S.doc Version 5.1 Page 24 yes 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 YA24 Regulation 23.2.b Requirement The registered person must ensure that the carpets in the home are deep cleaned or replaced. (Previous target of 31st October 2005 and 31st March 2006 not met) The registered person must ensure that all staff receive POVA training The registered person must ensure that an effective Quality Assurance system is in place and carried out in the home. Timescale for action 31/07/06 2. 3. YA23 YA39 13 (6) 24 31/07/06 31/08/06 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 YA6 YA16 Good Practice Recommendations It is recommended that the care plans that are used on a daily basis are kept in a more accessible place It is recommended that the care plans include the risk assessment that is carried out to assess whether a DS0000027527.V294403.R01.S.doc Version 5.1 Page 25 Northfields 3. YA24 resident is able to have their own key It is recommended that the programme of redecoration is maintained Northfields DS0000027527.V294403.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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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