CARE HOMES FOR OLDER PEOPLE
Northgate House 2 Links Avenue Hellesdon Norwich Norfolk NR6 5PE Lead Inspector
Mr Jerry Crehan & Hilary Shephard Unannounced Inspection 22nd February 2006 10:45 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 Northgate House DS0000027330.V284716.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 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. Northgate House DS0000027330.V284716.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Northgate House Address 2 Links Avenue Hellesdon Norwich Norfolk NR6 5PE 01603 424900 01603424900 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) Mr Faizal Ruhomutally Mrs Aisoobee Ruhomutally Mr Faizal Ruhomutally Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Northgate House DS0000027330.V284716.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 27th September 2005 Brief Description of the Service: Northgate House is a care home providing residential care for up to 22 older people. It is situated in a residential area of Hellesdon, which is approximately three miles from the city of Norwich. There are local shops, pubs and other amenities within the immediate vicinity of the home. Northgate House is an adapted and extended family house. The home accommodates twenty-two older people in single and shared bedrooms. Accommodation is located on the ground and first floor. Eight of the single bedrooms have en-suite facilities. The proprietors have recently completed the conversion of one of the homes lounge areas into two additional bedrooms. There are bathing facilities, including assisted bath, on both floors and communal toilets are located throughout the building. Communal areas are located on the ground floor. There is a garden to the front of the home and limited off road parking is available. Northgate House DS0000027330.V284716.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 over 6.5 hours. Opportunity was taken to tour the premises, look at care records and policies, and communicate with most of the nineteen service users in addition to visiting relatives, staff and the proprietor/manager. Prior to this inspection the Commission met with Mr Ruhomutally due to continued significant failure to comply with the National Minimum Standards of Care for older people. It was made clear that areas of repeated failure to meet National Minimum Standards would be the focus of attention at this inspection. It was hoped that this dialogue would provide Mr Ruhomutally with the opportunity to deal with the issues causing concern, as the Commission are concerned that he does not proactively seek to improve the service or seek the views of those who use their service to ensure that they are meeting need. The Commission reminds the proprietors that they are responsible for the quality of the service. What the service does well: What has improved since the last inspection? What they could do better: Northgate House DS0000027330.V284716.R01.S.doc Version 5.1 Page 6 There is considerable evidence that care and practice at Northgate House remains below the standard required by the National Minimum Standards of care for older people. Consequently there are a high number of requirements contained within this report. The areas of repeated failure include health and personal care, lifestyle, environment, staffing and management standards. The home’s practices to ensure that it can meet the assessed needs of service users (including specialist needs) are not adequate. Arrangements for protecting service users are not fully satisfactory as there is no measure of staff competence or understanding of their training in issues concerning adult abuse. Arrangements for the health and personal care of service users fall short of the standards required and in some instances (the absence of proper infection control practices) represent a risk to the health and safety of everyone at the home. When asked about whether there were any service users at the home with MRSA, the proprietor gave conflicting responses; initially stating that he did not know that a service user’s assessment indicated their MRSA positive status, and subsequently stating that he was aware. The lifestyle options available do not fully satisfy the needs of service users. The routines of daily living should be flexible according to individual preference and need. The home should be conducted so as to maximise service users capacity to exercise personal autonomy and choice. This includes giving service users control over aspects of their lives, maintaining a dialogue with service users at each opportunity, involving service users in care planning and consulting on and publishing activities on offer. The home’s environment does not provide sufficient warmth or light for the comfort and safety of service users. Staff recruitment practices remain a cause for concern. There was clear evidence at the time of the inspection of unsupervised care staff working without CRB and/or POVA checks. The practice of the home is not consistent with the relevant Regulation and may consequently compromise the health, safety and welfare of service users. The system for moving and handling service users is unsafe. Untrained staff were observed to be carrying out moving and handling tasks. The home should be run in the best interests of service users and in order to measure its success or failure to do this there should be evidence of an ongoing dialogue with service users, and quality monitoring systems based on seeking the views of service users, family and friends, and other community stakeholders. This does not yet happen at the home. Of the 21 Standards inspected on this inspection only 1 is fully met, a further 11 are nearly met and 9 have major shortfalls. However, the proprietor did say that he had done his best to improve the service. An overall decline in the adequacy of the service over recent inspections is noted. The Commission is not sure whether this is attributed to the proprietor’s attitude toward regulation, or a lack of willingness or ability to understand and address the requirements of care service such as Northgate House. However, the Commission met with Mr Ruhomutally only 3 weeks prior to this inspection and his wife/co-owner of the home was abroad. It is therefore decided to offer Northgate House DS0000027330.V284716.R01.S.doc Version 5.1 Page 7 further time to the owners to achieve compliance with National Minimum Standards. 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. Northgate House DS0000027330.V284716.R01.S.doc Version 5.1 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 Northgate House DS0000027330.V284716.R01.S.doc Version 5.1 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): 4 The home is not able to demonstrate its capacity to meet the specialist needs of individuals at the home. EVIDENCE: It was evident at the time of the inspection that the home is caring for a service user with advanced dementia. This was clear from discussion with the service user, from their care needs and from an assessment in their records. The proprietor stated that he is aware of her condition and that the home had continued to look after the service user at the request of their family. However, the home is not registered to provide this specialist form of care. Furthermore, it was evident that the home was experiencing difficulties in meeting needs as staff individually and collectively do not have the skills and experience to deliver the care required. The proprietor was informed that this matter should be addressed with the utmost urgency. However, the Commission will also refer this matter to the appropriate authority to ensure it is dealt with appropriately. Northgate House DS0000027330.V284716.R01.S.doc Version 5.1 Page 10 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, 8, 9, 11 Arrangements for the health and personal care of service users fall well short of the standards required and in some instances represent a risk to the health and safety of everyone at the home. There have been notable improvements in the management and administration of medication, following requirements from the last inspection. EVIDENCE: Several individual care plans and risk assessments were sampled. Those reviewed do not set out service user care requirements in satisfactory detail for care staff to follow. Shortcomings were noted in the absence of an analysis of risk and risk assessment for a service user who had experienced regular falls. Care staff were unaware that they were caring for a service user who has MRSA, furthermore there was no information in the service users care plan to indicate what care and infection control arrangements were necessary to safeguard service users and staff at the home. The proprietor gave conflicting statements about his knowledge of whether there were any service users at the home with MRSA. This service users health assessment clearly indicated their MRSA status however.
Northgate House DS0000027330.V284716.R01.S.doc Version 5.1 Page 11 It was of particular concern that a service user was observed to be restrained in their chair by means of a tray attached to it. The proprietor explained that this was to reduce the risk of their falling forward out of their chair. However, no relevant professional assessment had been carried out to consider the suitability of the arrangement, and no multi-agency agreement that this is an appropriate form of restraint given the potential risk to the service user. An inspection of medication requirements was undertaken. These were requirements outstanding from an inspection undertaken by a specialist pharmacist inspector on 27th September 2005 and followed up on 4th January 2006. The general recording of medication at the care home was improved, including records for controlled medication. Efforts have been made to ensure medicines requiring refrigeration are properly secured, however, the lock had to be replaced again at the time of the inspection by the proprietor. A system has been developed to ensure records for the administration of variable doses are completed in full. A further two members of care staff authorised to handle and administer medicines have undertaken appropriate medication administration training. Evidence of expired medication in the medication storage area was identified and removed. It is recommended that weekly audits of medication should be undertaken, and that a record of the weekly stock check of controlled medication recorded and kept in the controlled medication register. The majority of service users files reviewed contained evidence of some form of consultation with either the service user or their relatives (or both) as to their wishes in the event of their death. This is acknowledged as a significant improvement from previous inspections. Northgate House DS0000027330.V284716.R01.S.doc Version 5.1 Page 12 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): 12, 14 & 15 The social and recreational options available do not fully satisfy the needs of service users. The home is not conducted so as to maximise service users capacity to exercise personal autonomy and choice. EVIDENCE: There were no activities for service users in evidence at the time of the inspection. However, some service users indicated that there had been activities recently. These included an outing at Christmas, a visit from a local Brownies group, and the watching of videos of Norfolk from times past. This is evidence of an improvement from previous inspection. It is of continued concern that service users comment that their views are not sought about activities or other matters associated with the day-to-day running of the home. Examples of this were evident in significant numbers of service users complaining that the home was too cold for them (an issue that has been brought up by service users at previous inspection). Other service users stated that the food at the home at lunchtime had improved greatly in quality and variety, however, the teatime menu offered little interest or variety. These are matters that the proprietor should be aware of and addressing. The proprietor stated that care staff talk to service users each day and ask them for their views.
Northgate House DS0000027330.V284716.R01.S.doc Version 5.1 Page 13 The inspectors observed care staff working hard and doing their best to meet the needs of service users. However, there were several occasions where individual care was carried out by staff who did not initiate any communication with service users, thereby missing an important opportunity for individual interaction. This is also not acceptable practice. Northgate House DS0000027330.V284716.R01.S.doc Version 5.1 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): 18 Arrangements for protecting service users are not fully satisfactory. EVIDENCE: The home has a procedure for responding to allegations of abuse, including ‘whistle blowing’. Staff training in relation to adult abuse involves watching a video. There is currently no measure of staff competence or understanding of what they have watched. Therefore the adequacy of this means of training cannot be measured. Suggestions were made during the inspection as to how this may be addressed. Northgate House DS0000027330.V284716.R01.S.doc Version 5.1 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): 19, 24, 25, 26 Issues concerning the adequacy of central heating, lighting, odorous areas and repair compromise an environment that could otherwise be homely. EVIDENCE: The home is reasonably maintained and there is evidence of some ongoing redecoration. The pathway around the home has been cleared of encroaching shrubs providing safer access as it may be used to provide access to the designated assembly point in the event of fire. Lockable storage facilities for service users money or valuables have now been provided for service users. This is a welcome improvement. Bedding appeared adequate, though not of particularly good quality. The home’s heating and lighting are not adequate for the needs of older people. As already indicated in this report, several service users stated that the home was too cold for them (as they have at previous inspection). The inspection took place on a cold day. Radiators in the main lounge were evidently on but not providing adequate warmth for comfort.
Northgate House DS0000027330.V284716.R01.S.doc Version 5.1 Page 16 Energy saving light bulbs are fitted throughout the home. These do not provide sufficient lighting to meet the needs of older people. Of particular concern is the fact that these bulbs take time to emit their full light when switched on. The condition of carpet, or carpet tiles in one bedroom was brought to the attention of the proprietor, as these will need to be replaced. This bedroom was odorous, and its divan bed was broken. As indicated in respect of Standard 8 of this report, adequate systems are not in place to control the spread of infection at the home. Northgate House DS0000027330.V284716.R01.S.doc Version 5.1 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): 27, 28, 29, 30 There are serious concerns about staff recruitment practices that put service users at risk. Staff are not trained and competent to carry out tasks required of them. EVIDENCE: At the beginning of the inspection there were two care staff, one cook and one domestic on duty, in addition to the manager. One of the care staff on duty had been in post for three weeks and was undertaking induction training. However, it was evident that throughout almost all of the inspection they were working unsupervised. The proprietor indicated that this was due to staff sickness that day. As already indicated in this report (see Standard 4) care staff were individually and collectively finding it difficult to meet the needs of a service user who evidently has needs arising from dementia. The training and skills of care staff are not adequate to the needs of this service user. There are currently no care staff with NVQ 2 training at the home, however, several staff are currently undertaking this training. New staff were observed to assist a service user to mobilise, despite not having had access to appropriate training. The method used appeared to be safe and as instructed by colleagues. The domestic on duty assisted the same service user to the toilet later in the day using an entirely different method to assist them to mobilise. The proprietor acknowledged that assisting in the personal care of service users was not in their job description and they do not have access to the service users care plan, nor have they had access to
Northgate House DS0000027330.V284716.R01.S.doc Version 5.1 Page 18 appropriate training provided by the home, however, he indicated that the domestic would have carried out the task out of kindness to the service user. Induction training records for the most recently appointed staff were not available. Discussion with both the staff member and the proprietor suggests that some induction training has taken place, though as yet nothing has been recorded. There was clear evidence at the time of the inspection of unsupervised care staff working without CRB and/or POVA checks. Staff recruitment practices remain a concern. The home’s practices are not consistent with the National Minimum Standards or with Regulation and may consequently compromise the health safety and welfare of service users. An immediate requirement was left with the proprietor at the inspection to ensure that new staff do not start until a CRB and/or POVA check has been received. Staff must be fully supervised by a named person until the CRB check is received. Northgate House DS0000027330.V284716.R01.S.doc Version 5.1 Page 19 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, 37, 38 There are management shortcomings that compromise the health safety and welfare of service users and staff at the home. EVIDENCE: The proprietor/manager and his wife have nursing backgrounds (he being a state enrolled nurse). The manager has recently successfully completed the Registered Managers Award. Staff spoken with indicated that they felt they could approach the manager with a problem or difficulty if necessary. The management approach to care appears reactive rather than proactive or anticipatory. The recent improvements (that are welcomed) referred to earlier in this report have been brought about as a consequence of a growing concern expressed by the Commission. There was little evidence of the management seeking the views of service users and of giving them a stake in the running of the home. A periodic service
Northgate House DS0000027330.V284716.R01.S.doc Version 5.1 Page 20 user questionnaire is undertaken and evidence of this was seen, however, service users indicate that their views are not sought by staff or the proprietor. There is no evidence of the evaluation of questionnaires and its feedback to service users or relatives. There is no evidence of seeking the views of stakeholders in the community, such as GP’s, District Nurses, Social Workers, Chiropodists, Hairdressers, Voluntary Organisation Staff, Occupational Therapists, on how the home is achieving goals for service users. The home has appropriate policies and procedures, though record keeping practices are not adequate. They are compromised by omissions in information held in respect of staff employed at the home, and care planning, each referred to within this report. The health, safety and welfare of service users are compromised by a number of the homes practices, including, assessment and review of service users, care planning, risk assessment (including restraint), infection control, staff training and staff recruitment. Northgate House DS0000027330.V284716.R01.S.doc Version 5.1 Page 21 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 X X 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 X 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 1 X X X X 2 1 2 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X X X 1 1 Northgate House DS0000027330.V284716.R01.S.doc Version 5.1 Page 22 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 OP4 Regulation 14(2)(b) Requirement The registered person must ensure that the assessment of the service users needs is revised at any time when it is necessary to do so having regard to any change of circumstances. The registered person must ensure that appropriate interventions are carried out for service users identified at risk of falling. This Requirement Is Repeated The registered person must make suitable arrangements to prevent the spread of infection, including MRSA, at the care home. The registered person must ensure that no service user is subject to physical restraint unless restraint of the kind employed is the only practicable means of securing their welfare and there are exceptional circumstances. The registered person must ensure the effectiveness of the procedures for the disposal of
DS0000027330.V284716.R01.S.doc Timescale for action 22/02/06 2. OP8 13(4)(c) 22/02/06 3. OP8 13(3) 22/02/06 4 OP8 13(7) 22/02/06 5 OP9 13(2) 22/02/06 Northgate House Version 5.1 Page 23 6 OP12 16(2)(n) 7 OP14 12(3) 8 OP18 13(6) 9 OP24 16(2)(c) 10 OP25 23(2)(p) 11 OP27 18(1)(a) 12 OP28 18(1)(a) 13 OP29 19(1)(b)( 1) medicines, including medicines that have expired. The registered person must consult with service users about the programme of activities arranged by the care home. This Requirement Is Repeated The registered person must, so far as practicable, ascertain and take into account the wishes and feelings of service users in respect of their health and welfare, and care. The registered person must make arrangements, by training staff or by other measures to prevent service users being harmed or suffering abuse. The registered person must provide in rooms occupied by service users adequate furniture, bedding and floor coverings. The registered person must ensure that heating and lighting suitable for service users is provided in all parts of the care home. The registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the care home as are appropriate for the health and welfare of service users. The registered person must ensure continued progress toward meeting a minimum ratio of 50 NVQ 2 (or above) trained staff. The registered person must ensure that new staff are confirmed in post only following satisfactory checks set out in Schedule 2 of the Care Homes Regulations 2001. This Requirement Is Repeated
DS0000027330.V284716.R01.S.doc 22/02/06 22/02/06 22/02/06 31/03/06 22/02/06 22/02/06 30/06/06 22/02/06 Northgate House Version 5.1 Page 24 14 OP30 13(5) 15 OP33 24(1)(a&b ) 16 OP37 17(1)(a) 17 OP38 12(1)(a) The registered person must make suitable arrangements to provide a safe system for moving and handling service users. The registered person must develop a systematic cycle of planning action and review reflecting aims and outcomes for service users. The registered person must maintain records specified in Schedule 3 of the Care Homes Regulations 2001. The registered person must ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. 22/02/06 30/04/06 22/02/06 22/02/06 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. Refer to Standard OP9 Good Practice Recommendations It is recommended that weekly audits of medication should be undertaken, and that a record of the weekly stock check of controlled medication recorded and kept in the controlled medication register. It is recommended that service users are fully consulted as to improvements to the tea time menu options at the home. 2 OP15 Northgate House DS0000027330.V284716.R01.S.doc Version 5.1 Page 25 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
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