Inspection on 29/05/08 for Pinetree Lodge Nursing Home

This inspection was carried out on 29th May 2008.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Pinetree Lodge Nursing Home 30/05/07

Pinetree Lodge Nursing Home 27/06/06

Pinetree Lodge Nursing Home 22/11/05

Pinetree Lodge Nursing Home 28/07/05

Pinetree Lodge Nursing Home 11/03/05

Pinetree Lodge Nursing Home 19/11/04

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Pinetree Lodge Nursing Home Dryden Road Gateshead Tyne & Wear NE9 5BY Lead Inspector Suzanne McKean Unannounced Inspection 10:00 29th May & 18th June 2008 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 Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 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. Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pinetree Lodge Nursing Home Address Dryden Road Gateshead Tyne & Wear NE9 5BY 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) 0191 477 4242 0191 477 9319 www.mentalhealthconcern.org Mental Health Concern Mrs Kathleen Bailey Care Home 34 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (34), Mental disorder, excluding learning of places disability or dementia (5) Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th May 2007 Brief Description of the Service: Pinetree Lodge Nursing Home is owned by Mental Health Concern and opened in 1984. It is designed to accommodate the needs of older people with dementia care and nursing needs. The fees at the home are £634 but several grants and funding bodies pay these monies. The home is a purpose built bungalow style facility. It is divided into three units and provides nursing care for people with mental health needs, predominantly those needs associated with dementia-type illnesses, in each unit. There are a variety of lounges and dining rooms throughout the building as well as a sensory room. One lounge provides access to an internal courtyard and a sensory garden has been created. The home is situated in a residential area just off Durham Road in Gateshead. Other healthcare facilities are located in the same grounds. Public transport is within easy walking distance and this gives access to local shops and social amenities. Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Summary: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This is an overview of what the inspector found during the inspection. How the inspection was carried out Before the visit: We looked at: • Information we have received since the last visit on 30th May 2007. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on date 29th May 2008 and a further visit was made on 18th June 2008. During the visit we: • • • • • • • • Talked with people who use the service, relatives, staff, the manager & visitors. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around the building/parts of the building to make sure it was clean, safe & comfortable, Checked what improvements had been made since the last visit. Sent out surveys to the residents and their representatives. Asked for the view of visiting professionals through surveys. We told the manager/provider what we found. Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The food being provided is balanced and complies with the necessary diet required. However it lacks variety and it is not possible to make changes easily to the individual diet of a resident to take into account their changing needs. Although the home is well maintained the records were not available to show that regular to show that regular health and safety checks are being carried out. Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 Page 7 The alarm call cord system must be replaced during the planned redecoration and alternative means for summoning assistance must be in place in the interim. This has been a requirement from previous inspections but the timescales have been extended to take into account the redecoration programme. 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. The summary of this inspection report can be made available in other formats on request. Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 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 Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6 (the home does not provide intermediate care) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can be confident that their needs can be met by the home before a place is offered. EVIDENCE: The home has a specific criteria for admissions and the residents are referred via the Consultant and all of the residents fall within the Individual resident’s files contained a copy of a needs assessment carried out by the referring care manager as well as a detailed assessment completed by the home staff. The pre admission assessments contained a range of appropriate information. These are used to draw up both these initial assessments and the home’s subsequent service user plans. Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 Page 10 All prospective service users and their representatives are invited to visit the home prior to admission to the home. Relatives who were in the home during the visit said that they had been given sufficient information prior to their relative’s admission and that it proved to be accurate. Care plans were checked and staff members consulted during the visit. These confirmed that a range of specialist services was provided to service users. Staff interviewed had had a range of relevant training and experience. Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good systems ensure that health and social care needs are delivered in a respectful way and the care plan documentation shows how this is achieved. EVIDENCE: There have been improvements to the way the care plans are being maintained since the last inspection. There is a good range of documentation and each resident has an individual care plan. These contain risk assessments, which are a large amount of information and are detailed in many of the areas and describe the care being given. Case tracking was used. This is the examination of the care being given to a sample of residents and the documentation around this care. The residents and their representatives and the staff involved in the giving the care are also spoken to either informally through interviews or by using surveys. Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 Page 12 The relatives are involved in the completion of the care plans and all of them spoken to felt that they were included when there are decisions to be made about the care of the resident. Six surveys were returned and all felt that they were kept up to date with any event affecting the welfare of their residents. Although the home is registered to provide nursing care for residents with dementia and the home also has some residents who also have general nursing needs. The home has the necessary equipment to provide for the needs of these residents including intermittent pressure-relieving mattresses and patient lifting hoists. The care to these residents is good. During one of the visits it was possible to speak to the general practitioner who attends the majority of the residents. He or someone in the practice visits the home twice a week, which gives the opportunity for him to be consulted about residents without callouts being necessary. It also offers the staff the chance to have residents monitored more closely. Residents are provided with services available to the wider community for example chiropody, dentistry and other therapeutic services according to assessed need. The staff obtain advice from specialists from the local Primary Health Care team as necessary. The Tissue viability nurse attends the home to provide advice to support the staff to care for individual residents. Residents are weighed regularly and staff make changes in the care provided to take into account any changes. Although some weight loss was noted in the care plans examined action had been taken to address it. Dietary needs are identified and met for those residents who have requirements specific to their different religious, and cultural needs. Other choices and preferences are accommodated. Care plans include information regarding the individual cultural and religious needs of residents and this is considered when care is being provided. Staff were seen knocking on bedroom doors prior to entering although this could not be confirmed by residents (due to their conditions) that this was usual practice. Relatives said that they felt that their relatives were offered privacy during personal care. Any examinations by medical or nursing staff are carried on in the resident’s room. The records of the administration of medicines was examined, including the way the home orders, manages and stores it. The storage is appropriate. Residents are receiving there prescribed medication in line with the relevant legislation and good practice guidelines. Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are supported in the way they spend their time where possible. However, it must also be recognised that the level of dependency that service users have limits the social opportunities they can be offered. The food being offered could be improved. EVIDENCE: There is no formal social programme but there is a list of special events displayed with planned events. These include trips out or visiting entertainers. Comments from relatives suggested that the home provides social activities but the high dependency of the residents mean that they are provided in a more personalised and spontaneous way according their individual needs. The home has a people carrier to take residents out. Comments from the relatives of service users both in the surveys and during the visits were very positive. They said that staff, “are very good”, and that they were “very satisfied ” with the care also that “they show a great deal of compassion”. The residents were reacting very well to the staff and staff Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 Page 14 showed a good knowledge of the ways to approach individual residents so as not to upset them. Relatives also spoke of feeling “listened to” and felt their suggestions were acted upon. Service users looked tidy clean and well cared for. They were wearing appropriate daytime clothing. The majority of residents could not give a verbal response about the care they were receiving. One resident smiled when being approached by a member of staff. It was notable, and commendable, that staff did not avoid physical contact with service users and often gave such none-verbal assurance. There were staff in each lounge area however a relative survey said that they were concerned that this did not always happen. It is acknowledged that this will be the case if a resident needs individual care and the staff are involved in other areas of the home. The home does use “doll therapy”. Different types of dolls were in the lounge areas and could be used by any resident able to reach them. One resident was very involved in cuddling the doll she became animated and engaged with the inspector for a little while. There is a quiet room with some sensory equipment available. Staff said they are able to spend time in the room on a one to one basis with residents. Staff have a good understanding of the individual residents needs and care was given in sensitive manner. They were very busy throughout the day attending to residents’ very complex personal and health care needs. The staff spent time talking to the residents. The manager is also considering the use of activity boxes so residents can interact with objects of interest that they can remove and which can also form the basis on conversation or activities with the staff. There is a cook-chill system in place and there are now kitchen staff employed in the home. No menus are on display either in large print or pictorial style although the benefit of this could be questioned. Portion sizes were adequate but the vegetables portions were small. The absence of cooking aromas also lessened the sensory impact of dining. All of the food provided was served on to the plates therefore no one could have second helpings as there was none left and no resources to make more. Some residents require one-to-one help for meals or will need to have food at different times during the day. Staff are not able to modify individual residents dietary intake to take into account any change in their condition on a day to day basis or add supplements to increase the calorific contact in the event on a resident loosing weight. This results in a high use of prescribed dietary products. The survey from the general practitioner expressed some concern about the way the food is provided. This includes the “tea time” meal, which are always sandwiches. The food was tasted on the day and although it was not unpleasant the vegetables were very soft and the meal was not very tasty. Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 Page 15 Mental Health Concern recognised that the limitations of this system of providing food and the manager agreed that the way it is managed should be looked at. Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is proactive in dealing with complaints and protection issues and service users’ interests are safeguarded. EVIDENCE: The home is active in dealing with complaints although there are few that result in formal investigations being necessary. Relative’s surveys contained no concerns over this aspect of the service. The complaints procedure is made available to residents and relatives through the service user guide. Resident’s relatives felt the manager and staff listen to concerns people may have and they are confident they would act upon them. The manager actively seeks out service user’s and relatives feedback and she feels this resolves issues before they develop into complaints. Staff were aware on discussion as to how to deal with any complaints or concerns expressed. Staff have received training in adult protection issues and were also aware of the principles of this. Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a suitable environment to meet service users needs and maintain the safety of the occupants. EVIDENCE: Pinetree Lodge is a purpose built on one floor and is situated in a mixed residential and commercial area of Gateshead. It has good access to local amenities and transport services. It on a shared site with an NHS facility and has good parking to the front of the building. It has well-maintained gardens on the front of the home and a safe area within the building, which residents can access safely without concern for their welfare. Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 Page 18 The home is divided into two units and each has a keypad system. The door on the Cedars Unit was opened on occasion to let residents have more space the walk around the reception area. Where fire doors are held open by a system that is triggered by the fire alarm so that they close to maintain the fire safety precautions. A random inspection of the bedrooms found that they were clean and personalised. There are bathrooms and toilets close to all communal areas and bedrooms. The sluices were tidy and clean, they were locked and the disinfector was working. A cleaning schedule is in place and all areas of the home. The clinical waste is securely stored outside the building. The manager, and a senior manager confirmed during the last inspection that the home will be provided with pressure sensitive mats to alert staff to some residents, who cannot use a call system, getting out of bed at night. This will be reviewed as part of the redecoration programme. The majority of the doors to toilets, bathrooms and bedrooms are kept locked. Most of the locks are the same and are accessed by a master key, which all staff are provided with. While it is appreciated that some residents may go into other peoples rooms and touch or use their belongings residents who stay in the communal areas during the day cannot freely go into their own room should they wish to do so. There are suitable aids and adaptations to bathrooms and toilets. The home has variable height beds and pressure-relieving aids available. There are plans to carryout a redecoration programme and the manager is planning to make use this as an opportunity to make it a more appropriate environment for people with dementia. This will involve the use of the available research to make sure that the home is suitable for people with dementia. She is very motivated to achieve this and has begun to plan it. Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is very skilled, well trained and competent staff employed in sufficient numbers to make sure that they can provide good care to the residents. EVIDENCE: Mental Health Concern has a dedicated training department. This department provides staff with opportunities to go on a wide range of training. Mandatory training such as food hygiene is provided. More than 50 of care staff have completed NVQ training and the qualified staff are able to go on various courses including degrees and nurse training. Staff have a good understanding of residents needs and care was given in sensitive manner. They were very busy throughout the day attending to residents’ very complex personal and health care needs. Attending to the tasks, necessary to meet the mental health and general nursing needs of all residents. A significant number of resident’s required one to one support and this was carried out in a discreet manner. A survey from a relative suggested that there were some concerns about the number of staff who were available to be available in the lounges. There are times when the staff are assisting residents Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 Page 20 in the home and this means that for a short period the lounges are left without a member of staff present. This was discussed with the Manager and she acknowledged that this does occur however this is very infrequent and staff are aware of the need to ensure that residents are supervised. Recruitment and selection is carried out with support of a Human resources unit. There are extensive policies and procedures in place to make sure that the procedures are carried out effectively and make sure that appropriate staff are employed. These are in line with equality and diversity principles and the organisation is an equal opportunities employer. Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is very competent and endeavors to protect service user’s interests. The management systems are working effectively to protect service users and staff and to meet their needs. EVIDENCE: The previous report noted that, the manager is very competent and the management systems are working effectively and that quality in this outcome area is good. Relative’s surveys supported this. Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 Page 22 The manager is an experienced registered nurse with strong leadership skills and a track record of running good services. She is ethically motivated and understands the importance of providing person-centred care, which she promotes to others. The previous inspection noted that, a team of finance staff at the head quarters looks after the personal allowance records. Relatives and resident’s when they need information can get this from the manager via the intranet system. Only small amounts of money are held on behalf of residents. The manager confirmed that the arrangements around service user’s finances were unchanged and remains satisfactory. Staff and manager have a good awareness of health and safety issues and staff receive up to date training. Mental Health Concern has a very comprehensive quality assurance that is repeatedly tested and amended when shortfalls are found. Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 Page 23 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 Page 24 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 OP15 Regulation 16 (2) (i) Requirement Timescale for action 01/11/08 2. OP22 13 (4) (a) & (b) 3. OP38 13 (4) The home must ensure residents are provided with suitable, wholesome and nutritious which is varied for individual resident and is well presented well making it an enjoyable experience for all service users. The alarm call cord system must 01/01/09 be replaced during the planned redecoration and alternative means for summoning assistance must be in place in the interim. (Requirement made at previous inspections) The home must be in place to 01/09/08 show that regular safety / maintenance checks are being carried out. Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 Page 25 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 OP19 Good Practice Recommendations The home should review the decoration and furnishings in the home to reflect the needs of the specialist client group. Pinetree Lodge Nursing Home DS0000018176.V366704.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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