Inspection on 03/07/08 for Ravenswood Nursing Home

This inspection was carried out on 3rd July 2008.

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

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

Other inspections for this house

Ravenswood Nursing Home 28/06/07

Ravenswood Nursing Home 13/12/06

Ravenswood Nursing Home 04/10/05

Ravenswood Nursing Home 13/12/04

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

CARE HOMES FOR OLDER PEOPLE Ravenswood Nursing Home 47 Lower Bristol Road Weston Super Mare North Somerset BS23 2PX Lead Inspector Juanita Glass Key Unannounced Inspection 11:30 3 and 16th July 2008 rd 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 Ravenswood Nursing Home DS0000062326.V362010.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. Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ravenswood Nursing Home Address 47 Lower Bristol Road Weston Super Mare North Somerset BS23 2PX 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) 01934 412091 01934 644343 Extrafriend Limited Mrs Deborah Margaret Crawford Care Home 36 Category(ies) of Dementia (36), Mental disorder, excluding registration, with number learning disability or dementia (36) of places Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) 2. Mental Disorder, excluding learning disability or dementia (Code MD) The maximum number of service users who can be accommodated is 36. 28th June 2007 Date of last inspection Brief Description of the Service: Ravenswood Nursing Home is registered with the Commission to provide nursing care for 36 people with a dementia type illness. Their Statement of Purpose states they can meet the needs of both male and female residents who suffer from mental confusion and dementia. They state they will ensure that residents without relatives will have access to an advocate and aim to provide people with a ‘secure, relaxed and homely environment.’ The home has 29 bedrooms most of which are single rooms some having ensuite facilities. There is a passenger lift to all floors and a stair lift to help people negotiate a short flight of steps on the upper floor. The home manager is Debbie Crawford who trained as an RMN (Registered Mental Nurse) at Glenside Hospital, Bristol in 1985 and has extensive experience in the care of the elderly. She has attained the NVQ 4 In Management in Health and Social Care. Ravenswood is located on a main bus route into the centre of Weston-superMare. The home has easy access to the seafront, a number of local parks and local shops. Ravenswood is a large period building adapted to meet the needs of service users requiring nursing care. The home charges the local authority rate of £557.95 a week. Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection took place over two days in the presence of the manager Ms Debbie Crawford. A total of 7.5 hours were spent in the home. Evidence to support the findings of this inspection was obtained through written surveys from people living in the home and their relatives. Responses to our written survey were received from 9 people living in the home, 7 relatives, 7 members of staff and 4 social workers. An Annual Quality Assurance Assessment (AQAA) was completed by the home manager and forwarded to the Commission for Social Care Inspection (CSCI). We The Commission also carried out a review of documentation in the home. This included documents in peoples care plans, staff personnel records and records maintained for the day-to-day running of the home. Whilst in Ravenswood we discussed the care provided with 6 people living there on a one to one basis and as a group. We also spoke to 4 staff members working on the day of the inspection. What the service does well: We noticed that the staff at Ravenswood Nursing Home continue to provide a caring environment for people with a range of diverse needs. The staff team are qualified to deliver care, which is relevant to the needs of the people living in the home. We could see this in the person centred approach to providing care and support. The comments we received showed that those people living in the home who could say what they thought about their care were happy with the way they were looked after. All the surveys we received indicated that people were happy. People we spoke to said that the staff were nice and helped them. Many people living in Ravenswood cannot tell us how they feel or did not wish to. They looked well cared for and happy talking to staff and on the second day a busy lounge was the place for a game of bingo and dominoes. Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 Page 6 The surveys we received from people’s relatives showed us that they were also happy with the care provided. One survey stated they always found the staff ‘helpful and very kind, they always treat the residents with respect.’ This survey also said ‘the home has a very homely atmosphere the staff are always approachable.’ Another survey stated that the staff always ‘helped their relative to have a walk in the park which was very important to them.’ Staff indicated that they were well supported and received training appropriate to their role in the home and the needs of the people living there. One social worker said that the home manages to care for people with challenging and diverse needs. A robust administration system and team support the running of the home. 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. The summary of this inspection report can be made available in other formats on request. Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 Page 7 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 Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 Page 8 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): 1, 3, and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents benefit from adequate written information, a chance to visit the home and a full assessment of their needs. This means they can make an informed decision before moving in and their needs are fully met. EVIDENCE: We the Commission requested a copy of the homes Statement of Purpose and Service user guide. This was readily available and provided immediately. We saw that it is well written and contained all the information a person would need to tell them about what care the home can and cannot provide. It also states clearly the fees and what they pay for with a list of extra charges clearly mentioned. We asked the manager about how they would assess a person who wished to move into the home. She said they would visit the person either at their home Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 Page 9 or in hospital. They would talk to them, a relative or advocate and staff at the hospital or a social worker. They would also look at existing care plans for the person. We then looked at the records held in the home for people who had not lived their very long. They all had completed assessments and community or hospital care plans. We spoke to the people living in the home but they did not comment on the way they were assessed or moved in. People wanting to move into Ravenswood can visit and spend some time there to meet people living there and staff who will be looking after them if they decide to stay. This is often done by a relative or advocate on their behalf. If the manager and staff feel they can meet the needs of the person they will offer a trial period when both the person moving in and staff can decide whether the move is really the best placement for them. Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from personal and specialist healthcare support that is provided in a person centred way respecting their privacy and dignity. They benefit from and are protected by the homes policies and procedures for the administration of medication which staff follow. EVIDENCE: We looked at the care records for four people living in the home. We saw that since the last inspection the manager and staff have developed ways of ensuring all daily events are recorded clearly. The care plans are person centred and reflect the personal likes and dislikes of the person rather than task led roles for staff to follow. We noticed that care plans also gave clear guidance for staff on how to recognise the triggers that would indicate a person could be about to display challenging behaviour. All staff understood the diverse needs of the people in the home. They knew what they liked and how they liked to be cared for. Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 Page 11 We observed the way staff spoke to people and helped them in their daily activities. They were very respectful and were aware of the need for privacy and dignity when carrying out procedures. We heard staff with a cheerful and friendly rapport talking to residents. We mentioned to the manager that staff need to be aware that the use of nicknames should be carefully monitored and agreed with the resident as they could be clearly misunderstood by strangers or visitors. We did note that two members of staff assisted a person to his/her room then on leaving the room did not make sure the door did not lock behind them. We discussed this with the manager, as it is important that staff remember to leave doors unlocked when a person is in their bedroom if the person cannot make that decision for him or herself or lock/unlock the door. We spoke to people living in the home. Many did not wish to or were unable to discuss the care they received. Those who were able to express an opinion said they were very happy and liked the staff as they looked after them well. One person said they were ‘very very happy and liked their room.’ Residents have access to health care specialists and care plans showed that the district nurse and community psychiatric nurse were consulted when the home felt they needed some expert advice. Residents are helped to attend out patient appointments, the dentist and the chiropodist. Regular reviews are carried out with the GP looking at specific health needs and medication. We noted that the policies and procedures for the receipt, storage and administration of medication was very clear for staff to follow. We saw that the way things were being done had improved since the last inspection. Creams and ointments in people’s rooms were for their use only and handwritten entries and changes had been signed and witnessed. The protocols for why a person should be given an as required medication were very clear for staff to follow. Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from the development of meaningful activities which recognises their diverse needs, likes and dislikes enabling them to maintain some control over their lifestyle. They benefit from continued contact with family, friends and the community. A well-balanced menu means people benefit from a healthy and nutritional diet. EVIDENCE: The daily routines off the home are flexible and are designed to meet the needs of the people living there. At the last inspection we remarked on the use of locked doors and people not having the freedom of choice to go to their room. We noted that only doors that people living in the home have asked to be locked are now kept locked. People have been enabled to go to their rooms with the introduction of different coloured doors so people remember the colour of their door rather than complicated directions. One person when asked said what colour their door was rather than where their room was. Staff said it had been a help, as when asked where their room was someone could be directed by door colour rather than taken to their room which could be distressing for them. Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 Page 13 Care records showed that residents’ religious and cultural needs are taken into consideration. Alternative dietary arrangements had been made for one resident. Residents spoken to did not express an opinion about whether they could change the way the home was run. The activities organiser was observed to be finding out what people would like to do through initiating changes in the activities record. Since the last inspection a dedicated activities organiser had been employed. She was just beginning to introduce a variety of activities to the residents on the first day of the inspection and spoke about what she would like to do. On the second day a group of residents were observed after lunch sat in a circle playing bingo, dominoes and one resident watched whilst knitting. The activities organiser said the owner in purchasing suitable equipment had supported her in setting up enjoyable activities and finding out what people would prefer. This is obviously in a developmental stage and progress will be assessed at the next inspection. Residents spoken to said they could see their friends and relatives and that there were no restrictions to visiting. We looked at the menu provided in the home. It reflects the cultural and personal likes and dislikes of the people living there. The food supplied is freshly cooked and includes fresh fruit and vegetables. One survey said ‘if I don’t like it or want something different it is there for me.’ Meal times were relaxed and people were offered assistance in a respectful and dignified way. Nobody was rushed to be finished by a certain time and the atmosphere was cheerful and leisurely. Snacks and drinks were offered throughout the day. Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from and are protected by the complaints and safeguarding procedures in the home. Staff are fully aware of the procedures to follow to protect people from abuse. EVIDENCE: We looked at the homes complaints policy and procedure. It was easy to read and when asked one resident said ‘I know who to tell, her,’ and pointed to the nurse in charge and smiled. Other residents were not able to express an opinion on how to make a complaint. Three complaints had been received since the last inspection, each of which had also been forwarded to the CSCI. The manager had made very clear records of the complaint, how she had investigated and her response. The home also has a robust policy and procedure for safeguarding adults who may be vulnerable to abuse. Staff spoken to said they knew what action to take, they were aware that there was a local authority procedure and where to access the information if they needed to. Training on the North Somerset policy and procedure had been provided for all staff at the home. Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a comfortable, homely and well equipped home, which is well maintained and decorated to provide assistance with their specific needs in mind. People are protected by staff awareness of appropriate infection control guidelines. EVIDENCE: Since the last inspection the owner and manager took advice and looked at how they could provide an environment that helped people who may be confused or lost due to poor memory. We saw that each bedroom door was painted a different colour not only making corridors bright and cheerful but enabling residents to find their room without feeling lost or inadequate. One member of staff said that it was really good as they could tell residents what colour their door was and they could find their room unaided. This gives people a sense of wellbeing. Toilet doors are painted red with appropriate Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 Page 16 signage so any body could recognise where the toilet was. Doors that staff did not want people to enter, such as storage rooms remained the same colour as the wall. This is good practice and shows that the manager and staff understand the diverse needs of people with a dementia type illness, improving their feeling of wellbeing. We also noted that since the last inspection people’s rooms had been made more cheerful with personal pictures or posters. Staff had worked hard finding out people’s hobbies and likes and dislikes. They then found pictures and posters for their room. Individual rooms had pictures such as tractors for an ex farmer, football colours for an avid team supporter and to their surprise staff found out one resident had been a boxer and wanted pictures of famous boxers on his wall. We walked around the home and found that all areas were clean and tidy with no odours. Staff were using appropriate protective clothing and observing clear infection control guidelines. Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from and are protected by the staffing levels and skill mix of staff in the home. The homes recruitment procedures and staff training further protect them from the possibility of abuse. EVIDENCE: We looked at the personnel files held by the home for some of their staff. We looked at the employment records for three recently employed members of staff. We also looked at the staffing rota and the training records for people working in the home. We found that there were appropriate numbers of staff working in the home at each shift. There was a good skill mix of staff with qualified staff, senior carers, care staff and new staff who work supervised until they have completed their induction. All new staff complete an induction that is linked with the Common Induction Standards for Skills for Care and underpins the NVQ 2 In Health Care. Staff are encouraged to obtain an NVQ qualification, these include Health and Social Care, Domestic Services and Administration. We looked at employment files and found that the manager follows the homes strict policy and procedure on staff recruitment, obtaining all the required Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 Page 18 documentation before they commence work. This protects residents from the possibility of abuse by ensuring all new staff are appropriately checked. Staff training records showed us that the home supports staff in continuing to attend all mandatory training and to attend training that is specific to their role in the work place or to the identified needs of the people living in the home. One staff survey stated, ‘the company embraces a multi cultural policy and therefore able to meet the needs of people. With lots of training in these areas available to all the staff.’ Staff said they felt well supported in attending training and in the staffing levels in the home, they said there was plenty to do but enough staff to ensure residents had one to one attention as well as meeting their activities of daily living. Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from living in a well run home with an appropriately qualified manager and supervised staff. They are protected from financial abuse through safe and stringent policies for managing resident’s money. Both people working and living in the home are protected by robust health and safety procedures. EVIDENCE: The registered manager is a Registered Mental Nurse with 18 years experience in the care of the elderly. She has completed the Registered Mangers Award. People spoken to said they could talk to the manager. Staff said they felt well supported and one staff survey said, ‘The home manager is Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 Page 20 very keen to ensure the home runs as smoothly as possible and is always on the ball when it comes to interacting with staff, service users and any one connected with the home.’ The home does not manage money for many of the people living in the home. They encourage relatives or advocacy to ensure people are protected from financial abuse. We did a random audit on the finances held for three people living in the home. A very strict procedure is followed so that income and expenditure is recorded and proof obtained through receipt or copies of payments made. The audits showed that there were no errors. Both the manager and the provider provided examples of the home’s quality monitoring process. The manager was still awaiting feedback from their most recent quality assessment. It was evident from the development plan set up following the last assessment that both the manager and provider take into account the opinions of residents, relatives and out side professionals. Staff meetings are held regularly and regular checks on the way the service is provided are carried out at all levels by senior carers, qualified staff and management. The manager carries out regular supervision with current members of staff. Supervision sessions include looking at working practices and identifying training needs which staff are encouraged to access either in house or through external organisations. Health and safety within the home is generally satisfactory, with very clear risk assessments that all staff were aware of. The fire log was reviewed and showed that all the relevant checks were being carried out appropriately and that all staff had attended training. The home policies and procedure for health and safety and safeguarding residents and staff are regularly reviewed and up dated as necessary. Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 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 3 X 3 X 3 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 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 3 X 3 Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ravenswood Nursing Home DS0000062326.V362010.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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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