CARE HOME ADULTS 18-65
Redwood House 54 Sharpenhoe Road Barton Le Clay Beds MK45 3SP Lead Inspector
Leonorah Milton Unannounced 16 August 2005
th 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Redwood House Address 54 Sharpenhoe Road Barton Le Clay Beds MK45 4SP 01582 881325 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Complete Care Services Ltd Mr Stephen Ofosu-Koranteng Care Home 7 Category(ies) of LD Learning Disability - 7 registration, with number of places Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14.02.05 Brief Description of the Service: Redwood House was situated on the outskirts of Barton-Le-Clay approximately midway between Luton and Bedford with good road access to both towns. The registered owners were Complete Care Services Ltd who had operated the home since it opened in 2000. The manager had been registered in March of this year but had been in post for several months prior to this. The service was registered to provide care for up to seven younger adults with a learning disability. The home was within walking distance of the village centre and local amenities. The building had been converted and extended from its original use as a family home. It was set in generous grounds. All the bedrooms were for single occupancy, two rooms had en-suite facilities and the garage had been converted to provide a meeting room and when required an activity/day care area. Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on 16th August 2005 and took place over 6.15 hours. The deputy manager arrived at the home shortly after the inspection began and was available for information until its conclusion. Other information was gained at a brief second visit to the home on the morning of the 17th August 2005 at which time notifications were issued for action to take place within short timescales in relation to unacceptable standards of safety and hygiene seen on the previous day. Seven service users were in residence at this inspection. Two of these were temporarily absent from the home staying with relatives and one was out for the majority of the day attending a day care facility. The methods of inspection included a review of case files for two service users, conversations with these individuals and assessment of their private accommodation and also the communal accommodation that they shared with others. Brief conversations also took place with two other service users. Various other records relevant to the operation of the home were assessed. Conversations took place with three members of staff and the deputy. The evening meal was taken with service users and members of staff. What the service does well:
The home had a welcoming and relaxed atmosphere. It was evident that the service users felt at home. They were seen to move around the home and share in some of the domestic tasks of day-to-day living with confidence. Service users in the main had been supported to develop their independent living skills through attendance at colleges or day care facilities and individual development programmes in house. These arrangements had taken account of service users’ wishes where practical and realistic. Arrangements for service users’ leisure time appeared to suit their needs. Service users reported that they had been to a range of external social activities such as bingo, two social clubs, shopping trips and the local pub. The members of staff seen at this inspection interacted well with service users and treated them with respect. Each member of staff spoken to stated that they enjoyed working at the home and felt supported by the manager. Service users appeared to be satisfied with the arrangements for their daily lifestyle. One individual was disgruntled and depressed but records showed this was a usual pattern and that health care professionals were involved in the service user’s ongoing treatment.
Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better:
Despite the written assessments of risks to safety a delay to take action on maintenance issues had resulted in considerable breaches to safety: The external door to an oven had been missing for two months and left only the inner glass door in place. The oven was in use at this inspection. The door reached a very high temperature that posed a risk of burn if accidentally touched. Given that service users moved freely around the kitchen and there were records of behaviour that required intervention with restraint techniques, the risk posed by this oven door was unacceptable. Failure to repair an electrical socket in the laundry within a short timescale was also unacceptable as it too posed a risk to safety. Equally worrying was the condition of a service user’s bed. This was seen to have a mattress, which was greatly sunken in the middle, stained and smelt unpleasant. The base beneath was also stained and malodorous. On the day of the inspection the residents in the home appeared to be somewhat under occupied. This may have been because colleges were in recess. A member of staff was seen to be frequently engaged in watching the television when he may have been better occupied with service users. The meal served in the evening was plentiful and nutritious. Menus showed a variety of meals that had been planned in consultation with service users. However there was insufficient provision for the dietary needs of one individual that had not been supplied in accordance with his written plan of care. If, as explained, the service user had preferences that contradicted those usually associated with his religion, then his plan of care must reflect this. This same individual had few opportunities to mix with people of his own culture. Arrangements for him to attend religious services had not met his expectations. He stated that he wished to join a social club where he could
Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 7 meet others who spoke his language. Records indicated that a health consultant had also recommended the same. There must be a concerted attempt to meet this need. Records showed that service users had signed a document assuring them of their right to secure their rooms. These documents were somewhat ambiguous because the actual arrangements only allowed some service users to secure their rooms from the inside. Some of the bedroom doors were without external locks to enable service users to secure their rooms whilst they were absent from the building. Given that there was evidence that service users had signed to agree some plans for their care, they must also be given opportunities to agree their main plan of care and any restrictions in place for their welfare. 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. Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3,4 Service users had been provided with opportunities and information to assist them to make a decision about moving into the home. EVIDENCE: Records assessed identified that pre-admission procedures were satisfactory. Service users where practical had been able to visit the home prior to admission to gain an impression of the lifestyle on offer. Assessments of need prior to admission had been detailed and included reports from health care professionals, assessments from placing authorities and previous placements. The staff on duty had received training in relation to their responsibilities. This however was not linked to the Learning Disability Award Framework standards (LDAF) as is preferred to ensure that staff have the under pinning knowledge about best practice for the care of those with learning difficulties. It was stated that plans were in hand for such training to commence in the near future Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9. Whilst there had been an effort to meet service users’ needs the actual service delivery did not meet the aspirations identified on the written plans of care in total. EVIDENCE: The plans of care were “work in progress”. The plan that had been completed had taken account of the details specified by the National Minimum Standards (NMS). There remained to complete, some aspects of risk assessment as detailed in previous requirements and service user agreement to any restrictions to liberty. This must include an assessment of the risk of accidental burn from unprotected radiator surfaces for one service user whose epilepsy required monitoring at night via a listening device. Care plans or key aspects from them had not been produced in a format that was comprehensible to service users. There were records to show that service users had the opportunity to meet formally as a group with staff on a monthly basis to discuss plans for outings, activities and similar. Records indicated that minor grievances were aired at these meetings. It was reported that service users were consulted about menus. No formal records were maintained of such consultation.
Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 11 It was stated that none of the service users were able to manage their personal finances and that the home managed this on their behalf. Records indicated that service users had been given small sums of money for social activities. Appropriate records were maintained of the expenditures on a dayto-day basis. It was not possible to access all of the records in relation to service users’ savings but those seen indicated that each had individual savings accounts. Care plans must make reference to service users’ abilities in relation to money management and detail the level of assistance they require. None of the service users were in receipt of advocacy services. It was stated that a local advocacy organisation had stated that the service users were not in need of such a service. This was somewhat surprising. The home is advised to seek advocacy services from elsewhere. Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15,16,17 There was insufficient evidence to identify that each service user had been supported to achieve a fulfilling lifestyle within the home as well as outside of it. EVIDENCE: Service users confirmed that they had accessed a range of leisure activities and that holidays were planned for the near future. There was evidence to show that service users had been supported to access educational opportunities at day care facilities and colleges of further education. However the written care plan for at least one individual and the actual arrangements to meet it showed that his lifestyle did not meet his expectations. The plan for one service user stated that because of his cultural background he must not be offered meals containing beef. On the day of the inspection there was little alternative to the main provision and the service user was observed to eat a meal whose main ingredient was beef. It was unclear whether the service user was aware of the content of his meal. As recorded previously the same individual was frustrated at the lack of opportunities to socialise with people of his culture and who spoke his first language.
Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 13 Whilst there was a universal plan in the staff office of service users’ daily programmes and their responsibilities for house hold tasks there were no individual records to show the progression of the in house personal development programmes. Care plans and associated daily records must be accurate and reflective of the daily provision for service users. Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21. Appropriate arrangements had been made to meet service users’ healthcare needs. EVIDENCE: As had been noted at the previous inspection, the assessment and planning information on the files showed that there were appropriate systems in place to ensure that routine, ongoing and emergency medical needs were being addressed. In particular there was seen to be good support from the Learning Disability Resource Team, including the Outreach team, which provided twenty-four hour support on managing challenging behaviour. It was noted that there were agreed arrangements in the event of a service user becoming seriously ill and at death. Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 Service users had been able to share their problems with staff who, where practical, had take action on their concerns. EVIDENCE: Previous inspections had identified that the home had satisfactory written complaints and protection procedures. Observation of the lifestyle in the home, discussions with service users and assessment of records confirmed that service users had been able to discuss their feelings and problems with members of staff. Service users where need be had been referred to the Learning Disability Resource Team for support and assessment of particular problems that were not within the scope of the home. Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29,30 Whilst the layout of the home was suitable to service users’ needs there had been a failure to maintain standards, so that there had been significant risks to service users’ safety. EVIDENCE: The building was spacious. It’s layout was suitable to service users’ needs. In most part it was well decorated and furnished and had a homely appearance. Omissions to safety and hygiene have been noted elsewhere in this report and have been reported to the proprietor by notification and letter. At the time of writing this report a satisfactory action plan to deal with these issues promptly had been received from the proprietor. Each service user had been supplied with a spacious bedroom. Most were well decorated and furnished. Items of a personal nature were noted to be on display in most rooms. It was noted that the flooring to one was that usually required for those with continence problems. It was stated that the flooring had been fitted to meet the needs of the previous occupant. The current service user did not require such flooring. It was reported that the current occupant would be upset by any change to his room. It is suggested therefore
Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 17 that pre-admission procedures take account of the suitability of the accommodation to be provided before a service user moves in. It was also noted that the entrance to an ensuite facility was only provided with curtaining for privacy. Its lower edge was at some height above the floor. Given that the entrance was directly opposite the bedroom door, which the service user preferred to remain open all day, it is advisable to review the privacy arrangements of this situation. The adapted garage housed the manager’s office and a room that doubled for use as an activity and staff sleeping-in room. The joint use of this room must be identified on the statement of purpose. Given that at the registration of an additional bedroom in 2002 that was converted from the staff sleeping in room at which time the proprietor stated that there would be two staff on waking night duty and no further need of a sleep in room, this arrangement was puzzling. The proprietor must forward to the CSCI a copy of the risk assessment for night staffing arrangements. The walls of the corridor leading into these two rooms were exposed breezeblock. These areas must be plastered and decorated. The exterior of some cupboard doors in the kitchen were in need of a thorough clean. One of these doors no longer shut properly. Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,34. Sufficient staff had been rostered to support service users in house and to access external activities. EVIDENCE: Members of staff were observed to interact positively with service users. Service users appeared confident in their approaches to personnel and to engage in friendly dialogue with them. On the day of the inspection the daily life in the home proceeded at a leisurely pace. One member of staff as previously noted appeared to be under occupied as did some service users, but this may have been part of the overall plan for this particular day. The duty roster indicated that a senior person was on call for advice and support in the event of an emergency. It was explained that the manager had covered some of the direct care shifts each week. This being the case, the advertised roster indicated that sufficient support staff had been rostered to meet service user’s needs when the manager’s working time was taken into account. If the manager’s working time is to be included in the minimum support staff roster this must be included on the daily duty roster. Rosters seen were not entirely accurate as changes had been made and another record showed that other members of staff were covering parts of shifts. The rota is a legal record and must identify staff surnames and the actual hours scheduled and worked by each individual.
Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 19 The members of spoken to at this inspection confirmed that they had received induction into their roles and were receiving ongoing training. Whilst training as yet had not been linked to the LDAF standards as is preferred for those who support people with learning disabilities, the overall provision was aimed and covering essential learning for effective working with the service users. Statutory health and safety courses had been undertaken and also areas covering adult protection and restraint procedures. It was confirmed that supervision had commenced but had yet to be delivered with the frequency specified by the National Minimum Standards. Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38,41,42,43. The home had been managed on site in the best interests of service users but a failure to action maintenance and refurbishment issues, which were outside of the manager’s brief, had compromised service users’ safety and comfort. EVIDENCE: There was evidence to show that the manager had developed strategies to support service users through individual review and group meetings. Staff had similarly been supported and consulted through monthly meetings. Written procedural advice was available to staff. A review of emergency issues had resulted in a comprehensive contingency plan that included contact numbers of various emergency services and utility organisations. Records forwarded to the CSCI each month showed that the proprietor had visited the home on a regular basis in accordance with the regulation. The record of his survey of the premises however had failed to record the delay on maintenance issues that had resulted in the dangerous situations noted at this inspection.
Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 21 Records had been methodically maintained in a professional manner. Omissions have already been mentioned in this report. It was also noted that records of fire evacuation practice had not noted the names of those attending so that gaps in training might be identified. A business plan had been complied the development of the service since the previous inspection. There was however no linking financial plans to show how this could be achieved within the home’s financial resources. Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 2 3 x Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 2 3 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 1 3 2 3 1 Standard No 11 12 13 14 15 16 17 3 3 3 3 2 2 2 Standard No 31 32 33 34 35 36 Score x x 3 x x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Redwood House Score x 3 x 3 Standard No 37 38 39 40 41 42 43 Score x 3 x x 2 2 2 I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7,41 Regulation 17(1)(a) Requirement Timescale for action 30.11.05 2. 9 13(4)(a) 3. 17 16(2)(i) The registered person must ensure that each service user has an up to date fully completed individual plan that details how their needs will be met and how they will achieve their goals.16.11.04: The registered person must ensure that on each service user’s personal file there is an up to date service user’s plan that conforms to the relevant standards (2, 6, 7 and 9 along with all the other standards that require information to go into the plan). The service user and, as appropriate, his or her representative must be involved in drawing up the plan and their involvement noted in the document (Previous timescales of 1.03.05 and 01.06.05 had not been met in full). The risk of accidental burn from 31.10.05 unprotected radiators must be assessed in relation to the service user who has epilepsy. Food that meets service users 30.09.05 cultural and religious background
Version 1.40 Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Page 24 must be provided. 4. 5. 24 26 23(2)(b) (d) 23(1)(a) The walls in the corridor of the annex must be plastered and decorated. Bedroom doors must be fitted with individaul locks that permit service users to secure them during their absence and that will allow allow staff enty in the event of an emergency. The registered person must ensure that the LADAFaccredited induction and foundation training is introduced in a reasonable time. (Previous timecales of 01.03.05 and 01.06.05 had not been met.) The registered person must ensure that there is an annual business plan and financial plan. (Previous timescale of 01.03.05 and 01.06.05 had not been met in full). The registered person must introduce effective quality assurance and monitoring systems. 16.11.04: The registered person must ensure that there is appropriate reviewing of the findings of the monitoring systems leading to an annual development plan. (Previous timescaleyes of 01.03.05 had not been met. Not assessed at this inspection). 31.12.05. 31.12.05 6. 18 18(1) (c )(i) 31.12.05. 7. 43 25(1) 31.12.05 8. 39 24(1)(2) (3) 01.06.05 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 7 Good Practice Recommendations The support of independent advocacy services should be
I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 25 Redwood House 2. 13 arranged for service users. Social opportunities for service users to meet with people from their culture and who speak their first language must be explored. Redwood House I51 S14951 Redwood House V238400 160805 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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