Inspection on 28/01/09 for Rievaulx House Care Centre

This inspection was carried out on 28th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rievaulx House Care Centre Thornhill Road Upper Wortley Leeds LS12 4LL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Caroline Long     Date: 2 8 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Rievaulx House Care Centre Thornhill Road Upper Wortley Leeds LS12 4LL 01132205000 01132038556 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Meridian Healthcare Ltd care home 48 Number of places (if applicable): Under 65 Over 65 48 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 48 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP. Date of last inspection Brief description of the care home Rievaulx House Care Centre is owned and managed by Meridian Healthcare Ltd. The home is a care home without nursing, registered to provide personal care for up to forty-eight older people. The building is a purpose built home situated in Wortley, near Armley. It has a garden to the rear of the building. A large car parking area is located at the front of the building therefore access is easy for those with mobility problems. Local shops and bus routes are also within easy access. For the people who use the service, their accommodation is provided on both floors. Care Homes for Older People Page 4 of 29 Brief description of the care home There are forty-eight single bedrooms. All bedrooms have en-suite facilities. Lounge and dining areas are located on the two levels. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Information provided by the manager on 28th January 2009 indicated that the current weekly fee for the home is from four hundred and thirty two pounds to four hundred and ninety pounds per week. Additional costs include the provision of extra support by staff, toiletries, hairdressing, holidays, leisure activities and clothes. This is what we used to write this report. We looked at information we have received about the home since the last key inspection. We asked for information to be sent to us before the inspection, this is called an annual Care Homes for Older People Page 6 of 29 quality assessment questionnaire. We sent surveys to people living in the home, to staff and to health professionals. We received ten surveys from people who lived in the home, two from staff and one from a health professional. One inspector visited the home unannounced. This visit lasted over six hours and included talking to the staff and the registered manager about their work and the training they have completed, and checking some of the records, policies and procedures the home has to keep. We spent time talking with people who live in the home and one relatives who was visiting. We looked at four peoples care records to check that a plan had been formulated which helped staff provide support to people according to their needs and wishes. We focused on the key standards and what the outcomes are for people living in the home. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: To provide people with a fuller and more active lifestyle of their choice. A review of every ones daily life and activities must be carried out to make sure any activities are tailored to reflect peoples individual needs and these activities must be provided regularly. When reviewing the number of staff on duty the manager should always take into consideration peoples needs and the layout of the building. This is to be sure there are always enough staff available to meet peoples needs. To help protect people from possible risks, where a risk is identified an assessment of these risks should always be carried out. Care Homes for Older People Page 8 of 29 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed before they move into the home and are provided with sufficient information this means they can be confident the home is the right place for them to live. Evidence: Information is made available to anyone interested in moving into the home. Usually the registered manager will visit them at their home and complete an assessment to make sure the Rievulx House Care Centre will be able to provide a service that will meet the persons needs. As part of this process they will also gather information from any other agencies involved. Where possible the person is then encouraged to visit the home, for a day or overnight providing them with the opportunity to meet everyone and to get a feel for the home. Three peoples files who had recently moved into the home were looked at in detail. All Care Homes for Older People Page 11 of 29 Evidence: assessments were carried out before people moved into the home and all contained details of peoples daily life and health needs. Examples of the information included were mobility and nutritional needs. The records also contained information from the hospital or care manager which had been obtained before the person moved into the home. Both the pre assessment and the health information from the professionals would have enable the registered manager to make an informed decision about whether the home has the staff skills and equipment necessary to look after the person properly. Two people told us they were visited by the registered manager, and although they were not able to visit the home, their relatives did visit on their behalf. Both felt reasonably informed before moving into the home. The registered manager was also able to give us an example of when someone had moved into Rievaulx House Care Centre and the staff had found this may not be the best place for them. He told us that he had asked the care manager to carry out a review and was talking to the relatives about whether the home was suitable. A relative told us how they had been given a information pack and shown around the home. When we asked ten people in a survey if they had received a contract, nine said they had and six said they had received enough information before moving into the home. The staff records showed and three staff confirmed they had the necessary training and induction to enable them to look after people properly. The three files examined contained a contract, which had been signed and agreed either by the person living in the home or by their representative. The home does not provide intermediate care. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident the health and personal care they receive is based on their individual needs. The principles of respect, dignity and privacy are followed. Evidence: Four people told us they received the care and support they need. Examples of comments made were: Sometimes staff do over and above what is needed. They are kind and respectful and I have made friends in the home and with the staff. Staff are wonderful, nothing too much trouble. Staff are very good definitely respectful and polite. The staff look after you properly cant grumble the staff are very good but hard worked treat with warmth and respect. Care Homes for Older People Page 13 of 29 Evidence: A relative gave a example of how a persons health had improved since moving into Rievaulx House Care Centre. Surveys received from seven people said they always get the care and support they need and three said they usually did. One commented Sometimes they are short staffed and I have to wait if I need or want something. Four peoples case records were looked at in order to check that a plan had been formulated which helped staff provide support to people according to their needs and wishes. They contained plans that were comprehensive, and identified the individual personal needs. The plans covered aspects such as daily living, catering, spiritual, religious needs, social activities and medication. These were supported by risk assessments, which described the possible risks to people, and the actions the staff needed to take to minimise these risks. Both the care plans and the risk assessments had been reviewed regularly. The registered manager explained how peoples changing needs were being constantly reviewed and responded to and how staff constantly assessed any possible risk. However one did not contain a possible risk, we discussed this with the registered manager who explained this risk had only recently developed and they were taking precautions at present and would make sure it was written in the care plan. There were records which showed people gave consent about their plans however two people when asked were not aware of their care plans content. In all the records we were able to see the home has a policy in place which states where a female requires personal care this will always be carried out by staff of the same gender. The registered manager explained that the home will adopt a named worker system when the number of people living at Rievaulx has increased. A named worker system or key worker is where a person is allocated one member of staff as a point of contact to help them with any extra support they may need. Peoples health care needs are promoted and maintained. The records showed people were accessing health care professionals, such as General Practitioners, Chiropodists, and District Nurses. People told us both in the surveys and during our visit they are helped to access the medical support they need. A health professional survey was also very positive. Care Homes for Older People Page 14 of 29 Evidence: There is a medication procedure to guide the staffs practice and training is provided on safe storage, administration and disposal of medicines. A monitored dosage system is used and the staff were able to explain the system for administering the medication fully. The registered manager and senior carer told us that all staff who administer medication have carried out training. A sample of medication was checked and was correct. Where people keep their own medication we found assessments of risk had been carried out and people told us they kept their medication in their bedrooms locked away. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Rievaulx House Care Centre offers people limited opportunity to access social activities. People are not always offered a well cooked meal. Evidence: The home has been open six months and the registered manager explained that they have only recently started an activities co-ordinator. The activities co-ordinator has purchased various games equipment for people to use, for instance large dominos, magnetic darts and large cards. The registered manager told us at present the coordinator is getting to know people so they can develop an activities programme that people will like. The surveys indicated there were never activities in the home. However people told us during our visit that there had not been enough activities but they were hoping activities and social events would improve following the commencement of the activities co-ordinator. Two people told us how they had enjoyed playing domino and darts with them, another person told us how they had suggested chair exercises as a activity to the co-ordinator. Care Homes for Older People Page 16 of 29 Evidence: Two people also told us how the staff had made great efforts over the Christmas period and it had been lovely over Christmas, had children singing from school, dancing from a school, bell ringers, father Christmas, and a father and son singing. At Rievaulx House Care Centre people have access to a ten seater cinema and for people who smoke there is a separate small lounge available. One person commented upon how they had enjoyed a film and how staff had brought in ice creams once. However another told us they had been in the home for a while and had not seen a film at the cinema. The activities co-ordinator was not working the day we visited and we found people generally remained in the lounge area and there was only the television to stimulate them. The registered manager told us they have a religious service once a month . A visitor told us how they were made very welcome by the staff and were kept well informed. People told us they are able to choose what they want to do during the day and are able to move around the home as they desired. People have keys to their rooms, one told us how the cleaner always asked them to borrow their key each day so they could get into clean the room. The registered manager explained this is because he wants people to be aware when anyone is entering their rooms. Meals are generally served in the lounge and dining areas, tables are set with table mat, condiments and flowers, people are offered a choice of menu. People told us they are provided with drinks throughout the day and can make one if they need to. We saw people were sat talking, and the meal was taken at a relaxed pace and staff asked people about what they preferred. People who returned their surveys when asked do you like the meals five said always, two said usually, two said sometimes and one said never. There was a mixed response about the food provided comments made were:Only complaint is the food, sometimes the meat is difficult to chew. Food quite good, but I am fairly easy to please, favorite is broccoli which was served today. Puddings are very nice often get fresh fruit, salad and meals are always warm. Care Homes for Older People Page 17 of 29 Evidence: Food used to be lovely and not good at the moment. Two people told us how one member of staff had cooked a marvelous meal on Sunday when there was no cook available. Lunch is served at 12.30 midday but did not arrive until 1pm and tea is served at 4.30 pm, people told us they are not offered supper. These timing are close together, the registered manager should talk with people to be sure they prefer their meals at these times. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to express their concerns and are safeguarded from harm. Evidence: Four people living at the home told us they feel comfortable telling the registered manager if they have any concerns or complaints. Two stressed how approachable he was and one describe how he had dealt with their concern in a considerate way and how they were happy with the response. Seven surveys returned all said they knew who to speak to if they were unhappy, and eight knew how to make a complaint. People were seen visiting the office to see the registered manager to make their views known. The complaints policy is part of the information provided to people when they move into the home and includes how long a response will take. There has been two complaints since the home registered with us, which were resolved by the registered manager. The registered manager was able to show us how these had been recorded and he explained how he would monitor any complaints so he could identify any patterns. The home has a policy about safeguarding people which provides staff with the actions they need to take if they suspect abuse. The organisation also has a free phone Safeguarding and Vulnerable Adults line, this number is in the information guide and Care Homes for Older People Page 19 of 29 Evidence: is for anyone who has contacted the registered manager but is still concerned. Discussion with the registered manager showed he was aware of the actions to take to safeguard adults. Staff told us they have received training in adult protection and safeguarding issues either during induction or as part of their national vocational qualifications and three were able to tell us whom to alert if an incident occurred. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is decorated and furnished to a high standard and provides a comfortable, safe and very pleasant place for people to live. Evidence: The home is very comfortable and clean. Everyone who returned their surveys and who talked to us confirmed this was normally the case. The home is newly built and has only been open for six months, there are two floors. Access to the first floor is by a passenger lift. Both floors have a communal lounge and dining area, a quiet lounge, a smoking lounge and other alcoves where people can sit and meet. The corridors are very wide and would enable people to move around easily with a wheel chair or zimmer frame and have local pictures of Leeds landscapes. People said their rooms were clean, and comfortable, they liked them and they were able to furnish them to their personal interests and tastes. All the bedrooms are ensuite shower rooms. Each room has a lockable cabinet in the bathroom and a lockable drawer in the bed side cabinet. The home has a ten seater cinema where they play videos, one person described watching gone with the wind and having a ice cream. Care Homes for Older People Page 21 of 29 Evidence: People have access to a garden with raised flower beds and patio from the downstairs lounge areas. To help prevent the spread of infections and to make the home a clean and comfortable place, a cleaner is employed for four hours a day which is to be increased to six hours when the home is full. Anti-Bac soap dispensers are installed at washpoints and Alco-Rub hand dispensers are available in all communal rooms, staff are instructed to adhere to the infection control policies and procedures. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provider makes sure only suitable people are employed and staff in the home are generally trained and skilled. However at times the number of staff avialable may not be enough to meet peoples needs fully. Evidence: People told us staff do treat them well, and provide them with the support they need. They made many very positive comments about the staff such as:Staff are wonderful, nothing too much trouble but there are not enough. Staff are very good indeed. The staff look after you properly cant grumble the staff are very good but hard worked. In the surveys when we asked were enough staff available four stated always, four stated usually and two stated sometimes. One person commented depending on if there are enough staff on duty, or if they are short staffed. Four people told us there wasnt always enough staff and staff were hard worked. Care Homes for Older People Page 23 of 29 Evidence: However staff were generally unsure about whether there were enough staff on duty, they made comments such as not sure as we are not full yet and do not have as much time as we used to. They also acknowledged the home has been under occupied and is now filling up and this change could be the reason for peoples perception. When we visited there were fifteen people on the first floor and twenty people on the ground floor, there were two care staff and a senior on the ground floor and one senior and one care staff on the first floor. At night there are one senior and two care staff. We discussed the numbers of staff with the registered manager and requested the number of staff be reviewed as more people move into the home to make sure peoples needs are fully met. We looked at four staff records to make sure the home were employing suitable people for the job. We found all had the necessary checks carried out before staff started work. Four staff told us about their induction programme and how it had given them the right information for them to be able to do their jobs well. They also told us they have received necessary training in mobility assistance, first aid, infection control and safeguarding. The notice boards also had training organised for catheter care and first aid. However the records show some food hygiene, health and safety and safeguarding adults need up dating. Staff confirmed they have regular meetings, one was held on the day we visited. The annual quality assessment questionnaire states just under half of the staff have their National Vocational Qualification level two or above in care, this qualification helps to make sure staff are properly trained to carry out the work. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a home that is managed in their best interests. Evidence: Rievaulx House Care Centre has been opened six months. The registered manager is qualified to National Vocational Qualification Level four in care and is taking their registered managers award. The registered manager has previous experience in the day to day management of a care centre, and has ten years experience of working in the care of the elderly. Four people told us he was very approachable and one described him as excellent. The staff also said that they felt supported by the registered manager. The AQAA contains, clear, relevant information this supported by a wide range of evidence. The data section of the AQAA is accurately and fully completed. The registered manager explained that he will be asking for peoples opinions shortly Care Homes for Older People Page 25 of 29 Evidence: and he was going to commence residents meetings, so the home can be run the way people living in it want it. He explained the response to the questionnaires will be collated, any suggestions recorded and any actions needed acted upon. He also told us that the provider organisation has an audit system which the home will be commencing soon. The registered manager explained where people wish the home to keep money for them, all transactions are recorded, and receipts are kept and held separately in a locked cupboard. When we visited an officer from the head office was checking the moneys to see they were being kept properly. Although staff told us they have received supervision, they were inconsistent as to whether this was yet carried out regularly. The annual quality assessment questionnaire states the maintenance and service records are in order. The fire safety procedures were in place and these showed equipment was maintained and staff have received the appropriate training. Accidents are recorded and reviewed by the registered manager to identify and resolve any potential risks. The registered manager told us the annual checks for health and safety are in place. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 27 18 The registered manager must regularly review the number of staff working This is so everyones needs will be fully met. 27/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 To help protect people from possible risks, where a risk is identified an assessment of these risks should always be carried and staff should be informed of the actions they need to take to minimise these risks. People should be offered the opportunity to take part in social activities of their choice. This is to help them maintain a more active lifestyle People should receive consistently well cooked meals. 2 12 3 15 Care Homes for Older People Page 28 of 29 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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