Inspection on 12/07/07 for Rusthall Lodge Nursing Home

This inspection was carried out on 12th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Rusthall Lodge Nursing Home 27/06/06

Rusthall Lodge Nursing Home 29/12/05

Rusthall Lodge Nursing Home 16/08/05

Rusthall Lodge Nursing Home 08/09/04

Rusthall Lodge Nursing Home 21/06/04

Similar services:

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Rusthall Lodge Nursing Home Rusthall Lodge Nellington Road Rusthall Tunbridge Wells Kent TN4 8SJ Lead Inspector Elizabeth Baker Key Unannounced Inspection 12 July 2007 09:50 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 Rusthall Lodge Nursing Home DS0000026203.V343179.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. Rusthall Lodge Nursing Home DS0000026203.V343179.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rusthall Lodge Nursing Home Address Rusthall Lodge Nellington Road Rusthall Tunbridge Wells Kent TN4 8SJ 01892 531378 01892 517816 brenda@rlha.wanadoo.co.uk 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) Rusthall Lodge Housing Association Limited Mrs Sarah Ann Louise Burger Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34), Physical disability over 65 years of age of places (34) Rusthall Lodge Nursing Home DS0000026203.V343179.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th October 2006 Brief Description of the Service: Rusthall Lodge currently comprises phase one of a purpose built care home. The new home has been built on land previously occupied by the original home. Completion of stage two is due in November 2007. Phase one accommodation is on two floors with 34 single rooms, all with en-suite toilets and washbasins. Two en-suite rooms also have shower facilities. Twelve bedrooms are located on the ground floor and 22 on the first floor. Day space currently consists of a dining/sitting room on the ground floor and two sitting rooms on the first floor. A 12-person passenger lift accesses all resident accommodation on the first floor. Each bedroom has a call alarm, television, telephone and internet point. The home is located in a residential area on the outskirts of Rusthall. Access to public transport is a short distance from the home with the nearest shops and other amenities approximately ¼ mile away. The town of Tunbridge Wells is approximately two miles away with a wide selection of shops and other amenities and a main line station. Access to the garden is currently restricted due to the ongoing building work. Current fees range from £600.00 to £882.00 per week. Additional charges are payable for chiropody, hairdressing, newspapers and toiletries. Activities include armchair exercises, quizzes and games, external entertainers, film shows, arts and crafts and religious services. A copy of the latest inspection report is available on request at reception. Rusthall Lodge Nursing Home DS0000026203.V343179.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key unannounced visit to the home for the inspection period 2007/08. Allocated Inspector Elizabeth Baker carried out the visit on the 12 July 2007. The visit lasted about seven and a half hours. As well as touring the home, the visit consisted of talking with some residents and staff. Four residents and two members of staff were interviewed in private. Feedback of the visit was provided to the registered manager. At the Commission’s request the home manager completed and returned an Annual Quality Assurance Assessment (AQAA). Some of the information contained in this document has been incorporated into the report. At the time of the visit, 34 residents requiring nursing and or personal care were residing at the home. Since the last visit, the Commission has not received any formal complaints about the service. What the service does well: A calm atmosphere is noticeable around the home. The home manager and staff are receptive to advice given and act quickly to address matters. The home strives to obtain views and opinions about the service from residents to establish whether the current services are wholly to their liking. Staff are enthusiastic about their roles and there is good interaction between them and residents. The range and availability of activities continues to expand with staff eager to try new ideas, particularly where residents have made new suggestions. To minimise any anxieties new residents may have, plants or flowers and a greeting card are provided in the room to be occupied. This is much appreciated by residents. Residents’ comments included “Everybody is really nice here”; “they are open to new ideas and act on suggestions we make”; “the home felt right straightaway”; “everybody here is so kind and they speak to you by your proper name – no patronising terms such as darling”; “clothes beautifully cleaned”; “wonderful treatment here and extremely good meals”; and “staff are respectful and the chef is very good”. Rusthall Lodge Nursing Home DS0000026203.V343179.R01.S.doc Version 5.2 Page 6 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. Rusthall Lodge Nursing Home DS0000026203.V343179.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 Rusthall Lodge Nursing Home DS0000026203.V343179.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): 3 and 6. Residents who use the service experience good quality outcomes. This judgement has been made using a range of evidence including a site visit to this service. Residents move into the home knowing their needs can be met. EVIDENCE: Generally the home manager or her deputy visit prospective residents in their current place of occupation to determine whether the home is suitable to meet their individual assessed needs. Some residents are admitted on a trial basis to see whether Rusthall Lodge is for them. A number of residents remarked that they quickly felt at home as the atmosphere was right. Information obtained at the visits is recorded and is used to inform the resultant care plan. The home is not registered for intermediate care. Standard 6 is not applicable. Rusthall Lodge Nursing Home DS0000026203.V343179.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 10 and 11. Residents who use the service experience good quality outcomes. This judgement has been made using a range of evidence including a site visit to this service. Although the health and personal care needs of residents are met with evidence of good multi-disciplinary working taking place, proposed improvements in the maintenance of care records should provide a better audit trail of current assessed needs and care being provided. Personal support is offered in such a way as to promote and protect residents’ privacy and dignity. EVIDENCE: All residents are provided with a care plan and a sample of four were inspected. The home has a range of clinical risk assessments, such as skin integrity (Waterlow), wound charts, pain, nutrition, continence and moving and handling. These are used to monitor the effectiveness of treatment plans, where a need has been recorded. Where possible residents are involved in compiling care plans and risk assessments. Care plans are reviewed regularly. However where a review includes a change in the resident’s condition this does not always trigger an actual re-write of the Rusthall Lodge Nursing Home DS0000026203.V343179.R01.S.doc Version 5.2 Page 10 care plan component. One particular need recorded on an admission assessment had not generated a care plan component for the respective resident, despite the resident being prescribed three medications for the condition. Daily records, which are used by care staff as evidence of care having been delivered, are kept separately, preventing a coherent picture being quickly obtained. The new deputy manager has already identified this as a problem and action is being taken to address the matter. Generally the daily records provide a mix of residents’ condition and quality of day experiences, and had been signed, timed and dated. Social history details are obtained and some of the records contained comprehensive information. The home has a clinical room in which medicines, nursing aids and sundries are hygienically and securely stored. The room is appropriately fitted out. Temperatures of the room and drug fridges are recorded so that medicines are stored in accordance with manufacturers’ instructions. The disposal of waste medicines is carried out in accordance with regulations pertinent to care homes providing nursing care. Medicine administration charts are completed as evidence of medicines administered. Where possible residents are supported to self-administer medicines, after a risk assessment has been carried out. Pain charts are available for staff to use to monitor the effectiveness of treatment plans and some were seen in use, although this was not available for a resident experiencing an increase in pain. However arrangements had been made for the resident to see their GP about the problem. Residents spoke highly of the care and support they receive from staff. Staff were observed knocking on bedroom doors before entering and addressing residents by their preferred term of address. Residents were very complimentary of the laundry service they receive indicating their clothes are kept beautifully. Comments were made about the quick turnaround of washing, with clothes taken away early in the morning, sometimes being returned later that day. Medical examinations are carried out in the privacy of residents’ own bedrooms. All bathrooms have been fitted with hairdryers so residents do not suffer the indignity of transferring along corridors with wet hair. Although care records contained burial/cremation details of residents’ in the event of death, spiritual and cultural preferences and wishes are still not adequately recorded. Whilst recognising this is a sensitive issue, it is an important aspect of care and needs to be addressed. Since the last visit registered nurses have attended palliative care training. Health care assistants are to receive similar training shortly. Rusthall Lodge Nursing Home DS0000026203.V343179.R01.S.doc Version 5.2 Page 11 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. Residents who use the service experience good quality outcomes. This judgement has been made using a range of evidence including a site visit to this service. Residents are able to spend their time as they wish to. The meals in the home are good offering both choice and variety and catering for special diets. EVIDENCE: The home’s routines are flexible enabling residents to choose how to spend their day. All residents are provided with a weekly pictorial programme of activities, which covers a range of activities and occupation, including armchair exercises, arts and crafts and external entertainers. A recent recital by a harpist proved very successful. At the time of the visit a number of residents where enjoying a communal crossword puzzle with support from the activities coordinator. Other residents were resting in their rooms listening to their radios, watching TV or reading. The home is anxious to obtain residents views on the range of activities and meals and new forums have been set up to obtain the opinions of residents on the current provision. Residents are appreciative of these forums. Religious services take place in the home every Sunday afternoon. This is important to some residents. A number of residents were involved in the planting up of patio tubs and pots. When the Rusthall Lodge Nursing Home DS0000026203.V343179.R01.S.doc Version 5.2 Page 12 building is complete the gardens will be landscaped. It is the home manager’s intention to have a sensory garden and water feature. Residents are now provided with a quarterly newsletter, which provides useful information including resident and staff changes, as well as practical housekeeping matters. An appetising aroma was permeating around the home at lunchtime. Residents can choose where to have their meals. Dining room tables are attractively laid, reflecting the importance of this aspect of care. Residents are offered daily choices. If a resident does not fancy either choice, the chef will offer alternatives. Following residents’ suggestions provided at the recent food forum menus are being changed, including puddings. This particularly pleased one resident who on the day of the visit had enjoyed the pudding, as this was her suggestion. Indeed other residents spoke of the chef’s commitment of striving to ensure that they are provided with their particular preferences. Extra staff are used at breakfast and lunchtime so residents who require more time are not hurried. Rusthall Lodge Nursing Home DS0000026203.V343179.R01.S.doc Version 5.2 Page 13 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. Residents who use the service experience good quality outcomes. This judgement has been made using a range of evidence including a site visit to this service. Residents know their complaints will be listened to and acted upon. EVIDENCE: Residents spoken with knew what to do if they were unhappy about any aspect of their care. A complaints procedure is displayed in the main reception. Not all staff have yet received specific adult protection training. However arrangements are in hand to address this issue. During an interview with a member of staff the staff member described appropriately the action they would take if they had a suspicion of abuse. The Commission has not received any formal complaints about the home since the last visit. However an anonymous caller contacted the Commission in February of this year about staffing level concerns. This information was passed to the home manager who quickly and appropriately addressed the matter. The Commission is not aware of any adult protection referrals having been made. Rusthall Lodge Nursing Home DS0000026203.V343179.R01.S.doc Version 5.2 Page 14 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, 21, 22, 23, 24, 25 and 26. Residents who use the service experience excellent quality outcomes. This judgement has been made using a range of evidence including a site visit to this service. The new home has created a superior, comfortable and safe environment for those living there and visiting. EVIDENCE: Since the last visit residents have transferred to phase one of a new purpose built home. The new building meets the requirements of the building control and fire safety service. When phase two is complete the accommodation will exceed the national minimum standards for a care home providing nursing and or personal care. The current accommodation provides all residents with a single bedroom and en-suite facilities. Corridors are wide and fitted with handrails, enabling residents to move easily around. Accommodation is on two floors and is divided into four units. Each unit is colour co-ordinated. Rusthall Lodge Nursing Home DS0000026203.V343179.R01.S.doc Version 5.2 Page 15 Residents said this helped them find their own rooms. Until such time as the second phase is completed some communal rooms are being used for dual purposes, including hairdressing arrangements. Phase two will include a designated hairdressing room. Bathrooms and toilets are designed and fitted with appropriate equipment for residents requiring assistance. Corridors have been designed with alcove areas in which wheelchairs and nursing aids and equipment can be parked, when not in use. Bedrooms have been tastefully furnished and decorated. All rooms occupied by residents are connected to the nurse call alarm system. To assist residents with hearing impairments, loop systems have been fitted in sitting rooms. Low surface radiators are situated throughout the home and hot water temperatures are thermostatically controlled, minimising risks to residents. The sluice rooms and basement laundry are appropriately equipped for a home providing nursing care. To maximise infection control precautions, special wall gate units are strategically placed around the home, so staff, visitors and clinicians have ready access to hand-washing facilities. Rusthall Lodge Nursing Home DS0000026203.V343179.R01.S.doc Version 5.2 Page 16 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. Residents who use the service experience good quality outcomes. This judgement has been made using a range of evidence including a site visit to this service. Residents receive care from an enthusiastic, caring and trained workforce. EVIDENCE: In addition to care staff, staff are employed for business, administration, catering, cleaning, activities and maintenance. Staff were seen carrying out their duties in an unhurried manner. Additional staff are employed and/or redeployed at breakfast and lunch times, as well as the evening between 8pm and 10pm. Dependency assessments are used, which should assist the home in determining whether staffing levels reflect the assessed needs of the current residents. The percentage of unregistered care staff now trained to NVQ level II care has increased to 77 . Staff files inspected demonstrated procedures had been followed for the recruitment and appointment of staff. This includes attending interviews, completing application forms, obtaining relevant references and clearance from the Criminal Record Bureau (CRB). However it was noted on this visit that the current application form does not require applicants to state full employment history details, as is now required by regulation. Following a recommendation made at the last visit, a system has been devised which requires staff to inform the manager of any cautions received, convictions or offences committed since the last CRB check was carried out. Rusthall Lodge Nursing Home DS0000026203.V343179.R01.S.doc Version 5.2 Page 17 All new staff undergo an initial induction programme, which includes mandatory training. Care staff then undergo in-depth induction programme, which follows the Skills for Care training requirements and generally leads into National Vocational Training. Staff receive other training in support of their individual roles and responsibilities, including palliative care and activities. Rusthall Lodge Nursing Home DS0000026203.V343179.R01.S.doc Version 5.2 Page 18 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, 32, 33, 35, 36, 37 and 38. Residents who use the service experience good quality outcomes. This judgement has been made using a range of evidence including a site visit to this service. Residents benefit from a well run home. EVIDENCE: The home manager is a registered nurse and has managed the home for the last nine years. Residents and staff spoke openly throughout the visit. As part of the home’s quality assurance programme, the home involves residents and or their relatives in decisions affecting the services provided at the home. These include meetings, forums and surveys. Respite residents are asked to complete exit surveys. Trustees carry out monthly regulation 26 visits and take the opportunity to speak with residents, staff and visitors. The home manager now has “one to one” meetings with residents and these are Rusthall Lodge Nursing Home DS0000026203.V343179.R01.S.doc Version 5.2 Page 19 providing useful information. The completed AQAA records policies and procedures are regularly reviewed. This should ensure staff carryout their duties in line with current good practice and regulation. Systems are in place for maintaining monies on behalf of residents. Receipts are obtained for goods purchased or services provided on their behalf. Cash balances are individually maintained and are internally audited. Separate statements of account are maintained. Residents are informed of restrictive access to their monies in the ‘Welcome to Rusthall Lodge’ information pack, so they can make alternative arrangements during out of normal office hours. The home has a safe in which important items may be stored. Where this is used, records are maintained. Regular staff supervision takes place and notes maintained of points discussed. The home manager receives clinical supervision from the Specialist Nurse Vulnerable Adults, employed by the area’s Primary Care Trust. Records relating to residents and staff are kept with due regard to confidentiality. However as stated previously, care records inspected did not provide a coherent picture of residents’ complete assessed needs and wishes. It is acknowledged that the new deputy manager had already identified the shortfalls and arranged meetings with appropriate staff on proposals to improve the situation. Phase one of the building was completed in October 2006 and complied with building control and fire safety requirements. Staff receive mandatory training including moving and handling, fire and infection control. Accident records are maintained and are audited for trends. Rusthall Lodge Nursing Home DS0000026203.V343179.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 4 11 2 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 3 4 4 4 4 4 4 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 2 3 Rusthall Lodge Nursing Home DS0000026203.V343179.R01.S.doc Version 5.2 Page 21 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 2 Standard OP7 OP29 Regulation 15 19(1)(b) sch 2, paragraph 6 17 Requirement Timescale for action 31/08/07 3 OP37 Care plans must include all needs determined during the assessment process. The employment application 31/08/07 form must request full employment histories to be stated. Care records must be maintained 30/09/07 in a way to provide a coherent picture of the residents’ current assessed needs/wishes as well as evidence of care actually being delivered. Rusthall Lodge Nursing Home DS0000026203.V343179.R01.S.doc Version 5.2 Page 22 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 2 Refer to Standard OP9 OP11 Good Practice Recommendations Pain assessment should be used for all residents where there is an assessed need. Care records should include details of residents’ spiritual and cultural wishes and preferences in respect of death and dying. Rusthall Lodge Nursing Home DS0000026203.V343179.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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