CARE HOMES FOR OLDER PEOPLE
Ryelands 15 Beddington Gardens Wallington Surrey SM6 0JF Lead Inspector
Deborah Yapicioz Unannounced Inspection 28th October 2005 11.45 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 Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 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. Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Ryelands Address 15 Beddington Gardens Wallington Surrey SM6 0JF 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) 020 8647 6837 020 8254 7047 home.wal@mha.org.uk Methodist Homes for the Aged Mrs Sandra Carole Roche Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 3 Rooms to be used as Double Rooms for the use of husbands, wives, partners, brothers or sisters only. Room number 42 (Dementia Unit) size 19 Sq.m Room number 23 (Personal Care Unit) size 20.709 Sq.m Room number 25 (Personal Care Unit) size 23.256 Sq.m 1st March 2005 Date of last inspection Brief Description of the Service: Ryelands is owned by a voluntary organisation ‘Methodist Homes for the Aged’ and is situated a short distance from Wallington town centre. The home is open to all regardless of gender, race, financial position or religious faith. The home is now registered to provide care to 48 elderly persons (32 personal care and 16 dementia care). Methodist Homes for the Aged has just completed a major building programme. This included demolishing the original home on the site and rebuilding the home to include a residential unit (Ryelands), supported independent living flats (Moorlands), and a separate dementia unit (Brooklands). For the purpose of this inspection report both the residential units (Ryelands and Brooklands) are referred to as Ryelands. The new building it is generally well thought out and has been designed specifically for the purpose. There has been good involvement of the service users. The gardens are thoughtfully designed with level paths and handrails allowing full access to less mobile residents. The garden at Ryelands is shared with the residents of Moorlands. The garden at Brooklands (the dementia unit) is designed to stimulate the senses with safe water features and scented, colourful plants. Accommodation in both units includes spacious single bedrooms on both floors. All service users’ rooms have en-suite facilities and a kitchen area. There is a lift serving all floors. The conditions for registration included recommendations that the three double rooms are only used for husbands, wives, partners, brothers or sisters only. Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on 28th October 2005. The home was inspected under the National Minimum Standards Care Homes for Older People. The home is registered with the Commission for Social Care Inspection to provide residential care for up to forty-eight elderly persons. The inspector would like to thank the service users; home manager and the staff team for their time and willingness to facilitate the inspection process. Methods of inspection included a tour of the premises, observation of contact between staff and service users and a discussion with the registered manager. Records examined included the service users plans, complaints, Medicine Administration Record Sheets, health and safety records, and the pre inspection questionnaire, menus and staff information. Overall the inspection confirmed that Ryelands continues to provide a good standard of care to the people living there. What the service does well:
The staff team at the home are encouraged in participate in training to build on the skills and the cook informed the inspector that she has recently achieved a National Vocational Qualification level three. Other courses that the staff team have participated in include manual handling, first aid and challenging behaviour. Two other staff members at Ryelands have recently been successful in achieving a Diploma in Dementia Care. The service users at Ryelands can choose to participate in a variety of activities including prayers, reminiscence, trips out, various faith services, keep fit, crafts, games, quizzes, art, visiting shops, barbeques and the celebration of events. The home has exceeded this standard for the following reasons. The home having two activity coordinators and additional volunteers; an extensive activity programme which provides choice and variety. Activities in the Brooklands unit are tailored to the needs of people with dementia. Staff spending one to one time with service users for discussions, assisted walks etc; specific service users activity meetings; records kept of activities engaged in by service users, and a service user’s published collection of poems. During the inspection service users were seen undertaking various activities including one service user who wanted to go on a shopping trip to Wallington accompanied by a staff member. The new home is well thought out, designed specifically for the purpose, and with good involvement of the service users. When Brooklands, the dementia unit was built, current ideas on service provision for people with dementia
Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 Page 6 (from organisations such as The Alzheimer’s Association) were incorporated into the building i.e. no “dead ends” in corridors and seating areas by windows. The environmental standard in this inspection was judged as exceeded for the following reasons: personal autonomy has been increased through the design of the service users’ rooms, which all includes accessible showers and kitchenettes. Service users have the option of preparing their own breakfast in their rooms and are also able to be more independent with personal care. Four service users’ rooms have kitchen work surfaces and sinks with adjustable height levels, as well as adjustable power points. Choice has been improved at mealtimes with the flexible meal service. The home encourages service users involvement by meeting regularly to discuss areas such as menus. Six of the service users were involved in the decision making process to decide on the design and layout of the building and grounds through a steering group. The home keeps abreast of current thinking in the field of dementia care and has recently used “Doll therapy” for two service users, which has had a positive response. 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.
Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 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 Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 The home provides good information and introduction opportunities for prospective service users and their families to make an informed choice about moving to the home. A needs assessment is always completed to ensure that service users needs can be met at the home. EVIDENCE: Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 Page 9 Ryelands has a comprehensive statement of purpose and a separate service user guide in place, which contained all the information required under the Care Standards Act. The service users guide is in a tape format, which was compiled by the RNIB. Any new service user would only be admitted once a full needs assessment and care plan is completed by an appropriate person. The service user and their family (if it is appropriate) are involved and consulted in each stage of the admission. The home has separate assessments for Ryelands and Brooklands. The Ryelands domiciliary assessment covers areas such as personal care, physical care, social/emotional needs, contact details, personal preferences and food (likes and dislikes). The resident’s personal profile is compiled by a family member including a life history. The Brooklands unit assessment includes hospital admissions, medication and emotional needs. The service users files looked at during the inspection all contained appropriate assessments completed before the service users moved into the home. This also included information received from families, the service users care manager and other relevant professionals. Service users and their families are encouraged to visit the home before a decision to move is made. Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The service users have individual care plans, which include consultation with service users and their families. Care plans are regularly updated to ensure the service users changing needs are met. Personal care is carried out in a way that residents prefer so that dignity and choice are maintained. Residents’ medication is well managed to ensure good health, although there were some gaps in recording. Service users have been consulted on their personal and cultural preferences in relation to illness, death and dying, thus ensuring their individual wishes are respected. EVIDENCE: The home has care plans in place that carries on from the original care plan and assessment. These were comprehensive and indicated that residents’ individual needs were identified and the actions to be taken to meet the requirements. The care plans are reviewed regularly and the staff team at the home monitor the plans and make regular entries to record daily activities and any areas of concern. Risk assessments are on the service users files, some relating to behaviour and how to deal with them. Property lists were also seen on service users files. The service users at Ryelands need varying degrees of assistance with their personal care. The level of support needed is written into service users care plans.
Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 Page 11 The home has a policy on the receipt, recording, storage, handling, administration and disposal of medication. Records examined showed that all medicines administered are recorded on Medicine Administration Record Sheets. On the day of the inspection there were some gaps in the medication records. The home must ensure all medication records are filled in correctly. A pharmacist visits the home and a record of their findings is on file. A copy of the B.N.F. was kept in the medication cabinet for reference purposes. Service users who are prone to pressure sores had the necessary equipment for the promotion of tissue viability and prevention or treatment such as airbeds, soft cushions and heavy-duty foam cushions. Prevention of pressure sore training sessions is held for the staff team. Pressure sore risk assessments (Waterlow) are carried out and districts nurses routinely visit the home. The home encourages service users to be as independent as possible. Each of the service users has keys to their bedrooms and the front door of the home. If it is not practical for the service users to have a front door key then the reason is recorded on their care plan. Service users can have their own phone fitted if wanted. The home manager stated that issues of respect and how to treat service users with dignity and offer choices is incorporated into the induction training of new staff. During the inspection the staff team were observed to treat the service users with respect and kindness. Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The service users at the home are offered the opportunity to engage in various activities that satisfy their social, cultural, religious and recreational interests and needs. The daily routines and house rules promote residents’ rights and encourage independence. The home has an open visitors policy to ensure family links are maintained. Dietary needs are catered for with meals that are nutritionally well balanced, nicely presented, and clearly based on the service users food and drink preferences, providing them with daily variation and healthy eating options. EVIDENCE: The home has two activity rooms and two music rooms (all with induction loops). The music rooms and the communal lounge all have pianos. The service users at Rye lands can choose to participate in a variety of activities including prayers, reminiscence, trips out, various faith services, keep fit, crafts, games, quizzes, art, visiting shops, barbeques and the celebration of events. Records are kept of activities undertaken. The home has a hairdressing room and a hairdresser attends three days a week. The home keeps abreast of current thinking in the field of dementia care and has recently used “Doll therapy” for two service users, which has had a positive response. Exceeding the standard is evidenced by: the home having two activity coordinators and additional volunteers; An extensive activity programme which provides choice and variety, activities in the Brooklands unit are tailored to the needs of people with dementia. Staff spending one to one time with service
Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 Page 13 users for discussions, assisted walks etc; specific service users activity meetings; records kept of activities engaged in by service users, and a service user’s published collection of poems. During the inspection service users were seen undertaking various activities including one service user who wanted to go on a shopping trip to Wallington accompanied by a staff member. Another service user spoken to during the inspection commented on how much she enjoys the glass painting organised by the home. The home has recently acquired the funding for a mini bus. Once this is purchased the home manager has plans for days out to places of interest to the service users and shopping trips. The home also organises coffee mornings and fairs which help raise money for the homes amenity fund. There is an open visitors policy and families are welcome to visit at any time, although the service users can choose who they wish to see. Visitors can be seen in any part of the home including bedrooms. The home invites relatives and families to any social events. Service users can bring in their own possessions and furniture if they wish. Information regarding contacting advocates is included in the service users guide. Exceeding the standard is evidenced by: personal autonomy being increased through the design of the service users’ rooms, which all includes accessible showers and kitchenettes. Service users have the option of preparing their own breakfast in their rooms and are also able to be more independent with personal care. Four service users’ rooms have kitchen work surfaces and sinks with adjustable height levels, as well as adjustable power points. Choice has been improved at mealtimes with the introduction of a flexible meal service. Six of the service users were involved in the decision making process to decide on the design and layout of the building and grounds through a steering group. On the day of the unannounced inspection a wide variety of well-balanced, nutritional food was observed to be available in plentiful supply. Menus are on a six weekly cycle and there is a choice of two main meals. The homes meal system has been designed for meals where a self-service style selection of foods is presented. This removes the need to pre-book meals, allows meal items to be mixed and allows a change of mind at the time of the meal. Fresh fruit and vegetables are used at all times. Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 There is complaints policy and procedure, which facilitates good access to the complaints system for the residents, their family or their representatives. The home has the appropriate policies in place to ensure the protection of vulnerable service users. EVIDENCE: Ryelands has a complaints procedure, which outlines how a complaint is dealt with and timescales for action. The ‘Methodist Homes’ poster and complaints leaflet states how the Commission for Social Care Inspection can be contacted at any point of a complaint. The home keeps a record of all complaints. There have been ten complaints during the past twelve months, which were all appropriately recorded, investigated and resolved. The home’s adult protection policies include an adult protection procedure, a restraint policy, an aggression policy, a bullying policy and whistle blowing policy. The adult protection policy links in with local authority policies. The home has had one adult protection issue since the last inspection. The issue was reported and investigated according to the local authority Adult protection policy. The home provides staff training on issues of elder abuse. Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 This home provides a clean and safe environment, which has been designed specifically for its purpose. The general décor of the home is good providing a comfortable environment for the service users. Service user’s bedrooms provide privacy and reflect individual interests and preferences. EVIDENCE: Ryelands is situated close to the centre of Wallington. It is also close to rail and bus links. In recent years the home has been undergone a major building programme resulting in a newly built home, supported independent living flats, and a separate dementia unit. Evidence for exceeding the standard: The home is well thought out, designed specifically for the purpose, and with good involvement of the service users. When Brooklands, the dementia unit was built, current ideas on service provision for people with dementia (from organisations such as The Alzheimer’s Association) were incorporated into the building i.e. no “dead ends” in corridors. The unit has spacious communal areas allowing residents freedom to settle in a variety of seating areas. The gardens are also planned on a circuit and are designed to stimulate the senses with safe water features and many
Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 Page 16 scented and colourful plants. On the morning of the unannounced inspection the home was warm, comfortable, bright, well ventilated and free from offensive odours. There is ample communal space through out the home, which appeared comfortable, bright and was furnished appropriately with areas for service users and their visitors to meet in private. During the inspection many of the service users made positive comments about their bedrooms and the communal areas of the home. Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29,30 The staff team at the home have a range of skills and abilities, which enable them to meet the needs of the service users living at the home, ongoing training to build on staff skills is provided. The staff team have all had Criminal Records Check, as a safeguard to offer protection to the homes service users, although these are all held at the company head-office. EVIDENCE: The home offers training opportunities to staff at all levels within the home. The home has compiled a training profile of the staff team, which details the training completed by the staff team. New members of staff complete an induction programme covering various subjects including health and safety issues. The staff at the home have accessed a range of different training courses since the last inspection including, Dementia care mapping, Care of medicines, person centred care, Reminiscence, National Vocational Qualification at level two and three, manual handling, first aid and challenging behaviour. Two staff members at Ryelands have recently been successful in achieving a Diploma in Dementia Care. Criminal Records Checks are completed before a new member of staff can begin work in the home although it is company policy that Criminal Records Checks are held centrally at the head office. This is an issue being discussed at a head office level between the Commission for Social Care Inspection and Methodist homes and should be resolved in the next few months.
Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36,38 The management style is open and the home appears to be well run. There are clear lines of accountability, which is aimed at ensuring the interests of the service users, are safeguarded and their safety and welfare are protected. EVIDENCE: Sandra Roche manages Ryelands. Ms Roche has managed the home since January 2001 and has been very involved in the rebuilding programme. She has over thirteen years experience in a care setting and is particularly interested in dementia care. Ms Roche has completed National Vocational Qualification level four as well as other professional and academic qualifications. Throughout the inspection the manager demonstrated a good knowledge of the service users and the staff team. The home encourages service users involvement in the running of the home by meeting regularly to discuss areas such as menus. Six of the service users were involved in the decision making process to decide on the design and layout of the building and grounds through a steering group.
Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 Page 19 The home has quality assurance audits in place. A representative group of staff at the home are trained as quality coordinators. Every six months an audit takes place which includes asking service users, family members, talking to the staff team and other professionals involved in the home their observations and experience of the home. The findings of the audit are compiled into a summery report, feedback to Methodist Homes for the Aged management team and tied into a management review where targets are set as a result. The home manager has compiled a supervision chart, which details the number of supervision sessions planed and completed. Although there has been an improvement in the number of sessions occurring they are still not happening as frequently as they should. This requirement is therefore carried over to the next inspection. Overall, the manager and the homes caretaker continue to demonstrate a good awareness of health and safety issues. Environmental risk assessments have been completed and policies and procedures were available for inspection. Records indicate that fire alarms and emergency lighting are tested on a weekly basis and fire drills are undertaken at least quarterly, in line with good fire safety guidance. Portable appliance testing has been completed as well as legion Ella testing. Water temperatures are checked and the findings are recorded. A fire risk assessment was seen on the health and safety records file. Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 2 X 3 Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP29 Regulation 7, 2.1, 2.2,2.3 Requirement Timescale for action 31/12/05 2 OP36 18(1) 3 OP9 17 (1)(a)3 3.(I) Criminal Record Bureau checks must be held on site and made available for inspection. This issue is currently being discussed by Commission for Social Care Inspection and Methodist homes and should be resolved by the end of 2005. The home manager must ensure 31/01/06 that all members of the staff team receive regular supervisions. The registered person must 28/10/05 ensure medication administration records are correctly filled in at all times. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 Page 22 Ryelands DS0000007194.V262899.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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