Inspection on 20/03/07 for Santa Maria

This inspection was carried out on 20th March 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Santa Maria 30/09/08

Santa Maria 14/02/06

Santa Maria 23/06/05

Santa Maria 01/02/05

Santa Maria 10/08/04

Santa Maria 26/02/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Pinta

Kestrel House, St Anne`s Opportunity Centre,

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

CARE HOME ADULTS 18-65 Santa Maria 268 London Road Wokingham Berkshire RG40 1RD Lead Inspector Annette Miller Unannounced Inspection 20th March 2007 14.30 DS0000011363.V328758.R01.S.doc Version 5.2 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 DS0000011363.V328758.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 Adults 18-65. 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. DS0000011363.V328758.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Santa Maria Address 268 London Road Wokingham Berkshire RG40 1RD 0118 9791546 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) Atlas Project Team Limited Mr Grahame Lawrence Dillon Care Home 3 Category(ies) of Learning disability (3) registration, with number of places DS0000011363.V328758.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th February 2006 Brief Description of the Service: Atlas Project Team Ltd is the registered provider for Santa Maria, which is a care home providing personal care and accommodation for 3 adults aged 18-65 who have a learning disability with associated behavioural problems. The home is situated on the outskirts of Wokingham on a main road and has unmarked vehicles used for the short drive to all the recreational and shopping amenities within Reading and Wokingham. Santa Maria is a three-bedroom detached bungalow with communal space comprising lounge, separate dining room and a kitchen. There is a large garden at the back of the house with the front garden used as space for car parking. The flat rate fee for this home is £1,788.69 per week. DS0000011363.V328758.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of this home by the Commission for Social Care Inspection (CSCI) was unannounced and was carried out during a weekday by one inspector between 2.30 pm and 7 pm. The registered manager was in the home throughout the inspection, together with another manager from the company who had arranged to visit the home and was there when the inspector arrived. There were three residents with mental health problems living in the home and 2 carers on duty. The inspector toured the home, spoke to the managers and carers, and viewed documents to make a judgement about how well the home was meeting the standards set by the government. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager, and any information that CSCI has received about the service since the last inspection. Questionnaires were sent to the home to be distributed to people involved with the home to obtain feedback on the service, but no comments were received. What the service does well: What has improved since the last inspection? What they could do better: The Service Users’ Guide and other information about the home could be presented in a more user-friendly way to make it more meaningful and interesting. DS0000011363.V328758.R01.S.doc Version 5.2 Page 6 The back garden needs to be better maintained to improve its appearance, such as repairing the broken fence and mowing the lawn. The garden looked untidy at the time of inspection and would benefit from regular garden maintenance, to include planting shrubs and flowers. Residents might like to be involved in gardening as a recreational activity and this should be explored. The contact details for CSCI referred to in the complaints procedure should be updated to take account of a change of address and telephone number of the Commission’s South East North Hub office based in Oxford. 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. DS0000011363.V328758.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000011363.V328758.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides comprehensive written information to help people decide whether or not the home is able to provide the care they need. EVIDENCE: The Statement of Purpose outlines the aims and objectives of the home and gives clear information about the services that are provided. The document is regularly reviewed to ensure the information is kept up to date. There is also a Service Users’ Guide that consists of a collection of documents in a plastic folder. This provides useful information for people thinking of moving into the home, but the way some of it is presented could be improved to make it more meaningful and interesting. The inspector discussed the home’s admission procedure with the manager and was satisfied that an appropriate assessment of people’s needs would be done before any decision was made to admit a person. These assessments ensure the home can meet people’s needs before they are admitted. The assessments on the people living in the home were not inspected because they were admitted before the current standards were introduced. DS0000011363.V328758.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of care planning is good ensuring the individual needs and choices of people living in the home are met. EVIDENCE: Each of the three residents have a care plan where their major care needs are listed, together with the action carers need to take to ensure all aspects of the person’s health, personal and social care needs are met. Care planning focuses on identifying residents’ strengths and weakness, which is good because this promotes independence. The home has a low staff turnover and this provides residents with continuity of care from staff they know, helping them to feel safe. This is particularly important for these residents because they all have difficulty in communicating. The inspector saw that the carers had a good relationship with each person and were good at interpreting what people wanted from their body language and limited amount of speech, which the carers had learnt to understand through caring for them. DS0000011363.V328758.R01.S.doc Version 5.2 Page 10 The standard of care planning was generally good, but the manager needs to remind staff to sign and date what they write. A number of records did not have this information and therefore it was not always clear which of the records were the most recent. It is important that staff sign what they write so that if a query arises, it can be discussed with the correct member of staff. The staff team are good at identifying potential risks that residents might encounter, which was demonstrated by the range of risk assessments found in each of the care files. Risk assessments for everyday tasks, such as making hot drinks, cooking and trips into the community, had been carried out and also showed what action was to be taken to reduce risk. The philosophy of the home is to encourage independent living and this is taken into account when carrying out these assessments to ensure people are able to lead their lives as fully as possible. From the evidence seen by the inspector and comments received, the inspector considers that this home would be able to provide a service that meets the needs of individuals of various religious, racial or cultural needs. DS0000011363.V328758.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities are well organised providing stimulation and interest for people living in the home. Meals are nutritious and balanced and offer a healthy and varied diet. EVIDENCE: The staff organise a range of activities for the residents both in the home and in the community. When the inspector arrived one resident was attending her weekly dance class with her carer. Another carer had taken two residents for a car drive and a walk. During assessment people’s likes and dislikes are found out, whenever possible, and included in the home’s activity programme. The organisation has provided a trampoline in the back garden for residents to use. The inspector questioned the appropriateness of this activity and the manager said the residents do not use it, possibly because it is more suited to a younger age group. It is recommended that consideration be given to DS0000011363.V328758.R01.S.doc Version 5.2 Page 12 removing the trampoline and providing the residents with opportunities to develop an interest in gardening instead. There are limited job opportunities available to the residents, although one resident has a job delivering weekly papers with a carer in the local community. This work involves the resident preparing the papers beforehand, which was being done during the inspection. A carer helped the resident to stay focused on what needed to be done by giving prompts and encouragement when needed. This was done in a gentle and sensitive way. There was a pleasant, relaxed atmosphere in the home throughout the inspection and the inspector observed carers acting in a kindly and respectful way towards the residents. They appeared happy in the home and with their carers, but were unable to tell the inspector what they thought of their care and accommodation. The manager said that the residents do not have many visitors, although people who visit are always made welcome. The carers do what they can to help residents stay in touch with people important to them, such as making plans for one of the residents to attend a relative’s birthday party, which the resident was clearly looking forward to. The company pays for each resident to have an annual holiday and for staff to accompany them. A resident showed the inspector photographs of a recent holiday abroad and these showed her having a good time. The inspector observed the evening meal, served at approximately 6 pm, and there was a sociable atmosphere between the residents and carers who were eating together in the dining room. Meals are planned to take account of residents’ likes and dislikes and residents are encouraged to help in the kitchen within their capabilities. DS0000011363.V328758.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported with their personal and health care needs and are protected by the home’s policies and procedures when dealing with medication. EVIDENCE: The carers assured the inspector that the residents were offered personal and intimate care in private and that they could choose what to wear. The inspector noted that the residents looked clean and smartly dressed when they arrived back from their outings. The residents were unable to tell the inspector if they could get up and go to bed at the time of their choice, or if baths and other activities were flexible. Staff gave assurance that this was the situation. Residents have access to all NHS healthcare facilities in the local community and appointments are arranged when needed, or health professionals are asked to visit if this is more appropriate. Evidence of residents receiving health care was seen in their care files. The evening medication routine was observed. Two carers were involved in administering medication to the residents and the inspector saw that they checked the instructions on the administration chart against what was written on the medication container to ensure the correct medication and dose were DS0000011363.V328758.R01.S.doc Version 5.2 Page 14 given. Medication records were fully complete, contained required entries and were signed by appropriate staff. Medication was given to residents in an area where interruptions could be kept to a minimum to ensure the carers were not distracted during the procedure. Medication is stored discreetly in locked cabinets away from communal areas. The manager said that he provided medication training for new staff, confirmed by one of the carers on duty. DS0000011363.V328758.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear complaints policy in use within the home. Residents are protected from abuse, neglect and harm through the home’s policies and procedures and training. EVIDENCE: The home’s complaints procedure sets out clearly the stages and timescales for dealing with a complaint and this information is provided within the home’s Statement of Purpose. However, it is unlikely that any of the residents would be able to initiate a complaint and the prompt involvement of a relative or an advocate to act on a resident’s behalf would need to be arranged if carers suspected a resident was unhappy about his/her care. The manager gave assurance that this would be done. There was only one complaint logged between 1992 and the present time. The information about this was brief and the manager needs to ensure that complaints are recorded in sufficient detail, showing what action is taken and the outcome. No complaint has been made to the home since the last inspection and no complainant has contacted CSCI with information about a complaint. The contact details for CSCI referred to in the complaints procedure should be updated to take account of a change of address and telephone number of the CSCI South East North Hub office based in Oxford. A copy of the multi agency guidance on the protection of vulnerable adults for Berkshire was available in the home for staff to refer to. This ensures that the staff team has up to date information to hand about the action that needs to be taken if abuse is suspected. The manager confirmed that this guidance DS0000011363.V328758.R01.S.doc Version 5.2 Page 16 covered all local authority councils within Berkshire. Adult protection training is included in induction for all new staff, with updates regularly arranged. Information about new staff is given to the Criminal Investigation Bureau so that checks can be made on the staff member’s suitability to work with vulnerable adults. The staff team understands what restraint is and alternatives to its use in any form are always looked for. The company has a number of trainers who give training to carers on SCIP (strategy for crises intervention and protection). Guidelines on how to support residents who become agitated were seen in one resident’s care plan showing the manager is aware of current policy issues and good practice developments. The home has efficient systems to ensure effective safeguarding and management of individual’s money including record keeping. The inspector checked the money held for all three residents and found that it was correctly accounted for. DS0000011363.V328758.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is good providing residents with an attractive and homely place to live. EVIDENCE: The living environment is appropriate for the particular lifestyle and needs of the residents and is homely, clean and comfortable. The hallway has recently been redecorated and new carpet has been fitted, which gives the entrance to the home a good appearance. There is a selection of communal areas both inside and outside of the home, which means that people using the service have a choice of places to sit quietly, meet with visitors or be actively engaged with other people who use the service. Individuals have personalised their bedrooms and can use their own furniture if they prefer. Two residents escorted the inspector to their rooms and both rooms looked comfortable and homely and it was evident from each person’s behaviour that they were happy with this accommodation. DS0000011363.V328758.R01.S.doc Version 5.2 Page 18 The manager described recent improvements, such as the redecoration of a bedroom, lounge and dining room, as well as replacing some items of furniture. Redecoration of another bedroom is planned and the resident has helped to choose the colour scheme. This shows the importance placed by the organisation and the manager on the upkeep of the home to ensure it is pleasant for the people living there. The carers are responsible for cleaning and tidying the home, together with the residents who help to keep their bedrooms clean and tidy. The day carers do light housework and the night carers are responsible for deep cleaning. The onsite laundry facilities were found to be good at the last inspection and, were not, therefore, inspected on this occasion. There is a back garden that needs to be better maintained to improve its appearance, such as repairing the broken garden fence and mowing the lawn. The garden looked untidy at the time of inspection and would benefit from regular garden maintenance. DS0000011363.V328758.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good match of well qualified staff offering consistency of care within the home. A broad range of training opportunities is available and this ensures staff have the knowledge and skills they need to provide a good standard of care. EVIDENCE: The normal staffing levels are two carers from 7.30 am to 9.30 pm and one carer overnight, with an on call member of staff available if extra assistance is needed. The manager is sometimes extra to this level of staffing, but can also be one of the two carers on duty. Staff turnover is low and this means that agency carers are rarely needed. This benefits the residents because they receive care consistently from people they know and trust. The training records of two carers were randomly selected for inspection. These showed good attendance on a broad range of training including mandatory training. Of the eight staff currently employed four have achieved the NVQ in care (at level 2 or above), with more staff planning to enrol soon. DS0000011363.V328758.R01.S.doc Version 5.2 Page 20 One recruitment file was looked at and most of the necessary information and checks had been obtained. The one omission was that a full employment history had not been obtained, which is needed for gaps in employment to be checked. The home’s application form currently asks for a 10-year employment history and the manager said this would be amended as soon as possible. There has been no staff turnover during the last year and the last time a carer was appointed was in April 2006. The manager gave assurance that a full employment history would be obtained in the future. The organisation employs a manager to coordinate training across all of its care homes. This includes induction training for new staff and ongoing training for existing staff. Managers provide in-house training, with external courses arranged as and when needed. The home has a training and development plan that gives an overview of the training that has been done and what is planned. This showed that a broad range of training was provided and that staff attendance was good, which ensures staff are keeping up to date with current good practice. DS0000011363.V328758.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provides clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. EVIDENCE: The manager of the home is highly experienced and is committed to ensuring the staff team provide a good standard of care. He has achieved the Registered Manager’s Award, as well as the NVQ level 4 in care. The manager obtains information from a variety of sources to assist in the future development of the service. This is through regular care reviews involving the resident and other people involved, such as relatives, social service care managers and health professionals. The residents are not able to say what they think about their care, although can communicate through the use of symbols and pictures. Also, the one-to-one care that carers give enables them to get to know the residents well, which helps them to notice DS0000011363.V328758.R01.S.doc Version 5.2 Page 22 quickly any changes in a person’s behaviour and moods that might indicate unhappiness. In discussion with the carers it was clear they understood their responsibility to report promptly any concerns they had to the manager. Information provided by the manager showed that maintenance checks are regularly undertaken ensuring residents and people visiting the home are safeguarded. Training records showed that mandatory training, for example moving and handling, fire safety and food hygiene, was provided and this also ensures residents’ safety. DS0000011363.V328758.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X DS0000011363.V328758.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations The registered manager should arrange for the Service Users’ Guide and other information about the home to be available in formats suitable for the people for whom the home is intended. The registered manager should consider including gardening as one of the activity choices available to residents. Consideration should also be given to removing the trampoline from the garden as the residents do not use it. The contact details of CSCI need to be amended on the home’s complaints procedure to take account of recent changes at the Commission’s offices. The organisation should consider employing a gardener to keep the garden in a better state so that it provides a more pleasant area for residents to use. 2 YA12 3 4 YA22 YA28 DS0000011363.V328758.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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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