Inspection on 05/05/05 for Seaway Nursing Home

This inspection was carried out on 5th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Seaway Nursing Home 09/12/08

Seaway Nursing Home 10/01/08

Seaway Nursing Home 19/04/06

Seaway Nursing Home 14/10/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Seaway Nursing Home 33 Vallance Gardens Hove East Sussex BN32 2DB Lead Inspector Jennie Williams Unannounced 5 May 2005 9:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Seaway Nursing Home H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Seaway Nursing Home Address 33 Vallance Gardens Hove East Sussex BN3 2DB 01273 730024 01273 730024 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Seaway Nursing Home Limited Dr Leckman Sumoreeah Care Home 20 Category(ies) of (OP) 20 registration, with number of places Seaway Nursing Home H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1 That service users are over sixty-five (65) years of age on admission and that the numbers of service users accommodated in the home does not exceed twenty (20). Date of last inspection 31 August 2004 Brief Description of the Service: Seaway Nursing Home is a care home providing care for up to twenty (20) residents over the age of sixty five (65). It is located in a quiet residential area of Hove. Local amenities and the seafront are within walking distance of the home. There is nearby access to public bus routes. There is no parking available at the home. Paid parking is available in adjacent streets and also available at the nearby leisure centre. There is a small garden at the front of the home and a garden accessible to residents at the rear of the building. Rooms are located over three floors and are accessible by stairs or a passenger shaft lift is available for those unable to manage the stairs. Nursing care is offered at this establishment. Seaway Nursing Home H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over seven hours on the 5 May 2005. A tour of the home was provided. Staff files, policies and procedures and care plans were inspected. Care plans were spot-checked briefly as no shortfalls had been identified at the last inspection. Residents and visitors spoken to were complimentary about the staff and services provided at the home. This inspection involved discussions with staff, residents and two visitors. What the service does well: 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Seaway Nursing Home H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 Page 6 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 Standards Statutory Requirements Identified During the Inspection Seaway Nursing Home H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 Page 7 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 standard(s) 1, 3 & 4 Prospective residents have their needs assessed prior to moving into the home to ensure all their needs can be met. Standard 6 is not applicable, as the home does not have dedicated accommodation to provide intermediate care. Respite care is available at the home if a place is available. EVIDENCE: There was evidence that a newly admitted resident had been assessed prior to moving into the home. A copy of social services assessment had also been obtained. The manager or a trained nurse undertakes the initial assessment of any prospective resident. The home does not admit anyone whose needs cannot be met. There were no shortfalls identified in the Statement of Purpose at the last inspection. The manager confirmed that this is currently in the process of being reviewed to reflect the newly appointed registered manager. Changes in staffing also needs to be reflected in the Statement of Purpose/Service User Guide. Staff individually and collectively have the skill and experience to deliver the services and care which the home offers to provide. Seaway Nursing Home H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 Page 8 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 standard(s) 7, 8, 9 &10 Staff would have a better understanding of residents needs if all care needs as stated in NMS 3.3 is contained in the one area. The double checking of handwritten MAR charts would ensure the safety of residents more effectively. Residents’ privacy and dignity are respected. EVIDENCE: Care plans were not thoroughly inspected on this occasion as there were no shortfalls identified at the last inspection. Staff are advised to use the care plans in conjunction with the pre assessment information. This information is kept in separate folders. Care plans identify any changes in needs and any specialist needs an individual may have that differs from the pre assessment form. Risk assessments are undertaken on all residents. There was evidence that care plans are being regularly reviewed. The manager confirmed that relationships with some GP’s had improved since the last inspection. One GP spoken with confirmed to the Inspector that they had no concerns regarding the residents that were under the homes’ care. The GP confirmed that the manager will always contact them if there are any concerns regarding an individuals’ health needs. Seaway Nursing Home H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 Page 9 One resident was identified as having a visual impairment. The resident informed the Inspector that glasses used to be worn, but these had been lost prior to admission. This was addressed with the manager who will be looking into this. There was evidence that medication is being signed for at the time of administration. There were some prescribed creams found to be in residents’ rooms for whom they had not been prescribed. Medication must only be used for the individual they have been prescribed for. A MAR chart had been hand written. It is recommended as good practice that hand written MAR charts are double checked by staff who are trained to administer medications. This will reduce the risk of errors occurring. Any changes written on MAR charts must be signed by the person amending it. Residents spoken with felt that their privacy and dignity are respected. Seaway Nursing Home H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 Page 10 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 standard(s) 12, 13, 14 & 15 Documentation of all activities provided to residents would evidence that all residents are provided with activities to suit their lifestyle and capabilities. Visitors are welcomed at the home. Personal records are stored securely. A list of residents likes and dislikes/allergies of food provided to the cook would ensure that all meals are suitable for individual residents. EVIDENCE: Staff confirmed that activities are provided to residents on a daily basis. The activity records inspected did not demonstrate this. Some residents spoken with stated that there were not enough activities provided. Some residents confirmed they were happy with the amount of activities provided and some chose not be involved. It is recommended that the home undertakes a survey to ascertain residents preference of activities and ensure all residents are provided with appropriate stimulation. The cook had recently left employment and the assistant cook has taken on the role of cooking for residents until other measures are implemented. A record of meals provided to individuals that differ from the usual menu needs to be kept to ensure any residents nutritional intake can be tracked. This was recommended in the last inspection report. It is required that there is a list made available to the cook of individual’s preference/allergies with food. The menu demonstrated that residents are provided with a variety of meals during the week. Residents were complimentary about the food provided. Seaway Nursing Home H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 Page 11 Residents are encouraged to maintain their independence for as long as they are willing and capable. Some rooms were observed to be personalised with the residents’ belongings. Some residents spoken to confirmed that routines are flexible and they choose their own bed times. A visitor’s book is located by the front door that all visitors are asked to sign. Two visitors spoken to confirmed that they are always welcomed at the home and there are no time restrictions. Seaway Nursing Home H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 Page 12 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 standard(s) 16, 17 & 18 This inspection took place on election day. There were no residents involved in the political process, by choice. Staff are provided with sufficient information to inform them of the correct procedures if an allegation of abuse is made. EVIDENCE: The manager and staff nurse confirmed that all residents have been offered the opportunity to be involved in the political process if they wish. One resident confirmed that she did not wish to vote. Staff spoken with confirmed that they have received Adult Protection training. There was suitable information available on the procedures to follow in the event of an allegation of abuse. There had been no complaints made to the home since the last inspection. Seaway Nursing Home H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 Page 13 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 standard(s) 19, 24 & 26 The location of the home provides opportunities for residents and visitors to access local amenities and transport. A written cleaning schedule and regular checks would help to ensure the home is kept clean and free from offensive odours at all times. EVIDENCE: The home is located in a residential area of Hove and is close to the seafront and local amenities. Some areas of the home were not cleaned appropriately and some individual rooms were offensive smelling. Visitors spoken with commented that the cleaning was ‘fair’. Some toilets were observed to have no toilet rolls holders. The toilet rolls were located on the cistern. This may prove difficult for some residents to reach and therefore reducing their independence. There is a small staff room provided to staff. This is located near the entrance to the residents lounge/dining room. The staff room is used by staff smokers and non-smokers. Management needs to find a solution for this as staff also eat their food in the staff room. A non-smoker spoken with confirmed that they Seaway Nursing Home H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 Page 14 sometimes eat their meal in the residents’ dining/lounge room. This practice is unprofessional, as residents use this room throughout the whole day. On the day of the inspection, a staff member was observed to be smoking with the door open and the extractor fan not on. The smoke was smelt to permeate in the hallway and entrance of the lounge. Management and staff must find an alternative solution for a designated smoking area. The extractor fan was also very dirty. The bathroom on the top floor is currently not in use. There is a bathroom located on each floor with assisted bathing facilities. It was discussed with the manager that if changes are to be made, to consider where possible to place the bath in the centre of the room to allow staff access to both sides. All baths are currently assisted and located against a wall. The home currently has 10 adjustable beds. Management confirmed that the provision of adjustable beds will be an ongoing programme. The type of bed available must be taken into consideration when admitting any prospective resident. Information has been obtained by management on a variety of beds that are currently available. It was recommended at the last inspection that provision for bed bases with impermeable covers be included in the budget for 2005. The manager confirmed that a couple of mattresses have been changed and this will be an ongoing programme. Seaway Nursing Home H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 Residents would be protected and safeguarded better if the home implemented robust recruitment procedures. There were sufficient staff on duty on the day of the inspection. Staff were observed to have a good professional rapport with residents. EVIDENCE: The rota provided to the Inspector demonstrated that there are sufficient numbers of staff on duty. Residents, visitors and staff spoken with all confirmed that they felt there were always sufficient numbers of staff on duty. Residents spoken with were complimentary about the staff and the care they are provided with at the home. Staff spoken with confirmed that they have undertaken an induction and have received mandatory training. Recent training provided included; adult protection, food hygiene, moving and handling etc. There is one carer who is currently undertaking their NVQ level 2 training. There is one carer who is a trained nurse in another country and is working as a carer at the home. The home must continue to work towards the target of having 50 of care staff NVQ level 2 or equivalent qualified. There were shortfalls in the documentation required to be kept on all staff. These were discussed at length with the manager. Staff files must comply with Schedule 2. All new staff must have CRB and POVA clearance prior to commencing employment, including staff coming from abroad. Ensuring application forms are fully completed will assist in the home tightening up on recruitment shortfalls. Seaway Nursing Home H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 Page 16 The manager contacted a new staff member on the day of the inspection to advise them that they cannot commence employment the following week until all relevant checks have been undertaken. Staff spoken to had not been provided with contracts or terms and conditions of employment. Staff and management of the home must together resolve this issue. There is always a registered nurse present at the home to administer medication and undertake any nursing duties required. Seaway Nursing Home H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 36, 37 & 38 A developed and implemented quality assurance and quality monitoring programme would enable management to assess the suitably of services provided at the home and identify areas that can be improved. Provision of individual bank accounts will ensure all residents financial interests are safeguarded. Records currently maintained do not clearly identify any given individuals balance and interest for each individual has yet to be calculated. EVIDENCE: Staff spoken with found management approachable. They confirmed that supervision is being offered every two to three months. One staff member stated that they were not aware of where policies and procedures are kept. Policies and procedures are currently being updated. It is recommended that for all policies and procedures relating to (National Minimum Standards) Regulation 37- incidents that need to be reported to CSCI, information be Seaway Nursing Home H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 Page 18 reflected in the relevant policies to ensure that staff left in charge are aware of reportable incidents. Eg; death of a resident, any outbreak of infectious disease etc. The home currently has one trustee bank account where all residents pension cheques and personal allowance is kept. There was no running balance maintained at the home for individuals. There was no easy way for the Inspector to check these monies. Residents must be provided with individual bank accounts and records kept to clearly demonstrate how much money each individual has. All residents must receive their own share of interest from the account. The manager has yet to calculate these figures. There has been no formal quality assurance/quality monitoring or audits undertaken at the home. Management is currently seeking information from an external company on undertaking these. Some questionnaires have been undertaken by the home, but the home has not analysed these. The home proposes to also seek the views of other visiting health professionals. Records of accidents/incidents are maintained. It was noted that some residents were being transported in wheelchairs without footplates. Footplates were also observed to be lying around the home in inappropriate places. This must be addressed and it is required that risk assessments are undertaken to clearly demonstrate why it is unsuitable for some residents not to be provided with footplates when using wheelchairs. A staff member was observed to use an inappropriate moving and handling manoeuvre when assisting a resident at lunch time. This was discussed with the manager at the inspection. Inappropriate moving and handling practices were also identified at the previous inspection. The manager confirmed that there is a moving and handling video for staff to access in between moving and handling training sessions. It was confirmed that cleaners have received training in COSHH. A cleaner spoken with could not confirm where the data relating to substances were kept. It was required at the last inspection that a copy is stored with the substances being used. All hazardous substances are stored securely at the home. Any shortfalls in the health, safety and welfare of residents have been addressed in the relevant sections of the report. Seaway Nursing Home H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 x N/A 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 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 2 x x x x 2 x 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x x 1 x 1 3 2 2 Seaway Nursing Home H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 13.5 Requirement That reinforcement of the methods taught in moving and handling to be given to all staff and the manager to constantly observe that these are followed. (Timescale 31.08.04 not met) That all service users are provided with suitable activities. That accuarate records of activities provided and service users involved are kept. That service users likes/dislike/allergies in food are provided to the cook. That records are kept of meals eaten by individuals that differ from the main meal being provided. That the cleanliness within the home is improved. That the flooring in the individual rooms that are offensive smelling are thoroughly cleaned or replaced. That suitable measures are implemented with regards to staff smoking. Smoke should not permeate into service users communal areas. That nonsmoking staff are provided with a smoke free area for break times. That COSHH information is Timescale for action 05.05.05 2. OP12 16.2(m,n) 30.06.05 3. OP15 Schedule 4 (13) 31.05.05 4. OP26 16.2(k) & 23.2(d) 30.06.05 5. OP20 16.2(k) 31.05.05 6. OP38 13.4 31.05.05 Page 21 Seaway Nursing Home H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 7. OP24 16.2(c) 8. OP29 Schedule 2 9. 10. OP28 OP33 18.1 24 11. OP35 20.1 12. 13. OP9 OP38 13.2 23.2(n) & 13.4(b&c) stored with the hazardous substances used at the home. All staff must be aware of where this information is located.(Timescale 31.08.04 not met) That all service users receving nursing care are provided with an adjustable bed. This must be taken into account when assessing prospective service users. That all staff files comply with Schedule 2. All staff, including overseas recruitments, have CRB and POVA clearance prior to commencing employment. That 50 of staff obtain NVQ level 2 or equivalent qualifications. That an effective quality assurance and quality monitoring system is developed and implemented.(See content of report) That individual bank accounts are provided for individuals. That accurate records are maintained to clearly show the monies of any individual. That medication/creams are only used for whom it has been prescribed. That risk assessments are undertaken to clearly demonstrate why it is unsuitable for an individual to be using wheelchair footplates when being transported within the home. 31.12.05 30.06.05 2005 31.08.05 31.08.05 05.05.05 31.05.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 Page 22 Seaway Nursing Home 1. 2. Standard OP7 OP9 3. 4. OP21 OP1 5. 6. 7. 8. OP22 OP26 OP12 OP37 That all information relating to an individuals health need is kept in the one folder to allow quick easy access for staff and ensuring all individuals needs are met. That hand written MAR charts are double checked by another person who is trained in medication adminstration. Any changes written on MAR charts must be signed by the person amending it. That toilet roll holders are provided to assist in maintaining an individuals independence. That the Statement of Purpose is updated to reflect the newly appointed manager and changes in staff and their qualifications. That the amended document is forwarded to CSCI. That wheelchairs are serviced yearly and that foot rests are kept with the wheelchairs.(Outstanding from previous inspection) That provision for bed bases with an impermeable cover are included in the budget.(Ongoing programme from last inspection) That the home undertakes a survey to ascertain individuals preference of activities and ensure all service users are provided with appropriate stimulation. That the relevant policies and procedures relating to Regualtion 37 reflects that these incidents are reportable to CSCI. Seaway Nursing Home H59 H10 S61313 Seaway V224991 050505 stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 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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