Inspection on 01/10/08 for Shaftesbury Court Residential Home

This inspection was carried out on 1st October 2008.

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

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

Shaftesbury Court Residential... 15/11/06

Similar services:

Claremont House

Sun Court Nursing Home

Bramley Avenue (73)

15 Bramble Close

Dolphin Court

Fen Road

Wakes Hall

165 Putnoe Lane

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Shaftesbury Court Residential Home Rectory Road Lowestoft Suffolk NR33 0DQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: John Goodship     Date: 0 1 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Shaftesbury Court Residential Home Rectory Road Lowestoft Suffolk NR33 0DQ 01502511168 01502587702 alan.smith@sanctuary-housing.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Alan Smith Type of registration: Number of places registered: Sanctuary Care Ltd care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: Date of last inspection Brief description of the care home Shaftesbury Court is owned by Sanctuary Care, who took it over in April 2006 from Ashley Homes. Shaftesbury Court was first registered in 1989, to provide residential care for fifteen people with physical disabilities. The home is situated on the sea front, in South Lowestoft, and reasonably close to the town centre. Service users living at the home have access to the sea front and local facilities, which include theatre, pubs, cafes, cinema, sports centre, shops, ten pin bowling, and snooker / pool. The accommodation for service users is located entirely on the ground floor. There are fifteen single bedrooms all with en-suite facilities. There are two dining rooms, one large central communal lounge, a kitchen, and laundry. In addition to the en-suite facilities in bedrooms, there are communal bathroom, shower, and toilet facilities which are adapted to meet the needs of people with physical disabilities. Upstairs, there is a small suite of accommodation, used as two staff offices, and a w.c. for staff use. Access to the first floor is by staircase only, and therefore service users do not go Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 15 Brief description of the care home into these areas. Located on the same site (but not part of the residential care home) are four independent flats, in respect of which the Registered Manager of Shaftesbury Court provides oversight and support to the occupants. The range of the fees at the time of this inspection was £625 to £750 per week. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was unannounced and took place on a weekday during the daytime. The previous inspection was on 15th November 2006. We focused on the outcome for residents assessed against the standards listed under each outcome group. This report includes evidence gathered during the visit together with information already held by the Commission. The manager was not present but the deputy manager and other staff helped us throughout the visit. We toured the home, and spoke to four of the residents, and two staff in depth. We also examined care plans, staff records, training and maintenance records. Care Homes for Adults (18-65 years) Page 6 of 27 Before the visit, we sent a questionnaire survey to the home for residents, relatives and staff to complete. Seven residents responded and two staff. Their answers and comments have been included in this report. The manager was also required to complete an Annual Quality Assurance Assessment(AQAA). The information in this AQAA has been used in this report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be certain that they will have every opportunity to make sure the home will meet their needs. Evidence: The Statement of Purpose and Service Users Guide included all the information that people using the service would need to know, such as how the home was run, what choices people had, and what qualifications the staff had. The address of the Commission in these documents needed to be updated. The documents had been reviewed in June 2008. One person told us: I chose to live here because it was near my parents and close to and easy to get to Lowestoft. The AQAA told us that prospective service users were invited to the home, to meet the service users and staff, and look around and meet other people who lived there, before deciding if they wanted to move in. There had been no new admissions in the last twelve months, but previous inspections had confirmed with residents that this process was followed. Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: We had noted previously that there was a multi-agency assessment process, before any decisions were made about whether or not the home could provide suitable care. The home was designed to provide care to people with physical disabilities and had the necessary space and facilities to support the needs of the residents. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their needs are fully assessed. Their needs are monitored regularly to ensure that changes are made to the support they need. They are consulted on all aspects of life in the home. Evidence: Two care plans were examined. These were for residents who had been living in the home for some years, one with high care needs. The plans were easy to read through and find relevant topics. The plans recorded that regular six monthly reviews were undertaken. A schedule for these reviews was seen in the office. Care plans showed that the home was able to continue to support residents to cater for their changing needs and as they grew older. We saw that written consents had been given by those residents who needed one or more restraint belts or cuffs while they were in their wheelchair. There was a wide range of physical disabilities amongst the service users living at Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: Shaftesbury Court, for example, some were able to go out and about, unaided, using electric wheelchairs, whilst others were more confined to the home, and required staff support for the majority of aspects of their care. Staff described how some residents were requiring more support with personal care. This was noted in some of the care plan reviews examined. One person needed the support of two staff members for all their personal care, and for transfers into chairs or bed. We saw in the care plans, and observed during our tour round the home, that specialised equipment was identified as a need and had been supplied. We saw control panels which enabled the person to control the lights in their room and all the electrical equipment, and operate the call bell. We also saw a speech machine and a page turner. The wheelchair service was used regularly to adjust and provide residents with appropriate chairs. Residents meetings were held every 3 months, with a member of staff present only to take the minutes. Other staff could be invited to attend for particular topics. We saw the minutes of the meeting held in August 2008. The agenda was mostly about the proposed changes to the home. Two residents with communication difficulties were supported by an advocate. This person had previously been employed in the home. The staff felt this was helpful as they knew the residents and had the skills to communicate with them. We were asked by three residents to listen to their fears for their home if the proposed changes went ahead. They did not feel there had been enough consultation and that the change was going to happen anyway. We saw minutes of meetings where the senior management of the provider discussed the plans. The residents however felt they should be consulted in person about what should happen to their home. Two of these residents had communication difficulties but an enabler was present who was able to assist us. Another resident told us that they were looking forward to living in their own flat. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be offered the opportunity to take part in many educational and leisure activities inside and outside the home. They can be assured that their dietary needs will be monitored and they will be offered a choice of meals. Evidence: Several residents went out regularly to planned activities, including Centre Eight, a disabled workshop, sailing, art class and college. The Friends of Shaftesbury Court continued to organise monthly trips and events for residents, using their minibus. The venues for these trips were decided at the residents meetings. There was a notice on the board advertising ten pin bowling with room for people to put their names. Six out of the seven residents who replied to our survey said that they could do what they wanted in the evenings and weekends. One resident said that I can do what I Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: want but I would love to have staff who could take me out. Two staff told us that staffing levels did not always allow them to support residents on outside activities which needed one to one support. Three residents were funded by their authority for one to one staff hours for outside activities but there had not been agreement to cover any other residents. Residents mail was sorted into pigeonholes in the main lounge for them to collect. This was a mark of respect for their privacy. We saw records in the care plans about the visits of families and friends. Staff were seen to be talking to residents, and discussing future activities such as shopping, or what was for lunch. There was a whiteboard in the corridor near the kitchen listing that days menu. There were spaces for each resident to indicate whether they wanted the main dish or an alternative. The board had not been completed when we looked at it. A carer explained this was because the cook was off sick and a stand in cook was on duty. There was a notice inviting residents to suggest dishes for the next seasonal menu. Lunch on the day of our visit was cottage pie with fresh vegetables. Residents were having lunch in two dining rooms, one on each wing. Some needed to be supported by staff. There was a friendly and unhurried atmosphere in the rooms. We saw that care plans recorded details of the nutritional needs of residents, and special diets were provided under the guidance of the dietitian. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their healthcare needs will be monitored and action taken to meet those needs. They will be supporterd to be as independent as possible. Evidence: Care plans included a section for healthcare needs, and there were also medical record sheets detailing interventions from health professionals. Residents weight and nutrition were monitored where necessary. The home had one hoist with a built in weighing facility.Care plans showed us that the healthcare needs of residents were identified and action taken to meet their needs in a timely and appropriate way. We saw many examples of special equipment for individual residents both to enable them to be more mobile, for them to control what happened in their own rooms, and to improve their quality of life and independence. We saw a care plan for a resident with high healthcare needs. This included specific records and guidance for staff on for example sleeping positions and the use of a night time breathing alarm to ensure the persons comfort and safety. This person was fed Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: through a percutaneous endoscopic gastrostomy (PEG)tube. We observed a carer using this at lunchtime in the persons room. The carer told us that the dietitian had trained them to administer the feeds, and to monitor the results. The person attended the dietitians clinic regularly where they were weighed. We observed the lunchtime medication round. The medication administration records ( MAR )for each person were kept on the back of each ensuite door. There were several gaps in signatures of the ones we examined, and we noted that a carer signed the MAR sheet before ensuring that the person had taken the medication. A carer told us that there were medication cupboards in each ensuite for half the residents. No one was able to self medicate. We checked the record for one persons controlled drug. The amount in the book tallied with the amount in the packet. Medication was securely stored and the controlled drug cupboard was of the proper construction. All staff who administered medication had been trained by the pharmacy supplier. A carer confirmed that they had had this training and records were seen in the office. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect any complaints to be dealt with properly and the homes control systems protect them from harm. Evidence: No complaints had been made to the Commission since the previous inspection. The homes complaints record showed no complaints had been received by them either in that period. The homes complaints procedure was displayed in the home, and was included in the information given to prospective residents. All the residents who replied to our survey said that they knew how to make a complaint. Staff told us that they had received training in the protection of vulnerable adults and this was confirmed in the training records. No safeguarding referrals have been made by or about the home. We checked the cash held for one resident. The cash tallied with the receipts and record book. The monthly monitoring report by the provider includes a financial check on the proforma used. We saw the report for August 2008 and no discrepancies were found. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that they live in a safe and well-maintained home, and that they will be encouraged to personalise their rooms as much as they wish. Evidence: The building was nearly twenty years old and the provider had decided to seek to demolish it, and replace it with supported living flats. However this had not stopped improvement work on the home. We saw that new carpets had been laid, and a new kitchen had been installed in one wing. A handyman had been appointed on the week of our visit to improve the general maintenance of the home. All the residents rooms that were visited were personalised to a greater or lesser extent, with TVs, computers, books, aids to daily living and personal items. Several doors to the rooms had been personalised with pictures, signs and notices. The residents owned a number of electric wheelchairs and there were two charging areas for these. One was in one of the dining and activity rooms. This could be obtrusive but the residents said they had sufficient room. Six out of seven residents who replied to our survey said that the home was always or Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: usually fresh and clean. We noted that there were inevitable marks on the corners of doorways where wheelchairs had knocked into them. The handyman was repairing one of these corners during our visit. The home had an automatic opening door into the lobby suitable for wheelchairs. The next door into the corridor was then released by a button in the office. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be supported by trained and supervised staff. The homes recruitment process protects them. Evidence: There were six staff on duty during the day including a senior, and two waking night staff. The manager or deputy manager were also present during the week. Three residents had a dedicated support worker at certain times either to assist with their care or to enable them to go out. Several residents commented that they would like more staff so that they could go out more. We were told that the staffing levels were determined by the amount of fees which the placing authorities agreed to pay. The AQAA told us that there had been no use of agency staff in the three months up to June 2008. However a senior staff member told us that on two occasions there had only been two staff on the late shift, and no agency could help. A staff member said that: The home runs brilliantly when we are fully staffed, but we are often short staffed at weekends through sickness. We then do not have the time to do the extras eg writing letters for residents,putting make up on the females or tidying their room. Another staff member told us: We should employ more staff or go back to using agency staff. There was currently one vacancy for a part time support worker Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: covering four shifts. We were told that the provider had no system of on-call for senior staff. There was a headquarters number to call when a member of staff did not turn up for their shift. We were told this led to delays in starting the process of getting a replacement, and without the local knowledge of staff availability and willingness to cover. The training schedule was examined. It listed staff who had attended or were attending moving and handling, fire, adult protection, First Aid, Food Hygiene, control of substances hazardous to health and equal opportunities courses. Ten staff were qualified at NVQ Level 2, three were studying for it. Five staff were qualified at NVQ Level 3 and two were studying for it. Staff told us that they had the right skills and experience to care for the residents. The file for the two newest members of care staff were examined. All the documentation to protect residents was in place. The records of the staff supervision sessions for three staff were examined. Although there had been some gaps in 2007, all were now being seen regularly to monitor their competence and training needs. One support worker told us about their work as a key worker in supporting a resident, helping them with their clothes, their appointments and their holidays. They told us that there was a lack of certainty amongst staff about their future with the proposed changes. This key worker said they were suggesting to their residents that they start saving for what they will need to buy to set up their own flat. The residents who replied to our survey told us that staff listened and acted on what they said,and treated them well.They said that staff were always willing to help them in most things, and they couldnt be kinder or more caring and patient. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be consulted about the running of the home. They are protected by a good quality assurance system, and appropriate policies and records. Evidence: The management structure had been strengthened with the appointment of a deputy manager shortly before our visit. This person held an NVQ Level 3 and had worked in the home for some years. The provider had a quality assurance system that required the home to complete a self assessment each month. This was against the annual business plan which listed objectives and action to be taken. Monthly monitoring visits were made and recorded. We saw the one for August 2008. This met the legal requirement for monthly reporting. Residents meetings were held every three months to enable their views to be sought on any matter they wished to raise. Although recent meetings had been dominated by the proposed changes, other matter discussed included menus, outings and decor. Staff meetings were also held regularly. We saw the minutes of the April Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: and June 2008 ones. Topics included observing care practices and infection control. There had been a recent health and safety inspection by the local authority. Some recommendations had been made concerning updating the fire risk assessment and the control of substances hazardous to health policy, and to check their premises electrical safety, which had not been done since May 2004. We examined the fire log which recorded checks on fire equipment, emergency lighting and alarm systems. This was up to date to 12th September 2008. The deputy manager explained that this had now been handed over to the new handyman to take the responsibility for doing the checks. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 8 All residents should be given enough information about the reasons for the proposed changes in the staus of their care to allow them to express their personal views and make informed choices. The quality of medication administration should be audited and staff should have their knowledge refreshed at regular intervals. 2 20 Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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