CARE HOMES FOR OLDER PEOPLE
Sheldon House Sea View Road Falmouth Cornwall TR11 4EF Lead Inspector
Paul Freeman Unannounced Inspection 20th September 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Sheldon House Address Sea View Road Falmouth Cornwall TR11 4EF 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) 01326 313411 01326 317902 Mr Charles Barry Libby Mrs Anne Louise Libby, Mr Darren Libby Mrs Doreen Ann Peters Care Home 34 Category(ies) of Dementia - over 65 years of age (34), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (34) Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th March 2006 Brief Description of the Service: Sheldon House is a long established care home and is registered to provide nursing care for up to 34 people who experience dementia or enduring mental illness. The current owners have run the home since November 2000 and have ambitious plans to redevelop the site and create a purpose built care home. The current accommodation is a former hotel that was initially converted around 1994 and since then has undergone further structural changes. It is located on a quiet residential road close to the town and beaches of Falmouth. It is easily accessible on foot and by transport from the town and this results in frequent visits to the home by relatives and friends. There is also car-parking facilities at the front of the home. The current accommodation is provided over three floors and is accessible to people who experience a disability given two shaft lifts are provided. The building is not the best design to provide the care and support required by residents and the layout does not easily lend itself to meeting the needs of residents. The bedrooms are for both single and shared occupancy and three communal areas are provided on the ground floor. A dining room has recently been established on the ground floor that is also used as a quiet area and for activities. It is therefore constructive that positive plans have been developed to provide quality accommodation that will address the current shortfalls. Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A planned unannounced key inspection took place on 20 September 2006 and 21 September 2006. The purpose of the inspection was to consider the work that had been undertaken on the requirements and recommendations set at the last inspection on 20 March 2006 and to inspect other core standards. Therefore some of the key standards considered included assessment of resident’s needs, care planning, staffing arrangements and safe working practises. The registered manager, residents and staff were consulted about the services and facilities provided. The environment, records and documents were also considered. The Inspector also made direct observations of the care and support and the manner in which the staff interacted with residents. The providers have made significant strides to improve the facilities and services and to comply with the national minimum standards and Care Home regulations 2001 following the last inspection. What the service does well:
Prospective residents and their relatives and representatives are consulted as part of the assessment of need that is undertaken. The opinions of key professionals who are involved with the person concerned are also taken into account. Residents are provided with a flexible lifestyle and the staff are clearly skilled at adapting to their individual needs and requirements which can be variable throughout each day. There are no barriers to relatives or representatives visiting and visitors commented they were well looked after and warmly received. A varied menu is also in place that reflects the needs preferences and choices of residents. The qualified kitchen staff is also able to meet the needs of residents who have a special diet. Residents are provided with a choice at each mealtimes and the kitchen operates flexibly to make sure residents have a balanced diet. Suitable arrangements are in place to safeguard residents from abuse and any complaints or concerns raised are dealt with positively. The providers have continued to look a ways to improve the standards of the accommodation and facilities provided. Further improvements are planned to
Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 6 maximise the environments potential to offer a homely and comfortable setting. Sufficient numbers of staff are on duty each day and night to make sure that residents’ needs are promptly met. The staff is appropriately trained and regular training takes place in order their knowledge and skills are kept up to date. The staff group is well supported and advice and assistance is available when required. The facilities and services are well managed by experienced providers who are committed to providing quality care and accommodation. The registered manager has made a significant contribution to improving the day to day running of the care home. Staff and visitors view the registered manager as approachable, competent and reliable. The quality of the services and facilities are audited on an annual basis to make sure every reasonable step is taken to provide a good standard of care and support. A range of measures is in place to promote safe working practices and to safeguard residents, staff and visitors. What has improved since the last inspection?
The arrangements to assess prospective residents continue to improve in order the providers can be satisfied the needs of the person concerned can be met. The care planning arrangements have also improved and plans now provide staff with better information, guidance and direction about the care and support required. The plans are also regularly reviewed to make sure an up to date picture of the care and support required is in place. The plans also take in to account the individual residents preferences and choices. The standard of decor has also continued to improve and visitors described the facilities as comfortable. Further improvements have been made regarding cleanliness and hygiene and plans have been established to increase the housekeeping staff in order that standards can be improved further. The recruitment selection and vetting arrangements for new staff are robust in order that residents are safeguarded. The risk assessment and risk management arrangements have been developed and this has reduced the number of incidents and accidents. Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. The outcome group is adequate. This judgement is reached on information received prior to and at the time of the inspection. The assessment arrangements are not satisfactory and prospective residents needs, preferences and choices are not always fully taken into account. This impacts upon the providers’ ability to be satisfied they are able to meet the needs of the person concerned. EVIDENCE: Assessments of residents that had recently moved to the care home were sampled. It is evident the assessment arrangements have improved and there is evidence that prospective residents and their relatives and representatives are consulted. It is also clear the opinions of key professionals in contact with the prospective resident are also taken into account. The providers have established a format for recording assessments that are undertaken. The assessments provide a summary of the needs and in certain instances the information was limited. In other instances no information had been provided.
Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 10 Given the challenging ands potentially complex nature of the user group detailed assessments are required in order that the appropriate care and support is both available and provided. This will also make sure the providers are satisfied they are able to meet the needs, preferences and choices of the person concerned. The registered persons do not offer a dedicated rehabilitation or intermediate care service. It is evident that every effort is made to support residents to maintain their independence as far as possible. Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The outcome group is adequate. This judgement is reached on information received prior to and at the time of the inspection. The care planning arrangements continue to improve but further development is required to make sure a comprehensive picture of need is in place. Good arrangements are in place to meet residents’ health needs and medical services are promptly accessed when required. Medicines are stored securely and administered by qualified staff in order to promote each resident health EVIDENCE: There has been a significant improvement in the care planning arrangements following the last inspection. The information provided in care plans is more detailed and provides staff with better information, guidance and direction about the care and support required. However certain plans were incomplete and this related to residents that had moved to the home in the last three months. This may reflect the limitations of
Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 12 the current assessment arrangements. However it is of concern that care plans do not appear to be in place before a resident is admitted particularly given the complexity and vulnerability of the residents. The care plans are however regularly reviewed to make sure that residents’ needs, preferences and choices are met. Residents indicated they are very satisfied with the care and support they receive. It is evident that staff is skilled and build meaningful relationships with the residents. It is also clear that staff have a good understanding and knowledge of the needs of each of the residents. The staff treat residents with dignity and respect and residents privacy is also respected. The health needs of residents are well met and medical services are promptly accessed when required. There are qualified nurses on duty twenty-four hours a day and therefore residents’ health is regularly monitored on an ongoing basis. The qualified nursing staff also administers the prescribed medicines. Residents can administer their own medication providing this is safe. Where staff assists residents the medication is held in secure facilities. A suitable policy and procedure is also in place and any medicines that are no longer required are disposed of safely. Medicines that require refrigeration are also held in secure facilities. The records about the administration of medication were in a reasonable order but certain records were incomplete. Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The outcome group is good. This judgement is reached on information received prior to and at the time of the inspection. Lifestyles at the home are flexible and offer residents a varied and stimulating lifestyle. Recreational pursuits are also provided that reflect the residents interest. A varied and balanced menu is offered that promotes the residents’ health and well being. EVIDENCE: The lifestyles of the residents are flexible and are determined by the residents’ needs, requests or reactions at that time. The requirements of the resident’s are often variable given the nature of their condition and this therefore shapes the staffs responses and the support required. An activities coordinator has been in post over the last year and has developed and improved the range of leisure pursuits available at the care home. Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 14 This has made a constructive contribution to providing residents with a varied and stimulating lifestyle. The opportunities reflect residents’ interests and hobbies and residents decide if they wish to take part. The activities coordinator has recently changed and the registered manager plans that individual and group opportunities will be further developed. The manager also plans to broaden opportunities for frail and vulnerable residents who spend long periods in bed due to their health needs. There are also no barriers to residents accessing community opportunities providing it is safe to do so. A varied and balanced menu is in place that reflects the needs and preferences of the residents. Residents and their relatives or representatives have been consulted about the food and all appear to be satisfied. The registered manager plans to undertake further consultations in order that additional improvements can be made. Qualified cooks are employed and sufficient staff are provided each day to make sure a good standard of service is in place. The kitchen is suitably equipped and the equipment is regularly serviced and maintained. Appropriate standards of hygiene and cleanliness are maintained and suitable measures are in place to promote safe working practises. The kitchen staff is also able to met the needs of residents that require a specialist diet. Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The outcome group is good. This judgement is reached on information received prior to and at the time of the inspection. Satisfactory arrangements are in place to deal with complaints and any allegations of abuse. EVIDENCE: A suitable policy and procedure is in place for complaints and the providers are committed to dealing with any complaints or concerns expediently and in a satisfactory manner to all parties concerned. The Commission has not received any formal complaints following the last inspection. The providers have received one complaint that was satisfactorily resolved. Residents are safeguarded from abuse and any allegations or concerns are reported to the statutory authorities for investigation. A rolling training programme about the protection of residents is in place for staff and suitable advice, guidance and direction are provided to new staff during their induction programme. A suitable whistle blowing policy is also in place. This allows staff to report any concerns they have about abuse to a third party if they feel unable to inform the providers of the circumstances. This provides residents with additional protection against abuse.
Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 16 Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. The outcome group is adequate. This judgement is reached on information received prior to and at the time of the inspection. The current layout of the facilities place limitations on the providers to offer a suitable environment for residents. The providers have plans to build a purpose built facility that will provide quality accommodation for residents. In the interim every reasonable effort has been made to provide a comfortable and homely setting for residents that is decorated to a satisfactory standard. Suitable standards of hygiene and cleanliness are also in place. EVIDENCE: The providers have taken positive steps to improve the décor at the home in order that a homely and comfortable setting is provided to residents. The home is a three storey building with the communal areas located on the ground floor. The layout of the home has significant limitations in providing
Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 18 good quality services and facilities. This has been recognised by the providers and plans have been established to replace the current accommodation with a new purpose facility on the same site. The providers have consulted with residents, their relatives or representatives and staff about the plans and it is hoped that building work will commence at the earliest opportunity. It is planned the building will be undertaken in two phases to make sure that any disruption to residents is minimised. The providers are also aware the layout of the building does present certain limitations and challenges in creating and providing the homely and comfortable setting for residents. The providers have therefore taken reasonable steps to create the most advantageous setting for residents given the limitations and challenges of the layout. There is a range of disability equipment around the home to assist residents to maintain their independence and to promote their health and safety. In addition individual residents are also provided with equipment where this is required and following a specialist assessment. Suitable standards of hygiene and cleanliness are maintained and additional staff is in the process of being recruited in order that staff deployment can be improved throughout each day. Visitors described the setting as comfortable and many of the residents have personalised their bedrooms. Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The outcome group is good. This judgement is reached on information received prior to and at the time of the inspection. Sufficient numbers of staff are on duty each day and night to make sure residents’ needs are met. The staff is appropriately trained and regular training takes place in order that staffs skills are knowledge are kept up to date. Robust recruitment, selection and vetting arrangements are in place so that residents are safeguarded. EVIDENCE: The providers have further reviewed and improved the staffing arrangements to make sure that sufficient numbers of staff are on duty each day and night. This has resulted in a reorganisation of the duty roster to more effectively meet the needs of residents. Staff said they felt the new arrangements had improved their ability to provide the care and support required. The deployment of staff has also been improved to make sure that staff is in key locations during waking hours. This has also improved the residents’ access to staff whenever they require assistance.
Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 20 It is clear the staff has a good knowledge and understanding of residents needs and that positive and trusting relationships are in place. Residents speak positively and fondly about the staff and staff promptly responds when assistance or guidance is required. Qualified nurses are on duty each day and night and senior carers have been appointed to assist in the coordination of the care provided. The arrangements regarding the domestic staff continue to be under review given that currently all the staff is on duty for mornings only. It is evident the staff have a wide range of skills and abilities and many have long term experience of working in the care sector. The staff said they were well supported and it is clear that that communication at the home has improved. The recruitment selection and vetting arrangements have also improved to make sure that robust arrangements are in place that safeguard residents. Newly appointed staff undertake an induction programme to make sure they have the skills and abilities to meet the needs of residents. The programme continues be reviewed and developed in order that it meets the competencies laid down by Skills for Care. Staff said they were well supported and advice, guidance and direction were available when required. The staff group also regularly participate in a range of training opportunities in order their knowledge and skills are up to date. Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, and 38. The outcome group is adequate. This judgement is reached on information received prior to and at the time of the inspection. The home is well managed and in a manner that promotes the residents best interests. The quality of the services and facilities provided are regularly audited to make sure good standards are in place for residents. A range of measures is in place to promote safe working practices and to safeguard residents. The risk assessment and managements arrangements have improved but further improvements are necessary. This will further promote the health and welfare of residents. EVIDENCE: Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 22 The registered persons have considerable experience of social care and two of the registered persons are also qualified nurses. The registered manager is also a qualified nurse and has been in post for around one year. The registered manager has significantly impacted upon the services and facilities provided. Staff at the home described the management arrangements as supportive and reliable. The staff also view the registered manager as competent, reliable and a good communicator. Many of the staff commented upon the professional manner the registered manager undertakes her duties. It is evident that the registered providers and registered manager are committed to providing and maintaining good standards in respect of the care and support provided. Within the last year a quality assurance audit has taken place that took account of the views of staff, relatives or representatives, residents and professionals visiting the home. This highlighted opportunities for improvement and a suitable action plan has been established. The conclusions have also been recorded and are available for scrutiny by any interested party. Plans have been established to complete a further audit in the year ahead. A range of measures has been established to promote safe working practises and a number of policies and procedures are in place to guide, direct and inform the staff. The evidence indicates that the policies and procedures are regularly reviewed and updated where required. In addition staff are provided with training to make sure their skills and knowledge are up to date. The risk assessment and risk management arrangements have also improved and this has resulted in a reduction in the number of accidence and incidents occurring each month. The current arrangements continue to require improvement and development to make sure that every reasonable step is taken to safeguard residents and staff. This includes providing staff with more detailed information and guidance for residents who present aggressive or threatening behaviours. It is also clear that staff is more aware of risks and a number of staff were observed taking positive preventative action during the inspection. The equipment and services provided at the home are also regularly services and maintained. Sheldon House DS0000008894.V309892.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 Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X X X X 2 Sheldon House DS0000008894.V309892.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. 1. Standard OP3 Regulation 14(1)(ad) Requirement A comprehensive and detailed assessment must be completed for all prospective service users. Timescale for action 30/12/06 2. OP7 15(1) Comprehensive and detailed care 30/12/06 plans to meet the needs and preferences of service users must be provided. The records regarding the 30/10/06 administration of medicines must be complete. The environment must meet the 30/03/07 minimum standards required. Sufficient communal space must be provided. 30/03/07 30/11/06 3. 4. 5. 6. OP9 OP19 OP20 OP38 13(2) 23(2)(b)( d) 13(4)23(2 )(g)(h) 13(4)(a-c) Satisfactory risk management and risk assessment arrangements must be put in place. Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP12 OP30 Good Practice Recommendations The recreational and social opportunities should continue to be broadened and increased. A comprehensive induction programme should be in place for all new staff. Sheldon House DS0000008894.V309892.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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