CARE HOME ADULTS 18-65
Silverdene 709 Moston lane Moston Manchester M40 5QD Lead Inspector
Ann Connolly Unannnounced 01 June 2005 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Silverdene Address 709 Moston Lane Moston Manchester M40 5QD 0161 682 4901 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) Mrs Marie Hughes Mrs Marie Hughes Care home only (PC) 4 Category(ies) of Learning disability (3) registration, with number of places Physical disability (1) Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1 Should the resident requiring care by reason of physical disablement no longer be accommodated then that place will revert to the category of Learning disability (LD). 2 Staffing levels to be reviewed regularly to ensure that they are adequate to meet the needs of the service users accommodated. 3 The manager must receive updated training in the safe handling of medication by 30 June 2005. Date of last inspection 28 February 2005 Brief Description of the Service: Silverdene is a privately owned residential home providing 24 hours personal care and accommodation for three people with a learning disability and one person with a physical disability. The accommocation is also part of the registered providers family home and residents are treated very much as part of the family. The style of the property is a large dorma bungalow with residents accommodation all being at ground floor level. All bedrooms were single and furnished to a very high standard. One room has a purpose built en-suite shower room to meet the needs of the individual service user. one large lounge area was available for residents to use. A well fitted kitchen and dining area was avaiable which led out to a separate utility area to accommodate the laundry facilities. Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over the course of two and a half hours on 18 May 2005. An additional monitoring visit was made on the afternoon of 9 June 2005. During the inspection, time was spent talking to the four residents who live at the home, the manager and two members of staff to find out their views of the service. Time was also spent looking at medication, the care plan files, health and safety issues and meals. A tour of the building also took place. During this inspection only a selection of the key National Minimum Standards were assessed. In order to gain a full picture of how the home meets the needs of residents, this report should be read together with the previous and any future reports. What the service does well:
All four residents living in the home either stated or indicated that they were happy with the services provided by the home. There was evidence of positive and sensitive conversation and communication between staff and residents and there were numerous examples during this inspection of staff making considerable effort to listen and respond to residents in a sensitive and caring manner. One resident was very positive about the care she received and said, “They look after me properly, they don’t rush me, nothing is left out and I get looked after very well, in fact I should say excellently” The staff treated each resident as an individual. The care plans were ‘tailor made’ and included a lot of information on how the resident wanted to be supported. A lot of emphasis was placed on listening to what the residents themselves wanted. The service provided care in a ‘homely family environment’. Residents appeared relaxed and comfortable in their surroundings and it was evident from observations made during the inspection that residents had the freedom to wander about and access all parts of the home. One resident said she thought the home was “warm and cosy”. The care provided by staff extended to visiting a resident in hospital, and to supporting residents on all out patient and specialist health care appointments. The home was furnished and maintained to a high standard and, whilst maintaining a ‘homely’ feel, the home was very clean.
Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
One person in the home said she would like to visit a library. Another said she would like to go to the cinema. Staff in the home said that sometimes it was hard to encourage residents to try new activities, but by consistently and gradually offering new activities, residents may become more confident. It is important that staff continue to support residents in developing new skills to build up their confidence and levels of independence. The service needs to improve the management of handling and administering medication in the home. All staff would benefit from updated training in the safe handling of medication, which would promote the safety and well being of the residents in the home. The home used a variety of cleaning products, which were not locked up appropriately. The manager must ensure that cleaning materials are located in a safe lockable place to avoid unnecessary accidents and to make areas accessed by residents safe at all times. During the course of the inspection one resident referred to the manager and one of the staff as her ‘mum and dad’. Although this may be the preferred term used by the resident it is important that over dependency is not encouraged and that residents have a realistic understanding of their situation and that the manager and the staff team promote best practice. One resident was very enthusiastic with her affections to visitors to the home. It is important that the manager and staff help residents to understand and
Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 7 develop social skill taking into account behaviour that is inappropriate and appropriate in social situations. The manager should aim to develop her professional working practices in the home so that the residents and staff benefit from living and working in an environment in which the manager communicates a clear sense of leadership and direction. 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. Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3 and 4 The home provided existing and prospective residents with information about the services offered by the home. Residents’ needs are assessed and identified before they move into the home. EVIDENCE: No new residents had been admitted to the home since the last inspection. The home had a Statement of Purpose and Service User Guide, which would be offered to any prospective resident wishing to use the service. It was noted that a copy of this document was in each bedroom. The manager said that this document was under review to develop it in a ‘user-friendly’ style specifically designed to meet the needs of the residents in the home. All files looked at during the inspection contained a detailed assessment of need. The care management assessment from the purchasing local authority, was on file and supplemented by the home’s ‘in house’ assessment of need. This information was used to develop the care plan and to provide staff with information and instruction on how to provide care to each individual resident. The home’s admission policy stated clearly that all prospective residents would be offered the opportunity to visit the service and spend a trial period in the home prior to making any major decisions about their future. Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,8 and 10 Individual care plans reflected the recent changes in residents care needs. Generally residents were involved in the day to day running of the home and encouraged to participate in daily routine activities. EVIDENCE: Considerable improvements had been made to the care plans and there was evidence to show that there was an ongoing programme in place to continually develop these documents. The care plans included a detailed assessment, which focused on the strengths of the resident, the care needs, and the wishes of the resident on how they wanted their care needs to be met. This information was detailed and informative and provided staff with a useful tool to help them to provide care which was ‘tailor made’ to meet individual needs. The care plans included updated reviews and recordings of contacts made with other health professionals, e.g. visiting psychologist, district nurses, hospitals, and hearing clinics. Where changes had occurred in health and social care needs, these had been written into the care plan. It was pleasing to note that the reviews focused on involving residents and listening to their views about the care they receive. Detailed informative
Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 11 recordings of the issues discussed at the review were made. The content of the recordings provided clear evidence that the residents were at the heart of this process. On two of the files examined, residents had been asked about activities and improving leisure activities. Following this, goals had been set and this was then documented in the formal care plan. Full reviews were carried out by staff every month. During discussions with staff it was clear that residents were encouraged to take an active role in all aspects of the home. The residents were consulted about the routines in the home and were actively encouraged to personalise their bedroom space. It was clear that the residents took great pride in keeping their rooms tidy, making their bed etc. All information about the residents was held in clear comprehensive files. These files were available for staff to use as a daily working tool, and stored securely when not in use. Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15,16 and 17 On the whole residents’ rights were respected and recognised by staff in the home, however, it was noted that routines in place were not as flexible as they could be. Residents were offered a healthy diet and individual preferences were taken into account when planning menus. EVIDENCE: This inspection took place during the evening. On arrival one resident was in bed watching television, another was dressed ready for bed but appeared content as she enjoyed doing things in her bedroom. She was involved in a crayoning activity and watching one of her favourite television programmes. She told me that she liked to spend most of her time in her room. She said that she liked the home as it was ‘warm and cosy’ and added that she could talk to the staff mentioning them by name. This resident said she usually went to bed between 9p.m. and 10 p.m. It was evident from observation residents were comfortable in accessing all parts of the home. One resident wandered into the lounge and involved herself in conversations going on between staff and the inspector, and was later seen entering into the kitchen to help herself
Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 13 to a drink from the refrigerator. The atmosphere in the home appeared relaxed and informal. Initially, there was some concern that that some residents were ready for bed early. One resident said that she didn’t like going to bed early, ‘I would rather stay up talking to Marie’. Early settling down times for this resident was included in the care plan, however, staff need to be aware that routines such as bedtime can change on a day to day basis, depending on what takes place during the day. One resident said that she had regular contact with her sister and that she was always made to feel welcome at the home. The staff appeared to have a positive relationship with this relative and it was evident that she was regularly consulted on anything to do with the care of her sister. Each resident had an individual meal/menu plan on file. The manager said that menus were based on the likes and dislikes of individual residents. She said that it was sometimes difficult to encourage residents to eat fresh vegetable so where possible this deficiency was supplemented by encouraging residents to eat fresh fruit. At the time of this inspection a home cooked meal of beef curry was being prepared. One resident said this was the kind of meal she enjoyed when served with rice. All residents spoke highly of the meals served. There was a plentiful supply of fresh meat, fruit and a well stocked freezer and pantry. Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 and 20 Overall, all aspects of resident’s personal and health care needs were being met. However, the home’s systems and procedures did not ensure the safe administration of medication and placed residents at risk. EVIDENCE: The care plans focused on the strengths of residents. This enabled staff to encourage residents to maintain their independence and skills where appropriate. Care plans, and the reviews of care plans highlighted the importance of providing support in a manner, which was preferred by the resident. During the inspection, there was evidence of good communication between residents and staff. Staff appeared to respect each service user as an individual, with individual needs. There were numerous examples of staff making considerable effort to listen to residents in a sensitive and caring manner. The home had maintained a detailed and comprehensive record of residents’ healthcare needs and the involvement of any healthcare professionals. Records showed that where appropriate specialists services were consulted. This included specialist advise for a service user requiring special assistance with feeding. Recently the home identified communication difficulties experienced by one resident. There was evidence that the home provided a
Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 15 continuum of care where specialists had been involved resulting in a referral to the hearing clinic. One resident had specific emotional needs. These were included on the initial assessment and in a report from the clinical psychologist. Information from these assessments had been transferred to the care plan which provided information for staff on how to support and encourage this person. Discussions with staff showed that they had a detailed understanding of this person’s needs, and they were observed in positive and meaningful interactions with this person. During this inspection, it was evident that this person had settled into the home since the last inspection visit. Her anxieties had decreased and her behaviour to strangers was much more appropriate. Only one resident was in receipt of prescribed medication. Some concerns were raised about the methods in which the medication was administered. Medication which should have been administered in liquid form was being administered in tablet form. A requirement was made for the manager to contact the General Practitioner to review medication and to make arrangements for the resident to receive medication in a form that was appropriate for her. A medication policy was in place, which included information on ‘homely remedies’. Records of medication was kept on the medication administration record (MAR) sheets as provided by the supplying pharmacist. This was an improvement from the previous visits when recordings had not been accurately maintained. However, records of the receipt of medication and returns of medication had not been kept and the home did not maintain records of the original prescription as these were picked up by the pharmacist. The manager must follow the guidelines issued by the Royal Pharmaceutical Society of Great Britain and follow the good practice guidelines in ensuring that all prescriptions are picked up and checked by the home and to ensure accurate records are maintained of the receipt and disposal of medication. The previous inspection highlighted the importance of providing training in the safe administration of medicines to all staff. The manager had not addressed this at the time of inspection, however, it was noted that attempts had been made to secure this training and the manager must notify the CSCI when this training has been confirmed. Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 Residents in the home felt their views were listened to and felt confident in raising any issues of concern or worries to the staff and the manager. EVIDENCE: One resident told the inspector that she could speak to the manager if she had any worries or concerns. Throughout the inspection visit it was evident that there was a good relationship between staff and residents. There was a relaxed atmosphere and communication between residents and staff was informal. There was respect and genuine approach from staff towards the residents promoting an open positive atmosphere. Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,27, and 30. Accommodation provided was homely and comfortable and overall the safety of the residents had been considered. However, some aspects of fire safety had not been adhered to, and this may present a health and safety risk to residents in the event of a fire. The storage of cleaning products also presents a health and safety risk. Storage of cleaning products in the home was inappropriate and presented a health and safety issue if used in the wrong way by the residents in the home. EVIDENCE: The bathroom and toilets were sufficient in numbers to meet the needs of the residents in the home and these were furnished to a high standard. One bedroom was fitted with an en suite facility designed to meet the high dependency need of one particular resident. Laundry facilities were located in a separate utility room to the rear of the building. The home had a good stock of cleaning product to help maintain the high standards of hygiene and cleanliness, however, these were inappropriately stored in an unlocked cupboard which could present a health
Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 18 and safety hazard if used by residents incorrectly. The premises were clean and free from offensive odours. It was noted that a previous requirement from the Commission and Greater Manchester Fire Service to re- fit fire doors to the kitchen and lounge was outstanding. The manager must address this as a matter of urgency to ensure that in the event of a fire the residents are not at risk as a result of noncompliance with fire regulations. The inspector was informed by the manager that solid oak doors which were compliant with fire regulations had been ordered. The style of furnishings was of a high standard and provided both comfort and a ‘homely’ feel . Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 Staffing arrangements were sufficient to meet the needs of the residents in the home. EVIDENCE: The staff team on duty at the time of inspection consisted of the manager and two staff. Recordings on residents’ files provided evidence that residents were supported in attending all hospital out patient appointments. During the recent hospitalisation of a resident there were recordings on file which indicated that a member of staff made daily visits to see the resident whilst in hospital. Residents confirmed that they were supported by staff to go out to the shops and to the park. Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 and 39 The views of residents were sought on an informal basis, however, there was no formal structured programme of quality assurance in the home. EVIDENCE: It was evident that the view of the residents were taken into account in the day to day running of the home. The care plan files provided evidence of an approach which considered the individual needs of each person living in the home. Care plans focused on how the resident wanted the care to be provided. Meal plans were individual to each resident. The manager needs to develop a quality assurance programme which is used as a tool to continually develop the service and maintain a record of the process. During a follow up visit which formed part of the inspection, some areas of concern were highlighted and discussed with the manager. The manager’s reaction to this visit and the discussion was inappropriate. She was not able to
Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 21 discuss the issues raised in a consistent clear manner. This matter has been addressed in a separate letter to the manager. Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 x Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 x 3 x 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x 3 x x 4 Standard No 11 12 13 14 15 16 17 x x x x 2 2 3 Standard No 31 32 33 34 35 36 Score x x 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Silverdene Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x 2 2 x x x x F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 23 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 28 Regulation 12(3) Requirement Routines in the home must remain flexible and as far as possible take into account the wishes and feeling of residents in the home. The manager must arrange for all staff to receive training in the safe handling and administration of medication in the home. Medication must be administered in accordance with the Royal Pharmaceutical of Great Britain.(previous timescale not met). The manager must arrange for the fitting of fire doors as detailed in the fire report of Greater Manchester Fire Service to ensure the health and safety of residents.(previous timescale not met). All cleaning products must be stored away in a lockable unit The manager must communicate a clear sense of direction and leadership. Effective quality assuarance and monitoring systems based on seeking the views of service users msut be in place. Timescale for action 14/7/05 2. 20 13(2) 14/7/05 3. 24 23(4) ( c) 14/7/05 4. 5. 6. 24 38 39 13(4)(a) 9 24 2/7/05 20/7/05 20/8/05 Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 24 7. 15 12 The manager must support service users in developing appropriate social and persoanl relationships. 20/7/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations No recommendations have been made as a result of this inspection. Silverdene F55 F05 s21710 Silverdene V229533 D250505 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection 9th Floor, Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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