Inspection on 29/05/07 for Six Acres

This inspection was carried out on 29th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Six Acres 16/12/05

Six Acres 19/07/05

Six Acres 16/12/04

Six Acres 09/06/04

Six Acres 11/03/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Six Acres 401 Bickershaw Lane Bickershaw Wigan Greater Manchester WN2 5PR Lead Inspector Lucy Burgess Unannounced Inspection 29th May 2007 09:30 Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Six Acres Address 401 Bickershaw Lane Bickershaw Wigan Greater Manchester WN2 5PR 01942 861113 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) Mr Brian Malcolm Smith Mr Brian Malcolm Smith Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Six persons with a learning disability Date of last inspection 16th December 2005 Brief Description of the Service: Six Acres is a privately run care home for up to six adults with learning disabilities. Six Acres is a bungalow situated off a busy road in the village of Bickershaw. It is owned and managed by the Smith family. Mr. Brian Smith, Junior, is the Registered Manager. The Home is close to shops and local facilities and is served by public transport. A smallholding is located at the rear of the bungalow. Geese, ducks and hens provide activity and occupation for the people who live at Six Acres: everyone is involved in maintaining the well-being of the animals. One of the principal aims of Six Acres is to move people into their own or supported accommodation, where they can live more independently. Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home is registered to provide accommodation for up to 6 people with learning disabilities. The inspection visit took place over one day for a period of 7½ hours. The home did not know that the inspector was going to visit. The inspector took the opportunity to look round the home, view records as well as talk with residents. Discussion and feedback was also held with the Registered Manager and Provider. As part of the inspection the Manager was asked to complete a pre-inspection questionnaire and feedback surveys were sent out to residents and relatives. The inspector received feedback from 5 residents and 5 relatives. Comments have been added to the report. All the ‘key’ standards were looked at during this inspection visit. What the service does well: What has improved since the last inspection? No issues were identified following the last inspection. As outlined above the home continues to offer stable, consistent support for the people living there, offering them a lifestyle of their choosing. Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Relevant assessment information would be gathered prior to individuals moving in, enabling prospective residents and staff to make an informed decision about the suitability of the placement ensuring needs can be fully met. EVIDENCE: Standard 2 was looked at during the last inspection in December 2005. 2006. Residents living at Six Acres have lived there for some time, therefore no recent placements have been made. The Manager has a clear process, which is followed when assessing and resettling prospective residents. Information is gathered from a number of sources, which enables them to make an informed decision about the suitability of the placements. Prospective residents are also provided with information and opportunities to meet the staff team and other residents they may be living with. This too informs the decision about whether placements are made. Once agreed, information gathered would be used to inform the development of the care plan. Placements are reviewed following an initial settling in period. Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments are updated and reviewed on a regular basis and clearly reflect residents involvement in making decisions about a lifestyle of their choosing. EVIDENCE: Care plans are drawn up between the resident and the staff. This is done on a six monthly basis, however should it be necessary, an early review would be made so that information is up to date and accurate. Formal reviews have also taken place with individual social workers. It was noted that residents had signed their plan, to evidence that they were in agreement and involved in recording the information. Files were looked at for 2 of the residents. Information included assessment information, weekly sheets, correspondence, missing person information, record of appointments and professional visits and financial information. Weekly sheets provide a good overview of the resident’s routine and activities, meals, appointments and weight. The staff and resident then add comments. Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 10 As part of the care planning process, risk assessments are completed where areas of concern have been identified. These may include, road safety, alcohol, bathing, laundry, meals etc. Assessments are reviewed in line with the care plan, where additional concerns are identified these would be added to the plan. The home is relatively small therefore informal day-to-day contact is made between residents and staff with the views and opinions of both parties being easily aired. Residents are clearly given every opportunity to make decisions about how they live their lives and who to ask should they need help or guidance. Residents said they were free to make individual choices about most aspects of daily living. This had been recorded on their care plans. Residents assistance appointee regards to generally manage their own day-to-day finances, however is given should this be needed. The home acts as corporate for one of the residents. Arrangements were discussed with assisting the resident in opening her own bank account. Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are clearly encouraged and supported in living a lifestyle of their choosing enabling them to grow and develop in confidence and independence. EVIDENCE: Each of the residents has a lifestyle of their own choosing, which includes leisure activities, tasks around the home or occupation. This may include helping with some building work, completing daily chores or looking after the animals. Each person has a detailed record of daily activities. From discussion with residents each said they were satisfied with the range of activities that were available to them. Residents are also actively involved in the local community. Individuals access the local shops, pubs and other services that are available, as well as accessing the wider community. Staff will provide support however those individuals Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 12 who are more confident go alone, using public transport. The home also has a mini bus, which is also available. Relationships between the residents as a group, and between residents and staff continue to appear good. Interactions were relaxed and friendly. As apart of the daily diary a record is made of meals taken. Residents were happy with the meals served and the choice available. Menus are discussed at the beginning of each week so that shopping can be organised. Checks are kept of residents’ weight and general appearance, and a referral to a health specialist would be arranged if staff had any concerns. Staff are on hand to help any resident who requires assistance with eating. Residents continue to maintain relationships with family and friends with visitors welcome to the home at any time. Feedback surveys were sent to relatives as part of the inspection process. Five relatives returned them. Comments included; ‘I am quite satisfied with the home and have no complaints’ and ‘my relative seems very happy and content, more confident and independent’. Another family member expressed that their relative had ‘improved a lot since settling at the home’ and that ‘they were pleased with the support offered’. Another commented, ‘I am very happy with the overall care, their quality of life has improved 100 since living at the home, needs are met in every way and they have a happier life. We have good relationships with staff, they are very helpful.’ The inspector also spent sometime speaking with each of the residents as well as previous residents who now live in their own homes close by with continued support from the team. Everyone was very welcoming and happy to discuss their lives, routines and relationships with each other and staff. Feedback surveys were also received from a number of residents. Further comments included; ‘I am perfectly happy living at Six Acres’, ‘I am given opportunity to make decisions’, ‘I always do what I want at anytime’, ‘the staff treat me exceptionally well’, ‘I like the friendship here’, ‘I help with jobs around the home’. Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are encouraged and supported in maintaining their health and personal care in a manner, which suits them based on their needs and wishes. EVIDENCE: Where necessary residents living at Six Acres are assisted in meeting their personal care needs. Support required would be identified within individual plans and agreed with individual residents. Each resident continues to have access to all relevant health care professionals including GP’s, dentist, optician, chiropody etc. Support is offered for appointments. Should nursing be required the home would access the support of the community district nurses. Referrals to health specialists, such as neurology, OT assessments etc would be arranged through the GP. One of the residents uses a wheelchair, however is able to manage independently around the home as all facilitates are available on the ground floor. As part of the homes refurbishment grab rails are to be fitted to the toilet and a walk in shower room enables personal care needs to be easily met. Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 14 Another resident has Autism and is very clear about how he wishes to be supported. Clear routines have been established and staff recognise that in order to maintain his well-being these should be considered and supported. Information is recorded on the care file. A further resident was said to have been reluctant to pursue activities away from the home and would become quite anxious. Consistent staff support and encouragement to enable the resident to increase their confidence and overcoming some of the emotional difficulties previously experienced. Other residents spoken with felt able to speak openly with the Manager and owner should they have anything worrying them and felt were confident in them being supported in resolving any issues. Residents were supported and encouraged in meeting their physical and emotional needs ensuring their wellbeing was maintained. Should there be any restrictions on a person’s activities of daily living or areas of risk these are discussed fully. Action identified would only be put in place once this had been agreed with the resident and any other relevant parties. The medication system was examined. Items are securely held within the staff office. As present none of the residents require any controlled drugs. Individual medication records are held for those in receipt of medication and information was clear and easy to follow. Each of the staff have initialled each of the sheets so that it is clear who has been responsible for the administering of medication. A photograph of the resident is also available to refer to. Whilst each member of staff has received medication training this was some years ago. The manager is asked to arrange further training for the team to ensure that practice is safe and reflects up to date good practice. Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home holds clear procedures regarding complaints and adult protection, ensuring that residents were listened to and protected. Relevant training is to be undertaken by the staff. EVIDENCE: Procedures are in places with regards to complaints and are accessible to residents. This was confirmed in the feedback information received from residents. It was clear when speaking with individuals that they felt able to express their opinion or concerns with any member of the team and felt confident that issues would be addressed. Should individuals wish to speak with someone independent of the staff at the home they are able to do so and each have access to their own telephones so that calls can be made in private. This area is also discussed during residents meetings. Six Acres had received no complaints since the last inspection, and none had been received by CSCI. A previous inspection found that Six Acres has an Adult Protection procedure, which includes Whistle-blowing along with a copy of the local authority’s Protection of Vulnerable People document. However no training has been completed in this area. Good arrangements are in place in relation to resident’s money. Records are held. One resident who is supported by staff in managing finances has now saved a large sum of money, which is held in the business account. The Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 16 Manager and Provider have been advised to support the resident in opening their open bank account. Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Six Acres is a domestic dwelling providing a comfortable, homely environment for the residents. Further redecoration and refurbishment with enhance the property. EVIDENCE: The inspector spent some time looking round the home. Accommodation comprises of single bedrooms each have been personalised by the residents. There is also a lounge/dining room, kitchen, bathroom and toilet. The Providers also live at the property but have separate living space at one end of the building. Whilst the home is pleasant and offers a comfortable home for residents it was noted that several areas required attention. This was discussed with the owner and manager who explained that they are currently working through a programme of refurbishment. Some work has already taken place within the toilet and bathroom, with further work planned throughout the home over the year. Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 18 The providers also discussed future plans with regards to the outside of the building, as the land adjoining the property is also owned by them. Those people living at the home are able to manage independently and therefore do not require aids and adaptations to be fitted within the home to assist them however the manager and provider are aware that should this be needed appropriate arrangements would be made. The staff undertake the majority of domestic tasks however residents are happy to help out taking responsibility for certain tasks. The home was found to be clean and tidy. Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by a competent team who are skilled in meeting their needs. EVIDENCE: Staffing at the home has remained consistent. The team comprises of the Manager, Owner and his wife and a carer. At present the manager is looking at recruiting new staff to the team to enable more flexibility within the service. The inspector discussed with the manager the process of recruiting new staff and information required prior to them commencing their employment ensuring residents are protected. One of the new staff members is a tradesman who currently works along side some of the more independent people whilst they are carrying out their work. In relation to training all members of the team have previously undertaken mandatory and medication training. Arrangements have been made by the manager for individuals to undertake refresher courses in 1st aid, food hygiene, health and safety and moving and handling. Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 20 From discussion it was also found that none of the team had completed adult protection training, this is to be arranged and it was also recommended that medication training is updated as this was completed some time ago. This will ensure good practice is followed. With regards to NVQ training this too has been completed. The manager and provider have both completed the NVQ level 4/Registered Managers Award and the carer has completed level 3. Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The overall management of the home is consistent and reliable for the people living there including systems to review the service. Satisfactory arrangements were in place with regards to providing a safe environment however could be improved in some areas. EVIDENCE: No changes have taken place in relation to the management and running of the home. Both the Manager and Provider are available at all times and interact with residents on a daily basis. This provides a stable, consistent and supportive environment for those living at the home. As already stated both have also completed the NVQ Level 4 / Registered Managers Award. Further training has been identified, which will be planned over the year. Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 22 In relation to the monitoring of the service feedback is sought through the health care reviews of residents where staff meet with health and social care professionals. Questionnaires are also distributed on an annual basis for feedback from family members of residents. Residents are also actively involved in making decisions about the day-to-day running of the home. As already identified resident meetings are held and recorded, individuals are involved in the planning and reviewing their plans and are actively encouraged to make decisions about their lives. Residents also have access to an advocacy service should independent support and advise be needed. Based on the information and feedback received the home has developed an annual development plan for the year. This explores action to be taken in staff training and development, residents’ aims and objectives, home improvement programme and any additional areas identified such as reviewing policies and procedures, annual health checks, fire safety etc. Timescales for action are also set and signed off when completed. With regards to health and safety, regular checks are carried out by the home along with annual checks. Information was provided on the pre-inspection questionnaire with regards to checks carried out on the fire equipment, electric, small appliances, emergency lighting and gas. Sample certificates were requested during the visit with regards to the gas safety certificate and 5 year electrical check, however these were unavailable. Following the inspection an up to date gas certificate was received. Arrangements are to be made for the electrical check to be completed. Looking round the home it was noticed that doors were kept open. Whilst closing devise had been fitted to the majority of doors they had not been fitted to the kitchen door or middle door leading to the private accommodation. The manager was advised to seek advise from the fire safety officer and make suitable arrangements so that residents and staff were not placed at risk in the event of a fire. Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 3 X 3 X X 2 X Six Acres DS0000005762.V321710.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 YA42 Regulation 23(2) Requirement Arrangements must be made with regards to the 5 year electric check ensuring the premises is sound and in a good state of repair. Adequate precautions against the risk of fire should be provided so that individuals are protected from harm. Timescale for action 31/08/07 2 YA42 23(4)(a) 31/08/07 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 YA23 Good Practice Recommendations Training should be provided so that staff understand how to respond to issues related to adult protection ensuring residents are protected. Suitable arrangement should be made with regards to the bank account for one resident so that money held is separate from the homes business account. 2 YA23 Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 25 3 YA24 Arrangements should be made to ensure that the refurbishment of the home is completed to enhance the living environment for those living there. Up to date medication training should be completed by the team ensuring practice is safe and reflects current good practice guidance. 4 YA35 Six Acres DS0000005762.V321710.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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