Inspection on 13/09/06 for Southlea Residential Care Home

This inspection was carried out on 13th September 2006.

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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Southlea Residential Care Home 18/08/08

Southlea Residential Care Home 18/07/07

Southlea Residential Care Home 12/10/05

Southlea Residential Care Home 06/05/05

Southlea Residential Care Home 04/11/04

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

CARE HOME ADULTS 18-65 Southlea Residential Care Home 23a Cross Lane Radcliffe Manchester M26 2QZ Lead Inspector Lucy Burgess Unannounced Inspection 13th September 2006 09:30 Southlea Residential Care Home DS0000061330.V297669.R02.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 Southlea Residential Care Home DS0000061330.V297669.R02.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. Southlea Residential Care Home DS0000061330.V297669.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Southlea Residential Care Home Address 23a Cross Lane Radcliffe Manchester M26 2QZ 0161 764 0761 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) Southlea Limited Mrs Margaret Yvonne White Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (2), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (3) Southlea Residential Care Home DS0000061330.V297669.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Within the maximum registered numbers 5 , there can be up to 3 MD(E) Adults with Mental Disorder over 65 ; 2 MD Adults with Mental Disorder. The service should at all times employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection 12th October 2005 Date of last inspection Brief Description of the Service: Southlea is a privately owned care home registered to provide care and support for up to 5 people with mental health needs. The fee charged by the service is £339.00 per week. The home is a large Victorian property situated on a main road in the Radcliffe area of Bury. It is close to several amenities and has good transport links. The metro-link is close by and Bury is a 5-minute bus/tram ride away. Accommodation is provided in single rooms with en-suite facilities. The home provides practical and emotional support 24 hours a day from staff with training in, and knowledge of, mental health needs. Staff work closely with other professionals to ensure that the needs of service users are met and reviewed. Southlea Residential Care Home DS0000061330.V297669.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day. The inspector spent time looking round the home, viewing records as well as talking with residents, a relative and staff. Discussion and feedback was also held with the Manager. The home is registered to provide accommodation for 5 people. At the time of the visit there were no vacancies. Although the inspection was unannounced the completion of a pre-inspection questionnaire was requested. Feedback surveys were also distributed. Comments were received from 1 resident, a relative and a GP. All the key standards were looked at during this inspection visits. What the service does well: What has improved since the last inspection? What they could do better: The window in the lounge is damaged and does not allow residents to seeing outside clearly. This should be replaced. The new manager has now settled into the home. Arrangement should be made for the registered managers application to be forwarded to CSCI. Southlea Residential Care Home DS0000061330.V297669.R02.S.doc Version 5.2 Page 6 Consideration should be given to the home developing a quality monitoring system. Some training has taken place, however the manager is to arrange further session particularly for the new staff. This will include first aid and adult protection. 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. Southlea Residential Care Home DS0000061330.V297669.R02.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 Southlea Residential Care Home DS0000061330.V297669.R02.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 at least once during a 12 month period. 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. The system of assessing prospective residents prior to admission to the home gives an assurance that a resident is only admitted if the home is able to meet their needs. EVIDENCE: As already stated most of the residents living at the home have done so for some time. The last resident moving in approximately 18 months ago. The process of admission was discussed with the manager. Following referral to the home information would be sought from the funding authority as well as the home completing their own assessment. Opportunities would also be made available for prospective residents to visit the home, have a meal or stay over night so that further information in relation to individuals needs can be gathered Following placement at the home an early review would be made to establish the suitability of the placement. One of the current residents is moving from the home. contact the local authority with regards to the vacancy. The manager is to Southlea Residential Care Home DS0000061330.V297669.R02.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 at least once during a 12 month period. 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. Residents care plans and assessments clearly identify their support needs and how these are to be met ensuring their health and well-being is maintained. Residents expressed they were well cared for and were clearly involved in making decisions about their lives. EVIDENCE: Detailed information is held within each of the residents’ files. Files are orderly and easily accessible for staff to refer to. Information includes; care plan, risk assessments, daily records, review notes, appointments, and weights, missing person’s information, medication and correspondence. Residents are encouraged to be involved in the development of their plans. Once information has been drawn up, this is the read and discussed with the residents and they sign to evidence their agreement. The home has had a programme of reviewing plans on a monthly basis and a new plan is then drawn up. Whilst this is to be commended this process Southlea Residential Care Home DS0000061330.V297669.R02.S.doc Version 5.2 Page 10 generates a lot of work for the staff, particularly when there has been no change in needs. Discussion was held with the manager with regards to the level of information held, use of ‘pen pictures’ and the reviewing process. This is to be reviewed within the home. Risk assessments are completed to address areas of concern. These include; mental health, personal care, medication, use of appliances, nutrition. Assessments had been completed using different formats, with one using a scoring system to measure the level of risk. It was discussed with the manager about how the system is used to assess the score and level of risk. As there was no clear guidance it was felt that this was not an appropriate tool to use. The inspector spent time talking with residents, who expressed that they were well cared for and ‘very happy and settled’. A relative also stated that she was ‘able to relax knowing her dad was being cared for properly’. Southlea Residential Care Home DS0000061330.V297669.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 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 pursue a variety of activities both in and away from the home enabling them to increase their independence. Residents continue to maintain contact with family and friends. EVIDENCE: Most of the residents have lived at the home for some time. Three of the residents are of retirement age therefore having a relaxed routine with informal activities. The routine of the two other residents vary depending on their individual preferences. Some of the activities include watching TV and ‘soaps’, crosswords, local shopping centres, walks, bingo and helping staff with tasks within the home such as washing up, preparing meals etc. Previously arrangements have been made for residents to access the local drop-in or day service however attendance is based on the wishes of the individual. Southlea Residential Care Home DS0000061330.V297669.R02.S.doc Version 5.2 Page 12 Residents receive their mail unopened, however do receive support from staff should they need to or a response is required. Residents also have bus passes, which enable them to travel easily within the local community. Each of the residents continue to maintain contact with family and friends. Visits take place both at the home or with residents visiting family members. Contact is made on a regular basis. Arrangements with regards to meals are informal with no structured menu plan. Meals are based on individual preferences, which may mean each having different choices each day. Those able to prepare there own breakfast do so, with lunch and evening meals being prepared by staff with some assistance from residents. Staff spoken with stated that the providers ensured that sufficient food supplies were always available. Residents stated that the food was ‘good homemade cooking and lovely puddings’. One resident said they had been offered fresh meat each evening and that he had enjoyed the rice pudding made by one of the staff members. Records are made of all meals served along with regular weight checks ensuring residents are well. During the visit and in discussion with the manager, one resident has been experiencing some difficulties, which had impacted on his diet/weight. Appropriate action has been taken to address the concerns raised. Southlea Residential Care Home DS0000061330.V297669.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ physical and mental health needs are consistently met. Medication storage and administration is safely managed. EVIDENCE: Each of the residents are independent and in the main able to address their own care needs however where necessary staff offer encouragement and assistance. Residents tend to make their own decisions in relation to the daily routines generally spending time in the communal areas of the home, taking part in outside activities or spending time in the privacy of their own room. Clear information is recorded with regards to all contact with health and social care professionals. Staff, support and enable residents in attending appointments with a variety of health care professionals. This includes reviews with mental health professionals to ensure that the well-being of residents is maintained. The needs of one resident had changed. Whilst the home feel they are able to meet the needs of the resident, who has lived at the home for 12 years, a formal assessment of need and further funding would be required so that Southlea Residential Care Home DS0000061330.V297669.R02.S.doc Version 5.2 Page 14 additional staff can be provided. The home have been proactive in seeking the support of relevant health and social care professionals in order to meet his needs. Contact has been made with the speech and language therapist, district nurse regarding continence advise, dietician and orthodontist. On the day of the inspection a visit was made by the social work team to discuss what concerns the home have and what action was required. The manager will follow this up. The medication system was examined. This was found to be safe and records had been completed in full. Records are made of all items delivered and returned to the supplying pharmacist. The manager explained that consideration is being given to changing the pharmacy used due to some difficulties. One of the residents continues to self medicate. A risk assessment has been completed and is held within the care file and with the MAR sheet. Each member of the team has undertaken relevant training. The manager also assesses staff to ensure that they are confident and competent in the safe administration of medication to the residents. The visiting GP answered ‘Yes’ on the survey to medication being managed appropriately, staff understanding the needs of residents, that he was able to see residents in private and that there was clear communication and they worked in partnership. The relative also confirmed that she was kept informed of any concerns or changes in her Dads health. Southlea Residential Care Home DS0000061330.V297669.R02.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 at least once during a 12 month period. 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. Systems are in place with regards to the complaints and adult protection issues. Relevant training is still needed for some members of the team ensuring that residents are safe and protected. EVIDENCE: A copy of the home’s complaints procedure is displayed within the home as well as being included within the home’s guide. No issues have been raised with either CSCI or the home. Comments made by those who returned the surveys confirmed that they were aware of what to do if they had any concerns and who to speak with. One resident spoken with expressed that ‘If I have any problems I speak with the staff’. Other residents spoken with stated that they had no concerns and where happy to approach the staff if they needed to discuss anything. In relation to protection the majority of staff have received training, however this is needed for new members of the team. The Manager is aware of this and is to make arrangements for this to be completed. With regards to residents finances support is offered. Individuals have there own accounts, which are managed by the owner or local authority. Records are held with regards to statements, fees payable and personal allowances. Residents sign to evidence that they have received their money. Southlea Residential Care Home DS0000061330.V297669.R02.S.doc Version 5.2 Page 16 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 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. Southlea is a small domestic dwelling accommodation for those who live there. EVIDENCE: Southlea is small domestic dwelling providing accommodation for 5 residents. Accommodation is provided on 3 floors and comprises of a lounge, dining room and kitchen. There are 5 single bedrooms all of which have en-suite toilet and shower facilities. One of the bedroom is situated on the ground floor. The basement area is designated for staff providing an office, sleep-in room and separate toilet. At the time of this visit the home was found to provide a clean, free of malodour, warm, comfortable and very homely environment for residents. Residents and a relative spoke very highly in respect of the accommodation provided for them and the up keep of the home. Resident’s bedrooms, of which 2 were seen, were comfortably furnished and personalised with individuals belonging including pictures, ornaments etc. Southlea Residential Care Home DS0000061330.V297669.R02.S.doc Version 5.2 Page 17 providing pleasant comfortable Work has been carried out within the home and included new flooring to 3 ensuite rooms, new carpets in each of the bedroom, new fire doors and a new boiler. Further work was being carried out to the property. This included the outside of the home being painted. Laundry facilities are provided within the kitchen area however enclosed within a small cupboard. Due to the changing needs of one resident appropriate arrangements are being made be the manager with regards to the disposal of clinic waste. Provisions have already been made available with regards to gloves, aprons and red bags. The washing machine also has a boil wash so that items can washed thoroughly. Southlea Residential Care Home DS0000061330.V297669.R02.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. 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. Staff at the home are in sufficient numbers to meet the needs of residents. On going training and support is provided to equip staff with the knowledge and skills needed in meeting the needs of service users. EVIDENCE: The home has recently recruited 2 new care staff. Personnel files were examined. Information had been gathered in relation to an application form, written references, POVA and CRB checks, copies of identification, photo and copies of training certificates. It was noted however that information detailed on the application form with regards to employment history was insufficient. The manager must ensure that details including dates are sought along with an explanation into an gaps in employment. Staff training has been provided. Information provided on the pre-inspection questionnaire identified that all existing staff had received training in adult protection and medication. One member of staff had also undertaken first aid. The manager is aware of the additional training needs particularly for new staff and is making the necessary arrangements. Southlea Residential Care Home DS0000061330.V297669.R02.S.doc Version 5.2 Page 19 All staff are currently completing a distance learning course in Nutrition level 2, which is accredited from Manchester University. Further courses are to be arranged in first aid, adult protection, as well as mental health needs. The newest staff are currently completing their induction and have undertaken training in medication. The manager has also observed their practice in relation to assessing their competence and confidence in administering medication to residents. Some members of the team have also completed NVQ training. The manager holds the D32/33 assessors award as well as the Level 4 Registered Managers Award. Of the care staff, 2 have level 2, 1 has level 3 and another member of the team is a trained nurse. From discussion with residents and a relative, staff were described as being ‘very friendly and helpful’ and ‘kind’. Interactions between residents and staff were relaxed and open. Southlea Residential Care Home DS0000061330.V297669.R02.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Application should be made to the CSCI with regards to the Registered Manager. Systems are in place for the reviewing of the service provision however could be explored. Responsibilities in relation to health and safety are also addressed. EVIDENCE: The current registration still shows the previous manager in place. The providers should inform the CSCI in writing of the changes made. From discussion with the current Manager, who has worked at the home since March 2006, she is now ready to make application to the CSCI to become the Registered Manager. The Manager is a qualified nurse, both RGN and RMN and has worked within care settings for many years. She has also previously been registered as a Manager with the Commission. The Manager holds additional qualifications as Southlea Residential Care Home DS0000061330.V297669.R02.S.doc Version 5.2 Page 21 an NVQ assessor and has completed the NVQ level 4/Registered Managers Award. The Manager would like to join the local Care Homes Association group where further support, ideas and information are shared, which can assist her in her role. In relation is quality monitoring, the home regularly liaises with the residents in the main informally through day-to-day discussion. Further feedback would also be sought from families, where necessary, through the formal review meetings. The Manager also stated that questionnaires have been distributed. Whilst these have been provided to residents they have yet to be sent out to other parties involved with the home. Feedback is also sought from the staff during periodic team meetings and supervisions. Consideration needs to be given to developing a quality monitoring system, which may include feedback from other stakeholders, completion of the Regulation 26 monitoring visits etc. Information gathered would then inform the homes improvement and development plan. With regards to health and safety, external workmen undertake periodic servicing of the gas, electric, fire equipment, alarm, emergency lighting and appliances. Further in-house checks are also carried out in relation to fire safety. Staff have recently completed training in this area. Southlea Residential Care Home DS0000061330.V297669.R02.S.doc Version 5.2 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 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 3 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 2 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 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X Southlea Residential Care Home DS0000061330.V297669.R02.S.doc Version 5.2 Page 23 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. 2. Standard YA24 YA34 Regulation 23 19 Requirement That arrangements are made for the lounge window to be replaced. That a full employment history is detailed within the application form along with dates and an explanation into any breaks in work. That all staff receive training in adult protection and first aid. That application is now made by the manager to CSCI with regards to becoming the registered manager Timescale for action 30/11/06 30/11/06 2. 3. YA35 YA37 18 9 30/12/06 30/11/06 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 YA9 YA39 Good Practice Recommendations That consideration is given the use of risk assessment documents that do not provide clear guidance on how to reach a judgment. That consideration is given to the development of a quality assurance system and a report in relation to the findings. DS0000061330.V297669.R02.S.doc Version 5.2 Page 24 Southlea Residential Care Home Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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