CARE HOME ADULTS 18-65
Spinney Hill Road 56 Spinney Hill Road Northampton Northants NN3 6DN Lead Inspector
Stephanie Vaughan Unannounced 16 May 2005 08.00
th 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. Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Spinney Hill Road Address 56 Spinney Hill Road Northampton Northants NN3 6DN 01604 591179 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) Compass Care Limited Vacant Care Home 3 Category(ies) of MD Mental Disorder (3) registration, with number LD Learning Disability (3) of places Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No person falling within the category of MD, Mental Disorder excluding Learning Disability or Dementia, may be admitted into the home unless that person also falls within the category of LD, Learning Disability ie Dual Disability. Date of last inspection N/A Brief Description of the Service: Compass Care runs the home, which, is part of a group of other homes in the area. The home is registered to provide care for up to three people with a Learning Disability who additionally have a Mental Disorder. The house is on a road of similar houses in a residential area of Northampton.Service Users are encouraged to be as independent as possible with staff support and supervision. The home is within walking distance of local community amenities, which include shops, pubs and a park. There is a bus service from the estate into town.Accommodation to service users is provided across two floors. All bedrooms are single occupancy one is on the ground floor with en-suite facilities and two are on the first floor. The ground floor provides a sitting area, kitchen/dinner and conservatory. There is a garden area to the front and rear of the home. Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine unannounced inspection was conducted over a period of four and a half hours. During which the inspector made observations, spoke to three residents and one members of staff. A limited tour of the premises was conducted which involved viewing the communal areas and a selection of the private accommodation. Case tracking is the method used during inspection where of a sample of three residents were selected and all aspects of their care and experiences reviewed, including individual plans of care and associated documentation. A selection of staff files were viewed. The Commission for Social Care Inspection have received fourteen complaints during the last twelve months regarding this service. Subsequent investigations have been conducted and in the main the complaints were not upheld. What the service does well: What has improved since the last inspection?
Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 Stage 4.doc Version 1.30 Page 6 The management are aware of the needs of the individual residents and are now considering the implications of where the needs of one resident might impact on another. This conflict does increase the tension between residents within the home which affects both their behaviour and relationships with one another. The Commission for Social Care Inspection support the action that is being taken to address these issues. The home provides a clean and hygienic environment despite significant challenges. Senior Management are supporting four members of staff through National Vocational Qualification level 2 and are optimistic that the Department of Health Target of 50 will now be achieved by the end of the year. What they could do better:
Individual plans of care should be improved to include evidence of a key worker system One resident expressed a wish to have access to a front door key. However there was no evidence that the management had considered this and no formal risk assessment had been conducted. Although resident’s privacy is respected and supported by the homes Charter of Rights one resident expressed concern regarding voicing opinions within a formal care setting with the associated documentation. Individual plans of care did not evidence the provision of a key worker system and this should be addressed. Strengthening the relationship between a resident and his carers may address this residents concern. Individual plans of care contained information about personal support required by residents. However the detail was inconsistent, regarding specific instruction to staff on issues related to personal care. A previous requirement has been made regarding the identified needs of residents and the need to develop an associated plan, which makes clear the type and level of care to be provided by staff. Although there was evidence that personal care is provided in private, one resident expressed concern regarding the impact of staff using the main bathroom for another resident. Although en suite facilities are provided for this resident staff currently restrict access due to behavioural issues. It is therefore recommended that the current arrangements for the use of bathrooms be reviewed subject to risk assessment. Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 Stage 4.doc Version 1.30 Page 7 Serious shortfalls were identified in the medication systems and these must be investigated and a report submitted to the Commission for Social Care Inspection. Residents are able to utilize the complaints procedures both internally and externally and are supported to do so by advocacy workers. In addition, the Protection Of Vulnerable Adults procedures are sound and are used when necessary. Furnishings and fittings are appropriate to the residents needs with the exception of one resident who indicated that the metal bed frame caused restriction to his comfort due to his height. Window restrictors that had been fitted subject to a previous requirement were not being used, within the bathroom and the first floor landing. An immediate requirement was made regarding this practice. Staffing levels are generally adequate, however there are occasions when staff work alone in this challenging environment. Currently there is only one waking night staff on duty. However the service is being developed to provide an additional member of staff during the night to provide a floating support within the group and this good practice should be extended to the daytime staffing arrangements. Recruitment processes must be improved to ensure that all appropriate information is obtained and that this is evidenced within the staff files. 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. Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 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 Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 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) 2 Residents are able to make informed decision about whether the home can meet their needs and expectations prior to admission. EVIDENCE: The home has had no new admissions since the last inspection. However residents confirmed that they had been able to visit the home prior to admission to ensure that it was able to meet their needs and expectations. Evidence was seen that residents have access to appropriate information including the service users guide and the complaints procedure. In addition there was evidence that where the home is unable to continue to meet the needs of residents that alternative provision is sought. Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 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, 7, 8. & 9 Residents are supported to maintain control over their own lives EVIDENCE: All residents had an Individual Plan of Care, which conforms to the criteria identified within Schedule 3 of the National Minimum Standards. The individual plans of care set out in detail information to staff regarding planned interventions, communication, behaviour management and support. Individual care plans evidenced residents involvement, and regular review. However the care plans did not identify individual key workers, although residents were able to relate to staff members and access key members of staff and external agencies appropriate to their need. Residents are supported to make decisions about their own lives; examples included choice of décor and involvement in activities within the local community. Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 Stage 4.doc Version 1.30 Page 11 Where restrictions are placed on resident’s freedom appropriate documentation is included within the care plan for example Care Programme Approach Assessments and associated risk assessments. Residents spoken to confirmed that they were able to participate in the running of the home and there was evidence that their suggestions were acted upon. One example included the installation of a pay phone. Residents confirmed that meetings were held with staff to discuss issues within the home however these were sometimes cancelled due to other demands and this was a cause of frustration to residents. Residents are supported to take responsible risks and are able to participate in appropriate training to support this. Examples included food preparation and associated Food Hygiene Training and other domestic activities. Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 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) 12,13, 15, 16 &17 Residents are enabled to maintain appropriate and fulfilling lifestyles in and outside the home. However improvements should be made to aspects of privacy. EVIDENCE: Residents are supported to attend a range of educational and occupational activities. One resident had chosen to discontinue with college-based activity and was being supported to obtain suitable voluntary work in the local community. In addition residents are supported to develop life skills such as communication. Residents are supported to access a range of facilities within the local community; these include shopping trips, attendance at the local sports centre and social activities with one to one support from staff. Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 Stage 4.doc Version 1.30 Page 13 Residents confirmed that they are supported to maintain links with relatives and friends. This is by spending time on leave with family members or by receiving visitors within the home. Daily routines are flexible according to resident’s needs and schedule of activities. The Residents Charter sets out in detail resident’s rights, which include privacy and dignity. Residents were seen to have appropriate privacy locks fitted to their individual accommodation and to be able to have their rooms locked in their absence. Residents also had access to a lockable facility within their rooms, however one resident expressed a wish to have access to a front door key. However there was no evidence that this had been considered by the management. Residents confirmed that they were able to receive their mail unopened and that their privacy was generally respected. However one resident expressed concern regarding voicing opinions within a formal care setting with the associated documentation. Staff were seen to relate well to residents who were spoken to in their preferred form of address. Residents confirmed satisfaction with the food provided at the home and their participation in the menu planning and shopping. The menu evidenced three meals a day with options of a cooked breakfast at the weekend. The menu appeared to offer a varied and balanced diet. Residents are able to access the kitchen for drinks and snacks throughout the day and have opportunities to eat out according to their choice. Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 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 & 20 Care planning practices are inconsistent in the detailed instruction to staff which result in frustrations for residents. Provision of a key worker system needs to be developed and serious concerns were identified in the medication systems. EVIDENCE: Individual plans of care contained information about personal support required by residents. However the detail was inconsistent, regarding specific instruction to staff on issues related to personal care. A previous requirement has been made regarding the identified needs of residents and the need to develop an associated plan, which makes clear the type and level of care top be provided by staff. Although there was evidence that personal care is provided in private, one resident expressed concern regarding the impact of staff using the main bathroom for another resident. Although en suit facilities are provided for this resident staff currently restrict access due to behavioural issues. Individual plans of care-evidenced residents preferred routines and choices. In addition residents have access to a range of primary and secondary health care specialists. Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 Stage 4.doc Version 1.30 Page 15 Although there was evidence that residents have access to designated members of staff for supervision the care plans did not evidence a key worker system. One resident expressed concern regarding voicing his opinions in a formal care setting may be assisted to overcome these concerns by the development of a formal key worker system. Individual plans of care evidenced that residents are supported to access appropriate health care. Regular reviews are undertaken and general health is monitored. Residents have access to annual health checks, general practitioners and appropriate specialist support. One residents expressed a wish to self medicate however there was no evidence that a formal risk assessment had been conducted to accommodate this wish. Examination of the Medicine Administration Records identified serious omissions for one resident and it appeared that 10mgs of Chlorpromazine prescribed for bedtime administration had not been administered at any time on the current record. On enquiry the inspectors were informed that following a Care Programme Approach review that the medication had been reviewed. However the Medicine Administration Record did not reflect this. In addition the monitored dose system evidenced that this medication had continued to be given. The Responsible Individual is required to conduct an investigation into this situation and to submit a report to the Commission for Social Care Inspection. A previous requirement has been made regarding the homes medication policy which must include the action to be taken in the event of a drug error and this must be further reviewed to ensure that there is a system in place to identify when drug errors drug errors are occurring and to reduce the possibility of reoccurrence. Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 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 & 23 Residents are able to take full advantage of the Complaints procedure and their concerns are addressed. Residents are protected from abuse. EVIDENCE: The Commission for Social Care Inspection have received several complaints regarding a range of issues within the home from one resident. These have been referred for investigation by the senior management team responsible for the organisation. The investigations have been appropriately conducted and reports submitted to the Commission for Social Care Inspection regarding the outcomes and actions taken to address the complainant’s issues. In addition there has been one Protection Of Vulnerable Adults incident involving potential financial abuse that has been appropriately addressed by the organisation. The investigation has been referred to external agencies and the police who continue to conduct their investigations. Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 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 & 30 The home provides an environment that is generally appropriate for residents preferred lifestyles and needs. Serious concerns were identified regarding the failure to use window restrictors. EVIDENCE: The home is a small residence in keeping with the local community and accessible to local amenities. Appropriate communal areas are provided and residents have individual rooms with appropriate privacy locks and lockable storage facilities. Furnishings and fittings are appropriate to the residents needs with the exception of one resident who indicated that the metal bed frame caused restriction to his comfort due to his height. Appropriate safety devices were seen to be in place however the widow restrictors that had been fitted subject to a previous requirement were not being used, within the bathroom and the first floor landing. An immediate requirement was made regarding this practice.
Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 Stage 4.doc Version 1.30 Page 18 The home is well maintained, clean and hygienic. Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 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) 32, 33, 34 & 35 Staffing levels are generally adequate although some improvement is recommended. Shortfalls to the recruitment processes were identified and must be addressed to ensure the Protection Of Vulnerable Adults. Staff have access to appropriate training to meet the needs of residents. EVIDENCE: The home have experienced some difficulty in working towards the achievement of the Department of health target of 50 of staff having achieved National Vocational Qualification level 2 by 2005. However the Senior Management are aware of the need to address this and are now supporting four members of staff through this training. The management are optimistic that this standard will now be achieved by the end of the year. Staffing levels at the home on paper appear to be adequate. However the organisation is going through a period of considerable change and the Registered Manager has now been appointed as the Responsible Individual. He continues to oversee the management of the home. In addition the organisation has now identified a member of staff to act as manager whist the recruitment processes are being followed.
Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 Stage 4.doc Version 1.30 Page 20 On the day of inspection the Responsible Individual was available within the home for some time and able to give some support to residents and staff. Two of the residents require one to one supervision within the community, including day care. Although one member of staff was absent arrangements were made to ensure that the residents were able to continue to participate in their planned activity. It is clearly difficult for a small home like this to cater for all eventualities, however there are occasions when staff work alone in this challenging environment. Currently there is only one waking night staff on duty and appropriate risk assessments were seen to be in place. However the service is being developed to provide an additional member of staff during the night to provide a floating support within the group and this good practice should be extended to the daytime staffing arrangements. Recruitment processes must be improved. On one occasion it appeared that a staff member had commenced employment prior to receipt of a formal Criminal Records Bureau clearance and there was no evidence of a povafirst check. Satisfactory clearance has subsequently been obtained however files must provide information as to what steps the management have taken to ensure the Protection Of Vulnerable Adults in the interim. In addition the detailed employment history identified that the applicant had previously worked in a care home, however reference from this establishment had not been obtained. Both of the references that had been obtained came from the same establishment. Staff spoken to and staff files evidenced that staff have access to appropriate training in both those required for the health and safety of residents and those specific to the needs of individuals. In addition staff files evidenced regular staff supervision. Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 Stage 4.doc Version 1.30 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 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) 37 & 42 Interim management arrangements are in place to ensure that resident’s needs are met. The safety of residents is compromised due to the misuse of window restictors. EVIDENCE: The Registered Managers post is currently vacant and being overseen by the Responsible Individual. The organisation has now identified an acting manager to take on the running of the home until a permanent replacement has been found. The post is currently being advertised. Staff have the appropriate training to ensure the health and safety of residents and the environment is well maintained. However an immediate requirement was made regarding the use of window restrictors on the first floor. Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 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 x 3 3 x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 1 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 2 3 Standard No 31 32 33 34 35 36 Score x 3 2 1 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Spinney Hill Road Score 2 3 1 x Standard No 37 38 39 40 41 42 43 Score 3 x x x x 3 x C51 S63583 Spinney Hill V226815 160505 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 20 Regulation 13 (2) 17(3)(a) 13 (2) Requirement Medication systems must be reviewed to enable errors to be identified. Outstanding requirement 30/09/04 An investigation into the drug error idendified must be conducted and a resport submitted to the Commission Window resitictors must be used appropriately to ensure residents safety Staff files must evidence appropriate clearances Staff files must evidence appropriate references The Commission must be formally notified about the appointment of the acting manager The Commission must be kept informed regarding the progress towards the appointment of a Registered Manager Care plans must be reviewed to provide detailed instuction to staff regarding the personal support required by residents Outstanding requirement 31/08/04 Timescale for action 01.06.05 2. 20 01.06.05 3. 4. 5. 6. 24 & 42 34 34 37 23.4 (a&b) 13 (4) (b) 19.1 19.4 8 (1) (a) 16.05.05 01.07.05 01.07.05 01.07.05 7. 37 8 (1) (a) 01.07.05 8. 18 12 (1) 01.07.05 Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 Stage 4.doc Version 1.30 Page 24 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. 3. 4. 5. 6. 7. Refer to Standard 16 16 18 18 24 33 Good Practice Recommendations Residents who wish to have a key to the front door of the premesis should have a risk assessement conducted to establish if they are able Key worker systems should be strengthened to improve the confidence of residents regarding aspects of confidentiality Individual plans care should identify a designated key worker The use of the bathroom facilities should be reviewed Residents sleeping arrangements should be reviewed Floating support should be extended to provide support for day staff Spinney Hill Road C51 S63583 Spinney Hill V226815 160505 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection 1st Floor, Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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