Inspection on 24/10/06 for St Anselm`s Nursing Home

This inspection was carried out on 24th October 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Anselm`s Nursing Home 09/10/08

St Anselm`s Nursing Home 15/02/06

St Anselm`s Nursing Home 16/08/05

St Anselm`s Nursing Home 08/12/04

St Anselm`s Nursing Home 21/06/04

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

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

CARE HOMES FOR OLDER PEOPLE St Anselm`s Nursing Home St Clare Road Walmer Deal Kent CT14 7QB Lead Inspector Joseph Harris Key Unannounced Inspection 24th October 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Anselm`s Nursing Home Address St Clare Road Walmer Deal Kent CT14 7QB 01304 365644 01304 380514 stanselms@hotmail.co.uk 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) Mrs Aileen Jordan Mr Mark Redman, Mrs L A Redman, Mrs Irene Lane Mr David Paul Weller Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (25) St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Patients detained under Sections of the Mental Health Act may not be admitted to the home Patients must be aged 50 years and over Date of last inspection 15th February 2006 Brief Description of the Service: St. Anselms is a registered nursing home, which provides care for up to 25 with mental health needs and dementia. The home is a large detached building, set in its own grounds, in a quiet residential area of Walmer, Deal. It is near to local shops and facilities, Walmer Castle and the sea, and is within easy reach of the towns of Deal and Dover. It is run by a partnership, with all of the Providers actively involved in the running of the home. Accommodation is provided over 4 floors (lower ground, ground, first and second floors), and all floors can be accessed via a passenger lift. The communal areas in the main building consist of a large lounge, conservatory and dining area. There is also another small quiet lounge area for service users. The home has a gatehouse, which has recently been renovated to provide reception and office facilities, minimising disruption to Service Users in the main building. The home provides full laundry facilities The grounds provide a number of pleasant areas for Service Users enjoy in the better weather. The current fees for the service at the time of the visit range from £526.00 to £851.00. Information on the Home services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. The e-mail address of the home is stanselms@hotmail.co.uk St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection culminated in an unannounced visit to the service on 24th October 2006. The visit lasted from 9.30am until 4pm and during this time a tour of the premises was conducted, discussions were held with service users, visitors, staff and one of the Directors. The Registered Manager was not present at the visit. A range of documentation and records were examined including information relating to service users, staff, health and safety issues and the management of the service amongst others. No requirements or recommendations have been made as a result of this inspection. What the service does well: What has improved since the last inspection? Two requirements were made at the previous inspection regarding improvements to individual care plans and quality assurance processes, both of which have been satisfactorily addressed. Through discussion with one of the Directors and the nurse in charge it was evident that the service continues to strive to improve. Annual surveys are completed and action points are addressed. The service has shown a commitment to continually improving and updating the premises. St Anselm`s Nursing Home DS0000026117.V305593.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. St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 and 6. The home provides information to prospective service users in the form of a service user guide and a statement of purpose. A contract is provided. Prospective service users have their needs clearly assessed. The home does not offer a place to a person who cannot have their needs met. Trial visits to the home are available prior to moving in. The home does not cater for people requiring intermediate or respite care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On referral to the home prospective service users are given a service user guide and have access to the statement of purpose. Both of these documents provide clear details about the nature of the home including facilities and services, staffing and training and all other required information. In addition to this a statement of terms and conditions is provided covering fees and other contractual information. A signed copy of this is confidentially retained. St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 9 The registered manager and/or senior staff conduct a thorough assessment of the prospective service users needs and wishes prior to visiting the home. A number of assessments were examined and demonstrated that all relevant areas of need to ensure that the criteria for admission are met and the home can meet that individuals needs. Where service users have a care manager, copies of relevant care plans, risk assessments and history are obtained and pre-admission meetings are arranged as required. One service user spoken to confirmed that she was able to visit the home before choosing whether to move in. The staff stated that all service users are invited to visit the home when assessed and that these visits can range from short introductory visits to full day visits and overnight stays should this be required. The home does not have a dedicated respite facility and does not routinely offer such a service. However providing respite or intermediate care is considered on a case-by-case basis and would be judged after consultation with the relevant professionals. St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. An individual plan of care is completed and addresses assessed needs and risks in good detail. The healthcare needs of service users are met and changing needs are monitored. There are clear processes in place regarding medication issues. Residents confirmed that they are treated with respect. Issues surrounding illness and death are addressed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 4 service user plans were examined looking at service users with a range of needs and requirements. All of the files were well organised and set out in a logical order. Essential information and contacts were recorded. Individual plans of care were developed based on a good range of assessment tools covering manual handling, pressure area care and activities of daily living. The plans clearly identified needs and provided guidance and actions for staff. The plans showed evidence of regular review. There were also examples where plans had been updated in response to the changing needs of a service user. St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 11 There was clear evidence amongst all the service user files viewed that healthcare issues are monitored, reviewed and referred as appropriate. All service users receive routine health care input such as visits to and from the chiropodist, optician and dentist. All appointments, consultation and concerns are recorded in the healthcare section of the files with any outcomes from the visits such as medication changes documented. Regular contact is maintained with individual’s GPs and community nursing teams including psychiatric input where necessary. Medication systems were reviewed and examined. The home has a comprehensive set of policies and procedures relating to medication. Staff administering medication are adequately trained and their competency assessed. Storage facilities are good ensuring correct temperatures, security, space and hygiene. All medications were maintained in an organised fashion minimising the potential for errors. Administration records were up to date and records showed a clear audit trail from receipt to disposal. In discussion with residents it was clear that staff establish good relationships and treat individuals with dignity and respect. One resident said that, “the staff are very nice; this is a lovely place to live”, and “I get excellent help when I need it”. Staff demonstrated positive and inclusive attitudes spending time talking to service users and guiding and assisting thoughtfully. The staff spoken to showed a good understanding of individual and collective needs and carried out their work in a relaxed and unhurried atmosphere. Service users and/or their next of kin are consulted about funeral arrangements and care in the event of illness. This information is documented. The home responds to changing needs and liaises with relevant health and social care professionals appropriately. St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The home ensures that residents can live their lives in a way that they choose with a range of available activities and events for those that wish to participate. Visitors are made welcome. Residents are able to continue to make choices about their lives. A healthy and balanced diet is provided. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home achieves a positive balance between providing a relaxed environment and an active lifestyle. Some individuals choose or are not able to participate in some of the organised activities, but for those who do there are a number of opportunities available. Walks and trips out are arranged, seasonal and special events are celebrated. Other activities such as Bingo, art and craft and gentle exercise groups are organised. The home employs an activities coordinator who develops interests on an individual and collective basis. Visitors are welcomed in to the home at all reasonable times and are made to feel comfortable. There is space for available for visitors to meet in private should they wish. A brief discussion was held with a relative who stated that she thought that home was “excellent” and that she enjoys visiting frequently. St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 13 The home enables service users to handle their own finances for as long as possible. All appointee roles are arranged independently of the service. The home has an access to records policy and documents are maintained in accordance with the Data Protection Act 1998. Residents are encouraged to bring in personal possessions with them and all bedrooms viewed had evidence of this. The home employs a cook and kitchen staff to prepare all main meals. The menu records were examined, which demonstrated a balanced and healthy diet is provided. All produce and food stocks were of good quality and in adequate supply. There is a large dining room and people can choose when and where to eat. Residents all commented that the quality and choice of food was very good. Nutritional screening is undertaken and regularly reviewed ensuring that people have suitable diets. Drinks, snacks and fresh fruit are available throughout the day. The kitchen had been maintained to a high standard of cleanliness and the most recent environmental health report was positive. St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Complaints and concerns are listened to and acted upon. Service users are protected from abuse. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a clear complaints procedure in place. This is displayed in the home and is included in the service user guide. The procedure encourages concerns, opinions and complaints to be aired and sets out how the service aims to deal with any issues. Complaints are dealt with in a 28 day period and there is a proportionate approach. The home aims to deal with any concerns in an informal way in the first instance, but there are formal processes should an outcome not be satisfactorily reached. Service users all confirmed that they felt able to raise their concerns if they had any and new who they should approach. Complaints are recorded and any actions monitored. There have been no complaints since the last inspection. There are clear policies and procedures in place relating to adult protection and prevention of abuse. Staff are provided with training in relation to these issues through the induction process, additional training and NVQ. Issues of abuse were discussed with some staff who demonstrated a good working knowledge of the topic. There have been no Adult Protection alerts. St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, 25 and 26 The home is well-maintained and safe providing a comfortable range of communal space and bedrooms. The home is clean and hygienic. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was undertaken. The home is an older property, which has been decorated and furnished to a high standard providing a comfortable and homely environment despite the size of the building. There is a range of communal space with a large open plan lounge and additional quiet rooms. There is a good sized dining room, which is also used for some activities. There are attractive gardens surrounding the building, which are well-maintained. The home complies with environmental health and fire department regulations. Maintenance issues are addressed promptly and records kept of work done. A good number of bedrooms were viewed all of which provided a comfortable environment for the individual service users. There are currently 6 double bedrooms registered and 13 single rooms. Service users are able to St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 16 personalise their rooms and bring in their own belongings. A number of residents spoken to confirmed that they like their rooms and have all necessary furniture and fittings. The heat, lighting and ventilation within the home were reported to meet all environmental standards and were satisfactory for the purpose of use. Radiators and pipework are covered to prevent the risk of scalding. There is domestic style lighting throughout. Water is reportedly stored at appropriate temperatures to reduce the risk of Legionella. The home was clean and hygienic, although in one small corridor there was a faint odour, which was discussed the nurse-in-charge and director and a cleaning plan is in place. The home’s laundry facilities are suitable for the needs of the service and are appropriately finished in impermeable flooring and tiled walls. The service complies with water fitting and supply regulations. The home has available sluice facilities. Staff undergo infection control induction and training and the home uses universal precautions and has an infection control policy and procedures. St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. There are adequate numbers of appropriately experienced staff on duty at all times. Staff are supported and encouraged to undertake NVQ training. The home’s recruitment practices are robust. Staff are provided with good levels of training. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has a registered nurse on duty at all times of the day and night who is supported by a minimum of 3 healthcare assistants throughout the day and 2 HCAs at night. In addition to this an activities co-ordinator is employed from 9am to 12 noon during the week and a range of ancillary staff including administration support, housekeepers, laundry, maintenance and kitchen staff. Staff were observed to be working at a relaxed and unhurried pace being able to spend time with service users and ensuring individual needs were being met. The non-qualified staff are encouraged and supported to undertake NVQ training appropriate to their experience. 50 of the staff team have achieved an NVQ level 2 or above and further staff are continuing to work towards similar qualifications. Through discussion it was evident that staff on duty possessed good principles of care and were observed to carry out their day-today duties in a thoughtful, sensitive and caring manner. St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 18 A number of staff personnel files were examined ranging from more recently employed staff to long-standing members of the team. All of these records demonstrated that the home has a robust recruitment process retaining CRB and POVA checks on file, proof of identity, two written references and completed application forms amongst other documents. The files are well maintained and key staff were aware of the home’s responsibilities surrounding the Protection of Vulnerable Adults. The home has a good track record of retaining staff and no team members have left the employment of the service since the last inspection. Staff stated that they felt they received a good package of training and development and are supported to undertake a range of courses including all mandatory training requirements. The home is in the process of ensuring all staff have updated basic food hygiene training and the cooks have completed intermediate food hygiene training. Other recent courses have included POVA training, reminiscence and a meaningful activities course organised by the Alzheimer’s Society. All new staff work through an induction programme, which could be developed in line with the common induction standards. St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. The home is managed by an experienced and well qualified individual. The service has good quality assurance processes. Service user’s financial interests are safeguarded. Staff received regular and supportive supervision. The health, safety and welfare of service users and staff are promoted. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager was not present at the time of the site visit, so it was not possible to fully assess this standard, however all staff and service users spoken to were positive about his leadership and management style. The registered manager is a qualified nurse and has many years experience working in the home in a managerial capacity. In the past he has St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 20 demonstrated a willingness to liaise with the Commission and it was reported that he has an open and inclusive style of management. The service Directors have demonstrated over a number of years good selfassessment and quality monitoring processes, which are in the process of being further developed in line with increasing expectations in this area. Satisfaction questionnaires are completed annually with service users and their relatives and the comments from these form part of an annual report where any issues raised are noted and appropriate action taken. The service Directors audit all aspects of the home on a routine basis and there is evidence of ongoing review and updating of the home. The home does not act in an appointee capacity for any of the service users and individuals are supported to retain control of their finances. Where an appointee is required this role is taken by someone independent of the service such as a family member, care manager or solicitor. The home retains a clear record of any money or possessions held for safekeeping with all incoming and outgoing transactions noted, signed and audited. There was evidence on staff personnel files of good supervision and appraisal processes. A cascading supervision structure is in place with staff supervised by a senior member of the team. Staff reported that they receive regular formal 1:1 supervision and that the home is a supportive environment in which to work. Annual appraisals are conducted with all staff and these were noted to be completed in a positive manner enabling staff to work towards future targets and professional development. The home maintains the health, safety and welfare of all connected and visiting the home by ensuring all regular maintenance and service checks are completed including PAT tests, electrical wiring, waste contracts and gas safety. The home has in place procedures to ensure safe working and staff are provided with appropriate training. It was reported that the service complies with all relevant health and safety legislation. Environmental risk assessments are completed and reviewed on a regular basis. The home maintains fire records and has a fire safety risk assessment in place. Accident records are completed and retained in a confidential manner. St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Anselm`s Nursing Home DS0000026117.V305593.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Kent and Medway Area Office The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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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