CARE HOME ADULTS 18-65
St Raphael`s Integrity Care Home 93-95 Stanhope Gardens Haringey London N4 1HZ Lead Inspector
Susan Shamash Unannounced Inspection 26th September 2005 09:00 St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 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 Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 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. St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St Raphael`s Integrity Care Home Address 93-95 Stanhope Gardens Haringey London N4 1HZ 020 8800 6393 020 8800 0429 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 Eftychia Joannides Mr Phivos Joannides Mrs Eftychia Joannides Care Home 8 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (1) of places St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Limited to 7 adults of either gender with a learning disability (LD) and one female over the age of 65 years who has a learning disability (LD(E)). 9th June 2005 Date of last inspection Brief Description of the Service: St. Raphael’s Integrity Care Home is a care home registered to provide personal care for a maximum of eight residents between the ages of 18 to 64 years who have learning disabilities. One specified resident may be over the age of 65 years. The stated aim of the home is to provide a high quality of care within a comfortable and homely environment and to enable residents to lead as independent a life as possible. The home consists of two adjoining two storey terrace houses which have been converted to become a single home. There are eight single bedrooms located on both the ground floor and the first floor. None of the bedrooms have en-suite facilities although each bedroom has it’s own sink. The two kitchens, dining room and lounge are on the ground floor. The front of the building is primarily paved. The back garden is partly paved and accessible to residents. It is attractively arranged and contains a variety of fruit trees and flowers. The home is situated in a residential area of Haringey and close to a large selection of Mediterranean restaurants, shops and community facilities located along Green Lanes and in Wood Green. St. Ann’s Hospital is about half a mile away. St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection lasted approximately five and a half hours. The inspector was assisted throughout by the registered manager (Mrs Eftychia Joannides) and her son (who manages another care home nearby). The inspection took place as one of the two routine annual visits to the home. At the start of the inspection four residents were in the home, whilst the others (out at day services) returned later in the day. One resident was in hospital at the time of the inspection. The inspector had the opportunity to speak to six residents and one staff member independently. Four residents’ care plans, staff records and maintenance records for the home were examined and an inspection of the premises was carried out. What the service does well: What has improved since the last inspection?
Ten requirements were made at the last inspection in June 2005, three of which were fully complied with, and two of which were partially met. Improvements were seen in the number of activities available to residents outside of the home, including a number of day trips to places of interest. Detailed records of food served at the home continue to be maintained, and records of fridge and freezer temperatures were up to date as required. All care plans have been updated to include medical conditions diagnosed, and appropriate care and support to be provided. Some improvements have been made regarding the furnishings provided within residents’ rooms, although there remain some further minor issues to be addressed.
St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 Page 6 Evidence was available that staff had recently undertaken training in the control of substances hazardous to health (COSHH), adult protection and fire safety, to ensure the protection of residents at the home. Staff records appeared to be complete as required at a previous inspection to ensure the protection of residents. There was also a maintained improvement in the reporting of serious incidents affecting residents at the home to the Commission. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 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 the following standard(s): 2, 3 and 5. An adequate system is in place to assess service users’ needs and goals effectively and ensure that these are met. Service users are protected by appropriate statements of terms and conditions with the home. EVIDENCE: Four service user files were inspected and each included detailed assessments of service users’ needs and aspirations, prior to their admission to the home. Copies of contracts with the local authorities and statements of terms and conditions with the home, were also available within each service user file. No new service users had been admitted to the home since the previous inspection. Discussion with the manager and staff in the home indicated that the staff team is knowledgeable regarding the needs of users. Service users spoken to indicated that the home was meeting their needs effectively. St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 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 the following standard(s): 6, 7 and 9. Service users’ care plans are reviewed regularly to ensure that responsive care is provided to meet their changing needs. The majority of risks are recorded appropriately with strategies in place to ensure the protection of service users. However insufficient recording of their choices and preventative measures taken, compromises their independence. EVIDENCE: Four service user plans were examined in detail, and there was evidence to indicate that the individual choices of service users were generally respected, and their care plans had been prepared in consultation with them or their representatives. As required at the previous inspection care plans had been reviewed within the last six months. Progress had been made on the requirement made at the previous inspection that service users’ wishes with regard to furniture and equipment provision in their rooms be recorded. A format for recording this information was sent to the inspector, however the manager advised that these forms had not yet been completed with each service user. This requirement is therefore restated. St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 Page 11 At the previous inspection it was required that a risk assessment be undertaken with regard to any service users at risk of causing flooding in the home, whose water supply to their bedroom sinks had been cut off. It remains required that risk assessments be undertaken for all such service users and that agreement forms including the signatures of service users and relatives/advocates (when appropriate) and service users’ care managers should be completed, and reviewed regularly. The inspector was concerned that some service users who are not at risk of causing flooding within their rooms, have also had their water supply cut off. As noted at the previous inspection, the majority of risk assessments recorded within service user files had not been reviewed within the last six months. This requirement is therefore restated for the second time. Service users spoken to indicated that they were satisfied with the ways in which their needs were met at the home, and were encouraged to make their own decisions. St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14, 15, 16 and 17. Service users have access to meaningful activities both in the community and in the home and are supported to maintain links with their friends and families. There has been an increase in the number and variety of leisure activities available to service users outside of the home. Service users are encouraged to be involved in the running of the home and to develop independent living skills. Dietary needs of service users are catered for, with a varied selection of food available that meets their nutritional and cultural needs. EVIDENCE: A selection of photographs are available of service users involved in various recreational activities, and these activities were recorded within service user files. On the day of the inspection, several of the service users were out attending day activities (including attendance at local day centres). Most service users attend day centres on a full or part-time basis. Service user plans and staff spoken to indicated that service users are encouraged to maintain contact with friends and family members and to utilise independence skills at the home.
St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 Page 13 Service users spoken to were generally satisfied with the activities arranged for, or available to them, both inside and outside of the home. Indoor activities including puzzles, board games and basketball remain popular. At the previous inspection it was noted that the number of recreational activities available to service users had decreased with few leisure activities arranged outside of the home. Since this inspection, there had been an increase in activities provided including trips to the Natural History Museum, Clacton on Sea, fishing trips, eating out at McDonalds and a pub lunch. The manager advised that the possibility of taking some service users on a holiday in the next year was also being researched. Records indicated that a varied and nutritious diet is available to service users, and those interviewed spoke highly of the food served in the home. Greek cultural dishes are also available for the Greek service users in the home or other service users who wish to try these. St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 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 the following standard(s): 18, 19 and 20. Service users receive appropriate physical and emotional support according to their choices, and their medication needs are met. However insufficiently rigorous medication procedures and recording, places service users at risk of harm. EVIDENCE: St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 Page 15 The service user plans examined indicated that the personal and healthcare needs of service users had been assessed and responded to. Service users spoken to advised that their needs were met sensitively according to their preferences. They confirmed that their privacy was respected and that staff spoke to them appropriately at all times. As required at the previous inspection, care plans had been updated to include details of all diagnosed medical conditions affecting each service user, and appropriate care and support to be provided. A record continues to be maintained of all medicines dispensed into dosett boxes, for administration to service users by staff members. The signatures of at least two staff members were recorded for all medicines thus dispensed. However, although concerns were raised at the previous inspection regarding the recording of medicines administered, the inspector was concerned to note further errors in the recording of medicines administered on this occasion. The inspector noted that Sertraline tablets had been administered to a service user for at least one week without any record of this being maintained. The manager advised that this had been administered on the advice of the service user’s doctor, however there was no record of this consultation, available. It was also of concern that staff signing for medicines administered had not noticed that they were giving out an extra tablet, compared to those that they were signing for. Another service user had been receiving a dose of a particular medication, once daily, whilst the medication administration sheet indicated that they had been receiving this dose twice daily (i.e. double the amount) for almost a month. It emerged that the correct dosage was in fact once daily, however, concerns remain that a variety of different staff members had continued to sign for a dosage of medication that was not actually administered. Requirements are made accordingly, and the manager was advised that these issues must be addressed as a matter of urgency, to fully protect service users from harm. St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 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 the following standard(s): 22 and 23. The home has adequate complaints and adult protection procedures to ensure that the concerns of service users are acted upon effectively. EVIDENCE: Service users informed the inspector that they were well treated by staff. No complaints had been made to the home since the previous inspection, and none were received from service users by the inspector. The home had the required policies and procedures for safeguarding service users, including a complaints recording format and an adequate adult protection procedure. St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 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 the following standard(s): 24, 26 and 30. The home is sufficiently comfortable to meet service users’ needs safely with adequate private and communal space. The general cleanliness of the home is satisfactory, however service user’s comfort may be compromised by the need for a number of minor repairs and replacements in their individual rooms. EVIDENCE: All service user’s bedrooms were inspected and each was individualised with personal possessions as appropriate. All potentially hazardous chemical substances (COSHH materials) were stored appropriately, and COSHH hazard analysis sheets had been obtained for the materials used within the home. The home was clean and was generally well maintained. Service users spoken to advised that they were happy with their accommodation, and that they had the opportunity to personalise their own rooms according to their wishes. Inspection of individual rooms indicated that some minor repairs/replacements were required. It remains required that the carpets in a number of service users’ rooms in the home and the chair in one service user’s room, be replaced. It is also required that the tiles on the fire place in one service user’s room and drawer handles in a number of service users’ rooms be repaired, and that the upstairs bathroom radiator be repainted.
St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 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, 35 and 36. The home is adequately staffed and staff members are generally well trained to meet the needs of service users at the home, although they would benefit from training in addressing the needs of service users with challenging behaviour. There is evidence that an adequate recruitment procedure is in place to safeguard service users, and staff members are supervised appropriately. EVIDENCE: Service users spoken to spoke positively about the support that they received from staff, and the manager and staff members were knowledgeable regarding their roles and responsibilities. Training and supervision records for staff members were satisfactory and up to date. A sample of staff files were inspected and found to be satisfactory. At the previous inspection the manager and her son were reminded that the home must undertake its own CRB disclosures for any new recruits, even if they have recently undertaken CRB disclosures through another organisation. Evidence was available that staff had recently undertaken training in the control of substances hazardous to health (COSHH), adult protection and fire safety. In view of some of the incidents that have occurred in the home in recent months, it is required that staff also undertake training in working with people with challenging behaviour.
St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 Page 19 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. The home is managed appropriately, with the needs of service users in mind, however insufficient consultation with service users may mean their wishes are not always respected. Health and safety checks within the home are generally adequate to safeguard service users from harm, however inadequate labelling of meat and fish stored in the freezers may place service users at risk. EVIDENCE: Service users and staff interviewed indicated that they were happy with the way the home was managed, and with the support provided from the management team. St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 Page 20 At the previous inspection, a requirement was made regarding the frequency of service user meetings. Whilst it is accepted that a formal meeting may not be an appropriate format for every service user at the home, there was also insufficient evidence that informal meetings or one-to-one sessions are used to consult with service users about the home, and a requirement is made accordingly. It is also required that the results of the most recent quality assurance audit for the home must be made available to the local CSCI area office. As required, serious incidents affecting the wellbeing of service users were being reported to the local CSCI area office. Maintenance records checked were generally satisfactory, with recent gas, electricity and portable appliances test certificates available. Major work had been undertaken to upgrade the home’s plumbing systems in line with work specified by Thames Water following an inspection. Fire safety procedures were also found to be satisfactory. As required at the previous inspection the daily temperatures of the refrigerators’ and freezers’ were being recorded. However the inspector was concerned to come across both meat and fish in unlabelled packaging, stored within the freezer. All meat and fish must be stored in its original labelled packaging and dated appropriately with evidence available that it has come from a reputable source, to ensure the safety of service users. St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 Page 21 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 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 2 X 1 X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X 2 X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
St Raphael`s Integrity Care Home Score 3 3 1 X Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X 2 X DS0000010719.V250383.R01.S.doc Version 5.0 Page 22 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 YA7YA26 Regulation 15(2c,d) 23(2e,f) Requirement Timescale for action 02/12/05 2 YA9 13(4) 15(2b) 3 YA9 13(4c) 15(2c,d) The registered person must ensure that when individual service users choose not to have an item of furniture/equipment specified under Standard 26 of the national minimum standards e.g. a second chair for their bedroom, this must be recorded within their service user plan including the signature of that service user or an advocate to indicate that this is their choice. (Previous timescales of 17/12/04 and 05/08/05 not met). The registered person must 02/12/05 ensure that all risk assessments are updated at least six-monthly. (Previous timescales of 17/12/04 and 05/08/05 not met). The registered person must 16/12/05 ensure that risk assessments are drawn up with regard to all service users whose taps have been disconnected in their individual rooms, due to a risk of flooding. The assessments should include the signature of the service user or advocate (who has agreed to this measure being taken) and their social
DS0000010719.V250383.R01.S.doc Version 5.0 St Raphael`s Integrity Care Home Page 23 worker, at their next review visit to the home. (Previous timescale of 05/08/05 not met). Service users who are not at risk of causing flooding, must have the water supply to their bedrooms reconnected. The registered persons must ensure that the following concerns regarding the recording of medicines administered to service users are addressed as a matter of urgency: All staff must be trained to check the prescribed medicines that they are administering and sign for each individual medicine at the time of administration. No medicines should be administered without a record being maintained of each administration. No medicines should be signed for, before they are administered to the relevant service user. Any advice sought from a medical professional regarding the administration of medicines, must be recorded clearly within the service user’s plan, and should be confirmed in writing from the medical professional as soon as possible. 5 YA24 23(2b,d) The registered persons must ensure that the following issues regarding the homes furnishings are resolved: The tiles on the fire place in one service user’s room and drawer handles in a number of service users’ rooms must be repaired.
St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc 4 YA20 13(2) 24/10/05 23/12/05 Version 5.0 Page 24 6 YA26 23(2)(b) (d) 7 YA35 18(1c,i) 8 YA39 18(2) 9 YA39 24(2) 10 YA42 13(4c) 16(2,i,j) The upstairs bathroom radiator must be repainted. The registered person must ensure that the chair in the identified service user’s room is replaced and that the carpet is replaced in another identified service user’s room. (Previous timescale of 19/08/05 partially met). The registered persons must ensure that staff undertake training in working with people who have challenging behaviour. The registered person must ensure that the frequency of service user meetings within the home is increased, so that regular meetings are held at least six times a year. (Previous timescale of 05/08/05 not met). The registered persons must ensure that the results of the most recent quality assurance audit for the home are sent to the local CSCI area office. The registered persons must ensure that all meat and fish is stored in its original labelled packaging and dated appropriately with evidence available that it has come from a reputable source, to ensure the safety of service users. 23/12/05 17/02/05 09/12/05 02/12/05 28/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Raphael`s Integrity Care Home DS0000010719.V250383.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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