CARE HOMES FOR OLDER PEOPLE
Station Road (1) 1 Station Road Wheathampstead Hertfordshire AL4 8BU Lead Inspector
Claire Farrier Unannounced Inspection 10:00 25th February to 1st March 2007 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 Station Road (1) DS0000019556.V328507.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. Station Road (1) DS0000019556.V328507.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Station Road (1) Address 1 Station Road Wheathampstead Hertfordshire AL4 8BU 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) 01582 833 957 01582 833969 MacIntyre Care Manager post vacant Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (6) of places Station Road (1) DS0000019556.V328507.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th December 2005 Brief Description of the Service: 1 Station Road is a care home providing personal care and accommodation for six people with a learning disability, who may also be aged over 65. It is owned by MacIntyre Care, which is a voluntary organisation. Station Road is a two storey, Victorian house, standing in large grounds in the village of Wheathampstead, close to local shops and amenities. The accommodation comprises six single bedrooms, one of which is ensuite, dining room, lounge, large kitchen, utility room, two bathrooms plus a shower room. The first floor is served by a passenger lift. The home has a riverside garden with seating area and has car parking to the rear. The Statement of Purpose and Service Users Guide provide information about the home for referring professionals and prospective clients. The current charges were not available at the time of this inspection please contact the provider for this information. Station Road (1) DS0000019556.V328507.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over one afternoon, with a follow up visit the following week to provide feedback to the area manager. The focus of the inspection was to assess all the key standards, and some additional standards were also assessed. The majority of time during the visit to the home was spent talking to the people who live in the home, and one person showed the inspector around. Several members of staff also gave their views about the home, and some time was also spent looking at records, care plans and staff files. What the service does well: What has improved since the last inspection? What they could do better:
Most of the concerns that were found during this inspection are due to the lack of management in the home. There has been no registered manager for 18 months, and MacIntyre has not been able to appoint a permanent manager. There is no deputy manager and no senior staff in the home, and the manager of another home currently provides support for only three days a week. The care plans are not kept up to date, and there is no effective monitoring of health and welfare. Weights are not recorded regularly, and effective action has not been taken following a notable weight loss. Guidelines in the care plans for communication and for managing behaviour were not followed while the inspector was in the home. The people who live in the home are growing older, and all are now aged over 65. The staff have no specific training for the needs of older people, such as increasing physical dependence and the possibility of dementia or depression. One person is registered blind, but there are no facilities in the home to meet
Station Road (1) DS0000019556.V328507.R01.S.doc Version 5.2 Page 6 their specific needs, and the staff have had no training in visual impairment, nor in behaviour management. The care plan has not been completed for a resident who moved to the home six months ago. There are not enough staff in the home to meet the needs of the people who live there, and the number of staff employed in the home is not sufficient to meet their increasing needs as they become older and more dependent. Due to the lack of staff, most of the people who live there have no opportunity to take part in their choice of activities. Two immediate requirements were made at the time of the inspection, to provide sufficient staff to meet the needs of the people in the home, and to ensure that one person’s wheelchair was safe. A satisfactory response was received from the provider, that additional staff were in the home during the day, and an alternative wheelchair was provided to the person who needed it. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Station Road (1) DS0000019556.V328507.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 Station Road (1) DS0000019556.V328507.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of management and the low number of staff employed in the home means that the home does not meet the increasing needs of the people who live there. EVIDENCE: One person has moved into the home since the last inspection. They moved to Station Road following the closure of their previous home, and because of this the normal assessment and period of introduction was shorter than usual. An assessment was carried out before the person moved, and since they have moved in, there has been a continuous process of assessment, so that the staff can get to know the person’s needs. Station Road (1) DS0000019556.V328507.R01.S.doc Version 5.2 Page 9 On the day of the inspection there were not enough staff in the home to meet the needs of the people who live there, and the number of staff employed in the home is not sufficient to meet their increasing needs as they become older and more dependent. Some of the staff showed a lack of understanding of the specific needs of some of the residents, and in particular little understanding of the needs of a person who is registered as blind. There is no understanding of needs associated with increasing age, such as the possibilities of dementia, depression and decreasing mobility. Guidelines in the care plans for communication and for managing behaviour were not followed while the inspector was in the home. Further details of these observations may be seen in other parts of this report (see Health and Personal Care, Daily Life and Social Activities, Environment, Staffing, and Conduct and Management of the Home). It was reported that this has been raised with Hertfordshire Social Services, as the home is financed through a block contract. In January 2007 the psychiatrist from the Learning Disability Partnership also wrote to Social Services to raise concerns about one person who does not have sufficient support for their needs. Station Road (1) DS0000019556.V328507.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Health and personal care practices are inadequate, which may result in poor or inconsistent care being provided to the people who live in the home. EVIDENCE: The care plans are written in a person centred format, which shows that people are involved in making decisions about their care and their lives in the home. Most of the care plans that were seen contain good details of each person’s personal care and health care needs. Risk assessments have been completed that relate to the care plans, to ensure that the people who live in the home can do the activities that they wish to. One contained good details of the person’s likes and dislikes, and their preferences for activities. Station Road (1) DS0000019556.V328507.R01.S.doc Version 5.2 Page 11 However most of the care plans and risk assessments that were seen on this occasion have not been reviewed or updated. The care plan for the person who moved into the home in August 2006, which was six months before this inspection, has not been fully completed. There was no evidence on this occasion that the care plans are used as a source of good information for the staff on how to meet the needs of the people who live in the home. One person is registered blind, but there is little information on their specific needs. The only information relating to their blindness is “X needs support at all times outside the home when walking,” and “X likes to walk arm in arm with staff.” Even this brief information is not acted on. This person was observed walking from one room to another with a member of staff, not arm in arm or being assisted to find their way, but being pulled along by the member of staff walking backwards in front of them. Guidelines for communication were not followed. Some people were also encouraged to sit down, when they may have wanted to do something more active. No-one has been weighed since December 2006. One person’s record showed a continuing loss of weight totalling 7 kilos between October and December 2006, but no action was recorded following this, and no further weights were recorded. The home has satisfactory procedures for the administration and recording of medication. However an error was found in a spot check of the medication records. Most of the medication is provided to the home in individual dosage blister packs. One person has medication provided from the hospital in the original packaging. The person should be given two tablets every night, but there are two too many tablets remaining, which may mean that the wrong dosage has been given on one or two occasions. There is a thermometer in the office where the medication is stored, but the temperature is not monitored regularly to make sure that it does not rise above the manufacturer’s recommended temperature for any medication. On the day of the inspection, which was a warm spring day, the thermometer showed a temperature of 24.1°C. Most medications should be stored at below 25°C, and some supplies of Lactulose in the home state that it should be stored at below 20°C. Medication not stored at the appropriate temperature may loose its clinical effectiveness. One supply of paracetamol is kept for the use of any person who needs it. When it is given it is recorded on that person’s medication record, but it would be easier to monitor how it is used if there was a separate record book for paracetamol. The GP has signed agreement for one person to have paracetamol as a homely remedy, without prescription, but there is no agreement for the other residents. Station Road (1) DS0000019556.V328507.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of adequate staff in the home means that the people who live their do not have the opportunity to take part in their choice of meaningful activities. EVIDENCE: In the past the people who live in the home have been able to take part in their choice of activities in the home and in the community. Most of the residents attend a day centre for two or three days a week, and one goes to a local club once a week. However there are no daytime activities for one person, and the low number of staff at any time means that there are very few activities currently taking place. No evidence was seen of any organised group or individual activities during this inspection. The residents are not able to have one to one activities with the support staff, and some people were told constantly to sit down, when they may have wanted to do something more active. The home has a good relationship with the local community in Wheathamstead, especially with the local Church. The people who live in the home choose the weekly menus with the staff, and one person was doing the weekly shop with a member of the staff during the
Station Road (1) DS0000019556.V328507.R01.S.doc Version 5.2 Page 13 inspection. One person showed the inspector a communication book that they had prepared with their link worker, with pictures of their activities. This person had a review in March 2006 in which they were fully involved, and they set objectives that they would like to complete. One of these was to decorate their ensuite bathroom, which has been completed. However for other residents, observations during the inspection showed that they are not able to make decisions about their lives and activities in the home. The staff were only able to ensure that they were in a safe place, and they did not have the time to spend quality one to one time with anyone. Station Road (1) DS0000019556.V328507.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged and enabled to make their views and concerns known. Policies and procedures are in place to ensure that service users are protected from abuse and neglect. EVIDENCE: The home has a satisfactory complaints procedure in place. The people who live in the home are encouraged to make their concerns and complaints known. The record of complaints shows that people have made complaints about the care of their clothes and about the quality of food. The home has adequate policies concerning safeguarding adults (adult protection) and whistle blowing. All staff have had training in the prevention of abuse, and the staff spoken with were aware of the procedures for reporting any allegations of abuse. Station Road (1) DS0000019556.V328507.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The building provides a comfortable home for the people who live there, but lack of maintenance and poor decoration means that the environment does not meet some people’s specific needs. EVIDENCE: 1 Station Road is a two storey, Victorian house, standing in large grounds in the village of Wheathampstead. It is furnished and decorated in a domestic styles that produces a homely, comfortable environment that allows the residents to relax and feel very much at home. The residents all have their own rooms, arranged and decorated to reflect their particular interests and tastes. The lounge, dining room and kitchen are domestic in style and are comfortably furnished and well equipped. Station Road (1) DS0000019556.V328507.R01.S.doc Version 5.2 Page 16 The home appeared to be clean and generally well maintained, and the staff generally follow appropriate procedures to maintain hygiene and prevent the risk of infection. One bedroom and ensuite bathroom have recently been redecorated with the involvement of the resident. The bedroom for the person who is blind is decorated in very dark colours, and the person was observed having difficulty in finding their way around it, as there is no differentiation of colours or textures to help them. The dining room is due to be redecorated. In one bedroom there was a broken drawer, and in another broken shelf brackets. There is no liquid soap and paper towels to promote infection control procedures available in the bedrooms for the care staff to use when they provide personal care. Several people now use wheelchairs outside the home, and some need a wheelchair for moving around inside. The wheelchair that one resident uses to move around in the home has a handle that is insecure, and may cause a risk of injury. Following the inspection it was reported that the person was being assessed for a new wheelchair, and in the meantime another chair was provided for them. There is a lift to the first floor, which was out of operation for several days at the time of the inspection. One person had to sleep in the lounge on the ground floor until it was mended. Station Road (1) DS0000019556.V328507.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are insufficient numbers of staff to meet the increasing needs of the people who live in the home, and to safeguard their welfare. EVIDENCE: The permanent staff team consists of four day support workers and two night support workers. The staff rotas show that there are two support workers in the home during the day and one waking night staff. On the day of the inspection the night support workers were both working an additional day shift. One support worker had to remain in the home beyond the end of the shift until another support worker arrived. The home does not have a registered manager, and the manager of another home provides support in the home for three days a week. There is no deputy manager and no senior support workers. During the inspection the support manager was on leave, and there were no senior workers who could take responsibility for the home. Staff morale is low, and the staff who were spoken to said that they are unable to give the residents one to one time for activities, and to meet their increasing needs. A letter was seen from a psychiatrist that raises his concerns about the low number of staff and the effect that this has on the residents. Station Road (1) DS0000019556.V328507.R01.S.doc Version 5.2 Page 18 MacIntyre provides a good training programme that covers all the mandatory health and safety training. The induction training for new staff is designed for their work with people with learning disabilities. All the support workers either have a NVQ qualification or are waiting to start. All staff are expected to train for a qualification, and the company gives them a pay increase when they complete the qualification. However none of the staff have had training in the management of challenging behaviour and the process of ageing, or other specific needs such as visual impairment. Staff records are kept at MacIntyre headquarters. The procedures for recruitment of staff ensure that suitable people are employed to safeguard the people who live in the home. Station Road (1) DS0000019556.V328507.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of management has resulted in a poorer quality of life for the people who live in the home. EVIDENCE: The registered manager was on sick leave for a year, and resigned in May 2006. The manager from another home worked at the home until a new manager was appointed. Before he was registered, he was promoted to be area manager. Since then another manager has provided support to the home for three days a week. There is no deputy manager, and no senior support workers. At the time of this inspection the support manager was on leave, and there was no-one in the home with a management responsibility. At the feedback meeting, the area manager said that two managers had been
Station Road (1) DS0000019556.V328507.R01.S.doc Version 5.2 Page 20 appointed who had not accepted the post, and they were currently interviewing for the post again. The lack of management is evident in the findings of this report. Most of the issues for which requirements have been made are areas that have previously been assessed as good, such as care planning and activities. Macintyre has a robust system for quality assurance, including an annual audit of the service and regular monitoring visits to the home. These visits include consultation with the people who live in the home, and any issues that are raised are addressed by an action plan. The quality assurance process includes an annual development plan for the service. The last development plan recommended that everyone should have a person centred care plan, and this had been acted on. The arrangements for management of residents’ money were inspected and appeared to be accurate. Money is stored safely and adequate records are maintained in order to protect service users from financial abuse. The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff follow the home’s policies and procedures. All the staff have training in moving and handling, fire safety, food hygiene and infection control as part of their induction. Station Road (1) DS0000019556.V328507.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 X X 3 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 2 X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X X 3 Station Road (1) DS0000019556.V328507.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. 1. Standard OP4 Regulation 12(1) Requirement Measures must be put in place to ensure that the specific needs of each person can be met, and that the staff have understanding of the needs associated with increasing age. The registered person must ensure that all care plans provide adequate and appropriate information on each person’s needs, and that they are reviewed and kept up to date. Measures must be put in place to ensure that the weight of residents is recorded regularly. Appropriate actions must be taken following a recording of abnormal weight change, and the actions and results must be recorded in the care plan. Measures must be put in place to ensure that all medication is stored according to the manufacturer’s recommended temperature, in order to prevent the risk of administering medication that has deteriorated and is no longer effective.
DS0000019556.V328507.R01.S.doc Timescale for action 30/06/07 2. OP7 15 30/06/07 3. OP8 12(1)(a) 30/06/07 4. OP9 13(2) 30/06/07 Station Road (1) Version 5.2 Page 23 5. OP9 13(2) 6. OP10 12(1) 7. OP12 16(2)(n) 8. OP14 12(2) 9. OP19 23(2)(b) 10. OP22 13(4) 11. OP26 12(1)(a) Measures must be put in place to ensure that all medication is administered and recorded in accordance with the Royal Pharmaceutical Society guidelines and the home’s policy and procedures. This is in order to ensure that there is no risk of the wrong medication being given the people who live in the home. Measures must be put in place to ensure that the staff follow any guidelines for assisting the people who live in the home, in order to ensure respect for their dignity and independence. Measures must be put in place to ensure that residents are enabled to take part in a varied and appropriate programme of activities. The registered person must ensure that the people who live in the home are able to make their own decisions about their lives in the home and the care that they receive. The registered person must ensure that the premises are maintained in a good state of repair. The bedrooms must be decorated to suit each person’s specific needs. The wheelchair that one resident uses to move around in the home has a handle that is insecure. Measures must be put in place to ensure the safety of this resident until they are provided with their new wheelchair. An immediate requirement was made following the inspection. Facilities for hand washing must be made available for staff in the bedrooms, in order to promote good hygiene and prevent the
DS0000019556.V328507.R01.S.doc 30/06/07 30/06/07 30/06/07 30/06/07 30/06/07 01/03/07 30/06/07 Station Road (1) Version 5.2 Page 24 12. OP27 18(1)(a) 13. 14. OP30 OP31 18(1)(c) (i) 8 risk of infection. Measures must be put in place to ensure that there are sufficient staff in the home at all times to meet the residents’ assessed needs. An immediate requirement was made following the inspection. Training must be provided that meets the specific needs of the people who live in the home. The registered provider must ensure that a manager is appointed who can take day to day responsibility for the welfare of the people who live in the home. 01/03/07 30/06/07 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Station Road (1) DS0000019556.V328507.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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