Inspection on 12/07/06 for Stoneleigh

This inspection was carried out on 12th July 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

Stoneleigh 23/11/05

Stoneleigh 11/05/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Stoneleigh Retirement Home 19 Victoria Road Stechford Birmingham West Midlands B33 8AL Lead Inspector Jane Walton Unannounced Inspection 12th July 2006 10.00a 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 Stoneleigh Retirement Home DS0000062525.V303797.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. Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stoneleigh Retirement Home Address 19 Victoria Road Stechford Birmingham West Midlands B33 8AL 0121 628 6099 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 Pamela Sale Mrs Ann Patricia Smith Mrs Pamela Sale Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. That in addition to the care manager that there are a minimum of two care staff on duty throughout the waking day. That at night the minimum staffing levels of one person on waking night duty and one person on sleeping in duty are maintained. Ancillary staff are to be employed in addition to the minimum staffing levels to cover catering and cleaning. The ramped access at the side of the building is to be improved and enhanced to provide access into the building for people who experience mobility difficulties within six months of registration. Handrails are to be fitted next to the garden steps within six months of registration. Shower facilities within the home are to be improved to floor draining level access over a period commencing from six months of registration and completed within twelve months of registration. Additional aids and adaptations within bathrooms, toilets and shower rooms are to be fitted as guided by an occupational therapist within six months of registration. Temperature control valves are to be fitted to showers within the home within a period not exceeding three months of registration. Bedroom doors are to be fitted with suited locks within twelve months of registration. Velux windows are to fitted with window blinds within three months of registration. A guard or cover for the radiator in the en-suite shower room is to be fitted within three months of registration. 23rd November 2005 5. 6. 7. 8. 9. 10. 11. Date of last inspection Brief Description of the Service: Stoneleigh is an adapted domestic property located within the residential area of East Birmingham. The home is situated close to a local railway station and is well sited for public transport links and local road networks. There is sufficient off road parking at the front of the premises to accommodate 2 vehicles. Stoneleigh can provide residential accommodation for 15 older persons. The home has eleven single bedrooms and two shared rooms. Twelve bedrooms are located on the two upper floors and a single room is Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 5 situated on the ground floor. There is a shaft lift, which enables access to the first floor. The premises include a flat on the upper floor, which is currently utilised by staff for sleep-in purposes. Communal space is offered in two lounges, a dining room and a conservatory. There is a secluded staged rear garden including a paved area where residents can sit during clement weather. The home has a bathroom on each of the upper floors and a spacious assisted shower room is located on the ground floor. Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced Key Inspection took place over 1day in July 2006. This was the first inspection for the Inspection year 2006/07. There were 15 residents in the home and the inspector was able to speak to 6 of them. The manager was present throughout the inspection process. During the inspection process the inspector sampled residents files and case tracking was undertaken in respect of a small number of residents, in addition to inspection of other documentation relating to the management of the home. Discussion took place with 4 members of staff. What the service does well: What has improved since the last inspection? Further decoration and refurbishment has been undertaken and continues with a rolling programme. All residents now have height adjustable beds. Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 7 Training for staff has moved forward addressing shortfalls in mandatory training areas and all staff have now undertaken medicine management .training. 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. Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 8 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 Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 9 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, 5, & 6 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Documentation provide to prospective residents is adequate for them to make an informed decision about the home. Pre-admission assessments are carried out demonstrating the home’s ability to meet identified needs. EVIDENCE: The statement of purpose and service user guide contain sufficient information to satisfy the standard. Copies are made available for all prospective residents. The contract of terms of residency is included. The tool utilised for pre-admission assessments is further expanded on admission to form the framework of the care plan. The manager is aware that there is a need for a separate and more comprehensive assessment tool. Preadmission assessments are carried out by one of the owners at a venue convenient to the prospective resident. Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 10 Relatives and the prospective resident are invited to visit the home, socialise with staff and residents, sample the food and overnight or weekend stays can also be arranged. Following admission a trial period of 28 days is provided prior to a placement being confirmed. Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Care plans, and residents daily records set out an individual plan of care, which ensures health, and social care needs are being met. Staff interact well with residents and their privacy and dignity are maintained. EVIDENCE: Two care plans were examined. They were seen to be comprehensive and contained clear, easy to understand information. Evidence was seen that the plans had been reviewed regularly and a range of risk assessments had been carried out. The manager does need to make sure that staff always sign and date the assessments. There was a clear record of visits from GP, District Nurses and other health professionals such as optician and chiropodist. Residents are weighed monthly and where indicated regular monitoring of those at risk of developing pressure Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 12 ulcers. All residents have height adjustable beds. One resident who had a pressure sore, that is now healed had a suitable pressure relieving mattress on the bed. The activities of daily living are well documented including likes/dislikes and preferences. Files contain life histories, hobbies and social and recreational preferences. One resident has had a history of falls, and it was recommended that they be referred to a falls clinic. Daily records described the physical care given to residents but lacked information about the activities that they had undertaken. There were medication, homely remedies and self administration policies and procedures available. Staff have all undertaken Medication Management training. Medicines are kept in a locked cupboard. A Monitored Dosage System (MDS) is utilised in the home. The management have recently changed supplying pharmacist. There was a Controlled Drug (CD) cupboard, although at the time of the inspection there were no residents having CD’s. For safety and ease of reference a current photograph of each resident is attached to the Medicine Administration Record (MAR) chart. It was not possible to carry out a medicines audit due to the change in supplier the previous week, and carry over of systems had not been finalised by the pharmacist, although new MAR charts had been issued and were being used. An audit to assess standards will need to be carried out at the neat inspection. The MAR charts that were examined were seen to have a couple of gaps where signatures were missing. From observations and comments received from residents and relatives residents privacy and dignity is ensured. Staff were noted to be using the preferred term of address and personal care was delivered in the privacy of a bathroom or the bedroom. There was good interaction observed between the residents and staff. When a resident is very ill they are given the option of remaining at the home or being admitted to hospital. The decision is made in consultation with the family and health care professionals. The services of District Nurses and McMillan Nurses can be utilised if required. Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 13 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, &15 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. There is a variety of food served in the home which enables a balanced and nutritious diet. Residents are enabled to maintain contact with family and friends and local community as they wish. EVIDENCE: Activities offered are varied and being further developed. External entertainers are invited to the home including regular movement to music. On the day of the inspection an outside entertainer was in the home in the afternoon. Residents spoken to informed the inspector that a few weeks ago “We went out to the theatre to see “Roll Out the Barrel”. It was wonderful. Some of the carers came with us in the hired bus” Another resident stated that “ We have sing alongs to Music which I really enjoy” A session of Karaoke was arranged for the afternoon following the outside entertainer. The manager said that they were in the process of sourcing new and different activities for the residents. Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 14 Spiritual needs are met by visiting clergy. Residents are encouraged to make the most of their mobility, and go out with family and friends. There are wheelchairs available for anyone who cannot walk far. Regular residents meetings have been established with minutes being distributed accordingly. Members of the legal profession are able to make appointments and the home offers an advocacy service from an external source. The cook has worked in the home for many years. The home has compiled a rolling menu; lunch is the main meal of the day. The menu indicated that a balanced diet is provided and that alternatives are always available. All requests are catered for at breakfast and a light meal is supplied each evening, although the menus supplied were very repetitive for supper/tea, offering sandwiches, soup and cakes every day. The manager stated that residents are encouraged to eat a little and often, food is varied, hot or cold, and is available throughout the day as well as at the set meal times. An individuals preferences are catered for, and at supper time as well as sandwiches and soup there is a hot option available should anyone want it. Drinks are freely available throughout the day. The inspector joined the residents for lunch and tea on the day of the inspection. The dining room is able to seat all residents in one sitting if needed. Tables were laid appropriately with cloths, serviettes and cutlery. One of the residents was observed assisting with laying the tables. This is a task that this resident loves to do each day. Jugs of blackcurrant squash were on each table, and condiments were available. Staff were in attendance for anyone requiring assistance, and one resident was helped to cut up their meal. Another resident didn’t eat their meal, and carers were heard to offer her alternatives or just a pudding, but it was all declined. Instead, another carer brought the resident a glass of “build Up” meal replacement which was accepted. The meal served was hot and tasty, and residents appeared to enjoy their food. Some residents enjoy an alcoholic drink during the evenings and sherry is offered with Sunday lunch. Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 15 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 & 18 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure that is accessible to residents and visitors so that they are aware of how to make a complaint ensuring the promotion of protection matters. Residents opinions are listened to and acted upon and the arrangements for the protection of residents are satisfactory. EVIDENCE: The complaints procedure is comprehensive and available to residents and relatives. There is a tool for the logging and monitoring of complaints. There have been no complaints received since the last inspection. The written policy regarding adult protection provides adequate information and instruction to staff in how to respond to concerns raised or witnessed. There is also a policy advising about whistle blowing. Staff have had training in adult protection and dealing with challenging behaviour. Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 16 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 21, 23, 24, 25 & 26 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Residents live in a warm, generally comfortable and safe environment. The premises are tidy and hygienic throughout. EVIDENCE: A tour of the premises was undertaken. There are residents bedrooms on three floors, and five of these are on the 2nd floor. There is 1 passenger lift. Radiators are covered to prevent burn accidents and have been fitted with new thermostatic controls. The shower room on the 2nd floor is not used, and it is not a flat access shower. The one on the ground floor is generally used. All toilets have raised seats and grab rails fitted. Some of the bedrooms have had new carpets fitted and all have been redecorated. All residents have had new duvets and bedding, and personal possessions brought in by residents were evident. Lockable facilities are Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 17 provided for residents who want them, and privacy locks on bedrooms are fitted if a resident wishes to have one. There are 2 sitting rooms. The smaller of the two is designated a quiet room. There is a new carpet, a small television and video and comfortable chairs. The larger sitting room has a large flat screen television positioned on the wall to aid optimum viewing for the residents. As part of the rolling refurbishment programme there are plans to purchase all new arm chairs. There is a double glazed conservatory, that is designated for the 2 residents who smoke to use. Fire risk assessments are in place. There is a small garden with decking and pot plants. There are plans to purchase some garden furniture. The laundry facilities are in the basement, and a new tumble dryer has been purchased. The manager stated that there were still improvement to be made to the location of the laundry and the facilities, and other areas of the environment. The home was generally clean and pleasant, and residents stated that they were happy living at the home. An Environmental Health check was carried out on 4th July 2006 of the kitchen and food storage. The report stated that “good practices were being used by the cook.” Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 18 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, & 30 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Recruitment practices and appropriate training help protect residents and ensure their needs are met. EVIDENCE: Two carers and a manager are on duty during daytime hours and there is one carer at night with a senior person providing a sleep-in service. The manager informed the inspector that when dependency levels of residents required it there were 2 waking staff on duty at night. It was noted that as far as practically possible a member of staff is present in the lounge and dining areas. The home also has a full time cook who displayed in depth knowledge of residents preferences. A housekeeper is employed and a good level of cleanliness appears to be maintained. A recent Environmental Health check report stated that it was recommended that the cook undertake the Intermediate Food and Hygiene course. The manager is in the process of organising this. Recruitment practices were found to be satisfactory with all relevant checks being carried out prior to a post being confirmed. Newly appointed staff are expected to undertake TOPSS induction programme. The home is working towards 50 of staff completing NVQ level 2 training, and it currently stands at 48 . Some mandatory training has been supplied Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 19 and other courses have been arranged. Staff have had training in Adult Protection and abuse and on managing challenging behaviour. The co-owner of the home has enrolled to do the Registered Managers Award. Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 20 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): 31,32, 33, 35, 37,& 38 Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service. Senior staff have a well defined development plan and vision for the home, which is effectively communicated to residents and staff. The staffing structure provides clear lines of accountability. The programme of staff training and formal supervision helps to ensure the safety of residents. The homes’ generally good standard of record keeping safeguards the residents’ rights and best interests. The lack of a formal QA system could result in the home not identifying areas for improvement in meeting the needs of residents. EVIDENCE: Both owners have a wealth of experience within the care sector. One is the registered manager, and has an NVQ4 in management. The co- owner is currently undertaking the Registered Managers Award. Both owners demonstrate strong leadership and lead by example. Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 21 The home has not established a quality assurance system but improvements have been made and residents and relatives views are welcomed and acted upon. The manager is aware of the need to develop a formal QA system as soon as possible. The management of small amounts of residents monies are dealt with in the home, for the purchase of toiletries etc. The accounts, although normally kept in the home were not available due to a flood in the basement where the office is located. An audit will be undertaken at the next inspection. Regular staff meetings are held with minutes circulated accordingly. Regular formal staff supervisory meetings have been taking place and are documented. There is a file of policies and procedures available and accessible for all staff. Resident’s files are stored in a locked cupboard in the dining room; staff have access to them at all times. Accredited contractors have carried out all servicing and checking of equipment. Weekly fire alarm testing and regular fire drills are carried out. Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X 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 3 X 3 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 3 2 x x x 3 3 Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 23 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. 2 Standard OP12 OP15 Regulation 16(2)m 16(2)(i) Requirement A programme of activities must be displayed within the home. The tea/supper menu must reflect the wider choice of food that is available, not just sandwiches, soup and cake as stated on the menu provided. 50 of care staff employed should have completed NVQ level 2 training or equivalent. The home must implement a system of quality assurance. N.B. This requirement is carried forward. Timescale for action 30/09/06 30/09/06 3. OP28 18(1)c 31/12/06 4. OP33 24 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 24 1 2 3 OP3 OP7 OP15 It is recommended that the manager introduces a separate pre admission tool to the care plan. It is recommended that the manager refer all residents with a history of falls to a falls clinic. It is recommended that the manager introduces a more varied menu for the tea/supper menu. Stoneleigh Retirement Home DS0000062525.V303797.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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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