Inspection on 12/07/05 for Talbot Street (30)

This inspection was carried out on 12th July 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Talbot Street (30) 06/01/09

Talbot Street (30) 08/01/07

Talbot Street (30) 16/11/05

Talbot Street (30) 19/01/05

Talbot Street (30) 17/05/04

Talbot Street (30) 10/03/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 30 Talbot Street Southport Merseyside Address 3 PR8 1HA Lead Inspector Elaine White Unannounced 29 June and 12th July 2005. th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 30 Talbot Street F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 30 Talbot Street Address 30 Talbot Street Southport Merseyside PR8 1HA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Speciality Care (Rest Homes) Ltd 01704 548 269 Mrs Greta Morphet Care Home 8 Category(ies) of LD Learning Disability 8 registration, with number of places 30 Talbot Street F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 8 LD. 2. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 19th January 2005. Brief Description of the Service: 30, Talbot Street provides care and support for up to 8 young adults with a learning disability. The home provides 24-hour support to the student’s resident. The students attend Arden College, which is an independent specialist Further Education College for students aged 16 to 25 years with learning disabilities and/or behavioural, social or emotional difficulties. Placements can be provided for 52 weeks. These are agreed with the placing authorities and the company. The home is managed by Speciality Care (Rest Homes) LTD and is part of the Arden College network. The home manager, Pauline Harwood, is responsible for the day-to-day running of the home under the supervision of the registered manager, Mrs Greta Morphet. The home is a large semi – detached property, which is situated close to the town centre of Southport. The home is a converted house, which has been divided into 8 units of accomodation on three levels. Access is gained via a main entrance to the service users individual accommodation. There is a rear-grassed garden which the students can use in the summer months. The home provides two communal lounges, a large dining area and kitchen. The front has a paved parking area. An office is available for staff on the first floor. 30 Talbot Street F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 2 days. Both were unannounced visits and conducted as part of the regulatory requirement for care homes to be inspected at least twice a year. A tour of the building was conducted. Case tracking was conducted on the 3 residents to assess the care and support provided. Staff records were not viewed as these are stored centrally and will be viewed at the next inspection. A selection of home records was viewed. 2 support workers, the home manager and 7 students were spoken with and their views obtained of the home. Comments received have been favourable regarding the home, the staff employed and the activities provided. What the service does well: The home is divided into 8 bedrooms, which are individually furnished to meet the needs of the young students. Rooms contain their own personal possessions i.e. DVD’s, TV’s, music systems etc for their own use. 2 lounges and a large dining room provide ample space for the students to mix with staff and other students. These rooms are also used for student tutorials and daily living skills. The students are encouraged to maintain contact with family; friends and visitors are made welcome at the home. A range of activities are provided to meet the needs and interests of the young adults. These include – cinema, iceskating, bowling, discos, pubs and restaurants. Risk assessments are in place for activities undertaken. A key worker system is in to provide 1-1 support to the students. Discussion with staff and students confirmed that this works well as they can relate to one particular care worker. Access to other services is available as a number of the students require input from a speech therapist who attends the home to provide these sessions. Policies and procedures are in place and are regularly reviewed by the registered manager. 30 Talbot Street F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Although several improvements have been made to the environment since the last inspection some are still in need of addressing and are beyond the time scale set of June 2005. Improvements and repairs noted during this inspection are also included within the requirements of this report. These will improve the standard of the home. The home manager confirmed that the protocol in place for repairs/decoration/replacement is time consuming, as all requests have to be processed and agreed by head office. A security door entry system in place at the front entrance; however on the day of the first visit the entrance was not secured, the entrance open and the home found to be vacant. This was brought to the immediate attention of the home manager who in turn immediately brought it to the attention of the care staff. Staff must be made aware to secure the premises at all times to ensure the safety of the residents and their belongings. 30 Talbot Street F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 Page 7 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. 30 Talbot Street F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection 30 Talbot Street F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3. Prospective students are provided with an information pack prior to admission ‘Welcome to Arden College’. A full assessment is undertaken prior to admission to enable the home to meet their needs. Individual student agreements are in place. EVIDENCE: A statement of purpose is in place and meets the National Minimum Standards required. A service user guide (student agreement) is available in picture format and is signed by each individual. Records viewed showed that a full assessment of need is completed prior to admission and includes information on health and personal care, educational needs, background details, risk assessments and hobbies and interests. Access is available to a speech therapist at the college and other health care professionals when required. 1 student has communications aids i.e. makaton and dynavox. The home aims to become a ‘centre for communication’ and staff are to receive training in this area to help them meet the needs of the students. Staff were observed to communicate effectively with the students on their return from college. The students are provided with an educational, social and daily living programme to meet their individual needs and preferences. Tutorials take place at the home to monitor student progress. 30 Talbot Street F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9. The students are involved in decision making through tutorials, meetings and reviews. Activity programmes are in place to enable the students to take part in all aspects of life in the home. Risk assessments are in place to support their lifestyles and activities. EVIDENCE: Service user plans were viewed for 3 students, which are regularly reviewed with the involvement of the students. Reviews are conducted monthly by the home manager and annually by the placing authority. The plan is generated from the assessment and covers all aspects of health and personal care, social support and educational needs. Targets are in place for each student and are reviewed regularly. Risk assessments are provided and kept up to date through the reviewing process. Procedures are in place for students likely to be aggressive or cause self-harm. 5 students require 1-1 supervision at all times. A personal tutor is available weekly to provide tutorials with each student to monitor progress. A key worker system is in place and students are aware of who their key worker is. Pictures are displayed in the home for visitors to identify the key worker system in place and the students resident. The student’s were observed to communicate positively with the staff on duty and were very excited about the leavers’ disco taking place that evening. Prior to 30 Talbot Street F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 Page 11 admission the students and their families have the choice of opening individual bank accounts. College accounts are audited independently every 6 months. An advocacy service is available if required. Students are involved in decision making via tutorials, student meetings and within the reviewing process. 30 Talbot Street F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,17. An individual educational and activity programme is in place, which includes community involvement, use of the local facilities based on their assessed needs and interests. Menus are in place and alternatives available. Lunch is provided at the college and consists of a varied menu. EVIDENCE: Viewing of 2 students’ records, assessments, care plans, risk assessments and activity and educational programmes confirmed that the students are provided with the opportunities for personal development. The students are provided with the opportunity to develop social contacts via college, community activities and trips out with other units. Students spoken with confirmed that they enjoy the activities provided and are able to access those, which are of interest to them. All the students were excited about attending their leavers’ disco that evening and wished to show the inspector the outfits they had bought. 1 student is a football fan and likes to go the local pub to watch the matches. Staff spoken with said the students have access to the amenities available in Southport with their support. These are provided individually or as a group and include – swimming, cinema, ice-skating, bowling and discos. The home provides a flexible approach to the activities provided based on the 30 Talbot Street F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 Page 13 choice and preferences of the students. All rooms were viewed and were found to be comfortably furnished and contained personal equipment belonging to the students. These include CD players, TV’s and videos. The students were observed to choose to relax in the lounge, watch TV, mix and chat with staff or go to their room for privacy. The initial assessment and continued review process actively involves the students families who are involved in their placement. Family links are encouraged and relatives visit the home to pick up the students to take them home at the end of term or for weekend breaks. The students via their own mobile phones or the home’s phone maintain regular family contact. Menus are provided in picture format and 3 options are available – healthy option, daily option and vegetarian. The students confirmed their satisfaction with the food provided. Lunch is taken in the college canteen. The students take part in the preparation of the meals as part of their daily living skills. 30 Talbot Street F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21. A full assessment and reviewing process enables the home to monitor change and provide access to health care professionals. Policies and procedures are in place for the safe handling of medication. EVIDENCE: Records showed the students are all registered with a local GP. A speech therapist is accessed via the College and was attending the home during the inspection to discuss communication needs of the students with the staff. Nominated staff supervise medication and records kept of all administrations made. All medication is securely stored and policies and procedures are in place. Access is provided, with staff support, to other health care professionals locally, i.e., dentist, and all visits recorded. The community nurse visits regularly to monitor the progress of the students. 1 student is completing a ‘personal centred plan’ as she is due to move onto a new placement. This aims to identify ‘who and what is important ‘ and ‘where they aim to progress’. 30 Talbot Street F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22. A complaint procedure is in place for the students in a suitable format. Students are aware of how to complain. The staff are provided with the policies and procedures to enable them to deal with complaints. EVIDENCE: Policies and procedures for complaints are in place and available in suitable picture format for the students. Staff have access to the policies and procedures and are obliged to read them on induction. 1 student spoken to said that if he had a complaint “I would tell my family”. Another said she “would tell Pauline”, home manager. Regular reviews, tutorials and visits to other health care professionals provide the students with the opportunity to discuss their care needs. Staff spoken to said “students have their say in key worker sessions and student meetings”. 30 Talbot Street F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29,30. A number of outstanding requirements and further improvements must be made to raise the standard of the home and to meet the needs, safety and welfare of the students. Student’s bedrooms contain personal possessions and equipment to promote their independence. Sufficient toilets and bathing facilities are provided. The home is clean and hygienic. EVIDENCE: All rooms were viewed and were comfortably furnished and clean. However there are areas in need of general redecoration due to the wear and tear. The students spoken to commented on their satisfaction with their accommodation. A number of requirements from the last inspection have been met, however a several are still outstanding and are included in this report. These include – new kitchen, replace rotting windows and the painting exterior. Further improvements were noted during the inspection and are included within the requirements of this report. These are – replace carpets in lounges, continue new hall carpet up the stairs (to match), 4 new beds and bedding for (the new intake of 4 students), repair wall in room 2, general painting throughout, replace broken video unit in lounge, repair hole in ground floor hallway, repaint 30 Talbot Street F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 Page 17 front steps (non –slip substance in view of recent accident recorded) and clear rubble form rear patio and make safe for student use. Radiator covers are in place in most areas and the manager confirmed these are soon to be completed throughout. There is a planned maintenance programme and a maintenance person is available for repairs. However, discussion with the home manager confirmed that the protocol in place for reporting repairs/replacement/decoration is time consuming as all agreements are made at head office. 6 monthly home audits completed identify improvements required. There is no disabled access. A door entry system is in place at the front entrance for security, however the home was left ‘open’ during the first unannounced visit and was brought to the immediate attention of the home manager for action. All bedrooms are lockable with an override device for safety. All the students have their own personal possessions, which include, TV, Videos and CD players. A number of students have brought their own double beds for use in their rooms. There are 4 bathrooms, 3 showers and 2 additional WC’s. All are accessible on all three floors of the premises. Toilets and bathrooms are lockable. Bath and shower temperature regulators are in place and water temperature checks recorded. The home has two comfortably furnished lounges, one large dining room and kitchen, which are used collectively for all students and staff. The laundry facilities are located in the basement. There is a small-enclosed rear garden. Staff facilities include – staff room and toilet. No sleep-in facilities are required. 1 student has access to makaton and dynavox communication systems. Staff on duty were observed to communicate effectively with the students. The home aims to become a ‘centre for communication’ and is to train the staff in the use of communication aids. 30 Talbot Street F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,36. The home has a core team of staff who are well supported and appropriately supervised. EVIDENCE: Discussion with staff and home manager confirmed that there has been an improvement in the stability of staff cover at the home. 11 core staff provide continuity of care to the students. Staff were observed to communicate effectively with the students during the inspection. A training programme is in place and staff now receive ‘in house’ training from the home manager, which covers COSHH, health and safety, manual handling, fire safety and contagious diseases. The college provides other training during term breaks. The home manager confirmed that all care staff are registered on NVQ Level 2/3 courses. Staff spoken to and records viewed confirmed that support and supervision is in place. Staff meetings are held and records maintained. Staff personal records were not viewed at this inspection as they are stored centrally and will be requested for viewing at the next inspection. 30 Talbot Street F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,40, 42. Policies and procedures are in place, reviewed annually and available to staff. Staff are provided with the training required for them to carry out their roles. General records are maintained to ensure the health, safety and welfare of the students. EVIDENCE: The home manager has a qualification in NVQ Level 3 and has almost completed her Registered Managers Award. The registered manager is qualified in NVQ Level 4. The home manager demonstrated a positive approach to ensure the needs of the students are met. Records viewed and staff spoken to confirmed that the home is organised and staff are supported and supervised. A pleasant relaxed atmosphere was evident during the inspection and staff and students talked freely together and were looking forward to the leavers disco. Discussion with students and staff on duty demonstrated that the staff relate to the students. Staff and student meetings are used to voice concerns and discuss day-to-day running of the home. 30 Talbot Street F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 Page 20 The home manager conducts her own quality audit to grade the standard of the home. Regulation 26 visits are conducted monthly to monitor progress. Accidents and incidents are recorded and safety procedures are on display. Insurance cover is in place. Gas and Electrical certificates are up to date. Portable appliance testing completed 10/1/05. COSHH procedures are in place. Fire procedures in place and records viewed. Maintenance checks are completed monthly. Insurance is in place and on display. The home manager provides in house training for COSHH, fire safety and health and safety. The home has motor insurance to provide safe transport of the students when required. The home manager ensures that water temperature checks are in place and recorded. 30 Talbot Street F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 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 3 3 3 x x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 x x 3 Standard No 31 32 33 34 35 36 Score x x 3 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 30 Talbot Street Score x 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 x x 3 x 3 x F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 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 24 Regulation 23 Requirement Timescale for action 30th September 2005. 2. 24 23 The registered person must ensure the following improvements are made to raise the standard provided. - New kithchen units/replace rotten windows/paint exterior of the home/general repainting of interior due to wear and tear/replace lounge carpets/continue new hall carpet up the stairs to match/repair wall in room 2 and hall/continue completion of radiator covers/repaint front steps with non slip surface/purchase 4 new beds and bedding for new intake. The registered person must 31st August ensure that the home is safe and 2005. secure. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 24 Good Practice Recommendations The protocol of reporting repairs to be reviewed to avoid delays. F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 Page 23 30 Talbot Street 30 Talbot Street F53 F03 S5231 30 Talbot St V227681 220605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Burlington House, South Wing 2nd Floor, Crosby Road North Waterloo Liverpool L22 0LG 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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