Inspection on 07/08/06 for Tamarisk House

This inspection was carried out on 7th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tamarisk House 03/08/07

Tamarisk House 04/01/06

Tamarisk House 14/07/05

Tamarisk House 09/03/05

Tamarisk House 14/09/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Tamarisk House 26 Holt Road Horsford Norwich Norfolk NR10 3DD Lead Inspector Mrs Dorothy Binns Unannounced Inspection 7th August 2006 09:30 Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 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 Tamarisk House DS0000027586.V308163.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tamarisk House Address 26 Holt Road Horsford Norwich Norfolk NR10 3DD 01603 890737 01603 890840 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) www.caremanagementgroup.com Care Management Group Ltd (trading as CMG Homes Ltd) Mrs Deborah Jane Johnson Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th January 2006 Brief Description of the Service: Tamarisk is a care home providing personal care and accommodation for up to 3 younger adults with a learning disability. The service users may also have a physical disability. Care Management Group Limited, whose registered office is located in London, owns Tamarisk and other homes in the Norwich area. The home is located in the village of Horsford on the outskirts of Norwich. Local amenities, shops and pubs are also close by. The home consists of an adapted bungalow. All bedrooms offer single occupation. One of the bedrooms has ensuite facilities. There is ample communal space. Externally, there is a large rear garden with patio, lawns and furniture. This is easily accessible to all service users. Limited off-road parking is available at the front of the home. The level of fees for the service are dependent on the care needs of the service users. Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection lasting four hours. During the inspection discussions were held with the acting manager and with the deputy regional manager about the progress of the home and whether requirements from the last inspection had been attended to. Records and policies were also examined. Two of the service users were away on holiday but the one remaining service user was able to talk a little to the inspector and to show the inspector her room. One staff was interviewed in private and a tour was made of the building. In addition the Commission sent out surveys to the service users to see what they thought of the service. Information on the Commission’s files and contact with the home between visits has also been taken into account in the writing of this report. Only the key national minimum standards were covered in this inspection. Overall this is a good home for service users. Being small, only three service users, the care is individual and staff are very aware of their needs. There is a strong commitment to providing a good quality of life. Any deficiencies in the home are largely to do with record keeping. What the service does well: The service users are able to enjoy an active and stimulating life with a lot of outings, individual activities and attention from staff. They go out a lot and have good access to the community. They are also encouraged to stay in touch with their family. The health of the service users is monitored well to make sure they receive the attention they need. Medication is administered safely. Records about the service users are detailed enabling staff to properly look after them. The home has very good recruitment procedures and induction training for new staff to ensure that service users are protected and properly supported. The amount of training provided to staff is very good and makes for a more effective and competent staff group. The organisation is also showing a strong commitment to training. Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The quality of this outcome area is good. Service users are properly assessed when they are being admitted to the home and are reviewed regularly once admitted to ensure the care is appropriate and individual. EVIDENCE: Two service users files were examined and found to contain full assessments of the care needs, routines, behaviour, hobbies and family connections of each service user to ensure that the home assisted them appropriately and individually. There was a lot of information which was helpful to staff including what routine the service user was used to, how they communicated, and what they enjoyed. These service users had lived in the home for some time so the original information from social services or another service was not up to date but information is always sought from outside agencies when a new person is considered for admission. From this information the plan of care is devised. Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 The quality of this outcome area is good. Although there still needs to be some tightening up in the way financial records are kept, there has been some progress and the intention of the organisation is to be transparent. The care plans and risk assessments demonstrate that service users are supported to make their own decisions where possible and that the staff take into account their individual needs. EVIDENCE: The care records contain detailed information about each service user to enable staff to support them appropriately. From the assessment information, a pen picture is formed and details of what each person needs is drawn up. The records are very specific about how to deal with particular behaviour or health issues identifying where a service user is self caring, where they may need support, where they find things difficult, for example in a crowd. The plan is reviewed regularly and staff write daily notes on how the service user is progressing and what they have been doing. Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 Page 10 In terms of looking after their own money, the organisation as a whole has been working hard to enable service users to have their own bank accounts and enable service users to make their own decisions about how to spend their money though all the service users need support from staff. Two have all their benefits deposited into their own bank accounts (bankbooks checked) but one person has her money held by the organisation. This record was more muddled and not clear what benefits were received on her behalf. Named staff (the administrator of the organisation in the main home) had access to the bank accounts which showed money being withdrawn on their behalf for personal use. However this was held in the main home and only transferred to the home in small amounts. Once reaching this home, it was all well accounted for with staff signing the record and recording how it was spent. The gap was in the accounting for money held on a service users behalf at another place. It is accepted that as a small home, facilities are limited and it may be safer for cash to be held elsewhere. However it would help if the record accounted for this so an audit on paper could be done. A recommendation has been made. The care plans are supported by assessment of any risks involved in service users’ activities. These include not only whether they can handle their own finances or medication, but also what support they need when in a public place, travelling in a vehicle, drinking in a pub. These show that the home is thinking of the opportunities that service users have but where staff have had to weigh up safety issues. This is good practice. Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 The quality of this outcome area is good. Service users are at the heart of the service and are assisted by staff to take part in activities, see their family and friends, and do as much as they can to enjoy life. The routines of the home are flexible and the food is good. Overall staff try to make sure that service users have fulfilling lifestyles. EVIDENCE: Service users are not able enough to work in the community but do attend the organisation’s skills centre twice a week. One person has attended a college course in the past but is not currently. Service users do take part in age appropriate activities but these are largely organised by the home’s own staff. Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 Page 12 The service users use the facilities of the local community in terms of the shops, pubs and special events. Staff keep an eye on any activities which the service users might enjoy and tell them about it. The home has a shared access to transport and staff said that when they have the van they always go out for outings. Examples were given of such trips to the seaside, to visit friends, to picnics in the local countryside as well as shopping trips and visits to the pub. The care records showed that staff were aware of what each service user liked doing and some had particular activities like horse riding and swimming and ten pin bowling which they did quite regularly. One had also been to a concert recently. The daily notes in each service user’s record showed lots of references to being taken out. In house activities were also promoted. In the survey service users said they had lots of things to do. All service users in the survey said their family and friends could visit them in the home and the care plans made reference to visits from relatives and visits to their family homes. Two service users were currently on holiday with their families. The evidence was that service users are encouraged to keep in touch with their family and staff assist them to do so. Staff reported that routines were flexible and gave examples of the service users having different times for going to bed depending on what they were doing. Service users do not have keys for their rooms because of the dependency but they are able to have quiet times alone in their rooms as they wish. Staff spend a lot of time with the service users and involve them in home activities if they can. The ethos of the home is that staff spend time with service users taking them out as much as possible and ensuring they are happy and have access to facilities. The menus were seen and work on a three weekly rotating basis. They looked varied and nutritious and fresh salads and fruit were offered. A choice was available at breakfast and staff know what the service users like to eat so arrange the menus accordingly. Service users also go out for picnics and pub meals. None of the service users are on special diets and all can eat without assistance. All three service users in the survey said they could choose what to eat. Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 The quality of this outcome area is good. The evidence from the records is that service users’ health needs are monitored and action taken to see that they are met. Medication is safely administered. EVIDENCE: Service users are mobile but need some personal support with bathing and getting up and dressed. They are assisted in private and have their own rooms. Staff assist them to make decisions about what to wear, how their hair should be and they are encouraged to make as many decisions as possible. There are staff of both sexes on the staff so service users have some choice of who can help them. No specialist help is needed at present but where this is the case, staff said this would be arranged. Care plans showed that health issues were taken seriously with an assessment of health written in each care plan. These outlined what contact was expected with dentists, chiropodists or specialist assistance as well as specific conditions relating to physical or mental health. A weight chart was in evidence for one service user and the daily reports from staff commented on sleep patterns, upsets and other health related issues. Visits to GPs and community nurses were also noted. Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 Page 14 The medication systems were examined. Medication is kept locked and is prepacked by the pharmacist. Staff receive medication training and the administration record showed that they were giving out correctly. Staff records showed that training had been provided. There has been an incident in the past in this home where wrong medication was administered by an agency staff but steps were taken to ensure only experienced staff give out medication. On this occasion, medication was correctly dealt with and service users protected. Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 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 the following standard(s): 22 and 23 The quality of this outcome area is adequate. Procedures are in place to deal with complaints and suspicions of abuse and service users feel they can approach staff if they are unhappy. Better record keeping is required to show the home is dealing appropriately with these issues. EVIDENCE: The complaints procedure was available and is illustrated with pictures to make it easier for service users to understand. All three service users who were assisted to complete the Commission’s survey, said they knew who to talk to if they were unhappy. The complaints record was however empty though the information provided by the home for the inspection mentioned one complaint. Better recording of complaints is required with details of how the home investigated the complaints and the outcome from it. A requirement has been made. The home’s adult protection policy was seen and links in correctly to local multi agency procedures. Staff files showed that relevant training is provided to staff. Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 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 the following standard(s): 24 and 30 The quality of this outcome area is adequate. The home is cosy and comfortable though could be smartened up. The main area for change is the risk posed by radiators and safety covers have been recommended. EVIDENCE: A quick tour was made of the premises. This is an extended bungalow and located in a residential street near the shops and facilities of the village. There is access to a garden which can be used in summer. Each service user has their own bedroom and all share the communal facilities which are homely and cheerful. Parts of the home could be better decorated. There are no hoists as the service users are mobile though there are rails in the corridor. The main danger in the home is the unguarded radiators. At the last inspection it was required that a risk assessment of each radiator be carried out and action taken as a result, for instance the bathroom radiator may pose the biggest danger and should be a priority. Nothing was seen to show that this has been done. A further requirement is made. Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 Page 17 The laundry has the washing machine in a cupboard and the tumble drier in the staff room which is also an office and was very messy. However staff reported no problems with laundry and there is little incontinence. Staff have access to protective clothing if required. There is no unpleasant odour in the home. Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36 The quality of this outcome area is good. Service users are protected by the home’s recruitment procedures and benefit from trained and well supported staff. EVIDENCE: The home has three new members of staff but two have worked with people with learning difficulties before and are experienced and trained. One staff member seen in private confirmed the training she had received including NVQ2 and 3. Her staff file showed numerous training courses in 2005. Another member of staff also has an NVQ qualification. As there are only four members of staff the home is meeting the standard of 50 of staff trained to NVQ level. Other information provided by the home showed that several training courses were offered during the year, demonstrating that the organisation was committed to supporting service users with competent staff. Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 Page 19 The rota for the week of the inspection was examined and showed two shifts with one staff on duty all day as only one service user is currently in residence, two service users being on holiday with their family. The acting manager was also on the premises. Normally when all service users are at home, there are two staff on duty during the day with one staff on in the early mornings and in the evenings. The acting manager reported that these service users were all mobile and did not present challenging behaviour. He felt staffing was sufficient for the level of need of the service users. The rota showed that only two shifts were filled by agency staff and the manager confirmed that the same agency staff is used whenever possible so she is familiar with the service users. This is an improvement from the last inspection when more agency staff were having to be used. The manager confirmed that recruitment has been going well and one new starter was in today undergoing induction. The experienced member of staff on duty when seen in private confirmed that the level of staffing was satisfactory and she did not feel under pressure. Two staff files were checked to see what the recruitment procedure was like. Both showed that appropriate references were taken up, identity checks were made and criminal record checks were carried out. The new member of staff had received a POVA check pending the receipt of the criminal records check and would not be fully on the rota until that came through. The manager confirmed that he was receiving induction training today and was extraneous to the rota and under supervision at all times. The training record showed numerous courses had been arranged and the manager confirmed that a new role had been made in the main home of the organisation (nearby) to oversee the training plans for all staff to ensure there were no gaps in training. Contracts and codes of practice were also seen in the staff files. It had been a requirement of the last inspection that staff receive more support by way of individual supervision sessions. The acting manager confirmed these had now been started in July for all staff. The one staff file examined showed a record and date of supervision and the member of staff seen in private confirmed these sessions were taking place. Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 The quality of this outcome area is adequate. There is a good management structure for support to the home but some areas in quality assurance and in risk assessment on safety issues need further action. A new manager needs to be registered. EVIDENCE: The registered manager who has responsibility for all five small homes is leaving very shortly and was off sick. An acting manager was available in the home and the deputy regional manager was also available. The management structure of the organisation allows for some oversight of the work of all the homes and regular monitoring reports are received by the Commission. A new manager will be expected to be registered in due course. Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 Page 21 The organisation has a quality assurance system which needs to be fine tuned to each home. The home is visited monthly by a regional manager and these reports have action points. Surveys are also carried out with service users, staff and relatives. Some health and safety checks are also carried out monthly. However a simple set of standards would enable the home to measure itself on an annual basis and produce an improvement plan to deal with the gaps in service. A requirement has been made. Full policies and procedures are in place dealing with health and safety issues and the staff records showed that training was provided on these topics as well as fire prevention, emergency aid and food hygiene. A fire record showed the system and the fire extinguishers were recently checked and that drills are carried out every three months. Safety checks on appliances and equipment were also up to date and water temperatures in the bath were also monitored. Risk assessments were in place except for the hot radiators as already mentioned. An accident book was kept. Tamarisk House DS0000027586.V308163.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 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 Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 2 x x 2 x Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 Page 23 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 YA24 Regulation 13(4) Requirement The risk of burning from hot radiators must be assessed and remedial action taken where the risk is high. Previous timescale 31/01/06 The registered person shall supply to the Commission a statement of the complaints made since the last inspection and the action that was taken in response. In this instance a record needs to be kept. A system for reviewing and improving the care in the home (a quality assurance system) must be in place. Previous timescale 31/03/06 Timescale for action 31/10/06 2. YA22 22(8) 31/10/06 2. YA39 24 (1) 31/12/06 Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 Page 24 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. 2. Refer to Standard YA7 YA24 Good Practice Recommendations Although progress has been made in the keeping of the financial records, there are still gaps in recording which must be addressed. It is recommended that radiators are guarded to prevent burning. Tamarisk House DS0000027586.V308163.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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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