Inspection on 19/09/08 for Terrance House

This inspection was carried out on 19th September 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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1 Marten Road

Daubeney House

Three Gables

Aldwick House

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The Springs Community

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Belle Vue Country House

Extracts from inspection reports are licensed from CQC, this page was updated on 05/12/2008.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Terrance House 7-21 Belgrave Road Margate Kent CT9 1XG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joseph Harris     Date: 1 9 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Terrance House 7-21 Belgrave Road Margate Kent CT9 1XG 01843220715 01843231639 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Terrance House Care Ltd Type of registration: Number of places registered: care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 55. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home 55 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection took place on the 19th September 2008. It commenced at 10:00 hours and was completed at 17:00 lasting approximately 7 hours. The inspector was accompanied on the site visit by an Expert by Experience. An Expert by Experience is a person who, because of their shared experience of using services, visits a service with an inspector to help them get a picture of what it is like to live in or use a service. Experts by experience receive specific training to enable them to fulfil their role in the inspection process. During the course of the site visit discussions were held with service users, staff, the Deputy Manager and a Senior Manager within the organisation. The Manager was not available on the day of the visit. Care Homes for Adults (18-65 years) Page 5 of 29 A range of documentation was examined relating to issues including service users needs, medication, health and safety, staff files and the day-to-day running of the home. A tour of the premises was also undertaken. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 Care Homes for Adults (18-65 years) Page 7 of 29 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users are able to make a choice about moving into the home, although some documentation is in need of updating. Systems are in place to ensure the needs of prospective service users are assessed, but have yet to be implemented. Evidence: Terrance House was taken under new ownership in March 2008. A new statement of purpose has been developed addressing all required aspects of the service provision. A service user guide developed under the previous ownership is still in use and an updated version needs to be introduced. This should be in a format that is easy to read focussing on the issues that prospective service users want to know, whilst covering all points as set out in the National Minimum Standards. The home employs a welfare and placement officer who is responsible for assessing prospective service users. There have been no admissions from outside the organisation since the last inspection. The organisation has introduced clear and comprehensive paperwork to assist in the assessment of prospective residents and the Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: placement officer demonstrated a good understanding of the pre-admission process. She stated that at the point of referral information from key professionals would be sought including Care Programme Approach (CPA) care plans and risk assessments. Social and medical history would also be requested. Discussions with the prospective service user and family, if appropriate, would also inform the process. One service user was admitted to the home from another service within the organisation. An Adult Protection alert that indirectly raised concerns regarding this transfer of care was made. This has not resulted in an investigation into the role of staff at Terrance House. Issues were raised about the quality and level of preadmission information provided and received. The placement officer acknowledged that there were difficulties in this process, but assessment systems have subsequently been reviewed to avoid further occurrences of this nature. Prospective service users are offered time in the home to enable them to make a choice about whether they wish to move in, which also allows staff to make on going assessments of the needs and preferences of the individual. All new residents have a three month trial period and have a review meeting following this time period. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual service user plans provide limited information, but good systems of care review are in place. A risk management process is in place, but could be developed further. Evidence: Four individual service user plans were examined as part of the inspection process. In all circumstances the method for filing information was found to be somewhat disorganised. Information is stored in loose leaf folders, which does not aid easy access. The plans of care currently in use address assessed areas of need, but lack detail within the actions and guidance to meet those needs. However, the home develops a management strategy that provides an overview of the key aspects of care and risk giving some instruction. It was stated that a thorough review of all care needs is due to be undertaken when new care planning documentation is introduced. This is due to take place over the coming months. The new documentation was examined and Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: provides a detailed and structured process that should promote improved record keeping and plans of care. The home reviews care plans and the outcomes for service users on a monthly basis or as needs change. These are completed in good detail and provide evidence that needs are being met. In some circumstances the care plan reviews provided clearer instruction to enable staff to meet needs than the plans themselves. There are also opportunities for service users to take a more active role in the development of their own care plans. The home has a process of risk management covering individual needs in place. A preliminary risk assessment is completed and reviewed on a regular basis. Where an area is assessed as an issue of high risk a more detailed risk assessment is developed. In some cases the home uses generic risk assessments, which lack detail specific to individual needs. Areas of perceived risk could also have more proactive strategies in place to promote individual responsibility and responsible risk taking. New documentation is due to be introduced covering the management of risks. This was examined and should provide a detailed format to promote improved risk assessment processes. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have a lifestyle that suits their needs. Independence and choice can be further promoted in the home. Evidence: An expert by experience accompanied the inspector during the site visit concentrating her attention on the daily activities and lifestyle of service users living in the home. She was able to speak to a number of residents to build a picture of how the home runs on a day to day basis. In general service users stated that they are happy living in the home. One person said that she considers it to be her home. Residents reported that the staff in the home are friendly and helpful. They also considered that there are enough activities available both in the home, at the linked day centre and within the local town. There are reasonable mental health resources in the local area enabling residents to attend Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: college, occupational activities and work schemes should they wish to do so. However, it is considered that a more proactive approach in promoting this aspect of the service could be embraced. No visitors were present at the time of the site visit, but service users confirmed that they are able to receive visitors when they wish and that they are made welcome by staff. The deputy manager stated that service users are free to pursue intimate relationships, but that issues of consent are monitored. Residents stated that they are free to choose how they spend their time and can choose when to get up and go to bed within reasonable limits. Many of the service users, it was reported, have tea and coffee making facilities in their rooms. There are two small kitchenettes in the home and the deputy manager acknowledged that thee could be better equipped to allow people who use the service more freedom of choice regarding snacks and drinks. The expert by experience joined service users for lunch. It was noted that the food was adequate if not exceptional. The lunchtime period was relatively relaxed, but it was observed that residents had a lack of choice regarding portion sizes and drinks. Tea was served in plastic cups despite china crockery being available. This was felt to be somewhat undignified. Residents made a number of comments about the food in the home including, Its OK and The food is quite nice. It was also observed that there was a lack of fresh fruit and salad available at the mealtime, but staff stated that this is available on request and is not left out because some people have a tendency to hoard food in their bedrooms. There is a planned menu that residents are able to have an input to and choices are available at each mealtime. The nutritional requirements of each service user are assessed and monitor and appropriate diets prepared. The cook stated that the equipment in the kitchen is in good working order and suitable for the needs of the home. Local suppliers are used for food supplies and it was reported that sufficient stocks are available at all times. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and healthcare requirements of people who use the service are met. Evidence: Service users receive personal support, where required, in a sensitive and dignified manner. Residents stated that the staff in the home are helpful and caring and respect their needs and wishes in respect of personal care. The majority of service users are fully self-caring and require only prompting and encouragement to attend to their needs from time to time. There are some service users who require higher levels of support and staff have the understanding and competencies to address these issues. Support plans could provide more detail in relation to personal care giving, but it is evident from on-going reviews that the outcomes for service users are met. This was also underpinned by feedback from residents. Healthcare records are well maintained detailing information about individual needs, consultations with healthcare professionals and the outcomes of any appointments. It was stated by the welfare officer that the local Community Mental Healthcare Team (CMHT) do not always routinely forward copies of CPA reviews to the home and that some service users are overdue a review of their care and support needs. The home Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: was advised to write to the CMHT to address this issue. All service users are registered with a local GP and most have a current care manager. Some service users receive care management support through the duty system in operation. A Community Psychiatric Nurse visits the home once a fortnight to discuss any relevant mental health issues and to run a depot injection clinic in the home. This is considered a rather institutional practice and should be reviewed. A dietician visits the home to discuss nutritional needs for some service users and complimentary healthcare is available for those who wish to attend including chiropodists, dentists and opticians. Medication processes were examined. There are appropriate policies and procedures in place and administration records are kept up to date. There is a dedicated medication room that is maintained at a suitable temperature and has adequate storage facilities including controlled drug storage. Records of received, returned and destroyed medication are kept. All staff administering medication receive appropriate training prior to taking on this role. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users views are listened to and acted upon and they are protected from abuse. Evidence: A suitably detailed complaints process is in place that is included in the service user guide and displayed in the home. The Welfare Officer stated that no formal complaints have been received by the home since the last inspection and that the majority of issues raised by service users are managed on an informal basis. However, it was stated that service users are aware that there is a formal complaints procedure should a satisfactory resolution not be found. Service users told the expert by experience that they have an open and friendly relationship with staff. They said that they feel able to raise any concerns and that these will be appropriately addressed. No complaints have been received directly to the Commission for Social Care Inspection regarding the home since the last inspection process. Policies and procedures are in place relating to adult protection and abuse awareness issues. Staff receive training in these topics both through induction and additional courses. Some staff have also had training on the Mental Capacity Act 2005 and it was stated that this will continue to be provided to all care staff. Staff spoken to demonstrated a good working knowledge of adult protection issues and their responsibilities in this regard. No Adult Protection alerts have been raised directly in connection with the home since the last inspection. A Safeguarding Vulnerable Adults alert was raised in connection Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: with another service that indirectly involved the service, but this was not subject to an investigation into the conduct of the home. Care Homes for Adults (18-65 years) Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is suitable for the needs of the service users. Evidence: Terrance House is situated close to Margate town centre and the seafront on a main arterial road. It has been established for many years and was originally a row of terraced houses converted into one unit. The home is arranged over 4 floors with the ground floor mainly comprising of communal space and the upper floors consisting of bedrooms, bathrooms and further communal rooms. There is a car park at the rear of the home and a small garden area that has outdoor furniture for people to sit out. There is lift access connecting all floors. The home benefits from a large amount of communal rooms including 5 adjoining lounges, a large dining room, two smoking rooms and further quiet rooms including a library. Service users stated that the home is comfortable and meets their needs. There are two double bedrooms, currently shared by people who choose to do so, with the remainder of bedrooms single occupancy. A number of bedrooms were viewed with the permission of service users and they were well equipped and personalised according to taste. The service came under new management in March 2008 and a discussion was held with one of the organisations senior managers. She stated that there are plans for Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: extensive redevelopment and refurbishment of the service acknowledging a number of current limitations. It is anticipated that work will begin on the premises in 2009. There are toilets and bathrooms situated throughout the home on all floors, however t was noted that no soap was in any of the soap dispensers in service users toilets. The deputy manager stated that they were awaiting a delivery from a new supplier. The home was generally clean and hygienic and a team of domestic staff are employed. Universal precautions to minimise the spread of infection are in place and all hazardous substances securely stored. The laundry facilities are suitable for the needs of the home, although they would benefit from more worktop space. The kitchen is well-equipped and it was reported that all is in good working order. No major issues were highlighted at the last environmental health officers visit. It was reported that the home meets the requirements of the fire safety department. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have the required competency and training to meet the needs of the service users. There is a strong recruitment process in place. Evidence: The home has had the benefit of a relatively stable staff team for a number of years. Staff demonstrate good core competency in key areas of care and service users state that the care staff are helpful and respectful. 8 staff members have achieved a National Vocational Qualification at level 2 or above. Further staff members are due to commence NVQ training working towards a target of 50 . The staff training matrix was examined, which provided evidence that the majority of staff have completed all required mandatory training. It was noted that there were a number of gaps in training needs for some staff, but evidence was available to demonstrate that all necessary training has been arranged and staff are due to attend the appropriate courses in the near future. the organisation has its own training department and provides a comprehensive training package available to all staff. The home uses the Common Induction Standards alongside an in-house induction programme and evidence was seen that this is completed for all new staff. 3 staff personnel files were examined. These are well managed by the administrator for the home. All required information was on file including CRB/POVA checks, two Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: written references and proof of identity. It was noted that the current application form request employment history for the past 10 years, which should be amended to a full employment history. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run and in the best interests of the service users. The health, safety and welfare of service users is maintained. Evidence: The home has relatively recently come under new ownership and a new manager has been appointed following the resignation of the precious registered manager. The manager has worked at the home for over 16 years and was previously the deputy manager of the home. She is supported by a newly appointed deputy manager who was present throughout the inspection. The manager was not available at the time of the site visit. Staff were very positive about the attributes and abilities of the manager stating that she has introduced some new ideas, is open and approachable. It was stated that the manager will be applying for registration with the Commission for Social Care Inspection in the near future. The home has well established quality monitoring processes in place. These were developed under the previous ownership and the new owners plan to maintain and develop these quality assurance systems. Annual surveys are sent out to service Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: users, relatives and professionals and the returned information is collated within an annual report. A senior manager of the organisation visits the service at least once a month to complete a monthly monitoring visit and a report is produced detailing the aspects covered at these visits and any actions required. The home regularly reports any incidents and untoward occurrences to the Commission. Health and safety records were examined and all service certificates were kept on file and up to date. The fire safety log is routinely completed and checks carried. There is an up to date fire risk assessment that is regularly reviewed. Accident records are maintained. Safe working practices are addressed within the policies and procedures of the home. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 To update service user plans 23/12/2008 and ensure that detailed guidance is developed and accessible to staff. The plans of care lack specific detail and are maintained in a disorganised fashion. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 1 2 9 To update and develop an accessible service user guide. To ensure that new pre-admission assessment processes are put into practice. To develop risk management processes ensuring aspects of risk are addressed positively and detailed actions to minimise risks are in place. To introduce greater levels of choice and independence for service users around mealtimes and food preparation. To ensure a full employment history is gained for all new employees and evidence that gaps in employment are explored during the recruitment process. The manager should apply for registration with the Page 27 of 29 4 5 17 34 6 37 Care Homes for Adults (18-65 years) Commission for Social Care Inspection. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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