CARE HOME ADULTS 18-65
The Grange The Grange Redworth Road Shildon Durham DL4 2JT Lead Inspector
Mrs Tanya Newton Unannounced Inspection 12th May 2006 10:00 The Grange DS0000007510.V291254.R01.S.doc Version 5.1 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 The Grange DS0000007510.V291254.R01.S.doc Version 5.1 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. The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Grange Address The Grange Redworth Road Shildon Durham DL4 2JT 01388 775764 01388 771040 highleahomes.hq@btinternet.com 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) Highlea Homes Limited Care Home 19 Category(ies) of Learning disability (17), Learning disability over registration, with number 65 years of age (1), Physical disability (17), of places Physical disability over 65 years of age (1) The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24th January 2006 Brief Description of the Service: The Grange provides care for up to 19 adults in ground floor accommodation on the outskirts of Shildon. The home was previously a school and has been adapted. The home is suitable and accessible to people with mobility problems. The home has communal lounges, a dining area, a small kitchen area for service users to make snacks and drinks, a conservatory, a library/quiet area and a leisure room. Highlea Homes Ltd owns the home. The company head office is based on the upper floor of The Grange. Toilet and bathing facilities are available throughout the home, many of which are adapted to support the service users accommodated. Fees range between £378.50 and £405.00 per week. The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was carried out on the 12th May 2006 from 10:00 am until 3:30pm. Service users, visitors, relatives and staff were consulted as part of the inspection, feedback from which will be included throughout the report. Ten questionnaires were also sent out to gain feedback on the service being provided. All ten were returned; information within these surveys will be reflected within the report. In line with current CSCI policy on Proportionality, the inspection focused upon a number of key standard outcomes for service users. What the service does well:
Service users, relatives and staff spoken with during the inspection confirmed that a good standard of care is being provided within The Grange. Assessments are carried out to make sure that the home can meet an individual residents needs prior to them moving into the home. Service users say that they are treated well and there is a good rapport between residents and staff. Service users are able to make choices and decisions regarding all aspects of their lives and they are involved in writing their care plans. Service users are able to maintain friendships. Personal care is provided in a respectful manner. Visitors can visit at any time and there are quiet areas for residents to see their relatives/visitors in private. Menus are varied and residents are given a choice. All comments regarding the food were positive. There is an activities co-ordinator who provides a wide and varied range of activities to residents, which have included visits to the pub, theatre trips, outings and strawberry picking as well as a variety of holidays to different locations. Service users said that they are able to talk to the manager and deputy manager as well as any member of the staff team and that everyone is approachable. There are clear policies in place for complaints and adult protection. Staff morale is high and comments about the manager were positive. The home was clean and free from any unpleasant odours.
The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 6 The home has some good quality assurance systems in place to gain feedback from service users and staff. The Company has a high commitment to staff training and staff confirmed that they had lots of opportunities to access training of their choice. Service users are encouraged to attend a range of meetings so that they can provide the company with feedback on the service being provided. What has improved since the last inspection? What they could do better:
The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 7 The management must ensure that an up to date care plan is in place for all service users. Issues such as sexual health should be included within the care planning process. Risk assessments must be put in place for service users who go out alone and for those that require bed rails, this helps to ensure their safety. Some of the carpets within the home are still dirty and stained and need replacement. The activity room should not be used for storage and should be made more accessible for service users. The number of staff with NVQ 2 or above must increase so that the home can achieve the target of 50 of staff being trained to this level. All staff need training in adult protection and must have an up to date CRB to ensure service users’ safety. Quality assurance systems also require further development to ensure that the views of residents, visitors and other professionals are sought. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Grange DS0000007510.V291254.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection The Grange DS0000007510.V291254.R01.S.doc Version 5.1 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 the following standard(s): 2&5 Assessments are provided before admission. Only service users whose needs can be met are admitted to the home. Each service user is provided with a contract, which sets out what the home is providing within the fees being charged. The overall quality in this outcome area is good. EVIDENCE: Four service users’ files were viewed; all contained an admission assessment. This provides staff with basic information about how a resident’s needs should be met. Residents referred via a care manager also had a copy of the Social Services assessment on file. Service users are involved where possible in the assessmernt process and sign their assessments when they are complete. The home also admits service users for emergency respite (short stay). The home are trying to build up a regular respite group to enable better support and less disruption to the permanent service users accomodated. Many of the service users admitted to the home are placed following successful respite visits. The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 10 Ten service user questionnaires were received following the inspection; four of the service users said that they were not asked if they wanted to move into the home and two said that they did not receive enough information to decide if it was the right place for them. One service user commented “I had help from my social worker and my family, also from staff working at The Grange” Each service user is provided with a contract which they sign. The contract tells them what is included within the fees and what may be additionally charged for. Service users confirmed that they had seen their contract and had signed them. The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 11 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): 678&9 Each service user has a care plan, which reflects their changing needs. Some of the care plans still required updating. Service users are encouraged and supported to make decisions in all aspects of their lives and the home has good systems for gaining service users’ feedback. The home supports service users in taking risks by carrying out risk assessments. The overall quality in this outcome area is adequate. EVIDENCE: The home is in the process of updating care plans as a new pro-forma is being introduced. The new care plan is much more service user focused and encourages service users to be more involved. Four care plans were viewed; all contained detailed information. One of the care plans was written in full by the service user, it covered all areas of personal, health and social care. Care plans provide staff with information about how a resident’s needs should be met. Issues such sexual health should be included within care plans.
The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 12 Health care is included within care plans; nutritional assessments are also carried out by the home to monitor weight and diet. Reviews are carried out reguarly on care plans, this helps staff to monitor changes in a resident’s health. Residents have access to GPs, dentists and opticians. Comments included “I like it here because you have care when you need it but have space as well” and “I am really happy with the home. They keep us up to date. I am aware of the care plan, families are updated and involved”. From discussion with service users, relatives and staff, examination of records and observation made throughout the inspection, The Grange provides a good standard of care and support to service users. Service users are encouraged and supported to make decisions and choices in in all aspects of their care, comments included “I am very independent I can come and go as I please, I choose my own clothes, and the times that I get up and go to bed. I am able to make all decisions”. All service users said within the questionnaires that they could make decisions, choosing what they wanted to do both during the day and in the evening. The Company has good systems in place to consult service users. They hold regular quality action group meetings where service users are consulted about policies and procedures. Two of the service users living at The Grange confirmed that they attended these meetings. The home carries out regular service users meetings where service users help plan anything from what they would like to do socially, the décor of the home or what menus should be provided. Equality and diversity is included within care plans, one service user has attended a “train the trainors” course on equality, diversity and disability and is hoping to provide training in this area for staff and service users living within The Grange. Risk taking is encouraged where possible. The home carries out risk assessments and discusses these with service users. Risk assessments are included within care plans. One service user commented, “I try not to take risks but when I do staff carry out a risk assessment which they discuss with me and keep in my file”. The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 13 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 14 15 16 & 17 Social activities take place, which are age appropriate and which provide stimulation and interest for people living at the home. The home encourages service users to maintain contact with relatives and service users are able to develop friendships of their choice. Menus are varied and service users are given a choice. The overall quality in this outcome area is good. EVIDENCE: The feedback from staff, service users and relatives regarding the social activities taking place was positive. The home has an activities co-ordinator who supports service users in attending a wide range of activities. The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 14 Service users choose what activities they would like to do and where they would like to go. The feedback in this area was excellent and included the comments: “The activities co-ordinator is excellent, I am looking forward to my holiday which I helped to plan”, “I go on loads of activities, the theatre and trips out, I am going to stay in the caravan in Scarborough”. Holidays were booked to Scarborough and the Isle of Wight. Service users also take trips abroad. The owners have purchased a property in Spain which service users are able to access. Feedback from staff included “activities have really improved, they are age appropriate, service users are going out and doing things, they are living life to the full now” and “the activities are amazing, there is so much for service users to look forward to”. The activity co-ordinator said “I am very flexible, I fit in with what the service users want to do, many activities lead into other things for example a strawberry tea was held recently so residents went out and picked their own strawberries”. Service users choose on a weekly basis what they want to do”. The local community is accessed. Relatives are encouraged to visit the home; they attend social functions at the home and keep in regular contact via the telephone. Service users stated that they were able to maintain friendships. Care plans should include issues such as sexuality and sexual health. Service users confirmed that their rights were respected; the questionnaires confirmed that in the main staff listened to and acted upon what residents had to say. One service user commented “there are no improvements needed I get as involved as much as possible”. Menus are devised with input from service users. Comments were positive and included “the food is nice, tea time tends to be one main meal but residents could have something different if they wanted it” and “I like the food as I enjoy home cooked meals. I am involved with the menu plans so I choose what I want to eat”. “There is lots of choice at lunchtime”. Some service users make their own meals in the small kitchen, which is solely for service users’ use. The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 15 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 & 20 The personal and health care needs of the service users accommodated are being met. The systems for dispensing medication have improved since the last inspection although further improvements should continue. The overall quality in this outcome area is adequate. EVIDENCE: Personal care is provided to service users in a respectful way. Service users confirmed that staff would knock on doors prior to entering a service user’s bedroom. Service users could have a bath or shower daily. Where possible same sex care is provided. The home gains support from other health professionals where it is required. Comments from service users included “My health needs are well met by the home” and “I am well cared for”. A relative commented “The home are on the ball with health care, this place is ideal they don’t give medication for the sake of it. I have no complaints about the care, I am really happy about the way in which my relative is looked after”.
The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 16 Medication systems were looked at during the inspection; there were some improvements in this area. Medication is now being given in line with G.P instructions, nearly all medication is being signed for and stock is ordered and returned in the correct way. There are still some difficulties when ordering stock if service users are admitted mid-way through the medication system. At present only senior staff members give out the medication. The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 17 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 & 23 There are clear policies in place to protect residents and staff. The overall quality in this outcome area is good. EVIDENCE: All service users confirmed within the questionnaires that they were able to make a complaint. Relatives confirmed that they had no problem in rasing any concerns within the home and one commented “I would tell someone if I had any concern, things seem alright”. One of the service users said “I always tell staff if I have any problem”. The home has policies on adult protection and complaints. Staff had a clear understanding of these policies and said that they would have no hesitation in “whistle blowing” (telling someone) to protect people. The majority of staff had received training in the protection of vulnerable adults (POVA). This training should be provided for all staff. The home had not received any complaints since the last inspection. The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 18 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 & 30 The home was clean and free from odour during the inspection. Some of the carpets need to be replaced. The overall quality in this outcome area is adequate. EVIDENCE: The Grange is clean, homely and comfortable and generally meets the needs of the residents accomodated. Rooms are furnished to individual choice. There is an ongoing programme of redecoration and repair taking place throughout the home. Domestic staff are employed to clean the home and there is an ongoing programme to decorate service users’ bedrooms; those bedrooms viewed were individualised and service users said that they could choose how they would like their rooms to be decorated. New flooring has been put down in the conservatory, front entrance and dining room. Carpets in the hallways are badly stained. The manager confirmed that these would be cleaned and if this did not work they would be replaced. Some of the bedrooms require new carpets. The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 19 The room, which was previously used for activities, is now being used for wheelchair storage; it is hoped that this room will be developed as a social area for service users. There are plans to redesign the kitchenette for service users. The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 20 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 34 & 35 Training is provided for staff and staffing numbers meet the needs of the residents accommodated. Recruitment policies and practices in the main protect service users living at The Grange. The overall quality in this outcome area is adequate. EVIDENCE: The home has the following staff on duty, 4 staff between 7.30am and 11.30am, three staff between 11.30am and 10pm and two staff throughout the night, one waking and one sleeping. These hours do not include the manager’s hours. The home also employs a cook, domestic staff and an activities co-ordinator. Service users were complimentary about staff and commented “Staff are brilliant. I get on with them all and I am treated well”. Four staff were spoken to during the inspection, they all said that they were well supported by the manager and that they had seen improvements in the service being provided. Morale is high and there is a good rapport between the staff and the service users accomodated; this was observed throughout the inspection.
The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 21 Staff are given good opportunities to attend training courses and to progress within the service. Staff confirmed that staffing numbers had improved, four staff were on duty on a weekend, comments included “there’s enough staff now, the level of staffing is brilliant although I would like to see a weekend cook”. Five staff files were looked at as part of the inspection. All staff files contained an application form and two written references. Four contained a CRB. It was not evident from the pre-inspection information or the staff files that all staff had received a Criminal Record Bureau check (CRB). Any staff member without a current CRB must have one. This information helps to protect residents. Training is provided for all staff and includes manual handling, first aid, food hygiene, health and safety and NVQ’s. Additional training such as the safe handling of medicines has also been accessed for the senior staff. Out of the thirteen care staff employed 6 have gained an NVQ at level 2 or above and 7 are working towards this award. This means that the home have 45 of their staff trained to NVQ level 2 or above. The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 22 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 owner, manager and staff have formed positive relationships with service users living within The Grange. Quality assurance systems should continue to be developed to seek the views of service users/relatives and other professionals. Risk assessments were required in some areas but in the main the home assesses risks and help safeguard residents. The overall quality in this outcome area is adequate. The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 23 EVIDENCE: The home has a manager who following the inspection has been granted registration with CSCI. The home also has an assistant manager. Comments regarding the manager were positive and included “One of the best management teams, the staff get well supported” and “we are well supported, the manager is very approachable and “hands on” always interested and he takes time to support staff”. Service users and relatives also confirmed that the managers were both very approachable and that they would have no hesitation in discussing any issues with them. Quality assurance systems are in place and include Regulation 26 visits from the provider and meetings for staff and service users. Informal feedback is gained through staff meetings, residents meetings and day-to-day contact with service users and their relatives. The Company holds quality action group meetings, which are attended by service users and staff. The home should continue to develop systems to gain feedback from relatives and other professionals. Health and safety records are maintained by the home; regular checks are carried out on the equipment and premises to make sure that they are safe for service users. The home must ensure that in all cases where bedrails are used that a risk assessment is in place which is based on the Medical Device Agency guidance (MDA DB2001 (4) ). Regular checks must also be made on bed rails and a record of these checks maintained. This was a requirement in the last inspection report which had been actioned in part. Risk assessments should also be carried out for those service users who go out independently. The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 24 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 3 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 2 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 25 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 YA6 Regulation 14 & 15 Requirement Care plans need to be reviewed and updated onto the new proforma. Previous timescale of 31/03/06 not met. Carpets, which are stained, require replacement. The home needs to increase the number of staff attaining the NVQ 2. All staff must have training in adult protection. Timescale for action 15/09/06 2. 3. YA24 YA32 23(2) d 18 c (i) 31/08/06 31/08/06 4. 5. YA34 YA39 19(1)b 24 6. YA42 13(4) The home must ensure that all 31/05/06 staff have a current CRB. The home must develop 30/09/06 additional quality assurance systems, which seek the views of service users/relatives/other professionals. Risk assessments must be 12/05/06 carried out to protect service users and staff. Assessments on the safe use of bedrails must be carried out prior to their use and be based on the MDA guidance 2001. Previous timescale of 31/03/06 not met. The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 26 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 YA24 Good Practice Recommendations The activity room should be made more accessible to service users and should not be used to store wheelchairs. The Grange DS0000007510.V291254.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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