Inspection on 08/12/05 for The Lawns Residential Care Home

This inspection was carried out on 8th December 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Lawns Residential Care Home 22/08/07

The Lawns Residential Care Home 01/11/06

The Lawns Residential Care Home 23/06/06

The Lawns Residential Care Home 19/05/05

The Lawns Residential Care Home 11/10/04

The Lawns Residential Care Home 11/05/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE The Lawns Residential Care Home 1-2 Kensington Gardens Monkseaton Whitley Bay Tyne & Wear NE25 8AR Lead Inspector Glynis Gaffney Announced Inspection 09:30 8 and 29 December 2005 th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Lawns Residential Care Home Address 1-2 Kensington Gardens Monkseaton Whitley Bay Tyne & Wear NE25 8AR 0191 2530291 0191 253 7248 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) Mr Trevor Nesbit Mrs Julie May Charlton Care Home 28 Category(ies) of Dementia - over 65 years of age (8), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (19) The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th May 2005 Brief Description of the Service: The Lawns is situated on Monkseatons high street. The Home provides residential care for 28 older people, of whom up to eight may have dementia care needs. Nursing care is not provided. It is a large, older style, detached building and has been adapted to meet the needs of older people. It is a three storey building and a lift provides access to all floors. There are 26 single bedrooms, one of which has an en-suite facility. There is one double bedroom. There is a kitchen, a large lounge, a smaller lounge, a dining room and a laundry. There are toilets and assisted bathing facilities on each floor. At the front and side of the Home, there are pleasant and attractively landscaped gardens. There is a secluded patio garden to the rear. Bus routes, pubs and local shops are all within easy walking distance. The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and took place over nine hours. The premises were inspected as were a sample of records. The Manager, her Deputy and members of the staff team were interviewed and residents were spoken to during the course of the inspection. What the service does well: What has improved since the last inspection? Improvements have been made to the Home’s kitchen. The ventilation system has been upgraded. A number of bedrooms, passageways and staircases have been redecorated. The dining chairs have been refurbished. The laundry has been redecorated and a new washbasin fitted. The Manager has introduced a new laundry system. A more secure area for the clinical waste bins has been provided. New risk assessments have been prepared for all food processes carried out in the kitchen. The information held in staff records has been improved. The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 6 What they could do better: Ensure that assessment and care plan information completed by residents’ Care Managers is obtained prior to the individual’s admission into the Home. The Manager needs to ensure that: • • • • • An appropriate record is kept of all medications received into the Home; Identification photographs are available in residents’ Medication Administration Records; A hand wash facility is available in the area in which medicines are administered; A Controlled Drugs Register is used to record the receipt, administration and disposal of such medications; Arrangements are in place, which allow the Home to receive advice and guidance from a local pharmacist regarding its medication records and practices. The Manager needs to ensure that: • • • • • Each care plan sets out in detail the action to be taken by care staff to ensure that residents’ health, personal and social care needs are met; Residents, or their representatives, are consulted about the contents of their care plans; Six monthly reviews take place; Periodic checks of the quality of information held in residents’ care records are carried out; Residents’ care records contain signed evidence that they have been given a copy of the Home’s Statement of Purpose, Service User Guide, latest inspection report and Complaints Procedure. The current menu cycle needs to be amended to include the recommended good practice information. Arrangements need to be put in place to ensure that staff regularly update their training in the following key areas: First Aid; Basic Food Hygiene; Manual Handling; Protection of Vulnerable Adults; Infection Control. Staff need to receive structured supervision as least six times a year. An audit of the quality of care and services provided within the Home needs to be undertaken and an Annual Development Plan prepared. The Provider needs to ensure that he, or his representative, undertake regular unannounced visits to the Home to monitor its conduct and performance. The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3. Residents have been provided with a copy of the Home’s Statement of Terms and Conditions. This ensures that newly admitted residents are fully aware of their rights and responsibilities. Satisfactory arrangements were not in place to obtain the relevant Care Management documentation. This could mean that staff do not have access to all of the information required to properly meet residents’ assessed needs. EVIDENCE: A completed Statement of Terms and Conditions had been placed on each resident’s file. Care Management assessment and care plan information was not available in some of the care records examined. The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Care plans do not adequately cover all aspects of residents’ health, personal and social care needs. This could result in staff not being clear about how to meet residents’ needs. The arrangements in place for involving residents in drawing up their own care plans were not satisfactory. Residents’ health care needs were well met. However, due to inadequate record keeping, there was not always enough evidence to confirm that this was the case. Although adequate systems were in place to support the safe administration, storage and disposal of medication, additional improvements are needed to ensure that residents are properly protected. Staff were seen to provide personal support in such a way as to promote and protect residents’ privacy, dignity and independence. The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 11 EVIDENCE: Individual plans of care were in place for each resident and covered most health, personal and social care needs. However, there were some areas that had not been covered. For example, none of the plans examined covered residents’ needs for assistance with medication. It was also noted that the care plan of a resident with dementia care needs did not provide sufficient guidance on security arrangements and on how to manage this person’s ‘wandering’ behaviour. The risk assessment completed in respect of this individual was not robust enough. Although residents’ care plans had been reviewed on a monthly basis, six monthly placement reviews had not taken place for some individuals. Care staff did not always complete log notes at the end of each shift. This has resulted in gaps where it would be difficult for the Home to provide evidence of the level of care provided to some residents. None of the care plans examined had been signed by the resident, or their representative, confirming their agreement with the contents. The Manager had not undertaken regular checks of residents’ care records to ensure that they were being maintained to agreed standards. A Key Worker system was in operation and residents interviewed were satisfied with their Key Workers. Residents’ records were securely stored. Residents confirmed that their health care needs were well met. One person said that staff would immediately call her GP if she became unwell. A variety of risk assessments had been completed in each record examined and covered the following areas: nutrition; good skin care; susceptibility to falling; dental health and continence care needs. Weight checks had been carried out on a monthly basis. A Medication Policy was in place. Although the medication records checked were generally well completed, there was evidence that an item of controlled medication had not been booked in. Identification photos were not in place for each resident. The systems in place for the storage, administration and disposal of medication were generally considered safe and were followed by senior staff. However, an item of controlled medication had recently been miadministered. Appropriate action had been taken to prevent a further reoccurrence. Although there were no hand wash facilities available in the area in which medications were kept, staff had access to alcohol gel wash. Staff administering medications had received accredited training. However, some staff were in need of refresher training. Controlled drugs were not in use at the time of the inspection. However, it was noted that several record books were being used to record the administration of controlled drugs. This could result in staff committing recording errors. Temperature checks of the area in which medications were stored had not been undertaken. The Manager was unable to confirm that residents over 75, on four or more drugs, had received The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 12 an annual medication review. A local pharmacist has not been approached to provide the Home with advice regarding its medication practices and records. Staff were observed providing personal care to residents in a kind, considerate and helpful manner. Residents interviewed confirmed that staff respected their privacy and treated them in a dignified manner. The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The provision of social activities is good and opportunities for stimulation through leisure and recreational activities are available. Residents are encouraged and supported to participate in making decisions about their own lifestyle in so far as they are able to do so. Residents are supported to maintain contact with their families and friends and visitors are made to feel welcome. The meals in this Home are good offering residents both choice and variety that take account of individual likes and dislikes. Meals are served in pleasant surroundings by helpful staff that are willing to provide whatever assistance is required. EVIDENCE: A programme of weekly activities was in place. A different activity is offered every afternoon, for example – on a Wednesday morning, residents are offered the opportunity to participate in ‘chair aerobics’. The Home’s Social Programme states that individual interests will also be catered for. Residents confirmed that birthdays and festive occasions are celebrated. Information The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 14 about residents’ past histories, hobbies and interests is obtained prior to admission. Care plans addressing residents’ social care needs were in place. A resident commented that the Home offered ‘more than enough social activities and in-house entertainment.’ Residents spoken with confirmed that the Manager and her staff team always made families and friends feel welcome. One resident said that visitors could be seen in private or join residents in the lounge and dining areas. A policy outlining the Home’s approach to enabling residents to maintain contact with family and residents was available. None of the residents spoken with could recall the Manager placing any restrictions upon their visitors. Wherever possible, it is the Home’s Policy to support residents to maintain control of their own financial affairs. However, the Manager confirmed that safekeeping facilities, and day-to-day support with managing personal monies and valuables, would be provided if a need to do so was identified. Residents are permitted and supported to bring their own personal possessions with them when moving into the Home. A written menu was available and included a four-week menu cycle. The menus contained the required information with the exception of the following details: • • • • • The type of desert provided after the lunch time meal; Sandwich fillings offered; The range of snacks and beverages available between main meals; The availability of fruit; The timing of meals. Choices are offered at all main meal times and a hot meal is provided at the teatime meal. Food stocks were checked and considered adequate. The quality of the lunchtime meal was excellent and appeared to be enjoyed by all residents who participated in the meal. The dining room was a pleasant area and the tables were attractively dressed. Staff were on hand to provide residents with support throughout the mealtime. The kitchen was found to be clean and hygienic. Since the last inspection visit, the Home has experienced an outbreak of Salmonella, which resulted in a small number of residents becoming unwell. The Home’s Environmental Health Officer, and a nurse from the Health Protection Unit, were involved to ensure that appropriate action was taken to control, and eliminate, the infectious outbreak. The Home made a positive response to the demands placed upon it and demonstrated a willingness to work in partnership with the other professionals involved. Following the outbreak referred to above, the Commission required the Manager to: • Forward a copy of its Smoking Policy; DS0000000308.V257775.R01.S.doc Version 5.0 Page 15 The Lawns Residential Care Home • • • • • Review the Home’s Laundry Policy in the light of lessons learnt following the outbreak of Salmonella; Re-paint the laundry woodwork to make it easier to clean; Provide a hand wash basin in the laundry area; Provide effective ventilation in the kitchen; Forward copies of the kitchen cleaning rota and any risk assessments completed in respect of the kitchen. It was also recommended that the Provider create a secure area within which the Home’s Clinical Waste Bin could be stored. During a second follow-up visit to the Home, it was confirmed that the above requirements and recommendation had been met in full. The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 16 and 18 were assessed as part of the 2005/06 Unannounced Inspection. EVIDENCE: The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 22, 23, 24, 25 and 26 were considered as part of the 2005/05 Unannounced Inspection. EVIDENCE: The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 and 30. Staff have been supported to undertake qualifying training, which has provided them with the knowledge and skills, they require to properly care for residents. However, the arrangements in place for ensuring that staff receive regular refresher training in key areas, were inadequate. Residents are supported and protected by the Home’s recruitment policies, procedures and practices. EVIDENCE: An examination of training records confirmed that over 85 of the care team have obtained a relevant care based qualification. The Manager is committed to ensuring that every member of staff obtains such a qualification. However, a number of staff, including the Manager, had not received refresher training in key areas such as: the protection of vulnerable adults; manual handling; first aid, basic food hygiene; infection control. Staff personnel records contained the required information. A comprehensive Recruitment and Selection Policy was in place. Arrangements are in place to ensure that newly recruited staff receive relevant induction and foundation training. Care staff receive three paid training days per year. The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 36. Residents live in a home which is run and managed by a person who is fit to be in charge, is of good character and able to discharge her responsibilities fully. Adequate arrangements were not in place to review the quality of care and services provided at the Home. Staff had not received formal supervision at the recommended frequency. This could mean that staff are not properly supervised and provided with opportunities to develop, and reflect upon, their skills and competencies. EVIDENCE: A Manager was in post and is in the process of completing a relevant management qualification. Application to register as the Home’s Manager is underway. Although Mrs Evans has many years experience of working with The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 20 older people, she has not updated her training in key areas. Staff interviewed said that the Manager had made it clear to them the standards of care that they were expected to work to. One carer was able to clearly describe the purpose, aims and objectives of the Home. Another member of staff felt that she knew what was going on within the Home and felt able to raise any matters of concern with the Manager and her Deputy. Arrangements are not in place to review the quality of care and services provided at the Home. The Manager confirmed that she had not prepared an Annual Development Plan. The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 2 The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP2 Regulation 14 Timescale for action Ensure that a copy of the Care 01/03/06 Manager’s assessment and care plan are obtained before a resident is admitted into the Home. 01/06/06 Ensure that: • Each residents care plan sets out in detail the action to be taken by care staff to ensure that all aspects of residents’ health, personal and social care needs are met; Residents, or their representatives, are consulted about the contents of their care plans and are given the opportunity to sign them; Six monthly placement reviews take place; Periodic checks of the quality of residents’ care records are undertaken; The Home’s care records contain signed evidence that residents have been given a copy of the Statement of Purpose, Version 5.0 Page 23 Requirement 2. OP7 15 • • • • The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc 3. OP9 13(2) Service User Guide, latest inspection report and Complaints Procedure. Ensure that: 01/05/06 An appropriate record is kept of all medications received into the Home; • Identification photographs are available in residents’ Medication Administration Records; • A hand wash facility is available in the area in which medicines are administered. The Manager should take advice from the Home’s Infection Control Nurse regarding this matter; • A Controlled Drugs Register is used to record the receipt, administration and disposal of such medications; • Arrangements are put in place, which allow the Home to receive advice and guidance from a local pharmacist regarding its medication records and practices. Ensure that staff regularly 01/09/06 update their training in the following key areas: First Aid; Basic Food Hygiene; Manual Handling; Protection of Vulnerable Adults; Infection Control. A review of the quality of care 01/09/06 and services provided at the Home must be undertaken at regular intervals. The views of residents, their families, staff and professional visitors to the Home, must be consulted as part of the review process. A copy of the review must be made DS0000000308.V257775.R01.S.doc Version 5.0 Page 24 • 4. OP28 18 5. OP33 24 The Lawns Residential Care Home 6. 7. OP33 OP36 24 18 available to residents and the Commission. An Annual Development Plan 01/06/06 must be prepared and submitted to the Commission. Staff must receive supervision at 01/06/06 least six times a year covering the areas referred to in the National Minimum Standards. 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 OP9 Good Practice Recommendations Ensure that: Staff with responsibilities for administering medication receive regular refresher training; • Residents over 75, on four or more medications, are provided with an opportunity to access an annual medication review. Ensure that the Home’s menus include the following details: • • • • • The type of desert provided after the lunch time meal; Sandwich fillings offered; The range of snacks and beverages available inbetween main meals; The availability of fruit; The timing of meals. • 2. OP15 The Lawns Residential Care Home DS0000000308.V257775.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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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