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Inspection on 28/09/07 for The Mews Nursing Home

Also see our care home review for The Mews Nursing Home for more information

This inspection was carried out on 28th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home uses all of its communal space and gardens for the benefit of service users who are also able to spend their time in areas of their own choosing. Some service users have detailed social assessments in their care plan. The home has a sheltered and pleasantly planted garden area that is used by service users and their relatives when the weather permits. Generally the home is kept clean and generally odour free. Service users have pleasant and well-decorated bedrooms. Staff endeavour to provide good care in spite of managerial problems. Care planning is good and the delivery of clinical care is carried out well.

What has improved since the last inspection?

A number of carpets have been replaced in bedrooms but black continues to dominate corridor areas. Redecoration has been carried out in a number of bedrooms. Light levels have been improved and bathrooms have been redecorated in lighter colours.

What the care home could do better:

The foul odour persists in sluice areas. The home has been without a manager on site for some time and they no longer have a deputy manager. This has affected, either directly or indirectly, many areas of service provision. The kitchen did not have a permanent cook and was unable to provide the scheduled menu choices. Food stocks were low including many basic items. Some aspects of kitchen hygiene were poor, including the provision of stained cups to service users and the use of trolleys that were not clean. In the absence of an activities co-ordinator, the home does not have as varied a social programme as it should have and some service users have little stimulation.

CARE HOMES FOR OLDER PEOPLE The Mews Nursing Home Southburn Terrace New Herrington Houghton Le Spring Tyne & Wear DH4 7AW Lead Inspector Mr Tom Moody Key Unannounced Inspection 28th September 2007 10:30 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 Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Mews Nursing Home Address Southburn Terrace New Herrington Houghton Le Spring Tyne & Wear DH4 7AW 0191 512 0097 0191 512 0959 the.mews@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Pauline Mary Fox Care Home 50 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) Category(ies) of Learning disability (1), Old age, not falling registration, with number within any other category (50), Physical of places disability over 65 years of age (40) The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd August 2006 Brief Description of the Service: This home provides 50 places for elderly persons. This includes 5 respite places for persons requiring palliative care. The current scale of charges is between £410 and £643. The home is purpose built and the internal space is generous. There are a variety of lounge and dining areas. The bathrooms and WC’s have handrails and appropriate equipment for disabled service users. The home is constructed in a traditional style incorporating brick and a tiled roof. It has two floors with passenger lift access to the upper floor. Ground floor access is level. The home stands in grounds shared with another care home. The garden area is well maintained and there is adequate parking. There is a secure patio area for service users. The home is located in a village, in a suburban area. There are local facilities close to the home including shops. The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit took place over one day in September 2007 and was carried out by a single inspector. Information was obtained before the site visit from several sources, including the providers self-assessment. Records were examined and a tour of the premises took place. Discussion took place with the area manager and other members of staff. The midday meal was observed and the inspector also spoke to service users, staff, and visitors throughout the inspection. The feedback from service users and relatives was generally positive although some expressed reservations about staffing and management weaknesses. The home is reasonably well equipped with aids and adaptations suited to the client group’s age and lifestyle preferences. The home has plenty of space in all areas. It is popular with service users and their families. What the service does well: What has improved since the last inspection? A number of carpets have been replaced in bedrooms but black continues to dominate corridor areas. Redecoration has been carried out in a number of bedrooms. The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 6 Light levels have been improved and bathrooms have been redecorated in lighter colours. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 7 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 Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service Service users have contracts, good sources of information and assessments that ensure that their needs are met. EVIDENCE: The home has appropriate policies and procedures. The providers self assessment states that they offer a clear presentation of the service to new residents. This includes; Service User Guide, Terms and Conditions of residence, Statement of Purpose and Printed copies of the latest CSCI Inspection Reports are made available to enquirers. Trial periods are offered to new residents as well as offering a day at the home to new enquirers The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 9 Relatives confirmed that they are able to visit the home before their family members move in there. Service users said they are happy with information and choice of home although some said this was done by relatives. Care planning documentation records this and portrays an accurate assessment of service users needs. The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. There is enough information in care plans ensure that the home is meeting all of service user’s healthcare needs. Service users are protected by a safe system of medication that is properly operated by staff. EVIDENCE: The providers self assessment states that they, “Promote and maintain service users and ensure all access to all aspects of service is directed in pursuit of a high standard of care”. Staff training has been given to improve their understanding of the health needs of the residents. The home acknowledge that they need to “be more proactive of the documentation of personal care preferences and detail within the care plan”. The care plans continue to be improved and a new assessment document is now in use. The care plans that were sampled contained a good level of information, including risk assessments. They were updated in line with changes in service user’s needs. The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 11 The Area Manager said that a regular audit of care plans is carried out and the results of this were seen. Doctor’s visits were recorded, as were specialist services such as diabetic screening and speech and language therapists. Medication storage was secure and administration was properly recorded. The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. Not all service users are having their social and recreational needs met. Quality and quantity of basic foodstuffs was poor and hygiene practice makes it doubtful if service users nutritional needs can be properly met. EVIDENCE: The providers self assessment states that they have, “Good staff interaction with the residents and relatives and that residents and relatives meetings take place.The home Manager has an open door policy and there is a dedicated activities staff and an activities schedule”. Unfortunately much of the information in the providers self-assessment is now out of date. The activities co-ordinator is unavailable due to long-term absence and so is the home manager. A number of service users had their own selection of videos, books or music in their own rooms. Televisions were playing in all lounges but there was no organised activity at the time of the site visit. The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 13 One or two service users said they “listened to the telly”, and one said ”I didn’t do anything when I was at home”. Care plans indicated service user’s preferences and patterns of activity throughout the day. However, one of these indicated that the service user in question enjoyed company. This seemed at odds with their true situation, which was sitting alone in their room with little stimulation. Staff spoke pleasantly to service users but there seemed to be little interaction between staff and the majority of service users, other than that which was necessary to carry out care tasks. The social interactions that were seen were with “popular” service users who were easy to interact with. One relative also spoke of this, saying, “Some of the girls work very hard but there is no interaction”. The situation in the kitchen, described in the last report, had improved. However, on the day of the site visit there was a high degree of disorganisation. In the dining room the menu board indicated it was Sunday, and Sunday Lunch was available, although it was Friday. The regular cook had left, repeating what seems to be a familiar pattern in this home. The agency cook who was on duty, told me that there were not the correct ingredients available to cook the planned menu. He said that he was struggling to find appropriate ingredients to cook anything on the four weekly menu cycle. The cook did produce a meal of fish and chips and, bread and butter pudding that looked appetizing and was enjoyed by service users. The cupboards and freezers were low on basic ingredients. There were few fresh vegetables and those available were of poor quality. The cleanliness in the kitchen was slightly improved on the last visit but was not as good as it should have been. Surfaces were still stained and floors were not well cleaned. Water jugs and crockery were accumulating on benches, because of the unavailability of a kitchen assistant. The staff at the home stated that supplies were on order. The Area Manager indicate that replacement cooks employed by Four Seasons would be taking over very soon. The trolley used to serve drinks to service users was badly stained. The cups, in which service users drinks were supplied, were stained and not properly The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 14 cleaned. It was disappointing that staff did not challenge this situation and seemed resigned to supplying and serving drinks in these cups. It was observed that staff wore their hair in long styles that were of shoulder length or greater. This could be perceived as inappropriate for staff undertaking care tasks and serving food. There was an agency carer who was wearing everyday clothing. She did use plastic aprons but, although she was dressed very fashionably, again it could be perceived as inappropriate, from an infection control, and Health and Safety viewpoint. The carer indicated her agency had not yet supplied a uniform. The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. Service users and most relatives are comfortable about raising issues with staff and the management team. They are confident they will be protected by the homes procedures. EVIDENCE: The providers self assessment states that they, actively support our company Whistle Blowing policy, and strive to protect our residents from harm or discrimination of any kind. They also say they support and guide all staff in training and development, to enhance and maintain the best possible care to our residents at all times. At the time the self-assessment was completed, the home has had 3 complaints in the last 12 months. One of these complaints was investigated through the Safeguarding Adults Procedures. The self-assessment states that over the past 4 months there has been a reduction in complaints. Service users relatives spoke of their satisfaction with the care provided and most confirmed that they are able to raise issues with staff members. One service user’s relative made representation to the Area Manager at the time of the site visit when the inspector was present. She confirmed she had no hesitation in contacting him. The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 16 Several other relatives spoke of the receptivity of the area manager and his easy availability. However, several also commented on the lack of a permanent manager. The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. The environment is safe, the home is well maintained and decorated but the kitchen hygiene must improve to ensure service users needs will be met. EVIDENCE: The providers self assessment states that they, “Try to ensure that the home is pleasant for the residents,visitors and staff.” and that “the home is undergoing a re-decoration programme,improved kitchen environment.” The self assessment documents that all equipment and systems are regularly checked and certificated. During the site visit the inspector observed that many of the outstanding issues from the last report have been addressed. The light levels in bathrooms have been improved, using better lighting and appropriate decoration. The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 18 Carpets have been replaced in many bedrooms giving a much homelier feel to these areas. The worn and stained carpet outside the kitchen has also been replaced. There is no unpleasant odour in any area of the home used by service users, although the foul smell persists in the sluice areas. The home does not have a loop system for hearing aid users. The cleanliness in the kitchen remains poor with some surfaces still rather grimy. Although staff and the area manager stated that it has improved in recent months, it has apparently suffered a further deterioration in recent days. Trolleys, cups and crockery were not adequately cleaned. The décor in the dining room is pleasant with good quality dining chairs and tables available. Communal areas are clean and well decorated although the rather dour, industrial, black carpet remains in many corridor areas. The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. The number of care staff on duty was sufficient to meet service users basic care needs but there is not sufficient management input to improve care practice in the home. EVIDENCE: The home has appropriate recruitment and training, policies and procedures. The providers self-assessment states that; staff are well supported and they carry out regular staff meetings. Furthermore a structured staff supervision programme has been developed and training provided by the company has improved, giving staff more knowledge in key areas. Discussions with staff revealed a reluctance to undertake NVQ training because courses have failed in the past and they perceive this as wasting their time. This is a long-term problem that remains unaddressed by the company. Records indicate staff receive mandatory training in, fire precautions, health and safety, etc. The home was using an agency cook at the time of the site visit and there was no kitchen assistant to help him. The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 20 Significantly the lack of a manager in the home remains problematic. Several relatives spoke of this. Their perception that the nursing staff are hard pressed to manage the home as well as carrying out clinical tasks. One said, “Things were starting to happen and then the peripatetic manager was pulled out. I feel that corners are being cut.” Another relative said that, “Some of the girls; you can see the strain in their eyes.” In discussions with staff they confirmed this was a problem to them. On the day of the site visit service users were receiving adequate physical attention and their needs were being met. However, the nurse in charge did not have time to accompany me and she needed the support from the Area Manager to cope with the inspection. This would be equally problematic if any other unexpected situation cropped up. Recruitment and selection is appropriate and records indicate all necessary checks are carried out. The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgment has been made from evidence gathered both during and before the visit to this service. The home is not well managed because it does not have a manager or deputy on site. Certain weaknesses in practice persist and the home is unable to meet all of the service users needs. EVIDENCE: The providers self assessment states that they; try to maintain good personal skills towards residents, staff, families and external agencies. They state that the resident’s personal finances are well structured and regularly audited. The company says it has in place, care related audits and risk management controls to monitor how the home is caring for there residents; these systems can also provide audit trails for care and care related issues. They say, “ We will continue to develop our systems to provide a good service and promote The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 22 good practice within the management format for our home, residents, families and staff”. This however seems at odds with the situation in the home. Although there was a temporary manager in the home for a period, she has now left and the home no longer has a deputy manager. The day-to–day management responsibility falls to whoever is the nurse in charge. There are several deficiencies in practice, which are noted in other sections of this report, which are likely to be the result of a lack of supervision and leadership. Staff themselves confirmed that they were effected this lack of leadership. One said, “You don’t know what to expect when you come in; whether there’ll be enough staff or a cook.” Although the area manager is making himself available, this is not the same as having a manager on site. The area manager has indicated a manager will be restored to the home in the near future, however, the lack of management in the interim remains problematic. This is an area the Senior Management of Four Seasons should have addressed before now to ensure the homes staff are adequately supported and led. The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 23 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 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 2 3 3 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 x x 2 2 2 The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? yes 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 OP15 Regulation 13(3) 16(2)(g) (j) Requirement The kitchen and equipment must be maintained in a clean and hygienic condition. This requirement is outstanding from previous reports The home must arrange adequate recreational activities and opportunities for social interaction for service users. There must be an adequate variety, and quantity, of wholesome and nutritious food available for service users. Equipment must be provided for those with sensory deficits. This requirement is outstanding from previous reports. 5. OP28 18(1) (a) (c){i} A minimum of 50 of staff must be trained to NVQ level 2. This requirement is outstanding from previous The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 25 Timescale for action 14/11/07 2. OP12 16(2(n) 14/11/07 3. OP15 16(2)(i) 31/10/07 4. OP22 16, 23 31/12/07 30/12/07 reports. 6. OP27 18(1)(a) The home must ensure there are sufficient staff employed, including catering and domestic staff, to meet service users needs The home must have sufficient registered nurse hours to allow the person in charge, time to carry out management duties in addition to clinical tasks. This requirement is outstanding from previous reports. 8. OP36 OP38 OP32 OP31 OP37 9(2)(b)(i) (ii)10 (1)5(a)(b) 24 (1) (b)23 (2) (c)18 (2) 18(1) (b) The home must have a 30/11/07 competent manager in charge. They must be given sufficient support, by senior managers, to ensure staff are supervised and that the homes policies and care practice is carried out in a proper manner. This requirement is outstanding from previous reports. The source of foul odour in the sluice areas should be found and eliminated. This requirement is outstanding from previous reports. 30/11/07 7. OP27 18 (1)(a)18 (2) (3) 30/11/07 9. OP26 16(2)(k) 23(2)(k) 30/11/07 The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 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. Refer to Standard Good Practice Recommendations The Mews Nursing Home DS0000018210.V340457.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South Shields Area Office 4th Floor St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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