Inspection on 09/02/09 for The Vine House

This inspection was carried out on 9th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Vine House 26/03/07

The Vine House 21/02/06

The Vine House 01/09/05

The Vine House 22/02/05

The Vine House 21/12/04

Similar services:

Coopers Mill Ltd

Pocklington House

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Paradise Lodge

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Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Vine House 9 Northdrift Way Farley Hill Luton Beds LU1 5JF one star adequate service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Angela Dalton Date: 0 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: The Vine House 9 Northdrift Way Farley Hill Luton Beds LU1 5JF 01582485744 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): P & P Community Services Ltd Name of registered manager (if applicable) Mulenga Mumba Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 2 2 0 0 care home 2 learning disability sensory impairment Additional conditions: That the home be registered to provide residential care for 2 adults who have learning difficulties and who may also have sensory impairment. The condition that all persons who are admitted to the home must have learning disabilities as their primary assessed need. Date of last inspection 2 6 0 3 2 0 0 7 A bit about the care home The Vine residential home was registered on the 14th October 2003. It is owned by P & P Community Services Ltd. The house is located on the outer region of Luton and is within walking distance of shops, parks, pubs and places of worship. The ground floor has a sitting room and a kitchen combined with dining area. The upstairs floor has a bathroom and toilet, two bedrooms and a small office which also serves as a sleep in room for staff. The front of the house has a drive way with parking for up to two cars. The garden is located at the rear of the home and has both a lawn and patio area. The fees for this home vary from 1200 pounds to 1700 pounds per month Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: Adequate Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home One inspector visited on 9th February 2009 without telling anyone that they were coming between 10.15am and 4.30pm. We looked at the care of people who use the service to check the care they receive is the same as it is written in the care plan and meets their requirements. We also check that what we are told is happening is actually taking place. ’I like living here’ We spoke to the people who use the service and members of the staff team. The manager was not working on the day of inspection. The inspector watched how staff spoke to people and looked around the house to see if it was being well looked after. We looked at paperwork to check that what was happening in the service was being written down. The services monthly fees are under review but currently range from 1200 pounds to 1700 pounds. This does not include toiletries and private chiropody and other personal costs. What the care home does well 2 people live at The Vine House. Staff work alone and people tell them about how they want to spend their time. Each person has written a plan of monthly activities that they like to do. Both people have a yearly pass to go to the cinema as they like to watch films. The home is close to lots of places to go to which provides lots of choice. One person told us I really love it here. The house has a friendly feel because of its small size. People who live there have all their belongings around them. People talk about their problems with staff. Staff get regular training to help them do their job. What has got better from the last inspection What the care home could do better Some more information needs to be written to help staff know about all the needs people have and how to meet them. Staff need to have more information in care plans about how to look after people’s health needs like asthma and epilepsy. Biscuits are kept in a biscuit barrel but if this runs out biscuits are kept in a locked cupboard. Staff keep the keys and people ask for the keys to get more biscuits out. The way staff write about medication must be done in a better way. There must be records to show more detail about how health needs like asthma and epilepsy are managed. Some parts of the house need to be better cleaned and decorated: part of the ceiling of the bathroom is mouldy and the vent is dirty. An unclean brush was kept in a bathroom cupboard to clean the sink but has now been thrown away. Some of the kitchen cupboards are chipped and the transfers are peeling off bathroom tiles. The front door is locked and only staff have the keys to open it. This may be dangerous if there is a fire. If you want to read the full report of our inspection please ask the person in charge of the care home Mulenga Mumba If you want to speak to the inspector please contact Angela Dalton CSCI CPC1, Capital Park, Fulbourn, Cambridge, CB21 5XE Telephone: 01223 771300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The necessary information is in place to enable people who use the service to make an informed choice about moving in. Evidence: Each person who uses the service had access to service users guide. This was written in symbols so that service users could understand information about the homes facilities and what facilities are available locally. Both people who use the service had moved into the area and found the service users guide helpful in providing information about their new home and local facilities. There have been no new admissions since the previous inspection. We discussed the assessment process with the deputy manager who told us that if there were changes that the compatibility of people moving in would be the most important factor. The current people benefited from a phased moving in process which began with tea visits and built up to overnight stays. The statement of purpose was very informative and this is reviewed each year to ensure that all the information is current and correct. It stated what service users could expect from the home and staff team. There were copies of contracts in individual care plans but there was no evidence that the fees had been reviewed since moving in dates in 2004 and 2005. The deputy manager assured us that this would be done so that people who use the service had up to date information about their living costs. The rest of the information in the contract appeared up to date and accurate. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Care plans require some development to reflect how all needs are met and reviewed. Evidence: Both people who use the service had care plans outlining their needs and how staff worked towards meeting them. The care plan is reviewed monthly by staff and annual reviews are held with social services to ensure that people are still happy with the service that they receive. Some information was held in a separate risk assessment file and there were no directions to staff to refer to this information. It was also not included in the review of the care plan. Some information may have been more appropriately kept as a care plan. Examples being how staff managed a person being placed in potentially vulnerable situations when in public places and management of epilepsy. One risk assessment related to the number of biscuits that should be eaten and the potential side effects of over eating. Biscuits were available in a biscuit barrel but people had to ask staff for keys if they ran out. There was no evidence as to how the decision to lock biscuits away had been reached with other professionals. The risk assessment did not advise what measures were in place to enable people had reasonable access to biscuits as staff have control of the keys. On care plan was recording fallacious sayings with headings of untruth uttered, name of accuser and name of accused. There was no accompanying care plan and it was unclear why the monitoring form was in place and who had agreed it. This appeared a subjective document as the language used had already determined that an untruth had been uttered. The front door is locked and staff retain possession of the keys. This poses a risk in the event of a fire and a fire assessment must illustrate how the situation has been considered and is being managed. The Mental Capacity Act may have a bearing on Evidence: some of the practices in the home with regard to the Deprivation of Liberty aspect of the Act e.g. locking the front door and locking a kitchen cupboard. One service user has his water supply turned off in his bedroom and this has been done with their agreement. However, there is no evidence of this having been reviewed since 2006. Each person has a health action plan, which explains what their needs are and how they are met. However, there was no evidence of needs and interventions being reviewed even though this was occurring. The health action plan stated ongoing under the review section. One person with asthma was visiting their G.P. regularly and receiving reviewed treatment but this was not reflected in the health action plan. The service has not yet introduced person centred planning: this enables staff to work wth people to identify what their hopes, dreams and aspirations are to enable them to be incorporated into everyday life. The deputy manager plans to research how this can be introduced. Person centred planning would build on the work that is currently in place: people decide how they will spend their time and plan a monthly timetable. There are monthly house meetings and each service user has a keyworker that they can discuss any issues with. End of life wishes have been discussed and recorded and can be added to at a later date if necessary. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service are able to make choices about their lifestyle and how they spend their leisure time. Evidence: Both people who use the service devise their monthly activity schedule and copies were in care plans and in the office. They have an annual cinema pass which enables them to make unlimited visits to the cinema which they stated that they enjoyed. We observed both people telling staff about the film that they had recently seen. There is no designated vehicle for the home but there is easy access to local bus routes. Service users also use taxis or are driven by staff if necessary. There are many local facilities in the nearby town centre, local park and discovery centre that service users access. Both people went on holiday to Clacton last year and are planning a holiday during the summer. As well as leisure activities both service users attend college and one attends a horticultural placement. We were told by service users that they liked going out and were happy with the choices that were available. Service users had personalised their bedrooms and although they could lock their doors the keys were kept in the office. Service users reported that they were happy with this arrangement. Regular contact is maintained with service users families. They visit their families and families also visit. Contact with friends is maintained and both people attend a monthly disco where they socialise. We observed preparations for lunch and dinner. Service users requested meals and these were available even though they differed from the menu that they had written. Evidence: As discussed earlier, biscuits are not freely available but staff were observed to unlock the cupboard when asked for biscuits. At the previous inspection in 2007 toiletries were being kept in the office but this has since changed and service users keep their own toiletries. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The medication system does not safeguard people who use the service. Evidence: Service users told us that they got all the help that they needed to do things. We were shown that service users kept their clothes in their wardrobes and they did not get mixed up. Care plans gave clear information about individual personal care and how personal preferences were observed. Service users told us that they liked the staff and they were kind. There was evidence that service users were supported by a G.P surgery although there were letters detailing that appointments had not been kepy on four occasions and one service user had been asked to find an alternative G.P. This situation had been resolved and there was no further record of any problems. Service users do not currently receive any specialist support but the deputy manager stated that this was available if required. We checked the medication records and storage system to ensure that it met the needs of service users safely. Although a thermometer was in place the temperature records were not recorded to reflect that medication is stored at the correct temperature. Amounts of medication are not recorded so it was not possible to check that the correct amounts of medication were available and the appropriate amount had been dispensed. Existing amounts of medication were not recorded or carried forward and added to new medication received. There were no records of any checks made on medication entering the home. Although medication was available in the Monitored Dosage System (MDS) delivered by the chemist an additional supply was being stored in the medication cupboard. This may lead to confusion and result in medication being given twice. Copies of prescriptions were not being kept: these act as a receipt of medication prescribed by the G.P. and copies provide proof that the instructions on the Medication Administration Record (MAR) sheets are correct. Handwritten instructions did not reflect clear instructions about the route medication should be given or the Evidence: amount received. There was no record of staff signatures and initials to aid in identifying who had administered medication and compare to the MAR sheet. There are currently no controlled drugs or medication requiring refrigeration kept in the home. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service are enabled to express their concerns. Staff have a clear understanding of the safeguarding procedure. Evidence: The complaints policy reflected that people who use the service were able to make a complaint. A record of the complaint and the action taken are recorded which means if regular complaints are recorded an overall picture can be gained. There had been no recording of external complaints since 2006. Any concerns that people who use the service may raise are discussed and resolved in one to one support sessions with key working staff or in house meetings. Service users told us they knew who to speak to if they were unhappy. All staff have received training on safeguarding vulnerable people and local policy is available in the office. We checked two financial records and found them to be in good order. The deputy manager plans to record the financial checks which occur at each staff change as currently only weekly checks are recorded. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Infection control measures, cleanliness and privacy could be improved to ensure a higher standard of living for people who use the service. Evidence: The house was tidy and generally well kept. There were some exceptions: an area of the bathroom ceiling was mouldy and there was an odour of damp. The transfers on some of the tiles were peeling off and the vent was dirty and did not aid in the reduction of condensation. A dirty cleaning brush was kept in the bathroom cupboard which was thrown away during the inspection. The deputy manager explained that this was to clean the sink, as toothpaste was difficult to get rid of. There were no hand towels or soap available in the bathroom although this was rectified when brought to the deputy managers attention. The kitchen cupboards were damaged in places and some of the veneer was missing. This meant the chipboard was exposed and could not be easily wiped clean. The bathroom can be locked but only when the key is requested from staff. This poses a risk, as the door cannot be opened from the outside in the case of an emergency. Staff controls privacy as they retain possession of the bathroom key. The deputy manager stated that the key had been lost and flushed down the toilet on previous occasions. A two-way lock is necessary to afford the privacy and safety of people who use the service. The deputy manager told us that a maintenance book records the work that is required but there was no formal maintenance and renewal programme. One bedroom had pockmarked walls where blue tack had been removed. The deputy manager told us that the bedroom had been recently redecorated. An alternative wall covering may be more durable than the painted wood chip wallpaper. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Recruitment and training systems require some attention to ensure the wellbeing of people who use the service. Evidence: Only one new staff had been recruited since the previous inspection in 2007. The required documents had been received but there were some gaps in the application form. The deputy manager explained that this was because the staff member was from overseas. Two references had been received but one was from a neighbour. A more comprehensive application form would enable the manager to conduct thorough checks on experience and background. Staff have attended a variety of training and the staff team take advantage of the local authority training programme. Staff files reflect the training that has been obtained to meet the needs of people who use the service and identifies when an update will be required. Staff receive training to administer rectal diazepam, which is required, but they have usually been in post for a little while before this commences. We were told there is a protocol to guide staff what they action they should take prior to them receiving this training. Staff who join the home complete an induction in line with the Learning Disability Award Framework (LDAF) to ensure that their training is tailored to meet the needs of service users. The service has almost achieved one hundred percent of staff having obtained an NVQ award. The manager, deputy manager and senior support worker (also known as the acting deputy manager) have all obtained Level 4 NVQ. 1 staff has obtained Level 2 NVQ, 1 staff has obtained Level 3 NVQ whilst another staff is working towards their Level 2 award. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . A comprehensive fire plan would better assure the health and safety of people who use the service. Evidence: We were informed by the deputy manager that the manager was attending an appointment on the day of inspection. The manager is also the proprietor of the service and she is married to the deputy manager. Service users told us that they like the staff and that they could talk to anyone. Their views are regularly sought in house meetings and the deputy manager told us that there are annual questionnaires to find out views about the service. An Annual Quality Assurance Assessment questionnaire had been completed and returned to the Commission for Social Care Inspection last year. This outlined how the service aimed to maintain a quality service to people. As discussed earlier the front door is locked and staff retain the keys. This poses a risk in the event of a fire. The fire procedure does not reflect that the potential problem that a locked door may present. The deputy manager plans to refer to the local authority website to devise a more comprehensive fire evacuation protocol. Regular health and safety checks are conducted: hot water temperatures were recorded to ensure that people are not at risk of scalding. Fire drills occur at least twice a year. Staff attend training to ensure they are aware of health and safety needs - records reflected staff had attended moving and handling, food hygiene and first aid training. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 7 12 Care plans must reflect the 30/04/2009 care requirements of people who use the service and how they are met, monitored and managed. E.g. management of asthma and epilepsy. If information is held in a separate file then staff need to know where to look for guidance. All information must be reviewed to reflect that service users needs can be met and that they are well cared for. 2 7 13 Where freedom of choice is 30/04/2009 restricted the care plan must reflect how this decision was reached and who was consulted. The care plan must demonstrate how the restriction of choice is in the best interest of the individual and professional guidance has been sought so that quality of life is not reduced. 3 20 13 Accurate medication records 31/03/2009 must be kept to ensure the safety of people who uses the service. The amount of medication must be recorded to ensure that it can be checked and that adequate amounts are available. Handwritten instructions must detail the route, dose and amount of medication prescribed. Copies of prescriptions must be kept to evidence receipt of medication. Temperature records must be kept to reflect medication is stored at the correct temperature. A safe medication system must be in place to protect people who use the service. 4 24 16 The upkeep and cleanliness of the home must be improved. Part of the bathroom ceiling is covered by areas of mould, the vent is unclean and does not allow condensation to escape. 5 30 13 Better infection control 30/04/2009 measures must be observed. Some of the kitchen cupboards are chipped and good hygiene cannot be assured. 6 34 19 Service users must be protected by robust recruitment practices. 31/03/2009 30/04/2009 Application forms must be comprehensive and the reason any gaps in information exist must be recorded. Appropriate references must be sought to reflect the competence necessary for the role. 7 42 13 A comprehensive fire plan and protocol must be in place. 31/03/2009 The current procedure does not consider the implications of a locked front door in the event of a fire. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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