Inspection on 13/08/07 for Thornhill Road

This inspection was carried out on 13th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Thornhill Road 11/09/06

Thornhill Road 13/02/06

Thornhill Road 04/10/05

Thornhill Road 20/10/04

Thornhill Road 21/05/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Snydale Care Home

Whitwood House

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

CARE HOME ADULTS 18-65 Thornhill Road 22 & 24 Thornhill Road Rastrick Brighouse West Yorkshire HD6 3AX Lead Inspector Cheryl Stovin Key Unannounced Inspection 13th August 2007 11:00 Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 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 Thornhill Road DS0000001074.V346327.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thornhill Road Address 22 & 24 Thornhill Road Rastrick Brighouse West Yorkshire HD6 3AX 01484 401228 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) www.st-annes.org.uk St Anne`s Community Services Mrs Jillian Northen Care Home 7 Category(ies) of Learning disability (7), Physical disability (7) registration, with number of places Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th September 2006 Brief Description of the Service: 22 and 24 Thornhill Road is owned and managed by St Anne’s Community Services and is registered to provide nursing and social care for up to seven adults with a learning disability. The home is situated in a residential area in the Rastrick area of Calderdale, close to local community facilities and public transport links. The property is purpose built and the accommodation is provided on one level and is fully accessible for all people living at the home. All bedrooms are for single occupancy and highly personalised to reflect their occupants’ interests and tastes. Communal areas are comfortable and furnished and fitted to a good standard. The current weekly charge is £453.90. Additional charges are made for toiletries, clothing and social and recreational activities. Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report brings together evidence gathered during a key inspection of Thornhill Road. This included an unannounced visit I made to the home on 13 August 2007. The purpose of the inspection was to make sure that the people living at the home are receiving the care and support they want and that they and their families are satisfied with the service. During this visit, a full tour of the building was undertaken, records were examined and I spoke to management, staff and the people living at the home. In addition to this visit, comment cards were sent out to give people an opportunity to share their views of the service with CSCI. Three relatives responded. The information received from the surveys is included in this report. The last inspection of Thornhill Road was on 11 September 2006, no additional visits have been made. An Annual Quality Assurance Assessment (AQAA) completed by the home was returned promptly and gave useful information. I would like to thank everybody for their warm welcome and assistance given during this inspection. What the service does well: The home has a warm and welcoming atmosphere and feels very homely and relaxed. The property is well maintained throughout and furnished and fitted to a good standard. The home is fully equipped with aids and adaptations to promote people’s independence and all areas of the home, both internally and externally, are accessible for wheelchair users. Individual bedrooms are highly personalised reflecting the people’s interests and tastes and fully equipped to meet their needs. All of the people living at Thornhill Road have detailed and individual support plans which makes sure that they receive personal and health care support in line with their wishes. The staff team are well trained and were seen to be providing assistance to people in a manner which promotes independence and dignity. People living at Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 6 the home appeared comfortable with the staff and relationships between them were seen to be relaxed and friendly. The home is well managed and the manager is committed to ensuring that people living at the home, and the staff, contribute to the decision making processes. People living at the home are protected by the recruitment procedures in the home which ensures that all the necessary checks are carried out before staff are employed. All of people who sent in comment cards indicated that they were satisfied with the overall care provided. One relative answered the question ‘How do you think the care home can improve?’ with “No improvement is needed, she is happy at Thornhill Road and the staff are marvellous”. What has improved since the last inspection? 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. Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,5 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s needs are assessed before moving into the home and they are provided with written information about the services and facilities provided. EVIDENCE: The home has produced a Service User Guide which is written in an easy to understand format with pictures as well as words to make sure everybody can understand what it says. People living at the home have their needs assessed continually and their care plan adjusted to reflect their changing needs. There have been no new admissions to the home since 1993, therefore, it was not possible to assess the admissions procedure. The staff team were able to demonstrate that they have the skills and experience to deliver the care to the people living at the home in a caring and professional manner, and to communicate effectively. Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 9 Each person has a licence agreement which gives details of the terms and conditions at the home. Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s current needs are recorded in their plan of care to ensure that support is given in accordance with their needs and preferences. People are fully involved in all aspects of daily life within the home and are encouraged and enabled to be as independent as possible. EVIDENCE: All of the care records of the people living at the home were seen. Each person has an individual personal support plan which is detailed and holistic and covers activities of daily living as well as social and emotional needs. The care plans clearly show how the care needed is actually to be delivered. Each Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 11 person or their representative signs to say they are in agreement with the content of the care plan, and the aims and objectives set. Each person has an action plan which sets out their goals and aspirations which is reviewed monthly. The home uses a person centred planning approach and the personal support plans are reviewed on a regular basis. A daily record is kept which clearly details how people have spent their day. Staff have a good knowledge of the communication needs of people living at the home. They are skilled in using the person’s preferred communication method. Detailed risk assessments are in place which are reviewed on a regular basis; this makes sure that risks are minimised and people are kept safe. People are encouraged and enabled to be fully involved in the day to day running of the home and participate in all activities of daily living. Staff were observed to be offering people choices during the day and people were seen to be exercising choice in when to get up and where and with whom to spend their time. All of the relatives/friends surveys showed that they feel that the care home always meets the needs of their relative. One person made the following comment: “I think they do a wonderful job, I am very satisfied with the care they give to my daughter”. Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People enjoy active and varied lifestyles and participate in a wide range of community activities whilst living at the home. EVIDENCE: The atmosphere in the home is warm and welcoming with a homely feeling. People are actively encouraged to develop and maintain their own interests and enabled to participate in a wide range of community, social and recreational activities. Recent activities have included going out for meals, shopping, theatre trips, days out to Chester Zoo and The Deep in Hull, ten-pin bowling and the cinema. Some people are attending a cookery course at college. Staffing levels are sufficiently high to enable impromptu outings to Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 13 take place. On the day of the visit, two people went out for lunch and one person was enjoying a foot massage and toe nail painting by a member of staff who is a qualified masseur. People living at the home are very much part of the local community and make use of a wide range of local facilities Holidays are enjoyed by the people living at the home, this year’s destinations have included Blackpool and Centre Parcs. People are actively encouraged to maintain relationships with family and friends, with key dates of birthdays and special occasions recorded in their individual support plan. Visitors are welcomed into the home and all relatives/friends who returned a survey said that the home helps their friend or relative to keep in touch with them. The following additional comments were also made: “They keep me well informed of everything concerning my daughter’s welfare and health”. “I think they do a wonderful job and I am informed of anything that changes”. “They give you all the information you need to know”. “St Anne’s keeps parents informed in the day to day running of events at the home”. “I am notified immediately of any changes involving my daughter or the home”. “I am told of everything relating to my daughter’s welfare and we have regular meetings with the staff at the home where she is living”. The staff were seen to be treating people with respect at all times and relationships were observed to be relaxed and friendly with appropriate use of informality and humour. People living at the home receive a healthy and varied diet with likes and dislikes recorded. The main meal of the day is served in the evening and meal times were observed to be relaxed and unhurried with assistance given in a sensitive manner. Monday, the day of the inspection, is vegetarian day in the home and the meals served were mushroom, cheese and tomato omelette at lunchtime and Thai green curry in the evening. One person living at the home has specific dietary requirements. Her key worker has researched the condition to ensure that she receives as varied a diet as possible. The home Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 14 has introduced a five a day fruit and vegetable chart to help people to eat healthily. Some of the people living at the home are going to attend a special event hosted by the St Anne’s Service User Forum. The event will celebrate the achievements of people living in St Anne’s care homes and supported living schemes. Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s healthcare needs are met and personal care is given in accordance with their preferences. People are protected by the medication practices in the home. EVIDENCE: People’s personal support needs are assessed and form part of their plan of care. People’s physical and psychological health care needs are assessed and detailed in their individual support plans. An ‘OK’ health check is completed for everybody, this is a recognised tool to help ensure the health of adults with a learning disability. All personal care is given in private, and people were seen to be treated with dignity at all times. Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 16 People have all the specialist adaptations and equipment they require to make sure they are safe and comfortable at all times. All of the people who completed a survey said that the home always gives the support or care to their relative that they expect. Additional comments made included: “The turnaround of my daughter’s lifestyle has improved 100 over the last 10-12 years and I am more than pleased”. “There is no difference in age, colour or disability. They are all treated the same”. “The residents are well looked after. They are kept clean and I couldn’t look after her any better if she was at home with me”. Any medication held at the home is securely and appropriately stored. Medication policies and procedures are in place and medication is only given to people by the qualified nursing staff in accordance with Nursing and Midwifery Council (NMC) guidelines. Each person has a medication profile which details the medication taken, what it is for and any side effects or contra-indications. Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are protected by the procedures and practices in the home, the staff understand and promote Adult Protection Procedures. This makes sure that people living at the home are safe. EVIDENCE: The home has a complaints procedure which is included in the Service User Guide and provides information of the procedure to follow and the correct contact details. All of the people said in their surveys that they knew how to make a complaint about the home if they needed to. One person said: “St Anne’s, who run the home, have given me details of how to report anything of that nature”. The establishment holds a ‘whistle blowing’ procedure which is displayed in the staff room. The procedure details the responsibilities and obligations of the staff to report any instances of bad practices observed or suspected. All of the staff team have received training in Protection of Vulnerable Adults (POVA) and all staff spoken to were aware of the procedures to follow if they suspect that people are not being treated properly. Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,28,29,30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live in a safe and well maintained environment with specialist equipment to meet their needs. EVIDENCE: 22 and 24 Thornhill Road is located in a residential area of Rastrick close to community facilities and convenient public transport links to the town centres of Huddersfield and Halifax. The home is purpose built and comprises two interconnecting semi detached bungalows. The home is fully accessible and provides wheelchair access and adaptations to meet the mobility and personal care needs of the people living there. Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 19 The accommodation offers spacious communal areas and a private, landscaped and accessible garden, where people are able to spend time in the warmer weather. All bedrooms are for single occupancy and highly personalised to reflect their occupants’ interests and hobbies. The home has a programme of routine maintenance. Some of the decoration in the bedrooms was noted to be showing signs of wear and tear and this work has been prioritised. Relatives said in their surveys that: “The home is clean and very well maintained”. “”Provides a good homely atmosphere”. The home was observed to be clean and hygienic throughout with infection control measures in place. The laundry and kitchen facilities are well equipped and comply with regulations. Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s needs are met by a well trained and competent staff team, and are protected by the rigorous recruitment practices. EVIDENCE: There are sufficient staff employed to meet the needs of the people living at the home. There is always a Registered Nurse on duty supported by a team of three care staff during day time hours and one waking night staff plus a member of staff ‘sleeping in’ during the night. Two waking night staff have recently been deployed due to the increased health care needs of one person living at the home. The staff team work flexibly to meet the social, recreational and special needs of people. The staff appeared to work together as a team and relationships between everybody were seen to be relaxed and friendly. Low rates of sickness and Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 21 staff turnover support this. One member of staff told me that she was proud to say that she worked at Thornhill Road. All people who returned a comment card felt that the staff had the right skills and experience to look after people properly. Some additional comments made included: “The staff are marvellous”. “I am happy for my daughter, she is with people who care for her wellbeing, so that makes me happy”. “I am satisfied with the staff I think they do a wonderful job”. “All the staff are Fab”. There is a commitment to training within the organisation and all new staff receive induction training to Skills for Care Council specification. There is a wide variety of other training courses which the staff attend. Staff said that they enjoy and appreciate the training opportunities provided. There is a programme of NVQ training in place and over 50 of the care staff have completed the award. This makes sure that people living at the home are cared for by suitably trained and qualified staff. The staff spoken to during the inspection displayed a thorough understanding of the needs of the people. They appeared motivated and committed to providing a high standard of care and attention, and were observed to be meeting their needs in a sensitive and dignified manner. All of the people living at the home are protected by the home’s robust recruitment procedure. All staff are subject to the necessary Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks. An application form is completed and two written references are taken up prior to an offer of employment being made. This makes sure that only suitable staff are employed in the home. All staff receive job descriptions and statements of terms and conditions. Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,42 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live in a well run and managed service. People’s health and welfare are protected by the home’s health and safety practices. EVIDENCE: The Registered Manager of the home is experienced and competent to run the home. She is a Registered Nurse (Learning Disability) and holds a recognised management qualification. She is committed to ensuring an open and positive Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 23 atmosphere is prevalent within the home, and demonstrates a clear sense of leadership. Management and staff work in accordance with the General Social Care Council codes of practice and other legal requirements. Financial procedures are in place to make sure that people’s money is handled safely. There is a commitment to health and safety and safe working practices in the home. All staff receive mandatory health and safety training with regular updates. Fire drills are carried out on a regular basis and all staff receive fire safety training. Detailed risk assessments are in place which are reviewed and updated on a regular basis. Certificates were seen which showed compliance with gas and electrical regulations. A formal quality monitoring system is in place and people living at the home, their relatives and health and social care professionals are to be consulted as to their views on the standard of care and facilities provided by the home. Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 x 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 3 3 x 3 x Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 25 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 Thornhill Road DS0000001074.V346327.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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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