Inspection on 17/04/07 for Twin Oaks Nursing Home

This inspection was carried out on 17th April 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.

Other inspections for this house

Twin Oaks Nursing Home 10/11/05

Twin Oaks Nursing Home 01/06/05

Twin Oaks Nursing Home 11/01/05

Twin Oaks Nursing Home 08/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Twin Oaks Nursing Home Hudson Way Chapel Break Bowthorpe Norfolk NR5 9NJ Lead Inspector Ann Catterick Key Unannounced 17th April 2007 09:30 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 Twin Oaks Nursing Home DS0000015695.V336769.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. Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Twin Oaks Nursing Home Address Hudson Way Chapel Break Bowthorpe Norfolk NR5 9NJ 01603 743195 01603 748728 richard@twinoaks.fsbusiness.co.uk 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) Mrs Ruby Jane Francis Karen Moore Care Home 49 Category(ies) of Old age, not falling within any other category registration, with number (49), Physical disability (49) of places Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th November 2005 Brief Description of the Service: Twin Oaks Nursing Home is located in Bowthorpe, a suburb on the outskirts of Norwich. The home is purpose built and first registered in 1995. The nursing provision offers care with nursing for older people and for service users with a physical disability. Service user accommodation is on two floors divided into four wings with the building designed on different levels. There are 37 single rooms and 6 double rooms all en-suite. The reception and main services and facilities are sited on the ground floor. There is ample parking space to the front of the premises. The gardens to the rear of the premises are mainly laid to lawn with flowerbeds, and raised gardens and patio areas. Disabled access is at the front of the premises. The weekly fee for the home is between £330.30 and £480.00. Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection and took place on 17th of April 2007. The inspection was over a period of seven hours. Prior to the site visit a pre inspection questionnaire was received from the manager. Eleven feedback forms were received, three from health professionals whose comments were positive, eight from service users, mostly with help from relatives and three were from relatives. Comments from relatives and residents were mixed with some very positive comments and some less than positive comments. The feedback from the quality assurance that took place in the home was very positive. The management have been advised that the re visit their quality assurance system to ensure that it is an accurate reflection of service users and relatives comments. The inspector had the opportunity to speak with residents, relatives, staff and management as well as look at documents, care plans and have a tour of the building. Generally the environment is attractive with good size communal areas and bedrooms with attractive grounds for service users to use in the warmer weather. There is, however, opportunity for improvement in some areas of the environment. Positive comments were received from staff and all felt supported by the management within the home. There were lots of positive comments from residents and relatives as well as some less positive comments. An example of the comments received is given below. Overall the service provided is good but there are opportunities for some improvement What the service does well: The nursing needs of service users are well met. Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 6 Staff in the home feel supported by the management team and enjoy their work. Staff are offered and encouraged to complete training. Interaction observed between staff and residents was good. Visitors are always made welcome. The food in the home is of good quality and is well presented and nutritious. Some comments made by residents and/or their relatives. “I find the management and matron very helpful.” “Plenty of activities.” “Good nursing staff in general and good equipment.” “Welcomes relatives warmly so that we never feel we’re not part of the home.” “Creates a social life for my mum that she would not be able to access otherwise.” “Treat my mum with warmth and respect.” “Am treated kindly.” “Lovely here.” “Staff friendly.” “Staff respond to bells quicker than they did in hospital.” What has improved since the last inspection? What they could do better: Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 7 Formal supervision of staff needs to take place on a regular basis and this needs to be recorded. All areas of the home need to be free from offensive odours. The manager needs to ensure that a clear audit trail is in place for all medication received into the home. The manager needs to address some of the concerns identified in comment cards and on the day of inspection. Comments made by residents and/or their relatives. “There is usually a smell when you enter the building.” “Some staff are excellent and some are not.” “A little more attention for people who cannot talk for themselves.” “Kept clean but usually smells.” “The bell system is intrusive.” “Pressure on staff at busy times which means long delays answering call bells.” “Everyone is so busy.” “The only time staff come and see me is when they have to.” 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. Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. People who use 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 seek information about the service prior to making a decision whether or not the home suits there needs are offered the appropriate information. Before people are offered a placement in the home their needs are assessed to ensure that they can be met within the home. EVIDENCE: A copy of the homes brochure and Service User Guide were seen on the day of the visit to the home. These included most of the information needed to be included. The address and telephone number or the Commission should be included in the information with regard complaints. Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 10 Prior to a resident being admitted to the home a member of staff from the senior team would visit the prospective resident to assess their needs to ensure that these could be met by the home. When available the home would also have information from other social or health professional involved with the person. Evidence of these assessments was seen within the care plans. Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 11 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): 7, 8, 9 and 10. People who use 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 having their health and personal care needs set out in an individual care plan that informs the resident and care staff how there needs are to be met. This care is provided in a way that promotes dignity and respects privacy. Overall medication procedures are safe and well managed with one area needing improvement EVIDENCE: Several care plans were inspected on the day of the site visit. Care plans have been reviewed, in recent months, to ensure that they include all relevant information and are easy for staff and service users to read. Health and personal care needs were clearly identified within the care plans. There was limited social information in care plans and as some service users would not be Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 12 able to offer this information themselves this needs to be included to enable carers to be able to have meaningful conversations with residents. A recommendation has been made in this area. It was not easy to identify whose care plan was whose as many did not have names on or photographs within. A recommendation has been made in this area. Generally the medication process and procedures were safe and all staff who administer medication are trained to do so. Evidence of training was seen. The home was not able to show a clear audit trail for medication that is received separate from the MDS system. All medication needs to have a clear audit trail. A requirement has been made in this area. Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use 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 offered some opportunities to become involved in social activities. The level at which this meets individual preferences and choices is difficult to assess as for some residents their interests and preferences have not been sort and included in their care plan. There is the opportunity for further improvement in this area. The environment that meals are taking in and the quality and presentation of the meals are good. EVIDENCE: On the day of the site visit a notice of activities was seen on the notice board and in one of the lounges. There is a weekly music workshop, weekly bingo and ‘pleasant pastimes’ who visit bi weekly. Some of those staff spoken to felt they had the opportunity to spend enough social time with residents whilst other felt there was not very much opportunity for this. Feedback from Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 14 residents was mixed with some saying there was little to do and others being more satisfied. It appeared that for the more able residents the outcomes with regard activities and meaningful occupation was good, however this was not so good for less able residents. Examples of good practice in this area were given. One resident is taken to the football and another to the circus. At the time of the last inspection the home was planning to review the activities and social stimulation offered for residents both from a group and individual basis with a separate assessment for those residents with a physical disability and within the younger age group. This has not yet taken place. A recommendation has been made in this area. Residents felt that visitors were always made welcome. A relative who visited every day and stayed several hours said that he was always welcomed and felt included, being provided with lunch and drinks throughout the day. Some residents have independent advocates. The home is divided into four units with dining areas on each unit. Service users can eat their meals in the dining area or their own bedroom depending on preference. The chef spoken to on the day of the visit to the home has worked there for many years and run a well-organised kitchen. Food provided was presented well and liquidised or thickened food served in individual portions to make it look appetising and recognisable. There is the opportunity for a cooked meal at both dinner and tea. There is a choice at each meal and the menu for the day was on a board in the dining area. At present the residents do not influence what is on the menu. The manager has now introduced resident meetings and will have menus on the agenda with plans to encourage residents to have more say about what meals are provided. All staff working in the kitchen have completed their food hygiene training. Twin Oaks Nursing Home DS0000015695.V336769.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): 16 and 18 People who use 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 informed of how to make a complaint about the home and are protected by the homes policy and procedure with regard adult protection. EVIDENCE: The home has a complaints procedure and this is included in the Service User Guide. It needs to include the address and telephone number of the Commission. A recommendation has been made in this area. The manager advised that they would welcome complaints and/or concerns and take these seriously. Those residents who were spoken with were clear on how to make a complaint and said they would feel comfortable doing this. All staff have received, or are waiting to receive, training with regard the safeguarding of vulnerable adults. The home has a clear policy and this is included in the staff induction programme. All of those staff spoken to were aware of the whist blowing policy and said that they would always report poor or inappropriate practice. Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 16 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): People who use 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. People who use this service are mostly provided with a comfortable environment that meets their needs, however, on both days of the inspection, one unit had an unpleasant odour that had an impact upon the environment where some residents lived. EVIDENCE: The home does not have a written maintenance and renewal plan although the manager was able to say what plans for improvement there were for the coming year. All bedrooms are of a good size and provide comfortable accommodation for residents. All bedrooms except one are en suite. Those residents spoken to who shared bedrooms were happy to do so. The communal areas were bright and airy offering pleasant accommodation. Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 17 Bathrooms and communal toilet facilities were adequate. The home has made application for a grant to have a specialist bath that would enable those residents who are unable to use the present baths and showers to have a bath. Signage in the home was limited. For example toilets and bathrooms did not have a sign on the door saying what they were. A recommendation has been made in this area. Laundry and sluicing facilities are good and the infection control in the home is well managed. Some areas of the home have been re carpeted however in some areas of the home the carpets are well worn and looked like they were ready for replacement. On one floor there was a strong smell of urine on both days of the visit. Carpets on this unit are shampooed on a regular basis but this was not solving the problem. A requirement has been made in this area. The home has attractive and well-maintained grounds that residents have access to in the warmer months of the year. Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use 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 people who you this service are cared for by staff who have the experience, knowledge and skills to carry out their role as carers thus providing a good quality of care to the residents living in the home. EVIDENCE: There are adequate numbers of staff on duty to meet the needs of residents. On the days of the visits to the home staff appeared to be meeting all of the nursing and personal needs of the residents. Some activities for service users were taking place. Mixed feedback was received from service users and relatives who returned comment cards. Some said that sometimes call bells were not answered for some time, other said that it was not easy to locate staff or know who was in charge at any one time. Others were more positive recording that there were enough staff in the home. The overall feedback was positive. 33 of staff have a certificate in NVQ or above and the home has other staff completing this training. The aim is to have at least 50 of staff with this Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 19 qualification or its equivalent. A recommendation has been made in this area. Staff files were inspected and evidence was that the recruitment and selection process in the home is good and that all relevant information required about prospective employees was received by the home prior to them starting work. All staff receive induction training and evidence of this was seen on their files and the inspector was able to talk with the senior member of staff who takes responsibility for this. The home is not yet using the new common induction standards. A recommendation has been made in this area. The manager needs to devise a system of recording this training to enable easy access to the information to ensure training is kept up to date and refresher courses take place. A recommendation has been made in this area. Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 20 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): 31, 33, 35, 36 and 38. People who use 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 people who use this service will be living in an environment that is safe and well managed. There are some areas in this outcome area were improvement can be made, however the overall outcome is good. EVIDENCE: The home is well managed with a good management structure. The registered manager is a nurse and takes responsibility for all nursing and clinical aspects of care provided. The provider’s daughter has made application to become a Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 21 partner in the business and she is at the home full time taking responsibility for the administrative tasks within the home. Other senior staff have different managerial responsibilities. The way the home is managed appears to be transparent and open with staff given positive feedback about the management team. A quality assurance system is in place and feedback is gathered and published on a regular basis. The feedback received by the Commission and the feedback received by the home varied in some areas and the home may want to review the QA system it is using. Staff are offered informal and practical supervision on a regular basis but no formal written supervision takes place. A requirement has been made in this area. Staff receive the appropriate health and safety training needed to fulfil their role. The manager must keep a record of all the records referred to in Schedule 4 in the home, available for inspection. This ensures all information that may need to be inspected is in the home when needed. A requirement has been made in this area. The registered manager ensures that the home ensures that the health and safety of staff and residents is protected and promoted. General risk assessments were seen and people centred risk assessments were seen on file. All incidents and accidents are appropriately reported. The Provider needs to ensure that they fulfil their responsibility as identified in regulation 26 of the Care Home Regulations 2001. The home does not have a signing in book and therefore does not know who is in the building at any one time. A requirement has been made in this area. The health, safety and welfare of service users are protected by the homes policy and procedures. Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 22 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 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 2 x x 3 x 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 2 2 2 2 Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 23 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 OP36 Regulation 18 Requirement The registered providers are required to maintain a written record of all supervision sessions with staff to ensure development, practice, and training needs are acknowledged and form part of the annual appraisal process. This is a repeat requirement from the last inspection. Timescale for action 01/07/07 2 OP9 13.2 3 OP19 16.2 (k) 4 OP35 16.2l There needs to be a clear audit 01/07/07 trail for all medication kept in the home to ensure that the manager can be sure of how many medications are in the home at any one time. All areas of the home need to be 01/07/07 kept free of any offensive odours to ensure that all service users live in comfortable and pleasant environment. Residents money that is looked 01/07/07 after by the home needs to be looked after in a way that is independent from any of the homes financial systems. This will ensure financial independence and safekeeping. DS0000015695.V336769.R01.S.doc Version 5.2 Page 24 Twin Oaks Nursing Home 5 OP38 17.2 6 OP37 17.2 The home needs to have a record of all visitors to the home to ensure that they know who is in the building at any one time. Records relating to staff need to be in the home where the staff are employed to enable access to staff files by the commission. 01/07/07 01/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3 Refer to Standard OP7 OP7 OP12 Good Practice Recommendations Care plans would be enhanced if they had more information with regard the social history and preferences and aspirations of residents. Care plans would be improved if they were clearly marked with the residents name and had a photograph included. It would be of benefit to residents for the home to complete it’s planned review of activities and social stimulation. The plan was to complete this on a group basis and for the individuals. The complaints procedure should have the address and telephone number of the Commission to inform readers of how to contact the Commission. It would be helpful to residents if toilet and bathing facilities had clear signage. The management of the home should be aiming to have a least 50 of staff qualified to NVQ level 2 or its equivalent. This would ensure that staff have the basic training to fulfil their role. It would help the home ensure all staff are completing appropriate training if a clear training matrix was devised. When inducting new staff the home needs to be working with the new common induction standards that became available in April 2007. 4 5 6 OP16 OP19 OP28 7 8 OP30 OP30 Twin Oaks Nursing Home DS0000015695.V336769.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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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