Inspection on 18/07/06 for Westdene Residential Care Home

This inspection was carried out on 18th July 2006.

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

Other inspections for this house

Westdene Residential Care Home 17/01/06

Westdene Residential Care Home 21/06/05

Westdene Residential Care Home 13/01/05

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Westdene Residential Care Home 1 Rye Close Worthing West Sussex BN11 5EG Lead Inspector Mrs H Church Unannounced Inspection 18th July 2006 09:00 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 Westdene Residential Care Home DS0000061453.V304013.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. Westdene Residential Care Home DS0000061453.V304013.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westdene Residential Care Home Address 1 Rye Close Worthing West Sussex BN11 5EG 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) 01903 247808 Mr Mohammed Khalil Dulloo Mr Mohammad Khalil Dulloo Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Westdene Residential Care Home DS0000061453.V304013.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A total of 14 service users may be admitted, of whom one named service user under the age of 65 years may be accommodated. 17th January 2006 Date of last inspection Brief Description of the Service: Westdene is a Care Home registered to accommodate up to 14 service users in the category of OP (Old Age). The establishment is a large detached property, which has two rear extensions enclosing a small sunny courtyard. One of the extensions offers a conservatory, which provides a sitting area leading off from the dining room. There is a bathroom, which has an assisted bath and a shower situated on the ground floor. Single Bedrooms that are mainly of generous proportions are provided for the residents on two floors, a stair lift has been fitted to facilitate those with mobility problems access to the first floor. All bedrooms have ensuite w.cs. and wash-hand basins. There is a large paved garden to the front, which offers a sunny aspect for service users to sit in the summer. Situated in a quiet cul-de-sac just off the sea front in Worthing, the home is approximately half a mile from the town centre with all its amenities. The Registered Provider is Mr M.K. Dulloo who also manages the home. Westdene Residential Care Home DS0000061453.V304013.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit took place over one day and planned to take part during the morning and over the lunchtime and early afternoon period. The manager was present for the whole of the visit and assisted the inspector with her enquiries. The inspector noted that during the site visit, staff were spending time with individual residents, either in the communal rooms or in the resident’s own rooms. A homely, friendly and relaxed atmosphere prevailed. It was a very hot day and residents spent the majority of their time in their rooms as residents found it too hot to be out in the patio garden. For the site visit, the inspector examined previous information. Some of the information was not on file as part of the registration process when the home changed ownership in 2004. However, the previous report and subsequent action plans with the original Statement of Purpose did provide some information to assist the inspector with planning for this unannounced inspection. During the inspection, the inspector examined the records provided by the manager in respect of the eleven residents currently receiving care. The inspector saw all residents and examined five care plans in detail to assess if the care recorded was the care provided. Most of the residents were able to give a good account of their lives at Westdene. No visitors were present but a hairdresser arrived to provide an agreed service. Without exception all comments were enthusiastic about the way staff provide care and the opportunities for residents to live their individual lives there as they wished. There is a very small team of carers employed at Westdene. The inspector spoke to two members of care staff on duty during the site visit and both said they felt very supported by their manager. One care assistant had just started work and was being supervised in her duties by the senior member of staff. They currently have dual roles of care assistants and domestic staff and carried out their duties in a pleasing and relaxing manner. Two requirements were made regarding records concerning staff recruitment and training and residents care plans. One requirement was made regarding some safety aspects of the environment that require attention. The Registered Person has planned for the service to be user focussed and has assured the inspector of his commitment to ensuring the home complies with the Care Homes Regulations and subsequent National Minimum Standards for Older People. Subsequent to this inspection the Registered Person has carried out some essential work relating to the areas identified during the site visit where standards had not been met. An Action Plan detailing other action to be taken is to be provided by the Registered Person. Westdene Residential Care Home DS0000061453.V304013.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Westdene has concentrated its energies on providing a personal care service, dedicated to promoting independence and encouraging residents to take control of their lives. However, the Registered Person needs to become more familiar with the National Minimum Standards for older persons and follow the Care Homes Regulations on the provision of records. The safety needs of residents must be paramount in the provision of care and services. Residents would benefit by fully identifying the areas of care needed in the residents individual care plans and recruiting and training staff appropriately. Where areas of the environment are not meeting standards, the Registered Person will be prioritising the work required to ensure risks are minimised. Outcomes for residents are good and with the continuing commitment of the Registered Person to improve the required areas meet the standards, it is clear that Westdene will be able to deliver good quality care in a safe manner. Westdene Residential Care Home DS0000061453.V304013.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Westdene Residential Care Home DS0000061453.V304013.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 Westdene Residential Care Home DS0000061453.V304013.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All new residents had been assessed before moving into the home. The staff at the home are meeting the residents identified needs. Relatives were given enough information to help them decide the home would be suitable. Quality in this outcome area is adequate. This judgment has been made from evidence gathered during the inspection, which includes a visit to the service and takes into account the views and experiences of people using the service. EVIDENCE: The inspector recommended that the Statement of Purpose must reflect the business plan of the provider to assist prospective residents and their relatives or their representatives as to the suitability of the home. The Service Users Guide was provided at inspection for the Commission for Social Care Inspection records. The manager agreed to complete a full comprehensive needs assessment before admission to ensure that the home employs sufficient suitably qualified and skilled staff to meet the specialist needs of each prospective resident. All Westdene Residential Care Home DS0000061453.V304013.R01.S.doc Version 5.2 Page 10 residents had contracts signed by residents and/or relatives or their representatives. Westdene Residential Care Home DS0000061453.V304013.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All residents had an individual care plan set out for staff to follow. The home operates a policy where all medication is managed by care staff. Care staff are meeting the health care needs of the residents in a respectful manner. Quality in this outcome area is adequate. This judgment has been made from evidence gathered during the inspection, which includes a visit to the service and takes into account the views and experiences of people using the service. EVIDENCE: Five records were examined and two case-tracked for this outcome area. Each resident has a care plan but the practice of including pertinent information, updating and developing the care plans was variable. In most cases, the care plans include the basic information necessary to plan the individual’s care but there was no evidence to show that the resident had participated in this process. Some of the information (as detailed in the National Minimum Standards Older Persons Standard 3) was not included. There is some evidence in the care Westdene Residential Care Home DS0000061453.V304013.R01.S.doc Version 5.2 Page 12 plans of health care treatment but there are gaps in the information required of weight monitoring, nutritional assessments and any observations required following a fall. Some elements of risk were included on some care plans but these were not comprehensive and did not take into account all elements of risk. A requirement was made for the Registered Person to include all the necessary detail for appropriate care to be delivered. According to the manager residents are not encouraged to self-medicate and currently, no resident is managing any part of their medication. The home’s medication procedures ensure safe practice with the handling, administration, storage and disposal of medicines. Staff who administer the medicines to the residents have been assessed as competent by the manager following in-house training to undertake the procedure. Residents confirmed that they have access to health care services both within the home and in the local community. The Registered Person is monitoring the resident’s health care needs and taking appropriate action. Where the medication systems are in need of action, the Registered Person is working towards improvement. Care assistants on duty were well informed about the health care needs for the resident’s case tracked for this section. Residents are happy with the way that staff deliver their care and respect their dignity. Westdene Residential Care Home DS0000061453.V304013.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Activities are suitable for current residents, visiting is positively encouraged and residents are served meals that are nutritious and appetising. Quality in this outcome area is good. This judgment has been made from evidence gathered during the inspection, which includes a visit to the service and takes into account the views and experiences of people using the service. EVIDENCE: Activities are not provided on a regular basis but care staff are aware of the need to plan the routines and activities of the home in a way that meets the choice and wishes of the resident. The home encourages residents to take control of their lives and participate in the community. A hairdresser arrived at the end of the inspection visit and was warmly welcomed by staff. Residents had commented that this service was excellent and that family and friends feel welcome and know they can visit at any time. The Visitors Book confirmed this. It is clear that individuals and groups from the community are encouraged to visit the home. Maintaining independence and enabling residents to make their own decisions about how they wish to live is a key objective for the home. Residents told the inspector they were free to come and go from their rooms or go into the Westdene Residential Care Home DS0000061453.V304013.R01.S.doc Version 5.2 Page 14 communal rooms when they liked. All the residents who commented on this aspect told the inspector they were very happy with the sizes and layout of their rooms and were encouraged to bring in whatever personal belongings they like to assist them with settling in. One resident had thought about moving to a larger, vacant room but on reflection, she had decided to remain in her room, which suited her needs for privacy. There has clearly been a great improvement to the meals provided. All of the residents who were able to comment on this gave very positive comments. The inspector observed the lunch provided and noted that it was all home cooked dishes with fresh vegetables. The inspector observed that a list is kept of most of the resident’s likes and dislikes and birthdays and that this is updated was evidenced by one resident having an alternative to the lunch provided. He told the inspector that he is always looked after. Residents are encouraged to eat together in the dining room and the inspector observed that care assistants were sensitive to the needs of residents who find it difficult to eat by making them feel comfortable and unhurried. Westdene Residential Care Home DS0000061453.V304013.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Residents are confident that complaints are taken seriously and acted upon appropriately. Staff have had in-house training in adult protection procedures so are equipped to protect residents from abuse. Quality in this outcome area is adequate. This judgment has been made from evidence gathered during the inspection, which includes a visit to the service and takes into account the views and experiences of people using the service. EVIDENCE: The complaints procedure was included in the Statement of Purpose and Service Users Guide. The Complaints Book was in the hall next to the visitors book and it was agreed that the complaints procedure be included in this book. The book was examined but there had been no complaints recorded. Residents are supported to live as independently as possible and exercise their rights to make choices and decisions. Three residents all said they had no concerns or complaints but would initially speak to the manager if they had. The West Sussex Multi Agency Guideline on Adult Protection Procedures was available in the office. The manager told the inspector that all the staff had received in-house training on Adult Protection Procedures but this was not confirmed. The inspector did note that the induction and foundation training pack included information on this aspect of care. Westdene Residential Care Home DS0000061453.V304013.R01.S.doc Version 5.2 Page 16 Westdene Residential Care Home DS0000061453.V304013.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The indoor and outdoor areas used by residents are clean, safe and homely with good access to all parts. Resident’s rooms are suitable and homely. Quality in this outcome area is adequate. This judgment has been made from evidence gathered during the inspection, which includes a visit to the service and takes into account the views and experiences of people using the service. EVIDENCE: The Scale Plan of 1:100 was not provided at registration so the inspector was unable to confirm that the sizes of individual and communal rooms and the numbers of toilet and washing facilities is sufficient to meet the National Minimum Standards. The Registered Person has agreed to provide this for the Commission for Social Care Inspection’s records. The Statement of Purpose and Service Users Guide does not include sufficient information as to whether the needs of frail and dependent older persons can be met. The provision of an Occupational Therapist’s report would confirm that Westdene Residential Care Home DS0000061453.V304013.R01.S.doc Version 5.2 Page 18 persons requiring a wheelchair can safely access the home via the temporary ramp and that the stair lift providing access to the first floor rooms is suitable. The inspector toured the building and although homely, clean and well lit, did include some areas where the safety of residents required attention. The inspector discussed with the Registered Person a programme of improvement to guard unguarded radiators and provide thermostatic valves to restrict water temperatures to safe levels and protect residents from burns and scalds. Window restrictors need to be fitted to first floor windows to ensure residents are safe and prevent accidents. A requirement has been made for these areas to be meet the National Minimum Standards. Liquid soap and paper towels are required for all communal areas to prevent cross infection. The Registered Person agreed to ensure all areas have these items. Contaminated laundry is collected weekly and the home presented as clean and free from odours. Residents gave very positive comments on the size of their rooms and the agreement made to bring any of their personal possessions in with them to help them feel at home. Residents said they were comfortable and commented on the cleanliness of the home. The inspector observed the provision of a curtained area in their rooms providing a toilet and wash hand basin and noted that residents were happy with this arrangement. Locks on doors are not currently provided but each resident has a lockable facility to keep personal items safe. Westdene Residential Care Home DS0000061453.V304013.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The duty rota indicated that sufficient staff with a suitable mix of skills and experience are on duty over the 24 hours period to ensure needs can be met. Recruitment processes were in place to ensure residents are protected. Quality in this outcome area is poor. This judgment has been made from evidence gathered during the inspection, which includes a visit to the service and takes into account the views and experiences of people using the service. EVIDENCE: Residents are generally satisfied with the level of staffing provided and the inspector observed that staff had sufficient time to assist residents with their personal care needs. However, the Registered Person is required to demonstrate that there are sufficient, qualified and experienced staff to meet the care needs of all the residents at all times and must provide evidence of how skilled and experienced staff are deployed at all times in numbers that show that residents are in safe hands at all times. The dual roles of care assistants working at both domestic and care tasks are not acceptable as the care hours must be easily identified from any domestic or cooking duties. The Registered Person must ensure that the service has a good and consistent recruitment procedure that ensures the delivery of good quality services as well as protecting residents. The Registered Person was unable to provide sufficient evidence to demonstrate that the recruitment processes are robust in that Protection of Vulnerable Adults checks, Criminal Records Bureau clearances and references are received before starting work. Westdene Residential Care Home DS0000061453.V304013.R01.S.doc Version 5.2 Page 20 The Registered Person was also unable to demonstrate that staff are adequately trained in the mandatory courses at appropriate intervals to ensure all staff have are protected and have up-to-date skills and knowledge. Staff, when questioned could not confirm that they have received up-to-date training to ensure residents are in safe hands at all times. The inspector examined the induction and foundation pack and observed that it met the requirements of the National Minimum Standards. A requirement was made in respect of the recruitment processes and training of staff. Westdene Residential Care Home DS0000061453.V304013.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The home is run in the best interests of the residents whose health, safety and welfare is promoted and protected. Quality in this outcome area is adequate. This judgment has been made from evidence gathered during the inspection, which includes a visit to the service and takes into account the views and experiences of people using the service. EVIDENCE: The manager has the necessary experience to run the home and has commenced the Registered Managers Award. The home has developed policies and procedures to monitor practice. Although these were not examined in detail, it was clear that they are comprehensive and are produced specifically to inform staff of the procedures and guidance to promote god care in all aspects of the service. The Registered Person is aware of the need to plan the business activity of the home and manage the finances and resources to deliver the business plan. Westdene Residential Care Home DS0000061453.V304013.R01.S.doc Version 5.2 Page 22 The home manages some money where residents are unable to take responsibility for this and a system is in place to record transactions and accounts for spending. Checks show that these are generally up-to-date although some gaps were noted in the records. Supervision for staff has not yet commenced. This is a requirement made from the previous site visit and is now included in the requirement made at this site visit for staff recruitment and training. The health and safety needs of the residents are not always met, for example, in some areas of the environment and the recording of safety checks carried out. Subsequent to the site visit and from contact with the Registered Person, there is evidence to show that major improvements are being made. The Registered Person has prioritised the areas where improvements are required and is producing an action plan for undertaking the work. Westdene Residential Care Home DS0000061453.V304013.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 1 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 2 3 3 2 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X 3 3 2 X 2 Westdene Residential Care Home DS0000061453.V304013.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 OP7 Regulation 14,15 Requirement The registered person must ensure service users have been assessed by a suitably qualified person and consult with service users or their representatives and prepare a written plan as to how the service users needs are to be met. Timescale for action 31/08/06 2. OP25 18.2. The registered person must 30/09/06 ensure that all parts of the home are reasonably and practicably free from hazards to their safety. The Registered Person must not 31/08/06 employ any person not fit to work at the care. The Registered Person must ensure sufficient, suitably qualified and experienced persons are working in the care home and provide training appropriate to their work and are appropriate supervised. 3. OP27 OP29OP30 OP36 18,19. Westdene Residential Care Home DS0000061453.V304013.R01.S.doc Version 5.2 Page 25 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 Westdene Residential Care Home DS0000061453.V304013.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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