Inspection on 19/11/08 for Westonville Lodge

This inspection was carried out on 19th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Westonville Lodge 22/11/06

Westonville Lodge 09/11/05

Westonville Lodge 05/07/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

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 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Westonville Lodge 24 Royal Esplanade Westbrook Kent CT9 5DX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Nicki Dawson     Date: 1 9 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Westonville Lodge 24 Royal Esplanade Westbrook Kent CT9 5DX 01843220669 F/P01843220669 sueneal2005@yahoo.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Susan Helen Neal Type of registration: Number of places registered: Susan Helen Neal care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The last key unannounced inspection was 22nd November 2006. Westonville Lodge is a small residential home registered to provide care and support for up to ten residents whose primary need is that they are older people. The home is located in a residential area of Margate, in close proximity to the sea front and local amenities. There is on road parking to the front and side of the building. The statement of purpose gives information about the home and the service provided there. A copy can be obtained from the home. The most recent inspection report is on display and can be seen in the home. The Registered Provider Mrs Susan Neal is also the homes Manager. The fees at the time of the inspection are between three hundred and thirty seven pound and twenty six pence and three hundred and fifty pounds per week. Hairdressing, chiropodist, newspapers and toiletries are at an additional charge. 0 Over 65 10 Care Homes for Older People Page 4 of 29 Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was unannounced, which means that the residents and staff did not know that the inspector was calling at the home. The inspection started at 10am and took nearly 7 hours. Discussion took place with residents and the two members of staff on duty to gain their views and knowledge of the level of care, provided by the service. A tour was made of all parts of the home, including residents bedrooms. A number of records to do with residents care and safety were looked at. Prior to the inspection an annual quality assurance assessment (AQAA) was sent to the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Care Homes for Older People Page 6 of 29 Survey questionnaires (Have Your Say About...) were sent by the CSCI to the home before the inspection visit to be completed by staff, residents and social and health care professionals. There was a good response from care staff. Staff said that the management support that they receive enables them to look after the residents in their care to the best of their ability. A social care professional said that the home, maintains good communication with me regarding any concerns (of a resident). What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 29 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving to the home are given all the information they need to help them decide whether or not to it is the right place for them to live. Peoples needs are fully assessed before they move into the home so that they can be sure that they will receive the right type of care. Evidence: The aims and objectives of the home are clearly set out in the homes Statement of Purpose. The services and facilities that are available to residents living in the home are detailed in the homes Service User Guide. Both documents are kept in the entrance hall and so are easily available to the people who live in the home and to visitors. It is recommended that the content of both documents are reviewed since some of the staff training information in the Statement of Purpose is out of date. Care Homes for Older People Page 11 of 29 Evidence: The registered manager said in the AQAA that she has written a leaflet which gives potential residents advise on how to choose a care home. She also said that she visits all prospective residents and their families before admission so that she can assess their needs and give them information about the home. Assessments for three residents were looked at during the inspection. They contained basic information about each residents needs. Where the local authority funds a resident a copy of their assessment is also obtained. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from having their health, social and personal care needs assessed. Care staff require clearer instructions about how to look after some residents so that they can be sure that their needs will be met. Residents health needs are promoted. Residents may be put at risk of harm through care staff not following the homes procedures in safely recording the administration of all medicines. Residents are treated with dignity and respect. Evidence: Care plans contain a checklist for daily living, recording the individual needs and wishes for tasks such as dressing, washing and eating. For example, please ensure that things are in easy reach; encourage to walk down the corridor and back to the lounge to help with mobility. Although care plans are personalised, it is recommended that they could be further improved by using a person-centered approach. This is Care Homes for Older People Page 13 of 29 Evidence: where the resident themselves is put at the centre of the plan and the tasks are written from their point of view. In addition care plans clearly set out the health, personal and social care needs of each resident. However, the staff support that is required to meet these assessed needs is not always recorded. For example, one resident is assessed as getting quite upset and frustrated most of the time, but there is nothing written in the care plan to explain what staff should do to support the resident when this occurs. It is recommended that an audit be made of all care plans to ensure that there is clear guidance for staff to meet all residents assessed needs. The three care plans viewed were written with the agreement of the resident involved and are regularly reviewed. Written plans are in place to minimise the effect of any potential risks such as falls. Care plans detail very well the health care needs of residents such as mouth care, foot care and nutrition. The registered manager stated in the AQAA that all residents are supported to visit health care professionals to maintain their health. A number of leaflets have been produced on health related topics such as stokes and eye care. Entries in daily notes show that residents have access to the healthcare professionals that they require. However, evidence could not be found that all residents have regular check ups with a dentist. A social care professional stated that their residents health care needs are always properly monitored and attended to. Care staff have attended or are booked to attend training on the Mental Incapacity Act. Each residents capacity has been assessed according to the guidance in the Mental Capacity Act. This is a good, proactive piece of work. The home uses a pre-dispensed system for administration of medicines. This system is used to reduce the risk of residents receiving incorrect doses or incorrect medication. The person that is giving out the medicine records on a pre printed form (MAR sheet) the medicine has been given or, if it hasnt been given, the reason why. A carer was observed administrating medications safely in this way. However, the MAR sheets are not regularly checked to make sure that residents are given their medication as prescribed by their GP. Evidence to support this was on examination of these records. Two gaps in recording medicine for one resident was found, and it was not clear if they had received their medication. On pointing this out to the carer on duty she immediately checked to confirm that one resident had not been given one of their medications as prescribed. Three medications printed on the MAR sheet had been crossed out by a carer and a new medication written by hand over the top. One medication had been written as eye drops but the name of the medication had been omitted. When these records are written by hand there is a higher probability that a member of staff may incorrectly record the dosage of a medication. It is required that another member of staff should also check and sign this record to make sure that no Care Homes for Older People Page 14 of 29 Evidence: errors have been made. A medicinal cream was found in one residents room with no name on it or any instructions as to how or when it should be administered. It is required that all medicines are kept safely and are left in their original packaging so that it is clear to whom and how the medicine should be administered. There is a strict legal procedure for the handling and storing medicines of called, controlled drugs. The homes medication procedure states that two people must administer these drugs and that the date, time and number of drugs remaining must be recorded. Two people are administering controlled drugs in the home, but they are not recording the number of drugs remaining or recording the information in a separate bound book. A requirement is made that staff record the administration of controlled drugs correctly and safely. The registered manager confirmed that controlled drugs are being safely disposed. She also provided information to confirm that staff that administer medication are trained to do so safely. Staff demonstrated that they know how to maintain a residents privacy and dignity when undertaking personal care tasks with residents. During the visit staff were observed talking with residents in a respectful and individual way. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are offered a wide range of stimulating and motivating activities. Residents, families and friends from the local community are included and contribute to the homes many events. Residents benefit from mealtimes, which are an enjoyable, social occasion. Evidence: Keeping residents interested, involved and stimulated in the world around them is important in this home. Residents are offered a range of activities and a list of what activity is on offer each afternoon is available to residents. The registered manager has been creative with the programme of events. She has recently introduced music for health and down memory lane. There are visits from people from many different churches. One such visit took place on they day of the inspection. Residents, who chose, took part in a church service and singing songs. The care staff on duty also took part, which is very supportive and encouraging for residents. Photos of activities that take place in the home are kept and residents enjoyed looking through them and remembering events on the day of the inspection. Such activities include celebrating Care Homes for Older People Page 16 of 29 Evidence: special events with cakes such as Valentines Day and Mothers day. On these occasions the table is often decorated with special tablemats and coasters especially made for the occasion. A wishing tree has recently been introduced for each resident. This is where each resident makes a wish and staff support him or her to make it come true. Evidence of this was seen in residents care plans. This is an individual and person centred piece of work. The registered manager produces a monthly newsletter for residents, friends and relatives. This keeps people up to date with local and national events. It is presented in an attractive way and written in a style that is easy for people to understand. Residents said that their relatives and friends are always made welcomed. The home has regular coffee mornings for residents, friends, families and local people. Invitations were seen for a future event. Form a tour of the home it can be seen that residents are encouraged to bring in personal possessions with them and decorate their rooms as they wish. On the day of the inspection residents were are able to choose when to get up and what to wear and eat. The inspector joined residents for lunch. The meal was relaxed and unhurried and care staff put residents at ease with their jovial conversation. One resident requested that they have a bigger plate for their food and a member of staff on duty immediately attended this to. Residents who gave an opinion said that the food was always of a good standard and that they have enough choices. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are confident that any compliant they make will be listened to and resolved to their satisfaction. Staff feel confident to speak out and take action to protect residents, if they have any concerns about their care. Evidence: Neither the home nor the commission have received any complaints about the service in the last year. The homes complaints procedure is clearly displayed in the entrance hall of the home and included in the service user guide. Residents state that they would feel comfortable making a concern known to the registered manager or a member of staff. Staff demonstrated that they know how to follow the homes procedures if someone makes a complaint. Staff have a good understanding of what is good care practice. They said that if they saw any form of abuse taking place in the home, that they are confident to report the incident to a more senior person on duty. The registered manager provided information to confirm that all staff have received training or are booked to receive training in how to recognise and respond to any form of abuse. Care Homes for Older People Page 18 of 29 Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a safe, clean and comfortable home. Some residents would benefit from having their bedrooms made more pleasant. Evidence: Residents say that they are comfortable living at Westonville Lodge. Residents have use of a communal lounge and a garden in good weather. A computer has recently been purchased for residents and this is situated in the staff area on the ground floor of the home. Residents are able to personalise their rooms and have done so according to their individual choices and tastes. The home has one double room, which is shared by two people that have made an active choice to do so. The registered manager/provider has continued to make improvements to the home with the purchase of a new washing machine, new carpets and planned works to the garden. Covers have been provided to radiators to minimise the risk of residents burning themselves if they fall. However, it is noted that some areas of the home are looking a little tired. For example, paintwork is chipped in places and would benefit from a new coat of paint and some carpets are well worn. A smell of urine was found Care Homes for Older People Page 20 of 29 Evidence: in one residents bedroom. It is recommended that the bedroom carpet is thoroughly cleaned or a more suitable replacement acquired. The home was clean on the day of the inspection. The laundry room is situated in a resident bathroom, which is not ideal. The registered manager stated in the AQAA that just over half the care staff team have received formal training in how to minimise the spread of infection and that plans are in place to train the whole staff team in this area. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff on duty to meet the needs of the residents. Residents benefit from plans in place to make sure that all staff are fully trained, so that their needs are met in a satisfactory way. Residents are fully protected by the homes recruitment practices. Evidence: The staff rota shows that there is a minimum of two care staff on duty during the day and one care staff on duty from 8pm to 8am. The staff rota is not an accurate reflection of the members of staff on duty each day in the home. This is because there is a set weekly rota and any changes to this are not recorded on the rota displayed in the staff room, but in a separate book. It is recommended that any changes to the rota be more prominently displayed. In addition to care staff, there is a lunchtime cook. The registered manager spends some of her time at the home in a supporting role and some in a management role. Staff who completed a survey stated that there is usually or always enough staff on duty to attend to the needs of residents. 58 of staff are trained to National Vocational Qualification (NVQ) level 2 or above. This award is useful because it helps staff develop good care practices and their skills Care Homes for Older People Page 22 of 29 Evidence: in working with people who live in a residential care home. Before new members of staff are employed at the home a number of checks need to be carried out to make sure that all members of staff working at the home are suitable to care for vulnerable service users. A new member of staff who was spoken to, confirmed that this had occurred in their appointment to the home. At the last inspection it was found that there is a robust recruitment policies and procedures in place at the home. Staff files were not available at the inspection due to the absence of the registered manager/provider. It is recommended that a summary of the details of staff employed at the home is made available at all times. The registered manager is responsible for making sure that care staff have the skills they need to support the residents who live in the home. The registered manager stated in the AQAA that all new care staff receive the appropriate introductory training, which gives them the basic competencies they need to be able to work without direct supervision. In addition to the introductory training, care workers are required to undertake a number of training courses that develop their skills in caring for the people that live in the home. The registered manager sent the commission details of all staff training as requested, after the inspection. The records confirm that all staff are either formally trained or that staff training is booked in all necessary areas. Staff who were surveyed said that they usually or always have the right experience and skills to support the residents in their care. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the management approach of the home. The home is run in the best interests of the residents and their health, safety and welfare is promoted. Evidence: The registered manager is responsible for the day to day running of the home. She has fifteen years experience of working in the care sector and is an NVQ 3 assessor. She has both of the formal qualifications specified by the National Minimum Standards. These awards are recognised by the commission to be useful because they help to make sure that people who manage residential care services have the competencies that are necessary to do so. The registered manager is also the registered owner of Westonville Lodge. Although she was not present at the inspection staff, residents and visitors to the home, spoke Care Homes for Older People Page 24 of 29 Evidence: positively about her management of the home. Staff and residents said that the registered manager is approachable and that she is a regular part of the staff team. For the home to run in the best interests of the residents it is important to have a system in place which regularly obtains the views of residents and visitors about the standard of care that they receive from the home. The registered manager stated in the AQAA that there is a quality assurance system in place at the home. She said that as a direct result of the quality assurance, the home have made improvements. This information is also used to feedback into the homes business plan. In addition, residents have regular meetings to make their views known. It is recommended that the registered manager monitor systems used in the home to make sure that they are effective. Care planning has already been identified as one such area and the administration of medication is also an area for priority. At the last inspection the systems for holding residents monies were scrutinised and found to be sound. The registered manager states in the AQAA that staff meetings and supervisions take place. Staff who were surveyed reported that they often meet with the registered manager for support and to discuss how they are working. It would appear from discussion with staff, that this supervision is informal and irregular. It is recommended that that staff supervision is formalised so that all members of staff have the opportunity to discuss care practice and to identify any areas of development that are needed. The registered manager made a declaration in the AQAA that all items of equipment in use in the home remain in good working order and has given dates on which all equipment has been serviced. Fire records show that all equipment is in good working order and that regular fire drills take place in the home. As mentioned previously, the registered manager has sent the commission details of staff training. She is aware of where there are deficits in this training and has put plans in place to make sure that all staff are fully trained in all necessary areas of health and safety, first aid, moving and handling, infection control, safeguarding adults and safe administration of medication. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person must 12/01/2009 provide an action plan to the Commission setting out how they will make arrangements for the recording, handling, safe keeping and safe administration of medicines received into the care home including how they will: Accurately record the name and dosage of all medicines that are not pre-printed on the MAR sheet. The safe keeping of prescribed creams. The administration of controlled drugs must be recorded: on the MAR sheet in a bound book with numbered pages. And include the balance remaining for each drug So that all residents living in the home receive the correct medicines. Care Homes for Older People Page 27 of 29 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 The registered manager should audit the content of all care plans to make sure that there is clear guidance in place for staff to follow to meet all residents assessed needs. The registered manager should keep a record of staff details, including their start dates, training, emergency contact and recruitment checks available at all times. The registered manager should formally supervise staff six times a year so that staff are clear of their aims and objectives. 2 29 3 36 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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