CARE HOMES FOR OLDER PEOPLE
Wilton House Nursing and Residential Home 73-77 London Road Shenley Herts WD7 9BW Lead Inspector
Louise Bushell Unannounced 19 May 2005 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 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. Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Wilton House Nursing and Residential Home Address 73-77 London Road Shenley Herts WD7 9BW 01923 858272 01923 850019 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Wilton House Limited Linda Fuller Care home with nursing 51 Category(ies) of OP 51 registration, with number PE(E) 31 of places DE(E) 51 Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: The home may accommodate upto 25 older people who require personal care. The home may accommodate 25 people with physical disabilities who require personal care. The home may accommodate upto 26 older people who require general nursing care or who are elderly mentally infirm and require nursing care. The home may accommodate upto 25 older people with dementia who require personal care. The home must ensure a minimum of 5 suitably qualified and experienced staff work at night within the home. Date of last inspection 14 October 2004 Brief Description of the Service: Wilton House Nursing & Residential Home opened on 3 June 1987. The home is currently registered to admit 51 older people who are physically frail and may have dementia. Following a variation application, the home may now accomodate twenty six older service users for nursing care within the overall capacity of the home.Wilton House is a purpose built home in a village location. Resident accommodation is single rooms with en-suite facilities. Assisted bathing and toilet facilities are provided. The village shops and pubs are a short distance from the home.Extensive car parking is provided to the rear of the building for visitors. The home is on a sloping site. There is pedestrian access from the main road or residents/visitors can enter the home from the rear car park via the lower ground floor taking the lift to the ground floor. Although there are extensive grounds at the back of the building there is only a very small garden accessible to service users. Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection of the year, taking place early morning to mid afternoon. This was a positive inspection, reflecting the positive comments made by both service users and visitors to the home. Ongoing progress is being made to the homes environment and internal management systems ensuring service users changing needs are being met. Time was spent with the manager of the home discussing processes and procedures including record keeping, internal redecoration, staffing levels, training and service user care plans. The majority of time was spent with the service users engaging in activities that were available and talking with them seeking their views. The last inspection completed was a monitoring visit on the 14th January 2005 of which vast improvements had been made to the home. Progress is on going. The findings from the monitoring visit are available on request. What the service does well:
Internal policies and procedures have been developed and are working documents for all staff and service users. The home has the provision of a large training room, which has supported the provision of specific training. The level of training within the home is commendable. The home offers a comprehensive induction programme to all new staff; this is in line with the requirements from the National Training Organisation. The ethos of the home promotes an open, transparent approach by the manager, ensuring that service users changing needs are met. Staff and service users determined that they felt supported within the home by the manager. Comprehensive care plans and risk assessments were well maintained within the home and all appeared to act as working documents to ensure all service users needs are met. Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
Activities within the home are suitable and feedback from service users was mainly positive. Due to the diverse and complex needs of the service users, it is suggested that the activity time table be prominently displayed throughout the home so all service users are aware and are actively encouraged to make positive choices in their lives. All chemicals within the home must be locked away. Chemicals used within the home must have a data sheet available describing actions to be taken if contact occurs. The home has two small kitchenette areas within the home where breakfast and tea and coffee are served, fridge temperature records were present, however several gaps were identified in the recording and many entries made determined that the core temperatures of the fridges exceeded the safe zone. Some rooms with the home are still in need of redecoration. This has been identified within a renewal and redecoration plan. Works must commence to ensure that all service users are provided with suitably presentable personal space.
Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 Page 7 Service users dignity must be maintained at all times. It is felt that the use of incontinence equipment such a Kylies on each of the communal lounge chairs does not reflect and promote an individuals dignity. If continence were managed effectively within the home the need for this intervention would be minimal. Where a care need has been identified through the completion of an assessment, a care plan and specific input (if a specialist need) must be provided within the home. All service users must have access to the call bell system ensuring assistance can be gained when required. The home is currently developing the provision of meal choices within the home to encourage and empower service user self-determination. 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. Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 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 standard(s) 1, 3, 4, 5 All service users are provided with accurate and adequate information, visits and discussions prior to admission to the home, ensuring that they are empowered and encouraged to make informed choices about where to live. EVIDENCE: The home has a comprehensive Statement of Purpose in place, providing sufficient information for all prospective service users, friends, relatives and supporters. All service users are provided with the documents prior to admission to the home and following review. The service user or representative and registered manager signs the document on agreement and admission to the home. Care records of service users were inspected and there was evidence of pre admission assessment of needs being carried out in each case. The home receives a copy of the pre admission assessment of needs of prospective service users for those who are funded by the Social Services and discharge letters from hospital, where applicable. The manager or a senior member of staff would carry out the home’s own pre admission assessment of needs of any referred service user. Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 Page 10 The home has a comprehensive and holistic pre admission assessment of needs for people with dementia and for people needing general nursing care. This information is used to formulate an initial care plan on admission. The home provides nursing and personal care for older people, some of whom may have associated physical disabilities/illnesses and dementia. Prospective service users are invited to look around the home. Relatives invariably visit the home prior to admission of their next of kin to the home. The initial admission would be on a trial period for a mutually agreed length of time, which can be extended if need be. This allows the home staff ample opportunity to further assess the service user’s needs and to formulate a detailed care plan. Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 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 standard(s) 7, 8, 10, 11 Service users have full assessments completed on their individual files, ensuring that an individual plan of care can be set out meeting individual needs. Some care plans were identified as requiring implementation, to ensure a consistent level and approach of care is offered to individuals where an assessed need has been identified. EVIDENCE: All service users care plans were generated from the pre admission assessment and provides the basis of care to be offered to the individual. All care plans detail specific actions to be taken by the staff to ensure all aspects of the service users health, personal and social care needs are met. It was identified that a number of care plans were in need of being further developed following assessments identifying a specialist need. Area’s highlighted were around challenging behaviour and nutrition. Specialist training and advice must be sought in order to ensure individual needs are being fully provided for. All care plans will be reviewed once a month to ensure monitoring and changing needs can be addressed. The plan is drawn up with the involvement
Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 Page 12 of the service user as much as possible, some care plans had been signed by the service user and or representative. Where a service user is unable to sign or has refused to sign, representation is advised. However, suitable documentation detailing the choices, wish’s or reasons for not signing are sufficient. Detailed records must be accurately maintained with regards to pressure care. Records must be signed and closed following resolution of an issue and maintained as specified in the short-term care plan with regards to dressing and maintenance. All service users spoken with appeared well cared for clean. Self-care is promoted within the home where ever possible. Appropriate risk assessments and monitoring charts are in place to ensure an appropriate level of support is offered. All necessary equipment is provided within the home to meet service users needs. Following discussions with service users is was confirmed that the staff are very caring and supportive, encouraging them to make decisions about their lives with appropriate assistance provided. Service users commented that they felt respected at all times. Incontinence aids were observed placed on each of the communal chairs in the main lounges, it is anticipated that if a sound system of continence management occurs within the home the need to provide such aids on communal chairs is minimal. The home has an effective system in place concerning seeking the views of service users concerning their wishes at the time of death. This was observed being dealt with respectfully and sensitively. Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 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 standard(s) 12, 13, 14, 15 The home supports all service users to maintain family, representative and community links as they wish, thus empowering and encouraging service users to maintain, respect, dignity and personal autonomy over choices in their lives. Wholesome, adequate meals are provided within the home presenting a wellbalanced nutritious diet for all service users supporting them to maintain a healthy life. Meal choices are restricted and does not reflect or enable positive encouragement for choices to be made. EVIDENCE: The home employs a full time activities coordinator to work within the home directly with the service users. A variety of activities are available to all service users. Throughout the home outside entertainers are scheduled and information is displayed on large notice boards. Activity timetables were available. The timetables provided require development to ensure that the information presented to all service users is visible and user friendly. Feedback from a number of service users determined that most were happy with the level of activities provided. All service users are actively encouraged to maintained positive links with family, friends and or representatives. The home has a policy and procedure
Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 Page 14 regarding visitors to the home, which promotes service user selfdetermination. Service users views and opinions are expressed freely within the home and efforts are clearly made to ensure that service users maintain vital links, personal autonomy and choices. If further support and or advice is required in order to ensure freedom of choice for the service users the home is able to link with specialist advocacy services in the best interest of the service user. Following feedback from a number of service users positive comments were received regarding the meals within the home. A number of service users feedback that choices over meals was very limited. The registered manager determined that meal choices require developing within the home and a working party is to commence to develop an internal system within the home that actively promotes and encourages choice and independence for all service users. Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 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 standard(s) 16, 18 The home has a comprehensive complaints procedure in place, which ensures that the rights of all service users are maintained. Robust polices, procedures and training for staff is in place regarding abuse, to ensure all service users are protected. EVIDENCE: The home holds a comprehensive complaints procedure, which is on display throughout the home. The ethos of good practice within the home promotes that all complaints are taken seriously and acted upon. The open management of the home encourages and empowers staff and service users to make complaints with effective resolution. The procedure includes clear time scales and is accessible to all. A record of all complaints is maintained within the home. Service users and visitors spoken with stated that they were aware of the complaints procedure and would not hesitate in making their complaints known to the management of the home. They stated that they felt confident that their complaint would be dealt with effectively. The home has its own Whistle Blowing procedure, which is displayed in various locations in the home and has adopted the Hertfordshire Adult Protection Procedure. Staff members spoken had a clear understanding of the policy following further briefing in staff and team meetings. Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 22, 23, 24, 25 The home is well maintained, equipped and furnished. All areas are safe, comfortable and homely. This ensures that service users are able to maximise their independence and live in a warm, suitable, caring environment. EVIDENCE: Following renewal and redecoration works within the home, its environment presents as practical, clean and tidy. The home employs a maintenance person to work in the home, providing a total of 25 hours per week; these hours are split between other establishments. It should be considered, that in order to maintain the building to an acceptable level that the allocation of additional hours may be required. The home has a planned renewal and redecoration plan in place, with all emergency minor works being completed promptly. Some areas of the home have recently been redecorated and this includes the activity room and a main lounge. Some bedrooms are still in need of redecoration but have been identified in the renewal and redecoration plan. The home have developed an internal system within the home that further
Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 Page 17 promotes and enables service users to become familiar with their surroundings, this is through the painting of all surrounding wood work on all toilet facilities and the use of symbols on the doors. The home is a self-contained unit, promoting an accessible safe space for all service users. Service users spoken to confirmed that they like the decoration of the home. Communal indoor space provides lighting of a domestic style and a friendly homely atmosphere suitable for the needs of the service users. Bathrooms and toilet facilities are in abundance throughout the home, ensuring that they all suitably located for all service use, staff and visitors. Service users spoken to state that there are ample toilet facilities available at all times. Specialist equipment is also provided in throughout the home, ensuring all identified needs can be met. Suitable grab rails and other aids are available throughout the home. The home has a passenger lift to enable service users to have access to the 1st floor or ground floor. All rooms are single and provide adequate and suitable en-suite facilities. Rooms are personalised and many have been redecorated. All service users are encouraged to personalise their rooms to individual tastes. Laundry facilities are sited so that solid articles are not carried through where food is prepared. Hand washing facilities are provided throughout the building and staff are actively encouraged to maintain good hygiene practices. Policies and procedures are in place for the control of infection through out the home. Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 30 The home is suitably staffed to ensure that individual service users needs are met at all times. Staff are adequately trained ensuring service users are in safe hands at al times. EVIDENCE: Staffing rota’s reflected that adequately trained staff are working at any time within the building. Service users confirmed that they feel their individual needs are met with staff that are adequately trained. Following a recent application to increase the number of nursing beds within the home, it was determined that to ensure service users need was being maintained that the home must provide an additional floating support during the night. This is now fully implemented within the home and a dramatic decrease has occurred in the recorded falls and accidents within the home. Ancillary staff are employed in such numbers ensuring that the building remains well maintained and functions as a clean environment. The home has a detailed induction process of all staff that it staggered for the staff member ensuring that key task and training can occur at key stages throughout the process. The training and induction programme is in line with the National Training Organisations guidelines and ensures that staff are meeting the aims of the home and meets the changing needs of the service users. Recent training within the home has covered documentation training, medication, supervisory management, dementia training, first aid protection of vulnerable adults training, wound management, nutrition for the elderly, care planning and fire training. All training needs are identified in supervision and appraisals.
Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 Page 19 The home has an annual training schedule in place of which all staff are empowered and encouraged to apply. The home is able to provide ample on site training facilities and this has further developed the provision of the training within the home. Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 37, 38 The manager’s qualifications and style of operation of the home ensures that the home is run in the best interests of the service user. Health and safety issues within the home are well maintained and managed ensuring that the welfare of staff and service users is protected. EVIDENCE: The Registered Manager is a first level nurse of long standing experience, who is also NVQ trained at level 4. The manager undertakes periodic training in line with PREPP as the other qualified nurses. Regular meetings with staff, quarterly meetings with service users, relatives and advocates. The manager stated that she operates an open door policy and meet with relatives frequently. Members of staff and visitors spoken to during this inspection stated that they feel supported by the manager and senior members of staff. There are daily staff hand-over meetings at the start of
Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 Page 21 each shift to discuss service users care and progress. The home has policies and procedures in place to ensure that the health, safety and welfare of service users and staff are promoted and protected. These records are accessible to all staff. All accidents and injuries are recorded in the accident book and RIDDOR forms are completed where applicable. Fire drills have been held. Fire safety equipment has been serviced and a log of routine checks carried out in the home is maintained. Regular checks on hot water temperatures and moving and handling equipment are recorded. All chemical items that pose a risk to service users must be locked away at all times. Fridge temperatures must be recorded twice daily to ensure all food items are stored within a safe temperature zone. A call point system is available throughout the home and call bells are suitably located for all service users. All service users must be assured that they are able to gain access to the call bell if assistance is required. Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2
COMPLAINTS AND PROTECTION 3 x 3 3 3 2 3 x STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x x x 3 2 Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 7 8 Regulation 15 (1) 17 (1) (a) Schedule 3 12 (4) (a) 16 (2) (m & n), &12 (2) (3) 16 (2) (i) 13 (3) & (4) Requirement All identified needs must be supported with detailed care plans. All records regarding service users must be maintained, promoting service users health, ensuring records are accurate so identified needs can be met. The use of continice aids within the home must promote and dignify service users The provision of activities within the home must be displayed and presented to meet service users needs, empowering service user choice and preferences. Service users must a varied and appealing meal, offering choice and preferences a all times. Fridge temperatures must be accuartly maintained and appropate actions taken to ensure foods are suiably stored in conditions suitable and safe. All COSHH items must be locked away and suitable data sheets available. Timescale for action 30th July 2005 30th July 2005 3. 4. 10 14 15th July 2005 30th July 2005 5. 6. 15 38 15th August 2005 15th July 2005 Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 Page 24 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. Refer to Standard 24 Good Practice Recommendations Consideration should be given to the increase of the miantence hours provided within the home. Wilton House Nursing and Residential Home I52 s19620 Wilton House v227232 190505 stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden city Herts AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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