Inspection on 22/09/05 for Woodlawn Crescent

This inspection was carried out on 22nd September 2005.

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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Woodlawn Crescent 10/10/07

Woodlawn Crescent 13/09/06

Woodlawn Crescent 09/01/06

Woodlawn Crescent 13/01/05

Woodlawn Crescent 27/05/04

Woodlawn Crescent 05/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Woodlawn Crescent 8-10 Woodlawn Crescent Whitton Middlesex TW2 6BE Lead Inspector Sandy Patrick Unannounced Inspection 22nd September 2005 10:00 Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 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 Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Woodlawn Crescent Address 8-10 Woodlawn Crescent Whitton Middlesex TW2 6BE 020 8893 4948 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) h4mo67rusted@mencap.org.uk Royal Mencap (Housing & Support Services) Ms Elizabeth Rusted Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th January 2005 Brief Description of the Service: 8-10 Woodlawn Crescent is situated in a quiet residential road in Whitton. The premises are owned by Richmond Churches Housing Association. The home is managed by MENCAP, a charitable organisation. The home is registered for four service users who have a learning disability. The home is a bungalow, designed to accommodate service users who have a physical disability. Service users access local community facilities and attend local resource centres. They are also supported by staff from the home to develop and maintain community living, domestic and personal skills. The Registered Persons have produced a Service User Guide, which includes information on the aims and objectives of the service. Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 22nd September 2005, and was unannounced. The Inspector met with two service users and staff on duty. The Manager was not on duty at the time of the inspection. Throughout the inspection, staff on duty demonstrated a good knowledge of the home and the needs of service users. The service users presented as happy and comfortable and showed that they were relaxed and happy with staff. The Inspector heard staff offering services users choices and assisting them to make decisions about what they wanted to eat and to do. Following the inspection, the Manager telephoned the Inspector and was able to answer specific questions about the service and developments that had taken place since the last inspection. On the day of the inspection one service user was unwell and was at home. Staff on duty were very caring towards them and offered them support to make sure that their needs were met. Three service users were living at the home at the time of the inspection. Sadly, one service user passed away earlier in the year. They had lived at the home for many years and are clearly missed by other service users and staff alike. Photographs and other memorabilia were on display at the home to support everyone to celebrate the service user’s life and achievements. What the service does well: What has improved since the last inspection? Each service user has participated in a review of their needs and has made their own objectives with the support of staff. Individual interests and needs Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 6 are recorded and there is evidence that these are the focus of work at the home. The staff have worked closely with other professionals to ensure that health and other needs are met. Staff on duty reported that they felt confident and happy in their roles and they demonstrated a good knowledge of the needs of the service. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Potential service users are given a range of information and are able to visit the home before they decide whether they want to live there. There are appropriate procedures for assessment, which include information from the service user, their representatives and health care professionals who work with them. EVIDENCE: The home is registered to provide a service for up to four people. Those living at the home have a range of complex needs, including differing health care, dietary, mobility and sensory needs. Service user plans reflect assessed needs. The staff works in partnership with the Community Team for Learning Disabilities who offer support and advice. Staff receive training in relation to their work at the home. The Registered Person has produced a comprehensive Statement of Purpose and Service User Guide for the service. These incorporate the required areas, including the home’s aims and objectives and the complaints procedure. Copies of the Service User Guide are given to all service users. There have been no changes to these documents since the last inspection. There was one vacancy at the home at the time of the inspection. The Manager reported that a potential service user had been identified for this place. The service user has visited the home and the Manager reported that Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 9 more visits had been organised, including over night stays. The Manager reported that she is working with the funding authority and the service user’s current home to gather information for the assessment of this person. The service user knows the home and the other service users already, and the Manager reported that this was helpful for them to make a decision about whether they wished to live at the home. The service user will have a six week trial stay once they move to the home and at the end of this period, they will meet with staff at the home and their own representatives. The service user and other parties will then be able to make a decision as to whether they remain at the home. All service users are given tenancy agreements which outline their terms and conditions of residency. Copies of these were seen to be held on each service users’ file. Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Service users are able to make choices about their own lives and are involved in the development and review of their plans of care and personal objectives. However, further work to present accessible information and person centred planning should take place. EVIDENCE: Individual service user plans are in place for all service users. These record needs and wishes and include guidelines and information from other people who work with the service user. The staff on duty told the Inspector that they would be working with service users to produce person centred plans which would be presented in a way that the service user chose. The Manager and Deputy Manager were attending training on person centred plans on the day of the inspection. It is important that this work is prioritised because the current service user plan, while a useful guide for staff, are not accessible to service users. The Inspector saw evidence of regular reviews which focused on individual objectives and how these were being met. Service user plans were well Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 11 maintained and regularly updated. Records monitoring health, behaviour and other needs were in place where necessary. Service users are supported to wide range of risk assessments subject to regular review. The also include promoting a good these are important. make informed choices and to take risks. A were in place for each service user and were work around person centred planning should understanding of risk assessments and why Staff support service users to make informed choices on a daily basis, such as when they wish to rise and retire, what and when they eat, the clothes that they wear and the activities they participate in. Regular service user meetings are held to provide information and to allow service users to give their opinions. Service users at the home have a variety of communication needs. Staff are supported to understand these needs and to learn to interpret behaviour. All staff have attended Makaton training. Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12,13, 14, 15, 16 & 17 Service users are supported to develop and maintain life skills and to make decisions about activities, education and relationships. Service users are involved in the planning, shopping for and preparation of food. EVIDENCE: Service users are supported to pursues a range of activities both inside and outside of the home. All service users are supported to use the local community and to be involved in shopping for the house. Service users participate in household tasks and the preparation of food. Each service user has a set of personal objectives. Staff support them to work towards these. Objectives for individuals focused on maintaining independence and developing skills and interests. There was evidence of work towards meeting these objectives. Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 13 Service users attend local colleges and resources centres to pursue interests of their choice. One service user had recently started two new college courses which they had chosen. Service users make use of local community resources, such as shops and leisure facilities. They have also participated in a wide range of activities including trips further a field and holidays during the summer. Staff at the home work closely with families and reported that they visits the home on a regular basis and that service users also visit their families. Throughout the inspection the Inspector saw examples of kindness and support. Service users and staff were heard to share jokes and enjoyed each others company. Staff were heard to offer choices and one service user, a member of staff and the Inspector had a conversation about what they wanted to do that afternoon. Their choices were supported by the staff member. The home caters for specialist diets, one diet is a result of a health need and must be strictly followed. Appropriate procedures are in place to ensure that the dietary needs of this service user are met, and choice is not compromised for others. Highly detailed information on what all service users can and cannot eat is available for staff within the kitchen. One service user has also written a list of their likes and dislikes. Comprehensive monitoring charts are in place to ensure that all service users’ nutritional needs were met. Some of these were in pictorial form and this supports the service users to understand them. The Inspector saw a sample of menus for the home. These were varied and indicated nutritionally balanced diets. Food is appropriately stored and is fresh and in adequate supply. The kitchen was clean and hygienic. Service users participate in food preparation where possible and the objective for one service user is that they become more involved in this area. Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 & 21 The staff work closely with other professionals to ensure that complex wide ranging health care needs are closely monitored and met. and There is an appropriate procedure for medication. Not all medication was stored securely and alternatives to the current storage arrangements should be considered. EVIDENCE: Personal and health care needs are recorded within service user plans. Each service user has their own health plan which outlines individual needs. These are subject to regular review and record all medical needs and consultations. The staff on duty reported that the Manager had produced guidelines for individuals about health care conditions, which had been very useful and informative. Service users have a number of complex health needs and these require close monitoring and support. There is evidence that the staff team have a good knowledge of these individual needs and work closely with other professionals to make sure that they are met. There was evidence that health care professionals were invited to team meetings and that specific health needs were discussed at these. Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 15 There is a clear record of all medical appointments, accidents and incidents. There is an appropriate medication procedure and all staff have been appropriately trained. The medication cabinet is rather small and medication storage is difficult within the existing facilities. It is recommended that the Registered Person consider alternative arrangements for storage. Three containers holding medication were not locked away at the time of the inspection. The Manager reported that medication profiles were being reviewed at the time of the inspection. Medication records were accurate and appropriately completed. Sadly, one service user became ill and passed away earlier in the year. The staff team worked closely with their family during this period and offered support to all service users through their bereavement. A gathering to celebrate the service user’s life was held at the home and a tree planted in their memory. Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 There is an appropriate complaints procedure and all complaints and concerns are recorded. There are appropriate procedures to promote protection of service users. EVIDENCE: There is an appropriate complaints procedure, detailing timescales and information on how to contact the Commission for Social Care Inspection. There have been no formal complaints since the last inspection. The Manager keeps a record of all informal concerns and how these have been addressed and responded to. The record is clear and informative. The home has adopted the local authority Protection of Vulnerable Adults Procedure. Mencap has its own procedures on abuse and whistle blowing. All staff have relevant training and this is part of the induction package. Pre employment checks, including criminal record checks are made on all staff. There are clear procedures to offer service users support to manage their finances and make rent payments. Small amounts of cash are held securely at the home. The records relating to two of these were inaccurate on the dya of the inspection. In addition, one service user had a small amount of foreign currency and this was not recorded. The Manager reported that the records were audited following the inspection and missing monies accounted for. She also reported that she has introduced a system where all records relating to money are checked at each handover to minimise the likelihood of reoccurrence. Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 & 30 The environment is suitably equipped, furnishes, maintained and decorated and meets the needs of the service users. EVIDENCE: The building is a single level bungalow. It is owned by Richmond Churches Housing Association. All rooms are for single occupancy. There is a large lounge/dining area and an accessible kitchen. There is one bathroom and one shower room and a separate WC. The home is attractively decorated throughout and appropriately maintained. The staff on duty reported that there were no major decorative or environmental needs and that minor repairs had been reported and were being attended to. The garden is well maintained and attractive. Communal and private rooms are appropriately furnished. Picture, photographs and plants throughout the home add to the welcoming and comfortable atmosphere. Two bedrooms are under 10sq.m, although there is additional communal space to compensate for this. The Registered Persons should consider the lack of space in two rooms when admitting service users in the future, especially if equipment is required, because this would restrict space further. Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 18 The house has been adapted to be wheelchair accessible. There are low-level surfaces in the kitchen. There is a range of specialist equipment throughout the home, in communal and private areas and bathrooms. The Physiotherapist works closely with the home to assess and meet equipment needs. Evidence of this was seen in service user plans. Corridors and bathrooms have been equipped with handrails as required. The shower is accessible for all service users. The home was clean and hygienic throughout on the day of the inspection. There are appropriate procedures for ensuring infection control, Control of Substances Hazardous to Health, disposal of clinical waste and laundering of clothes. Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 & 36 The staff team receive a full induction into the home and their work and are able to access detailed information about the service. There is a wide range of training opportunities and the staff are supported by their manager through individual and team meetings. EVIDENCE: There is an excellent range of information for staff on their roles and responsibilities. These include induction information and updated guidelines. Staff on duty stated that the Manager was very good at providing clear written information which assisted them in their roles. All staff have received contracts and job descriptions for Mencap. There are good systems for staff communication, including verbal and recorded handovers between shifts, shift plans and use of a communication book and diary. The staff all access the computer and were seen to use this as part of their normal work during the inspection. The staff on duty spoke positively about the support of the team and their Manager. They stated that they had regular individual supervision and team meetings and that they were able to share ideas and contribute their opinions. Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 20 The staff on duty reported that they were able to attend a wide range of training and that this was useful for their roles. They commented that some training had been more useful than others. Mencap have a comprehensive training programme. There is an approved induction and foundation package which links into NVQ training. Staff on duty reported that this was very good and had been useful for them. One staff member told the Inspector that they worked closely with other professionals and that they were invited to team meetings to provide in house training and support. One staff member reported that they had recently undertaken keywork training and that this had been really useful. The Manager and Deputy Manager were on a training course on the day of the inspection. Each staff member is delegated keyworking and other responsibilities. Staff on duty reported that they were responsible for the health and safety of the home and the management of medication. They said that they were well supported with these responsibilities and enjoyed them. Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 24 The service is managed by an appropriately experienced and qualified person. The management approach is one, inclusive an supportive. Appropriate checks are made and recorded on the health and safety of the home. EVIDENCE: The Manager has been in post at the home since 2002. Prior to this managed another registered service. Throughout her discussions with Inspector she has consistently demonstrated an excellent knowledge of needs of the service users and a commitment to the development of service. she the the the Staff on duty reported that the Manager was supportive and gave them good guidance and information to help them with their jobs. Mencap have a suitable quality assurance programme, including an annual quality audit. Monthly visits to the home are made by the Area Manager. Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 22 Reports of these visits are held in the home however these have not been forwarded to the Commission for Social Care Inspection since December 2004. The reports must be forwarded to the CSCI monthly. There is a record of checks made on all areas of health and safety, including fire safety and regular fire drills. Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 x x x 3 3 CONDUCT AND MANAGEMENT OF THE HOME 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Woodlawn Crescent Score 3 4 2 3 Standard No 37 38 39 40 41 42 43 Score 3 3 2 X X 3 x DS0000017399.V253211.R01.S.doc Version 5.0 Page 24 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. Standard YA20 Regulation 13(2) Requirement The Registered make sure all stored securely. Timescale for action Person must 15/10/05 medication is 2. YA23 13(4) & (6) The Registered Person must 15/10/05 make sure that records relating to service users’ finances are correct. The Registered Person must 31/10/05 make sure that reports of monthly visits made to the home in accordance with Regulation 26 are forwarded to the Commission for Social Care Inspection. 3. YA39 26(5)(a) 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 Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 25 1. YA6 The Registered Person should give consideration to developing accessible information and further promoting person centred planning. The Registered Person should consider providing a larger lockable facility for the storage of medication. 2. YA20 Woodlawn Crescent DS0000017399.V253211.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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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