CARE HOMES FOR OLDER PEOPLE
Woodleaze EMI Unit Station Road Yate South Glos BS37 4AF Lead Inspector
Kathy Marshalsea Key Unannounced Inspection 09:30 3rd & 9th May 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Woodleaze EMI Unit Address Station Road Yate South Glos BS37 4AF 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) 01454 866043 01454 866041 South Gloucestershire Council Mrs Susan Elizabeth Simmons-Tasker Care Home 34 Category(ies) of Dementia - over 65 years of age (34) registration, with number of places Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24th May 2006 Brief Description of the Service: Condition of registration: The Home cares for people with Dementia aged over 65 years. South Gloucestershire Council operates Woodleaze and the Manager is Mrs. Sue Tasker. The Home is registered to accommodate thirty-four older people with dementia. Two of these places are kept for short-term care. Each of the 34 single bedrooms has a wash hand basin. None of the rooms have an ensuite facility. The property is arranged over two floors with shared space on the ground level and bedrooms on both floors. There is a central courtyard, which is pleasantly laid out with flower and plant containers and exterior furnishings. Woodleaze is a purpose built home, which was built in the 1980s. It is one of 8 care homes for older people operated by South Gloucestershire Council. The Home is close to shops, amenities and bus routes. The fees that are charged for staying at the Home are around £574 a week. There are extra charges for chiropodist, and hairdresser services. Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the home’s key inspection and the visit took one and a half days to complete. Before the visit took place information about the home was assessed by the inspector including the pre-inspection questionnaire sent to the home and duly returned, the last inspection report, any information sent to us by the home for example incidents happening to residents such as accidents (Regulation 37’s) and survey forms. Relatives of people living in the home and health care professionals who visit the home completed these surveys. During the inspection visit several residents were spoken with about their view of life in the home and two visiting relatives. The senior staff and Manager were helpful in making the visit as useful as possible. Four residents were case tracked by the inspector who spent time with them, read their records and talked to staff about how they cared for them. The findings of the visit were discussed with the Manager and Deputy Manager on the second day of the visit. What the service does well:
The Manager leads the staff to support the residents in respecting each person as a unique individual who should have all the rights expected as a citizen. (Person centred philosophy). There is an effort to understand the person’s perspective and how their condition is affecting them, and accepting those changes. This supportive structure promotes each person’s well being. This is shown in the care plans and reaffirmed by the survey forms. There is a staff and management team which has the skill mix to offer the residents a consistent and well thought out care package. The staff work hard to offer meaningful activities for residents to do every day. This includes impromptu trips into the local community. The care plans are of a high standard and are used as a working document and offer staff the details needed, including a biography and social history, to meet the person’s health, personal and social care needs. Staff are given regular training in Dementia care and the different aspects of this condition. This enables them to offer a skilled service. There is good use of the day service the home offers which often leads into respite care, and sometimes then to a permanent placement. This process is a seamless assessment and ensures that the home is able to meet the needs of the residents and that the resident is cared for by familiar people.
Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 6 The staff are able to offer a home for the resident to stay and see out their last days if they wish to. Relatives confirmed that the staff team are marvellous at supporting them and being pro-active in giving them information about any changes to their loved ones. The home benefits from being managed by Sue Simmons-Tasker who has an open and inclusive management style. The Manager ensures that after admission any use of medication is reviewed to see if it necessary. This should prevent medication being used as a form of restraint. The home regularly seeks to make sure it being run in the best interests of the people who live there. As it is not always possible to do this directly with residents staff complete quality assurance questionnaires regularly to assess their state of well being, and if there are any changes to a person’s behaviour or condition. The environment has been adapted to allow the people living there to be as independent as possible taking into account their age and the way dementia affects their ability to find the right room. Positive comments on survey forms included: “ Woodleaze always do their best for residents and relatives-from people in the office to all the staff who work there. We couldn’t wish for a better place for our relative to be.” “The patience and understanding given by every carer on my very frequent visits is to be admired. I have the highest regard for their care of the individual at all times.” What has improved since the last inspection?
Most Requirements and recommendations made at the last inspection (May 2006) have been met, these included: Care plans and assessments are now regularly updated and reviewed. Changes are also noted now. Guidance is now given to staff about when they should give medication which is prescribed, “as needed”. Residents are now being weighed regularly and if necessary their food intake recorded.
Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 7 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
Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives can be sure that the home will make sure that a full assessment is done before they are admitted to the home. This means that the home are sure, before admission, that they can meet each person’s needs. EVIDENCE: Woodleaze offer 2 day care places daily and carefully select each person to fit in with the current resident group and the staffing numbers. These people have a full Social Services assessment before day care begins and then the home do their own assessment. Often these people use the opportunity to have periods of respite care at the home and some then go on eventually to have a permanent place at the home. The inspector met two residents who had started coming to the home for respite care. Their paperwork showed that the staff continually note how they had settled into the home and any changes to their behaviour or physical condition.
Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 11 The information obtained is holistic, which means that every aspect of the person is considered including their previous life before they became unwell. As the home offers specialist care for dementia this was assessed. Staff receive regular training in this subject formally and also by seeking advice from specialists such Community Psychiatric Nurses (CPN’s). The inspector spent time watching staff to see how they reacted to various situations with different people who live in the home. Most staff reacted well by offering choices and empathising with expressions of anxiety and reassuring each person. It was seen that two staff members spoke to residents in an infantile way “have you been a good girl” and “sit down”. The manager was told about those incidents. The environment had been adapted following advice from a dementia specialist for example the use of a primary colour for residents to recognise communal toilet doors. They have also disguised doors they may wish people who live in the home not to use such as the “medical” room by continuing the colour of the walls. There are pictures of old Bristol and some orientation aids such as calendars and information displayed such as menus. The home may wish to keep the environment under review by seeking advice to make sure that they are still keeping up to date with best practice. Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans set out in detail the health, personal, social and specialist care needs of each resident. EVIDENCE: The inspector read four care plans as part of the case tracking process, this means choosing four people who live in the home and finding out as much about their care as possible. This includes meeting them and reading their records. All of the plans read were comprehensive, individualised, reflected the current condition of each person and showed a sensitive and skilled management of problems. The inspector met a resident who was fairly new to the home but had been coming to the home for respite care. There was a lot of information about this person’s previous problems while they were living at home which staff had
Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 13 considered to make sure any risks were minimised. There was a very full biography complete with a medical history. A full assessment took place on admission and covered all aspects of daily living. Important social, emotional and mental health needs were also assessed and reviewed regularly to check upon the effectiveness of the staff’s interventions. There had been short-term health problems experienced by this person which had been referred to the Doctor. Information about medical support needed from the community was also recorded. Health care checks had been done such as the recording of the person’s weight as one identified problem had been them not eating complete meals, the records showed an increase in weight since admission. The second plan was for someone who had been living at the home for a few years. This showed very clearly the changes in this person’s condition and had a very good plan to make sure staff knew how to make this person comfortable and pain free. Their religious beliefs had been recorded and the family consulted about the plan. The Manual handling assessment also reflected the need for staff to give more assistance. The third plan contained a very complete biography and medical history. This person sometimes presented as being aggressive to other people who live in the home and staff, but this had been properly assessed and strategies decided for reducing the risk of aggression. It was clear that the strategies had been successful. This person was also a diabetic and there were the correct health checks recorded and done for their well-being. The fourth plan showed again that staff had sensitively assessed this person’s needs and recognised when they needed quiet, private time. The use of a sedative medicine had been reduced after careful review and discussion with positive benefits. The inspector observed the giving out of medicines at lunchtime. The home uses a Monitored dosage system from a local pharmacist. The duty manager gave out the medicines according to the correct policies and procedures. There are now guidelines for staff to decide whether to give medicines which are prescribed “as needed”. Staff observe the effectiveness of any painkillers given and make sure that if a person refuses that they are checked regularly, and may be given at a later time. As mentioned in the summary most staff treated people who live in the home with respect, preserving their dignity whenever possible. Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The routines of daily living are flexible and meaningful activity takes place on most days. Residents can be sure that staff gather as much information about their interests, hobbies, family background and life before they became unwell so that they as people are known and understood. EVIDENCE: The pre-inspection questionnaire stated that there are a variety of activities for people who live in the home. The inspector saw a group enjoying word association games with lots of interactions and participation by most people attending. There were also individual time seen with one staff member and one person which was meaningful to them. The inspector saw photographs of seasonal events such as the Christmas party and meal. The manager said that staff often take people who live in the home out in the community to the shops, pub or coffee shop. The home has an amenities fund for trips out but does its own fund raising too. Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 15 The interest and previous hobbies of people who live in the home are recorded so that staff are better able to give meaningful activities for each person. Survey forms confirm the way the families are supported by the staff and that was witnessed during the visit. They also said how well informed they were about any changes in their relatives’ condition. The people who live in the home are helped to exercise choice and some control over their lives. However, as mentioned in the summary choices of going into their bedrooms is restricted by the policy of the bedroom doors being locked. There is also restricted access to the top floor by the stairs. This policy has been in place for some time and needs to be carefully considered so that the home can prove that this is not a breach of human rights. Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are good at gauging residents’ well being even though they may not be able to make a formal complaint. EVIDENCE: Complaints received from relatives are taken seriously and investigated. This is not recorded in a file so that it is not easy to see the investigation or any actions taken. The manager agreed to record these in accordance with the National Minimum Standards recommendations. In order to try and gauge the well being of the people who live in the home listening surveys are done periodically by staff. These cover varying aspects of life in the home. Other quality assurance survey forms piloted by the home, and devised by a dementia trainer, are used when there is a change in a person’s condition or behaviour. These are evaluated and decisions made about whether changes need to be made by staff. The manager said that there had been no allegations of abuse made since she had been in post. The home has relevant guidance and policies and procedures to guide staff in the event of an allegation and for information.
Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 17 The staff are trained in the detection and prevention of abuse. Restraint is not used and if a person leaves the building the staff are aware that they cannot make them return. During the inspection a person who was at the home for respite care wanted to leave the building and became very agitated. The staff dealt with this situation very well and determined that this was not the best place for this person to be. Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The house is accessible and safe for the people who live there. Adaptations are there to help residents move around the building and recognise rooms. Residents are not able to go freely into their bedrooms, as the doors are kept locked, the home needs to prove that this restriction is in their best interests. EVIDENCE: Woodleaze is a purpose built home, it is wheelchair accessible and there is a lift servicing the upper floor. Bedrooms are situated on both floors. There are choices of communal lounges and a spacious dining room. There is an enclosed courtyard and the people who live in the home are able to use the garden next to the day centre. Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 19 The home was clean during the visit and some area quite homely such as the lounge near the front door. The corridors have had vinyl flooring laid and have hand rails to help people who live in the home walk around safely. Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff receive regular dementia training so should have the skills needed to deliver consistent care based upon best practice in dementia care. There are enough staff on duty to meet the holistic needs of the resident group. EVIDENCE: The people who live in the home benefit from having group of staff who have worked at the home for a number of years. This means that no agency staff are used which is good for continuity of care. Many of the people who live in the home need minimal assistance with getting up and washing and are able to walk around unaided. There are three duty managers who take charge of each shift. Staff are able to spend time doing various activities and trips out of the home. This shows that the number and skills of staff on duty are sufficient to meet the needs of the people who live in the home. There are also ancillary staff with an administrator to complement the care staff. The home has not done very well at achieving their 50 of care staff being trained in their National Vocational Qualification in care. The manager said that
Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 21 this was because there have not been enough assessors and this is being sorted out. Only one member of staff has been recruited since the last inspection. These records were checked. All of the information was there to make sure that suitable checks had been made for the people who live in the home’s protection. The pre-inspection questionnaire stated that staff are to have the following training: Dementia awareness, communication in dementia, violence and aggression, good grief and loss plus the mandatory topics such as manual handling, first aid and fire safety. Discussion took place between the manager an inspector about what should happen if staff do not change their practice after receiving training in dementia care and behave in a way which could affect a person’s well being. She stated that this has been dealt with in supervisions but had not been dealt with using a disciplinary process. This will be checked at future inspection visits and needs to be reviewed by the home’s line manager. Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 22 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Everyone in the home benefits from a Manager who is very open and has the best interests of the residents as her priority. EVIDENCE: Mrs Simmons-Tasker is the registered manager of the home. This is her first post in dementia care but she is an experience manager in care of the elderly. During the inspection visit she was able to show her commitment to treating people who live in the home with respect and making sure that they are given the same rights as any citizen should expect. During our discussion about the restriction of choices due to locked doors, she agreed that this needed to be
Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 23 re-considered. Staff and relatives commented that she had brought a sense of calmness and openness which hadn’t been there previously. She is able to embrace the concept of person centred care and apply that whenever possible to life in the home. She communicates this clearly to staff. Regular staff meetings are held and as well as being venues for giving information changes to working practices are also discussed. As mentioned previously quality assurance surveys are done so that the home is being run in the best interests of the people who live in the home. The manager was asked to make sure that the action plan produced as a result of the surveys are sent to relatives. They are planning to hold carer meetings for relatives. A random sample of peoples’ cash records looked after by staff was done. All balances were correct and cash sheets filled in correctly. Receipts for items bought were attached to individual sheets and the administrator does regular balance checks. Where possible two signatures are used on sheets. The pre-inspection questionnaire showed that equipment is serviced regularly and other safety checks such as testing for legionella and making sure the hot water is of a safe temperature, are done. The fire log was checked and showed that most staff receive enough training in fire safety to be competent in the event of a fire. Only one night staff care assistant hadn’t had a recent update and so the manager was asked to arrange this promptly. Safety checks of the fire fighting equipment and fire alarms are checked regularly. Fire drills are done as part of the staff’s training and also done often. The manager said that a new wireless system had been installed so that each room now has its own smoke sensor. Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 2 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 2 X 3 3 x 3 Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP17 Regulation Schedule 3. (q) Requirement The registered person shall ensure that as service users are restricted access into the top floor and bedrooms during the day, this is based upon an assessment supporting the decision process and kept under review. Timescale for action 31/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP16 OP33 OP4 OP28 Good Practice Recommendations A record should be kept of all complaints made and include details of the investigation and any action taken. The results of quality assurance surveys should be published and made available to current and prospective users, their representative and other interested parties. The service users independence would be better promoted with the use of individualised doorplates. Staff need to have the opportunity to take their National Vocational Qualification in care so that the home achieves
DS0000034159.V336030.R01.S.doc Version 5.2 Page 26 Woodleaze EMI Unit the 50 of trained staff target. Woodleaze EMI Unit DS0000034159.V336030.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Regional Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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