Inspection on 14/06/06 for Yew Tree Nursing Home

This inspection was carried out on 14th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Yew Tree Nursing Home 28/01/06

Yew Tree Nursing Home 21/09/05

Yew Tree Nursing Home 22/02/05

Yew Tree Nursing Home 08/09/04

Similar services:

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

Insight - Eastchurch

Southfields

Magenta

Seabourne House

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

CARE HOMES FOR OLDER PEOPLE Yew Tree Nursing Home Yew Tree Nursing Home North End Road Yapton Arundel West Sussex BN18 0DU Lead Inspector Miss Helen Tomlinson Unannounced Inspection 14th June 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Yew Tree Nursing Home DS0000047860.V298272.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. Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Yew Tree Nursing Home Address Yew Tree Nursing Home North End Road Yapton Arundel West Sussex BN18 0DU 01243 552575 01243 554901 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) Yew Tree Care Ltd Mrs. Janette Mary McCorquodale Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (12), Physical disability of places over 65 years of age (12) Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Only service users over the age of 40 years in the PD category can be admitted. Those service users currently residing at Yew tree falling outside condition 1 may remain in the service, providing the registered manager`s assessmen t that their care needs can continue to be met 28th January 2006 Date of last inspection Brief Description of the Service: Yew Tree Nursing Home is a care home registered to offer personal and nursing care for up to 40 residents in the categories of old age, or with a physical disability over the age of 65 years. Within the 40 residents 12 could be aged over 40 years and under 65. The home is situated in the village of Yapton, near Bognor Regis. Shops, a public house and links for public transport are within walking distance. Accommodation is provided in two buildings which are linked with a corridor on the ground floor. Both buildings have bedrooms on two floors. The upper floor is accessed by a passenger lift. Communal space consists of a large lounge/dining room and a smaller lounge on the each floor. There are gardens accessible and suitable for the residents. There are twenty four single bedrooms and eight double bedrooms. Some have ensuite facilities. Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried, in part, by two inspectors. Miss Helen Tomlinson arrived in the home at 7.10am and left at 6pm. Mrs Sheila Gawley arrived at 9am and left at 11.30am, having looked specifically at the records for some residents with a learning disability. At the time of this inspection the residents accommodated had a variety of complex needs. Some residents had both physical and mental health needs whilst others required assistance with physical nursing needs and had no mental health problems. Sixteen of the thirty two residents accommodated had a diagnosis of learning disability, some of who had a physical disability which was their primary need. There was a large age range in the home with the youngest resident in their twenties and the oldest over 100 years old. It was discussed during the inspection, that the home did not have a registration which allowed them to offer accommodation and care for people whose learning disability was their primary need. Following the inspection discussions with the owner and manger resulted in a change of registration being applied for, to the Commission in order to clarify the registration categories. At the time of this inspection the care of all residents, including those outside the categories of registration, was being adequately managed and their needs were met. The registered provider and manager were working closely with the Commission on this issue. Prior to the visit to the home information was gathered from previous inspections and information received regarding the service. During the inspection a full tour of the premises took place, inspectors spoke to the residents, deputy manager, registered providers, staff and visitors. Care practices were observed, care plans and daily records examined and other documents seen as necessary throughout the inspection. The inspectors met the majority of residents living at the home during the visit and six were spoken with in detail. Many were unable to discuss with the inspector, their experience of life in the home, due to their mental frailty. Following the last inspection five requirements were made. At this inspection four of these had been met, with one outstanding and two new ones being made. What the service does well: Visitors said they were welcomed into the home when they looked round choosing a home for a relative. They were given lots of information about the services and facilities offered. Residents said staff were polite and respectful when speaking to them. The personal hygiene and appearance needs of the residents was met. Interactions with staff and residents were lively, personal and informal but respectful. There was a happy atmosphere in the home. Visitors were Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 Page 6 welcomed in, with a friends of Yew Trees committee providing community contacts. There were plenty of social activities for the residents and two dedicated co-ordinators were employed. Staff interacted well with residents during the day, taking opportunity to sit and talk with them on a one to one and group basis. Residents are assisted to go out into the local community to visit shops and the public house. The food served was tasty and nutritious with assistance given and preferences understood. Hot and cold drinks were given during day. Staff were aware of their responsibilities regarding the protection of vulnerable adults. They knew the procedures to follow. The home was clean, tidy and well maintained. The dining area was set for mealtimes to make a congenial place for social dining. Residents benefit from a manager who is experienced and knowledgeable. Staff receive supervision, training and support in their work. What has improved since the last inspection? What they could do better: Only residents whose needs can be met by staff, who have been appropriately trained, must be admitted to the home. Any resident admitted must be within the category of registration of the home. Staff should receive training in the care of people with a learning disability. The documentation used for care planning was improved and better organised. However some of the documents in the files were blank, others had not been reviewed or completed. Where risks were identified, for example that of poor nutrition, appropriate management for prevention of ill health should be in place. Evidence of learning disability input or therapeutic interventions should be present. Not all residents had bed rail protectors in place and these must be used at all times. The option of having pre-printed medication administration sheets, rather than needing to handwrite them, should be explored. Generally staff were very respectful of the residents dignity and protected their privacy, however one incident where this did not occur gave cause for concern and this issue should be reviewed with all staff. The provision of drinks for residents as they get up in the morning should ensure they are not left without a drink for a long period of time. Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 Page 7 The management of clinical waste should be reviewed with staff to ensure the protection of residents and staff from the spread of infection and prevent odour in the home. The residents monies must not be paid into a bank account which is in the name of the home. 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. Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Residents were assessed prior to being accommodated. Some residents were admitted with additional needs to those stated in the registration of the home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service EVIDENCE: One resident discussed with the inspector how they had been visited in their previous home, by the manager and the owner of Yew Trees, prior to being accommodated. He had been given verbal and written information regarding the facilities and services at the home before moving in. A visitor discussed how they had visited the home prior to their relative being accommodated. They said they had been welcomed in, had a tour of the premises and been given appropriate information about the services offered, to help them make a choice. Of the seven resident’s files examined in detail one pre-admission assessment was present. This gave some information regarding their past medical history, personal care needs and social background. The deputy manager stated that a pre-admission assessment was carried out an all residents but there was not any evidence of this in the care plans. Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 Page 10 A discussion took place regarding the identified needs of some residents admitted to the home and whether these were within the registration categories of Yew Trees. It was agreed by the manager and the owner, that some residents, who had a learning disability, may be outside their current categories of registration. No issues of management of the needs of any resident accommodated was raised, however it was agreed the categories of registration must be reviewed and revised. Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Health assessments were carried out for most identified health needs. The documentation did not always evidence the way health needs were met or how residents should have their personal care delivered. The storage and administration of medication was safe. The recording of medication administration was not always accurate. Residents said staff treated them with dignity and respect. Staff should be more aware of preserving the privacy of residents. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Eight residents files were examined in detail. Four of these residents had a learning disability recorded on their documentation. Since the last inspection the documentation used for recording the resident’s needs and how these should be met had been changed. The opportunity to record more comprehensive information was now present. Seven of the residents had care plans documented, one had some health assessments on file, but did not have plans of how their care needs should be met. The care plans covered the personal, social and nursing needs of the residents, but did not list any needs in relation to the resident’s learning disabilities or any therapeutic Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 Page 12 interventions. The way the identified needs were met was not however comprehensively recorded with entries such as “all care given” and “usual day” in the daily notes. There was no evidence the care plans had been reviewed and this led to some out of date information being present. The plans of care were based on health assessments which were present for nutrition, mobility, pressure sore risk, continence and risk of falls. These had not been completed for all residents, or reviewed. Where these assessments did indicate a risk to the resident a plan of care or prevention was not always present. On arrival in the home some residents had bed rails in place without protectors present. The care charts in the resident’s bedrooms were not up to date with the majority present being for the month of March. The medication in the home is administered by the registered general nurses. Medication storage and administration was safe. Not all medication administration charts were kept up to date. The MAR chars were hand written and as this is a potential cause of preventable drug errors it was suggested to the deputy manager that the use of printed MAR charts be investigated. The label on one medication differed from the dosage written on the chart. Since the last inspection a new medication fridge had been bought and staff were monitoring the temperature of medications. Residents who were able to discuss life at the home said the staff were polite and respectful when assisting them. The relationship between staff and residents was one of mutual respect and understanding with social interactions being friendly, lively and informal. Residents said they were assisted to maintain their personal appearance and all residents in the home had been assisted with their personal grooming. Toilet and bathroom doors were closed when in use, but staff assisted a resident with personal care, in their bedroom, without closing the door. One resident discussed how some staff from overseas spoke in their first language, not English, to each other, whilst caring for them. This is disrespectful to the resident and the deputy manager said the matter would be resolved. Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 The social needs of the residents were understood and their needs in this area met. Visitors were welcomed into the home and links with the local community were maintained. The meals served were nutritious, pleasantly presented and tasty. Residents were assisted to have adequate diet. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: There was an emphasis on the social activities of the residents accommodated, with two activities co-ordinators being employed and other staff understanding the need for social interaction with residents as part of their daily care. During the inspection some residents received hand massages from an aromatherapist, who visited the home three times weekly. Other organised activities included board games, quizzes, puzzles, music, videos, exercises and one to one interactions. One resident was pleased to have been assisted to visit the local shops, in his wheelchair, in the short time he had been at the home. Staff also took residents to church, the local pub and to visit family members. Residents said they had enjoyed the nice weather in the well kept gardens around the home. A sensory garden had been made for all residents to enjoy. Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 Page 14 Social and leisure activities are recorded in a diary in the small lounge. Entries such as watching others make puzzles were recorded next to two of the residents being case tracked. A discussion with the activities coordinator highlighted an enthusiasm for the work but a lack of training in dealing with residents with learning disabilities. The home has a committee of “friends of Yew Trees” who organise fund raising events and involve the local community, where possible. Visitors said they were welcomed into the home, could visit any time and be part of their relatives care, should they wish. The meals served were nutritious, pleasantly presented, hot and tasty. Residents were assisted with their food and encouraged to have a good diet. The preferences of residents was known by staff and choices offered. Hot and cold drinks were given throughout the day. When the inspector arrived at 7.15am few residents who were up in the lounge had a drink. Many were asking for a drink, had dry mouths and empty cups in front of them. The owner said this practice would be reviewed. The dining area was laid for meals and residents who wished could have theirs in their bedrooms Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Residents, relatives and staff were confident to discuss any concerns or complaints with the manager or owner of the home. Residents were protected from abuse by training of staff, but not all staff were aware of the procedure to follow if an allegation was made. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. EVIDENCE: No complaints had been received by the home. The complaints procedure was on display. Relatives and residents spoken with said they would discuss any issues with the manager, owners or deputy manager. Staff spoken with had received training in the protection of vulnerable adults. They knew their responsibilities with regard to this and the procedure to follow should they have any cause for concern. One person, who may be in charge of the home was spoken with. They were not aware of the correct procedure to follow should an allegation be made to them. Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 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 the following standard(s): 19 and 26 The home was clean, tidy, well maintained and safe. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: The home was clean, tidy and well maintained. Some areas had an offensive odour present. The main lounge area was tidy, with comfortable seating being present for the residents. A small lounge was available though this was used by one resident only. Seating was available for residents and visitors in the well kept and attractive gardens. Residents had been able to personalise their bedrooms with pictures, photographs and other items. There were adequate toilets and bathrooms. A level access shower is now available for residents to use, as well as assisted baths. Staff were aware of the procedures to control the spread of infection and had received training in this area. They wore appropriate protective clothing and hand washing facilities were readily available. Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Staff were employed in sufficient numbers and with an appropriate skill mix to meet the needs of the residents accommodated. They received training but additional training in the care of people with learning disabilities was needed. The necessary checks had been carried out to make sure staff were fit to work with vulnerable adults. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: The duty rota showed there were sufficient numbers of staff on duty to meet the needs of the residents accommodated. Two registered nurses were on duty during the day with one at night. Staff said they received a lot of training and were supervised, by senior staff, in their daily work. There was an ongoing training programme of both statutory and additional training. It was discussed with the manager and the owner that due to the large number of residents accommodated, who had a learning disability, specific training in this area was needed for all staff. Staff were encouraged and supported to complete the NVQ training. The files of the two most recently employed staff were examined. All the necessary checks and information had been obtained prior to them starting work in the home. A requirement made at the last inspection was met. Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Residents and staff benefit from the home being run by an experienced manager who is knowledgeable, approachable and supportive. Resident’s financial interests are not safeguarded by the current system. Staff receive support and supervision from senior staff members, to enable them to carry out their duties. The health and safety of residents was protected. Safe ways of moving and handling residents were not always used. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: The manager was not present during this inspection. The deputy manager was on duty and provided all the help and assistance the inspectors required. Staff spoken with said the manager was extremely supportive and approachable, being knowledgeable and caring whilst “expecting high standards.” They said she provided the help and support they needed to do their jobs. Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 Page 19 Resident’s personal monies, managed by the home, were in a specific bank account. This did not have sufficient safeguards in place to ensure the resident’s interests were fully protected. The owner agreed to revise the management of resident’s money in the home. Staff receive one to one supervision from a senior member of staff. This is recorded, covers all aspects of their work and is used to ensure ongoing development of staff. Staff had received training in health and safety. Accident records were kept. Since the last inspection staff had received training in the safe moving and handling of residents. However two concerns regarding this were raised during the inspection. These were the use of wheelchairs without footplates resulting in residents feet dangling on the floor and incorrect moving and handling, which could lead to injury for both staff and resident. This was brought to the attention of the manager at the last inspection and a requirement is made that all moving and handling is safe. Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 Page 20 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 3 X 2 Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 Page 21 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 OP7 Regulation 15 Requirement All residents must have an up to date plan of care, which is comprehensive and kept under review. Residents, when possible, should be involved in the drawing up of the plan. This remains unmet from the inspection of the 28/01/06. The timescale for action has expired. The registered person shall not pay money into a bank account unless the account is in the name of the resident. A safe system for the moving and handling of residents must be in place. Timescale for action 30/06/06 2 OP35 20 31/07/06 3 OP38 13(5) 30/06/06 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 Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 Page 22 Yew Tree Nursing Home DS0000047860.V298272.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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