Care Home: 12 High Street

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What the care home does well Students have very good assessments and care plans, which tell staff what care and support they need and how they like it to be given. The plans are looked at regularly to make sure that students continue to get the right support, and people who are important to them, such as their families, are encouraged and helped to take part in this. They use things like photographs and videos to show what student`s have achieved. Staff have good training and support so that they can understand how best to help and protect the students. They use lots different ways to help students make their own choices and decisions about what they want to do. They also make sure that there is a wide range of activities available to help students learn new things and enjoy themselves. What has improved since the last inspection? Since the last visit to the home, there have been improvements to the way that they record and use information. Weekly summaries of the student`s daily journals are now done, so that the information is easier to find. There are also separate records for student`s activity programmes, so that their progress and achievements can be seen more easily. The menus are now done weekly so that students are able to make clearer choices, and they can relate the shopping they do more closely to the menus. At the last inspection the home had a very small office area. Since then the garage area has been converted into a large office, which means that there is a lot more room to manage and store records and medication. What the care home could do better: We did not make any requirements during this visit, but we did make some recommendations for good practice. Although care plans show how students make choices and decisions, we suggested that they contain information about recent legislation that is designed to protect people`s rights and choices. This is so that they can show that they have looked at the effects the legislation has upon student`s lives. We also suggested that there is portable and lockable storage to put medicines in when they are taken out of the home, for instance when student`s have a day out. This is so that the medicines can be kept safely. Lastly we suggested that the reports of visits to the home by senior managers, are separated from reports for the whole college service, and they are kept in the home. This is so that things that are specifically about the home can be identified and reviewed more easily. CARE HOME ADULTS 18-65 12 High Street Brant Broughton Lincolnshire LN5 0SL Lead Inspector Wendy Taylor Unannounced Inspection 29th April 2008 09:10 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 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 12 High Street DS0000040002.V363478.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 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. 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 12 High Street Address Brant Broughton Lincolnshire LN5 0SL 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) 01400 272929 01400 273438 keith.salmon@cambiangroup.com Cambian Care Services Limited Keith Salmon Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only:Care home only - Code PC To people of the following gender: Either Whose primary need on admission to the home are within the following categories:Learning disability - Code LD The maximum number of people who can be accommodated is: 5 2. Date of last inspection 4th May 2006 Brief Description of the Service: 12 The High Street is a 5 bedded home and was registered for younger adults with a learning disability in March 2003. The home is operated by Cambian Care Services and is situated across the road from Broughton House College, a larger residential establishment, owned by the same company, for the same service user group. The home is located in Brant Broughton, where local shops are within walking distance. Access to public transport is available and the home has its own vehicle in order to access resources in the wider community. The home is a two-storey domestic style residence and is in keeping with the local community. All bedrooms are for single occupancy and, with the lounge, dining and kitchen areas; this home provides a homely and comfortable environment for the service users. Attached to the rear of the building is a self-contained annexe with lounge/kitchen, bedroom and bathroom to promote independent living. The home is situated within landscaped gardens. The aim of the home is to provide a safe and supportive environment and to promote the emotional, social and independence skills of the service users. The staff promote a clear perspective on respect for the rights of individuals to privacy and dignity and to work in partnership with families and other agencies. 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 Page 5 People who use the service refer to themselves as students. The manager told us that the current fees for the service range between £162726.21 and £215080.16 per annum, depending on individual needs. Information about these costs as well as the day-to-day operation of the home, including a copy of the last inspection report, is available from the main office of the home. 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the students who use the service receive good quality outcomes. This key unannounced inspection took place on one day in April 2008 and lasted for approximately 7½ hours. The care and support received by two students was followed in detail, using a method called case tracking. This method involves talking to the students and observing the care and support they receive. It also involves looking at their care plans, medical records and daily notes. Some of the general house records and staff records were also looked at. Staff and the registered manager were spoken to during the visit, and information already held by us, such as a self-assessment and notifications, were used as part of this inspection. Surveys received from staff and relatives were also used. Comments made by students, relatives and staff are contained in the body of the report. What the service does well: What has improved since the last inspection? Since the last visit to the home, there have been improvements to the way that they record and use information. Weekly summaries of the student’s daily journals are now done, so that the information is easier to find. There are also separate records for student’s activity programmes, so that their progress and achievements can be seen more easily. The menus are now done weekly so that students are able to make clearer choices, and they can relate the shopping they do more closely to the menus. 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 Page 7 At the last inspection the home had a very small office area. Since then the garage area has been converted into a large office, which means that there is a lot more room to manage and store records and medication. 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. The summary of this inspection report can be made available in other formats on request. 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 Page 8 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 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is enough information to help people choose whether the service is right for them, and the assessment process helps to make sure that their needs can be met. EVIDENCE: There is a service user guide in place, which contains up to date information about the type of care the home can provide, and it helps students to recognise the staff that work there. Photographs of the home and the activities it offers support the written information in the document. The main college information booklet contains the up to date statement of purpose for the home, and it gives details about the educational curriculum provided. Assessments are in place for each student, which cover needs such as communication, self care, independence skills, health care, diet, behaviour and leisure. The assessments are very detailed and tell people what the student’s wishes and preferences are. Records show that they are reviewed and, if necessary, updated at least every six months. The records also show that student’s, where they are able, relatives and other relevant people are involved in carrying out the assessments. 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed care plans help students to develop their independence, whilst risks are minimised. They are consulted about their daily lives, and supported in an individualised and respectful way. EVIDENCE: Students have very detailed care plans, which link clearly with their assessments. As well as plans for needs such as communication, self-care and health care, there is an individualised learning plan that sets out the student’s educational activities. The plans show people what the students like and don’t like, and they also show how students make their own choices or decisions. It was recommended that the plans contain some information to show how they have considered recent legislation about decision-making. Records show that staff have received training about the new legislation. Staff said that they are currently developing personal booklets for students, which contain pictures and symbols, so that they can be more involved in the care planning 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 Page 11 processes. Risk management plans are also in place, and cover needs such as self-injury, mental state, kitchen access, vulnerability and travel. They also cover any restrictions to choice or freedom, which are in place where there is a high risk to the student’s health or safety. Records show that care plans and risk assessments are reviewed every month, and at six monthly and yearly intervals. At yearly reviews the information is presented in the form of photographs and video footage, as well as a detailed report. This is so that the student can clearly demonstrate their achievements. Copies of the different formats are made available for relatives. Review records show that relevant people are consulted about, and agree to care plans. Since the last inspection, weekly summaries of daily reports have been introduced. This is so that information is easier to access and review. Relative’s surveys said that students have a ‘good quality of life’ at the home. They also said that students receive ‘good educational programmes’, and ‘they are helped to maintain and develop their independence’. Through discussions and observation of practice the staff showed that they have a very clear understanding of each student’s needs. They were seen offering choices in whatever way the individual student could understand, for example using objects of reference, pictures, gestures or verbally. They also responded to students in a respectful way, and offered gentle reassurances where necessary. 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Students benefit from a wide range of social and educational opportunities, which help them to develop their skills and live a fulfilling life. EVIDENCE: Individual daily programmes, including evenings and weekends, clearly show leisure, educational and home management activity. Activities such as meal preparation, walks, art, paper rounds, music sessions, community based sports sessions, social clubs and meals out are offered. Since the last inspection, daily reports specifically for activities have been introduced, so that progress can be more easily reviewed. Students said they liked to do things such as changing their beds, mowing the lawn and going to ‘play zone’. Students are supported to join in with daytime activities by staff at the home, and education staff based at the main college site. During the visit students 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 Page 13 went out to local sports facilities in the morning and afternoon. Staff used things like a portable DVD and a personalised picture system, which show photographs of different activities, to help a students make their choice, and to show people what they had done. Staff respected student’s decisions not to join in with activities. A variety of games and puzzles are also available in the home. Personal effects, photographs, individual records and surveys show that student’s are supported to maintain their relationships with families and friends. Menus are now developed on a weekly, instead of monthly, basis so that it is easier for student’s to make clearer choices, and relate the shopping they do more closely to the menu. Menus remain flexible, and during the visit staff offered choices before the lunch time meal was prepared. Choices were also offered for desserts. Staff supported a student to take part in preparing, and cooking the meal. Students said that they enjoyed their meals, and they said what their favourite foods were. These preferences were reflected in the menus, and the foods available in the home. 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good arrangements to make sure that student’s health needs are met, and they are protected by the medication policies and procedures. EVIDENCE: Each student has a medical file, which contains information about their health needs, and this information links with care plans. Again care plans are detailed and show staff how to support needs such as behaviours and epilepsy. They also include information about emotional needs such as anxiety. Records show when students have seen health professionals such as GP’s, dentists or opticians; and they show that things like weight and seizures are monitored. Students have an allocated key worker and a co-worker so that they have a consistent support network. Staff demonstrated through discussions and practice that they know the student’s health needs very well. For example, they were able to describe how needs such as hay fever and epilepsy are managed. They also made sure that any personal support was provided in a 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 Page 15 private and dignified way, and they respected student’s decisions about things like what time they got up in the morning. Records show that staff receive training in how to administer medications in a safe way. The training includes special techniques for medicines that are not given in tablet or liquid form. There are clear protocols in place to show how and when medicines that are taken only when necessary, should be used. There are also systems in place for taking medicines out of the home when students go on trips or other activities, and staff were seen using these systems appropriately. A recommendation was made that lockable storage is provided for medicines that are taken out of the home. There is a company policy regarding general administration of medicines and staff followed the procedures satisfactorily. Medicine recording and storage arrangements were also satisfactory. Since the last inspection, the home has notified us of two medication errors, and records show that they were managed appropriately. 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Students are protected by the home’s procedures for handling complaints and allegations of abuse, and by the knowledge of staff. EVIDENCE: Since the last inspection there has been one complaint to the home, and records show that it was managed and resolved in line with the complaints policy. This policy, and policies about child and adult protection are available on the company’s intranet site. One safeguarding adult referral has been made and records show that it was reported in line with company, and Local Authority guidance. Records also show that immediate action was taken to address health and safety issues, and risk assessments were reviewed and updated. Staff demonstrated a good knowledge of what abuse is and how to protect students. Records show that they receive training in this subject. Any restrictions to choice or freedom are referred to in care plans, and the manager said that he is soon to undertake training about new legislation referring to rights and freedom. An independent advocate currently supports one student. 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 Page 17 Students are supported with their personal finances and there is a company policy available in regard to this support. Storage and records were satisfactory, and they are managed through the main college site. 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Students enjoy a clean, comfortable and homely environment, which is well maintained. EVIDENCE: On the day of the visit the home was very clean, tidy and well maintained. Student’s bedrooms were well decorated and furnished, and were personalised to the taste of the individual students. Students said that they liked their rooms. Since the last inspection the garage space has been converted into a larger office, which also provides a better storage and administration area for medications. Maintenance staff visit daily to undertake repairs and regular maintenance tasks. Records, for example, show that electrical equipment is tested regularly, showerheads are changed regularly and carbon dioxide monitors have regular 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 Page 19 checks. Records also show that fire alarms and water temperatures are checked regularly. Substances used for cleaning were securely stored in the laundry area, and safety information sheets about the substances are in place. Staff demonstrated their understanding of infection control practice, and they were seen washing their hands wherever necessary. 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment procedures protect students, and they benefit from a well-trained and supported staff team. EVIDENCE: We looked at records for three staff members. The recruitment records included criminal record bureau checks, application forms and two written references. They also contained identification and interview records. The manager said that new post has been developed for a recruitment coordinator, who manages the process from advertising to arranging interviews. They are also responsible for monitoring absences and turnover of staff. This means that the processes are more consistently applied. Surveys from staff show that they receive a good induction and training package, and this was confirmed by individual training records, and by talking to staff. Pre inspection information shows that the majority of staff have or are working towards a nationally recognised care qualification. Staff said that they receive training in subjects such as fire safety, moving and handling, and 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 Page 21 medication administration. The plan for the coming year also includes training about infection control, food hygiene, observation skills, diversity and autism. On the day of the visit a training session was taking place away from the home, and staff were attending. Records show that supervision sessions are carried out regularly with staff, and they confirmed this during discussion. They said that supervision helps them to look at their personal development, and they are able to voice their views and opinions. They said that there is good teamwork within the home, and they get good support from their colleagues. They also said that there are good communication systems within the home such as handover periods. 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed, which means that students receive a good standard of care and support. The systems within the home protect their health, safety and welfare needs. EVIDENCE: Since the last inspection the manager has registered with us, and a new team leader is in post. Staff said that they have good management support, and there is an on-call managers rota in place. They said that they have always had a good response from the on-call managers. Staff also said that there are regular staff meetings, and minutes show that there are discussions about subjects such as student support issues, training, and health and safety. 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 Page 23 The manager makes sure that we are informed of anything that affects health, safety or welfare within the home, for example, if a student hurts themselves. Pre inspection information shows that there are a range of health and safety policies in the home such as fire safety, infection control, and moving and handling. Records are also available to show that fire safety equipment is checked regularly, and there is a fire risk assessment in place. Quality monitoring arrangements include regular audits of care files, medical files and daily journals. The records of these audits are kept within the files so that any identified issues can be addressed. Records also show that things like accident and incident records are audited regularly. Representatives of the provider company visit the home regularly to monitor the services. The reports of these visits are currently held at the main college site, and are part of the overall college service report. A recommendation was made for the home to have a separate report that is held on the premises. Surveys are also carried out to gain the views of students, relatives and staff. 12 High Street DS0000040002.V363478.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 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 Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA7 Good Practice Recommendations It is recommended that care plans include reference to the Mental Capacity Act, 2007 and the effects it has upon the students’ lives. This is to ensure that their rights and choices are protected It is recommended that portable and lockable storage arrangements are provided for medicines that are taken out of the home. This is to ensure that they are kept safely. It is recommended that written reports of visits by the provider’s representative are prepared separately from other services, and they are kept within the home. This is so that conduct of the home can be reviewed more easily, and specific issues can be identified and addressed. 2. YA20 3. YA39 12 High Street DS0000040002.V363478.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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