Care Home: Ashby House

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What the care home does well When asked what the service does well relatives told us " the home is a happy, caring atmosphere. My relative is anxious to get back after visits and physically is well cared for. I believe the home provides a good and valuable service" and another relative said " ensures wellbeing of clients." Social care professionals told us that there is "good liaison with social services generally. Will raise concerns immediately and will raise adult protection alerts appropriately. Responds well to client individuality. Client reports that she is happy." The environment of the home is in keeping with a family home and is well maintained and decorated. The recruitment procedures are thorough and protect people who use the agency. Care plans and associated records are clear and person centred. What has improved since the last inspection? We are told in surveys returned to us that communication has improved and one social care professional told us " the general welfare and happiness of my client has improved considerably." The homes policy and procedures for administering medication have been improved as a result of previous medication errors so that there is less chance of error. What the care home could do better: The providers have told us that they are to recruit a new an manager who after appointment must be registered with the Commission for Social Care Inspection. CARE HOME ADULTS 18-65 Ashby House 40 Richmond Avenue Bognor Regis West Sussex PO21 2YE Lead Inspector Mrs Diane Peel Unannounced Inspection 26 February 2008 12:45 th Ashby House DS0000014370.V358080.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 Ashby House DS0000014370.V358080.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. Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashby House Address 40 Richmond Avenue Bognor Regis West Sussex PO21 2YE 01243 822145 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) ashby@beaconcaregroup.co.uk Emeraldpoint Limited Mr Alan Shepherd Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th June 2006 Brief Description of the Service: Ashby House is a care home, which is registered to provide personal care for up to six service users in the category learning disability (LD). Ashby House is a spacious house located in a quiet residential road on the Western outskirts of Bognor Regis. The property is a two storey building providing private accommodation to service users in six single bedrooms one located on the ground and five on the first floor. Communal accommodation is made up of a lounge, a conservatory and a dining room located on the ground floor. An enclosed garden, which is available to service users, is located to the rear of the premises. The registered provider of this service is Emeraldpoint Ltd and Mr Jawad Sheikh has been appointed as the Responsible Individual acting on behalf of the organisation. There is currently no registered manager in place to manage the home. The fees for this care home range from £900 to £1300 per week. Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. Mrs Diane Peel carried out a visit to Ashby House on the 26th February 2008. We had carried out an Annual Service Review (ASR) in August 2007, which did not include a visit to the service but looked at information that we had received, or asked for, since the last key inspection. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service, surveys returned to us by people using the service and from other people with an interest in the service Information we had about how the service has managed any complaints What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement. Information from other organisations. What other people have told us about the service. From the information gathered in the annual Service Review (a copy of which can be requested from us) we decided to bring this key inspection forward. During this key inspection on the 26th February 2008 the intended outcomes for 30 standards were assessed; these included the key standards for care homes for younger adults. Prior to the site visit we sent surveys to people living at the home, staff working at the home, relatives of people living at the home and other social care professionals involved in the care provision of people living at the home. Have Your Say surveys were returned to us by seven care staff, two relatives of people living at Ashby House, three social workers/ reviewing offices and four out of the five people living at the home. Comments were positive and the majority of people talked about recent improvements to communication and care practices at Ashby House. What the service does well: When asked what the service does well relatives told us “ the home is a happy, caring atmosphere. My relative is anxious to get back after visits and physically is well cared for. I believe the home provides a good and valuable service” and another relative said “ ensures wellbeing of clients.” Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 6 Social care professionals told us that there is “good liaison with social services generally. Will raise concerns immediately and will raise adult protection alerts appropriately. Responds well to client individuality. Client reports that she is happy.” The environment of the home is in keeping with a family home and is well maintained and decorated. The recruitment procedures are thorough and protect people who use the agency. Care plans and associated records are clear and person centred. What has improved since the last inspection? 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. Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have information available to be able to make a choice about if the care home is the one, which they want to live in and people’s needs are assessed before they move into the home so that they can be sure that the staff can meet their needs. EVIDENCE: The Statement of Purpose and Service User Guide was hung on the notice board in the hallway. It was in a format of pictures supported by text. Some of the pictures were photographs of the home both inside and outside of the house so that people considering moving to Ashby House could see what it looked like. It gave information about what people could choose to do when they live at the home, what kind of support they can expect from the staff and what to do if they were not happy about something when they lived at the home. The care records, which we saw during our visit to the house, included checklists, which had been completed to show that people had a chance to Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 9 visit the house before they decided that they wanted to live there. These had been completed some time ago as no new people have come to live at the home for sometime. We looked at the care records for two people during our visit to Ashby House and saw that both people had had their care needs assessed before they had moved went to live at Ashby House. We also saw that people living at the home had been involved in their assessments and when people had limitations and restrictions on things they could do safely these were written down and signed by the person who the care records belonged to or by somebody important to them like their parents or brother or sister. Four out of the five people living at the home returned Have Your Say surveys to us before we visited the home. Three people told us that they had enough information about the home before they moved in so that they could decide if it was the right place for them and all three ticked yes when asked “ where you asked if you wanted to move to this home?” The other person didn’t answer these two questions. Two relatives of people living at Ashby House returned Have Your Say surveys to us and they both told us that they always get enough information about the care home to help them make decisions and that they felt that the home meets the needs of their relative living at Ashby House. They were also asked “ are you kept up to date with important issues affecting your relative or friend/ relative” to which both ticked always. Ashby House DS0000014370.V358080.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. The care needs and assistance required are recorded appropriately so that the people living at the home and their relatives/advocates know that they have a plan of care which will meet their individual needs and so that they can continue to be valued as a person and continue to make individual choices. EVIDENCE: Five people were living at Ashby House during the time of our visit although only three were at home for part of the time that we were there. The person in charge on the day of our visit told us that everybody had a care plan. Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 11 The care plans, which the care staff use, are kept downstairs but there are two other files for each person, which we saw when we went up to the office. We looked at two care plans and other care records for the same two people whos needs assessment we had looked at so that we could see how a care plan had been put together from the assessment. Both plans showed how people’s needs were to be met by staff. They identified problems, which people might have, and how best staff could help people to avoid the problems and help to sort the problems out. They looked at how people could eat healthily, maintain their individual levels of independence and described how peoples cultural and diverse needs should be met. There was an activity assessment plan and an activity timetable to show how people spend their day and staff keep daily records so that they can monitor peoples wellbeing. There were risk assessments and when people had limitations and restrictions on things they could not do safely these were written down and signed by the person who the care records belonged to or by somebody important to them like their parents. The care records, which we saw, had been regularly reviewed and showed that people living at the home and other people important to them are involved in agreeing the care plan. Ashby House DS0000014370.V358080.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 good. This judgement has been made using available evidence including a visit to this service. People are encouraged to take part in leisure activities, meaningful education, the day-to-day flexible routines within the home and maintain links with their families, friends and the community so that they can continue to live a fulfilling lifestyle. EVIDENCE: On the day of our visit two people were out at either work or an educational activity. The other three people were not at the home when we arrived they had gone out with staff for a trip out locallyand returned later. Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 13 We saw the activity diary and activity time table for two people during our visit which showed that people do have have leisure activities, have some integration into the community and take part in the day to day running of the house. We were told by the person in charge during our visit that two people go to college of which one person goes everyday and another person goes one day and to another day care provision for another two days, other people use other day care facilities for part days of the week. We received Have Your Say surveys from other profesionals involved in the care provision of some people living at the home. One person commented “ day and leisure activities are structured based on individuals neeeds and preferences.” and other comments made indicated that plans for holidays were made around each individual or short outings thoughout the year. The five people living at the home who returned surveys to us were asked “ can you do what you want to do :a) in the day, b) in the evening, c) at the weekend , to which everybody responded “yes” to all. We saw that staff keep a record of visits by peoples relatives and friends and also when they go to stay with their realtives in peoples care records. There is also a visitors book in the entrance hall which records visitors to the house. The person in charge of the home at the time of our visit told us that meals at the home are flexible. We were supplied with a six week menus and the staff were writing out a shopping list whilst we were in the home. A person living at the home was heard to ask what was for tea that night They then asked if they could have lasagne instead. The staff member agreed to the request. We were also told that during the daily report and planning for the day staff are allocated for meal preparation with assistance from someone living at the home. Care records observed during our visit showed that the staff have a healthy eating plan for people, weights are being monitored and the actual quality of food which people are eating is being monitored. A professional involved in the care provison of people living at the home told us in the survey which they returned to us “Recent improvements to service users diet. Better menues with healthy food available.” Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 14 Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 15 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. People’s health care needs are being met and there have been improvements to medication administration practice so that people are better protected by the homes policies and procedures for dealing with medication. EVIDENCE: The personal care and health care needs of people living at the home were observed to be identified in the care plans, which we looked at during our visit. There was also records of the daily support undertaken which each person and we also the records kept of visits by and to health care services such as the doctor or district nurse. Healthy eating plans are in place and weight was being monitored in the care records, which we saw during our visit. Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 16 The person in charge of the home told us on the day of the visit that no-one living at the home could look after his or her own medication. Medication profiles were observed in individual care records being kept in the office. The most recent manager had improved the medication practice within the home following two medication errors reported to use in the last year. We looked at the medication records, which were up to date on the day of our visit. There was also a record of what medication had been received for each person and a detailed description of each medication and its side effects. The person in charge told us during our visit that a senior member of staff administers medication and another carer witnesses this. Records showed that two people sign a record of administration in addition to the printed Medication Record Sheets. A local pharmacy support agreement was observed to be in place and we were told that the staff have training packages from this pharmacy to complete. Consent for administration of medication forms was observed to have been signed by those people living at the home who are able to sign them. Medication was being stored in a locked metal cabinet attached to the wall in the office. Medication administration boxes are made up by the pharmacy and delivered each week, and topical and liquid medications are delivered monthly. Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 17 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. The welfare of people using the service are promoted and protected so that they can feel safe. EVIDENCE: The homes complaints procedure is on display in the entrance hall. It was observed to be in a format of pictures supported by text. The service users guide also had information about how to make a complaint. All five of the people living at the home who returned surveys to us reported that they knew who to speak to if they were not happy and two confirmed that they knew how to make a complaint. There was a note on one survey, which stated that there was no response to the question asked due to limited communication skills and one other person told the person helping them to fill in the survey that they didn’t know how to make a complaint. Two relatives who returned surveys told us that they both knew how to make a complaint and for one person who had raised concern about the care of their Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 18 relative living at the home, they told us that it had been responded to appropriately. All seven staff returning surveys to us reported that they knew what to do if a service user/relative or advocate had concerns about the home. We were told by the service in the AQAA, which they returned to us in July 2007 that there had been two complaints received which, were both resolved within 28 days. Complaints records viewed during our visit to the home showed that complaints made had been taken seriously and acted upon. We have been told by the service that they have made four safeguarding adults referrals in the past twelve months and two members of staff have been referred to the POVA list as a result of investigations. During our visit to the home we observed that the home has a copy of the revised West Sussex Multi Agency Safe guarding Adults procedures besides its own policies and procedures on safeguarding adults. Staff training records showed that the majority of staff had attended safeguarding adults training and others more recently employed were awaiting the training. Comments received in surveys from social care professionals returning Have Your Say surveys to us reported “good liaison with social services, will raise concerns immediately and will arise AP alerts appropriately.” There was also indication that in the past this may have been a problem, which had now improved. Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 19 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): 24,25,26,27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a homely well-maintained environment so that they can feel comfortable and safe. EVIDENCE: On the day of our visit the home was observed to be homely and the décor in keeping with a family home. We were told by the person in charge that there wasn’t any hot water that day but this had already been referred to head office for them to organise repair, however we were told this hadn’t effected the heating. All the accommodation was visited and it was observed that people who live at the home had personalised their bedrooms to suit their needs. Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 20 All areas visited were clean and tidy and the person in charge on the day of the visit told us that people living at the home are encouraged to clean and tidy their own bedroom. The person in charge told us on the day of our visit that new lounge furniture had been ordered and was awaiting delivery. Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The wellbeing, health and security of people living at the home are being protected by the agency’s policies and procedures on recruitment. EVIDENCE: We looked at recruitment files of two people who had started work at the home recently. We saw that they had been asked to fill in an application form, provide identification of themselves, which included a photograph, and show that they were medically fit to work with people at the home. Then they had attended an interview and there was a record of what they had been asked during the interview. References had been requested from people who they had worked for before. There was also a Criminal record Bureau (CRB) and Protection of Vulnerable Adults (POVA) clearance for both people in place. Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 22 All seven staff returning Have Your Say surveys to us told us that that their employer had carried out checks such as CRB and references before they started work and most people said that they felt that their induction to the job covered most things that they needed to know to do the job when they started. When asked the question in the surveys for staff “ are you being given training which is (a) relevant to your job, (b) helps you understand and meet the individual needs of service users, (c) keeps you up to date with new ways of working, everybody responded “yes” to all the points. A training matrix on the wall of the office gave us information to show that three staff have an NVQ level two, two staff have an NVQ level 3 and two other staff are currently undertaking an NVQ. Staff training records, which we saw during our visit showed that people, have the opportunity to develop and maintain their skills regularly. Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 23 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. Management arrangements are in place to ensure that people living at the home continue to benefit from a well run home. EVIDENCE: The senior person in charge of the home on the day of our visit told us that the most recent acting manager of the home left the previous week. We have since been informed of the temporary arrangements for the management of the home in the absence of a manager, which includes Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 24 additional support to senior staff from relief managers, the area manager and other members of the senior management team of the organisation. Quality assurance systems are in place and monthly checks had been carried out on the environment and administration of records prior to the acting manager leaving the home the previous week. Recent quality assurance surveys returned from relatives and staff were available to us during our visit which all had positive comments made about improvements since the manager at the time had taken over. A maintenance book is kept and we saw that fire equipment and electrical had been regularly maintained. On the day of our visit no health and safety matters came to our attention and the home continued to be well run. Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 25 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 3 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 26 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. Refer to Standard Good Practice Recommendations Ashby House DS0000014370.V358080.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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