Care Home: Compton House

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What the care home does well Residents are able to say how they want their care to be provided, and about the way they want to live their lives. They are able to speak directly to the manager, responsible individual and the staff. Residents are give a healthy and balanced diet, and they have choice over the food they are given. Residents said they were very satisfied with the food they received. Residents also indicated they were satisfied with how their emotional needs, and health care needs are met. Residents are supported to have an active and varied social life with many opportunities to be included in the local community. Opportunities exist for residents to further their recreational activities. Staff are enthusiastic and are safely recruited for the jobs they do. Residents made very positive comments regarding staff and the manager. What has improved since the last inspection? Since the last inspection residents have been more empowered to make choices regarding how they spend their time. Their choices are known and they are supported by staff. Two walk in baths have been fitted, as have grab rails to assist with mobility. The manager continues to develop the service to ensure it is run n the best interests of the residents and that they have as many opportunities available to them as possible. What the care home could do better: The responsible individual works at the service most days and does speak with the manager daily. A monthly report regarding the conduct of the service does need to be maintained so the other directors and the commission can be kept up to date on the development and changes in the service. CARE HOME ADULTS 18-65 Compton House Otterbourne Road Compton Winchester Hampshire SO21 2BB Lead Inspector Kathryn Emmons Unannounced Inspection 12th August 2008 12:00 Compton House DS0000011878.V369496.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 Compton House DS0000011878.V369496.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. Compton House DS0000011878.V369496.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Compton House Address Otterbourne Road Compton Winchester Hampshire SO21 2BB 01962 712086 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) miriam554@btinternet.com Mr Martin Kenneth Peake Mr Ronald John Simkin, Sandra Winifred Peake Mrs Miriam Long Care Home 12 Category(ies) of Learning disability (12), Learning disability over registration, with number 65 years of age (12) of places Compton House DS0000011878.V369496.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in LD category must be at least 50 years of age. Date of last inspection 30th August 2006 Brief Description of the Service: Compton House provides care for up to twelve male and female older Residents over the age of 50 with learning disabilities. Three Directors own the home privately with Mr Martin Peake as the registered individual and Mrs Miriam Long as the registered manager. The home is situated in a quiet rural outskirts of Winchester. Local services and amenities require transport to access although there is a local garage and shop within reasonable walking distance. The Home hires appropriate transport and staff cars are available to access the community. The building is a double storey domestic in style house, comprising of two large single bedrooms and five large double bedrooms. The home’s communal space comprises of one lounge, additional open plan sitting area and a separate dining room. Compton House is surrounded by substantial parkland and has large gardens providing additional recreational space and parking. The manager confirmed the fees range from £441 to £602 per week. Compton House DS0000011878.V369496.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 3 star. This means the people who use this service experience excellent quality outcomes. A visit to the service took place on 12 August 2008. This visit was unannounced and took place over 4 hours. The registered manager was working and assisted during the visit. Care received by three residents was looked at in detail. This is a method called case tracking. This included looking at their personal records, a range of general home records and staff detail records. Staff were spoken with and the care they provided was observed. We received a completed self-audit document completed by the registered manager, to provide information before we did a site visit. We also looked at how the provider makes information about their service, including CSCI reports available to prospective service users. During the visit we spoke with two members of staff and all of the residents. What the service does well: Residents are able to say how they want their care to be provided, and about the way they want to live their lives. They are able to speak directly to the manager, responsible individual and the staff. Residents are give a healthy and balanced diet, and they have choice over the food they are given. Residents said they were very satisfied with the food they received. Residents also indicated they were satisfied with how their emotional needs, and health care needs are met. Residents are supported to have an active and varied social life with many opportunities to be included in the local community. Opportunities exist for residents to further their recreational activities. Staff are enthusiastic and are safely recruited for the jobs they do. Residents made very positive comments regarding staff and the manager. Compton House DS0000011878.V369496.R01.S.doc Version 5.2 Page 6 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. Compton House DS0000011878.V369496.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 Compton House DS0000011878.V369496.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 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can be confident that their assessed needs can be met by the service. Contracts are in place so residents can be clear on what service they can expect. Support is provided to enable a smooth move into the service. EVIDENCE: We could see from looking at care files that residents had contracts in place. We asked a couple of residents if they remembered what had happened when they came to live at the home. One resident said “I had a look and I liked it”. The manager informed us that any new admission to the service was made only after an in depth assessment was in place and the resident understood what the service could offer them. The statement of purpose and service users guide are in place and these were in a format that residents were able to understand. An advocate service provides support for residents to understand their terms and conditions for living at the service. These two documents contain information about the service, staff and services offered. Residents and their relatives use this information to help them make decisions about living in the service. Compton House DS0000011878.V369496.R01.S.doc Version 5.2 Page 9 We saw a file for a new resident, which showed that a thorough pre admission assessment had taken place and that the resident had been able to visit the home. The manager informed us in the AQAA (Annual Quality Audit Assessment) that a care manager from social services and a home manager had written to her saying they were very pleased with the services admission process. We asked two residents if they had been given information before they came to live at the home and they both said they couldn’t remember as they had lived at the home for a “long time”, but we did see the statement of purpose and service user guide along with the previous inspection report on display in the front hall of the home. Compton House DS0000011878.V369496.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 and 9. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Written records provide residents with confidence that their needs are known and are able to be kept safe. Regular reviews of needs provide staff with detailed information to provide the correct level of support. EVIDENCE: We saw care files for three residents. These contained written assessments, care plans and risk assessments. It was clear what the residents needs were and how these were going to be met. Staff told us that they have access to the care plan and wrote at least daily in the care records. This enables staff to be kept up to date on the resident’s welfare. There was evidence that reviews had taken place for all of the resident’s case tracked and there were reports in place from relevant people such as the care managers, hospital doctors, and for one resident a speech therapist. We could see that residents had been involved in their care plan and that they were also involved in reviews. A key worker system has been implemented since the last Compton House DS0000011878.V369496.R01.S.doc Version 5.2 Page 11 inspection and this means that each resident has a dedicated member of staff who is responsible for ensuring tasks such as shopping and keeping in touch with relatives is maintained. We spoke with all the residents and talked to them about how the service was run and if they felt that they were involved in the running of the service. We were told “Miriam listens to us and asks us what we want to do” and “I do what I like but I have to stay safe”. Staff were clear on each residents needs and what support they needed. We saw risk assessments and these varied depending on the individual needs of residents. Examples were accessing the gardens and going up and down stairs independently. Residents have clear ownership of the home and were seen answering the door with staff and checking who they were letting in to the service. Compton House DS0000011878.V369496.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): 12,1314,16,and 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents lead lifestyles they chose. They are empowered to make decisions and are supported to experience new opportunities. They receive a well balanced diet, which is of their choosing. EVIDENCE: We spoke with all of the residents to understand how they spent their days. At the time of our visit one of the local church groups was visiting to carry out a communion service. We were told, “Whenever we visit here all the residents are happy and look well cared for”. We saw activities taking place such as drawing, listening to music and rug making. A couple of the residents were being assisted to do jigsaw puzzles. The AQQA gave a list of visiting entertainers and there is a piano in the home as one of the residents enjoys singing. Compton House DS0000011878.V369496.R01.S.doc Version 5.2 Page 13 All of the residents regularly go out into the community and attend appropriate activities which range from swimming to horse riding to eating out and shopping for items for the home such as plants and decorations. We saw that due to varying abilities some residents did find it hard to access the local community to do shopping. This need is met by the service providing internet access and catalogues for residents to look at and then purchase from. Residents told us they had gone on holiday to a cottage in Devon and had “loved it all and cant wait to go back”. We were also told “I always have a lot to do and I like the help I get to make my room nice” and “I go out a lot and like it a lot, I can say what I like and someone will help me go and do it”. Discussion with staff evidenced that staff understood the need to support residents to be as independent as possible and participate in as much community inclusion as was possible as long as the residents were kept safe and it the residents choice. We arrived at the home during the lunchtime. Residents told us “I love the food its good” and I help in the kitchen sometimes but even if I don’t I always have lots to eat” and “I helped chose the food”. The manager confirmed that menus are always discussed at the residents meetings, which are held regularly and chaired by the responsible individual. We saw the kitchen which was clean and tidy and staff told us they did not have a restricted budget and residents could chose what they ate. Specialised diets such as sugar free and low fat are available. Compton House DS0000011878.V369496.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 and 21. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents receive the care they need and are satisfied with how this is delivered. Health care needs are met and medication systems keep residents safe. The ethos of the home enables residents to live in the home for as long as possible. EVIDENCE: We asked residents about the care they received and if they were happy with this. We were told “I get all the help I need” ,“They are nice to me and look after me “ and “I have a bath when I want and I get help to do things”. The ethos of the service is that it is resident led with staff providing support where needed. We observed interactions between staff and residents. It was clear that staff showed respect to residents and this enables the resident to feel that the service is their home. Interactions were appropriate and valuing of the residents. Residents made comments to us such as “I think the staff love me like their own family” and “Miriam is looking after me and I like it “ and “we are a big family and Miriam is good to us”. Compton House DS0000011878.V369496.R01.S.doc Version 5.2 Page 15 We looked at the medication arrangements for the residents. Staff who give out medication have been trained to do this and understood the importance of giving the right medication at the right time. Staff were seen giving out some medication over lunchtime and they did this in a safe way. There is a medication policy in place. Medication records we saw had been signed and completed correctly. During our visit we were able to talk to the doctor who looked after all of the residents who live at the service he told us that some of the residents had “very much improved since living at the home” and “Overall most have had their physical health improved and are much healthier and their conditions are much better managed”. We could see from care records that residents had access to opticians, chiropodists and well person appointments. On the day of the visit one of the residents was being supported to attend a care review at the local hospital. All of the residents living at the service are over 50 years of age. The ethos of the service is for residents to remain at their home for as long as possible and the staff receive training which is relevant to the needs of older people so they can continue to meet the residents needs not only due to them having a learning disability, but also as they become older people. Compton House DS0000011878.V369496.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 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident their concerns will be listened to and acted upon. Staff are trained in safeguarding adults procedures and service users are protected from harm. Advocates are provided for residents who are unable to make their own decisions. EVIDENCE: We spoke with four of the residents about what they would do if they had any worries or concerns. One of the residents said, “I don’t worry because its good here” another said, “Miriam is here and it’s all all-right”. Since the last inspection an advocate has been recruited to provide independent support for those residents who are unable to make their own decisions. A complaints procedure is in place in a format, which is easier for residents to understand. The manager has an open door policy and residents are able to raise any issue with her or with the responsible individual. Two staff were spoken with and given safeguarding adult scenarios, which they were able to answer appropriately. Staff spoken with said they were confident to challenge the other staff including their senior staff colleagues if they thought a decision was not in the best interest of the residents. An up to date Hampshire safeguarding adult policy was in place. Compton House DS0000011878.V369496.R01.S.doc Version 5.2 Page 17 Staff confirmed they had received training in safe guarding adults procedures and we also saw from staff training information that training had been planned and taken place. Compton House DS0000011878.V369496.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 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is clean and tidy and provides residents with comfortable surroundings, which they are able to personalise. Adaptations such as a stair lift and walk in baths enable residents to be as independent as possible. EVIDENCE: We undertook a tour of the premises with two of the residents. With their permission we saw a few of the residents bedrooms. These had been personalised and generally were in a good state of décor. One bedroom we saw was in need of some décor update and the manager confirmed this was on the maintenance plan to do in the coming month, at the time of the visit the responsible individual was painting the exterior of the home. Since the last inspection two new walk in baths have been installed and there is a stair lift to enable less mobile people to go to the first floor of the home. One bedroom is located on the ground floor to assist those residents who Compton House DS0000011878.V369496.R01.S.doc Version 5.2 Page 19 cannot manage stairs. The lounge has been redecorated and new lighting has been purchased to enable residents to carry on with hobby work such as rug and wool work when the natural light is not sufficient. Staff supported a resident to purchase an electric recliner so the resident is able to maintain their independence with getting in and out of a chair. The communal areas of the home were clean and tidy and the home smelt fresh throughout. Staff work with residents to maintain the cleanliness of the building. There is a laundry room adjacent to the main house and this is where cleaning materials are kept to minimize risk to residents. Staff have received training in infection control and we saw staff using good infection control measures while we were at the home such as washing hands and wearing aprons when dealing with food. Compton House DS0000011878.V369496.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): 32,33 35 and 36. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are cared for by enthusiastic and trained staff. Recruitment records evidence that the appropriate checks are made so that the right people care for residents. Supervision sessions enable development and training needs for staff to be identified. EVIDENCE: We looked at the staff recruitment records of three staff including the newest member of staff. We could see that all the necessary checks had been carried out and references were obtained before an offer of employment was made. Staff received an induction and ongoing supervision sessions. There is a very low staff turnover, which benefits the residents as they can build up relationships with the staff. The staff are able to become familiar with residents needs and learn how to understand the different ways in which residents make their needs known. Compton House DS0000011878.V369496.R01.S.doc Version 5.2 Page 21 All staff have either attained NVQ 2 (national vocational qualification) in Health and Social Care or started the course in March. Some of the care staff have started to undertake Level 3. This means that the staff group have an increased skills and knowledge base, which may improve the quality of care residents receive. The staff group consists of men and women of varying ages. This means that residents can chose who helps them with their personal care, if they have a preference to gender or age of their carer. Staff receive regular supervision sessions from the manager of the senior carer. During our visit we could see that care needs were being met and that staff and residents enjoyed positive relationships. We asked residents how they got along with staff and they said “They are really good”, “they are nice and kind” and “They give you a lot of help if you want it”. The duty rota demonstrated that there were always at least three staff working in the morning, two working an afternoon shift and at night one awake carer and one on call in the building. Staff told us that they felt this was a sufficient level of staff to carry out the care required. A training plan is in place and recently staff have been developing a key worker system and becoming more involved in person centred planning. The staff we spoke with said they had a contract of employment and a job description. This enables them to be clear of their job role and what is expected of them. Compton House DS0000011878.V369496.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): 37,38,39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is well run by a competent and trained manager. Residents are able to express their opinions. Checking of equipment and servicing of house systems keep residents and staff safe. EVIDENCE: The registered manager is Mrs Miriam Long. Mrs Long has many years experience of working with people who have learning disabilities and has completed the Registered Managers Award. This provides her with up to date skills and knowledge to manage a service effectively and ensure it is well run. Staff told us that the manager is “really supportive and easy going” “you can go to her about anything and she will listen and try and help”. Residents told Compton House DS0000011878.V369496.R01.S.doc Version 5.2 Page 23 us “I like Miriam, she is nice and I can talk to her when I want”, “She helps me and asks what I am doing” and “She helped me to go out and I know I can speak to her and go and see her in the office” A quality assurance programme is in place and part of this needs to consist of a monthly report produced by one of the organisations representatives. The responsible individual works in the home often and does carry out the tasks involved with the monthly visits but a report is not actually produced. This needs to happen to enable the manager and the commission and the other people involved in the organisation to be aware of the conduct of the service. Quality satisfaction surveys are sent to residents and their relatives and an action plan is written following the return of the surveys. Polices and procedures are reviewed at least annually to ensure they reflect current care practices. From the AQQA we received, we could see that all testing of equipment had been carried out regularly to keep staff and residents and visitors to the service safe. Compton House DS0000011878.V369496.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 3 4 3 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 4 33 3 34 x 35 3 36 3 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 4 14 4 15 x 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 4 4 4 2 x x 3 x Compton House DS0000011878.V369496.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. Refer to Standard Good Practice Recommendations Compton House DS0000011878.V369496.R01.S.doc Version 5.2 Page 26 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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