Care Home: Dom Polski

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What the care home does well The home provides a specialist service to older Polish people who have lived most of their adult life in the UK. The needs of people in terms of their culture and language are positively addressed in the delivery of care by staff skilled in responding to people`s needs. The staff team consists of contracted lay staff and religious members of the Society of Christ. Care is provided in a way which reflects people`s life experiences, meets their needs and reflects their culture and religious identity. The staffing arrangements in the home ensure people are safe and adequately supported. Personal and health care needs are monitored through care planning and reviews, which are conducted internally and with the placing/funding authority. Programmes of decorating and refurbishment are ongoing to ensure a safe a homely environment is maintained. Maintenance arrangements are overseen by a religious Brother and by external contractors. What has improved since the last inspection? The current manager has proactively developed recording systems, which are completed in both English and Polish translations. This supported and enabled staff to develop their writing skills and ensure the needs of people were clearly recorded and understood by all persons involved in the delivery of care. Procedures had improved in relation to recruitment of staff with specific reference to completing required checks on staff prior to their employment. The manager had taken action to ensure advisory instructions provided by the pharmacist were retained in the Medication Administration Records (MARs) for each individual. At the time of the inspection a new wet shower room was being fitted. What the care home could do better: The recording of medication administration needed to be improved to ensure that the record is accurate and that people only received their prescribed dose. Some work was required on a number of bedroom doors, relating to fire smoke seals on doors and large gaps at the base of doors, to ensure people were safe when in their rooms. CARE HOMES FOR OLDER PEOPLE Dom Polski 18 Carlton Road Whalley Range Manchester M16 8BB Lead Inspector Joe Kenny Unannounced Inspection 5 December 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dom Polski Address 18 Carlton Road Whalley Range Manchester M16 8BB 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) 0161 226 1836 Society of Christ (Gt.Britain) Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th March 2007 Brief Description of the Service: Dom Polski is a large detached property that provides accommodation for 14 older people requiring personal care only. The home provides a specialist service for older Polish people. The home is owned and operated by the Fathers Of The Society of Christ (Great Britain), a Polish religious organisation and a registered charity. The home is situated in a residential area in the south of the City of Manchester. Local facilities and bus routes are within easy walking distance. Parking facilities are available to the rear of the property. The Polish language, culture and traditions are upheld within the home. There is a garden area which is accessible to residents. The fees for the home were £373.54 per week. Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out unannounced on the 5 December 2007. The inspection started at 10:00 a.m. and lasted seven hours. During the inspection time was spent in discussions with the manager, staff and informal discussions with people living in the home. The inspector also looked at records relating to medication, staff files, and service user files and conducted a tour of the premises. A completed self-assessment report /questionnaire which was completed by the home’s previous manager was received by the Commission on the 19 June 2007. The current manager has been in post since the 28 May 2007. Nine questionnaires completed by people living in the home were returned to the Commission, all indicating they were “happy” with the care and support they received. The home does not provide intermediate care. What the service does well: The home provides a specialist service to older Polish people who have lived most of their adult life in the UK. The needs of people in terms of their culture and language are positively addressed in the delivery of care by staff skilled in responding to people’s needs. The staff team consists of contracted lay staff and religious members of the Society of Christ. Care is provided in a way which reflects people’s life experiences, meets their needs and reflects their culture and religious identity. The staffing arrangements in the home ensure people are safe and adequately supported. Personal and health care needs are monitored through care planning and reviews, which are conducted internally and with the placing/funding authority. Programmes of decorating and refurbishment are ongoing to ensure a safe a homely environment is maintained. Maintenance arrangements are overseen by a religious Brother and by external contractors. Dom Polski DS0000021545.V340125.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. Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of people are assessed before a service is offered to ensure people are confident their needs can be met. EVIDENCE: The Statement of Purpose and Service User’s Guide outline the staffing and management structure of the home. The document required minor amendments relating to the role of the current manager. Both documents were available in English and Polish and are made available to prospective residents and/or their representatives. Prior to admission the funding authority or hospital social work team assesses the needs of people. Where possible the home will conduct its own preadmission assessment. When people are referred who live outside the area, Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 9 the manager liaises directly with the placing authority and relatives of the person considering moving to Dom Polski. The pre-admission assessment form recorded information received from the person being placed, their social worker and relatives and is completed in English and Polish. People are encouraged to visit the home prior to admission and in most cases relatives will visit on their behalf. The manager also meets with staff prior to an admission to discuss the needs of the person considering moving to the home and to plan for their care. This was seen as a positive exercise aimed at informing staff. Information about the home is clearly written to inform people about the home and the culturally appropriate care provided to people living there. The home did not provide intermediate care. Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal and health care needs of people are clearly recorded to ensure staff supporting people are aware of their needs. EVIDENCE: The manager was in the process of completing the review and introduction of care plans for all people living in the home. The care plans and all records relating to people are now maintained in both English and Polish translations. This enabled the inspector to look at a sample of people’s files to assess identified needs and action taken to support people living in the home. This was a positive piece of work and supported and assisted staff in developing their skills of maintaining records. Care plans contained information from the time of the person’s admission and gave a brief personal history for each person. Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 11 Information relating to health care support is recorded within the care plan. This contained information relating to outcomes of visits by general practitioners and other health professionals. One person was supported by the district nurse service in relation to a pressure area. The nurse’s records and treatment plan are kept within the care plan of the person being supported. The nurse visits the person twice a week and staff also maintain documented records of such visits. People continue to be supported by a dentist, optician and chiropodist. The chiropodist was in the home on the day of the inspection to attend to six residents and visits every three months. Records were also available to evidence that each identified need within the person’s care plan was reviewed each month to ensure the changing needs of residents were identified and met. Senior staff, in consultation with the person being reviewed, conduct the review of care plans. Daily records contained up to three entries made by staff relating to how people were supported during the day and at night. One entry on a record examined had been erased using correction fluid. Errors on records should be crossed through, but remain legible.. Medication records were examined. There are seven named members of staff with responsibility for medication procedures. Staff were using single initials when signing the MARs. This practice should be revised as single letter codes are also used to indicate if medication has not been administered such as R for “refused” or L for “leave”. Stocks of medication brought forward from the previous month need to be recorded in the quantity section of the MAR sheets to assist in monitoring and auditing procedures. Procedures were in place to record medication received by the home and returned to the pharmacist for disposal. Medication is received in blister form and each label had a descriptor for each tablet. Hand written entries on the Medication Administration Records should be countersigned to confirm accuracy. Procedures relating to the administration of painkillers required monitoring. The time of administration should be recorded, as prescribing directions clearly stated that no more than two tablets, four times per day should be given. The records for one person for the day assessed, indicated the prescribed dosage was given during the day hours and one further dosage dispensed during the night. Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 12 The pharmacist had provided the home with equipment for appropriate storage of medication and also provides the home with training in administration and recording procedures. Throughout the inspection people were observed to interact well with each other, the manager and staff were both caring and professional in the support they offered to people. The emergency call point was tested on a tour of the building, with a prompt response made by staff to the activated call point Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The lifestyle experiences of people living in the home meet their expectations, social, cultural, dietary and religious needs. EVIDENCE: A clear objective of the home is to enable people to live in a setting which meets their personal, social and cultural needs. The home aims to support older Polish people who have lived in the UK for most of their adult life. The daily living arrangements reflected people’s preferences and cultural and religious identity. People are free to plan how they spend their day, when they get up and when they wish to access their rooms. A number of people, rise early in the morning as they choose to attend daily mass held in the chapel located in the basement of the home at 08:30 hours. The staff team comprises of contracted staff and religious nuns who speak Polish and were clearly understanding and aware of people’s abilities and needs. Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 14 The needs of individuals are clearly recorded and set out in their care plan and address cultural, social and dietary preferences and individual choices. In addition residents’ meetings are held to discuss dally living and social arrangements in the home. The main topics discussed on previous meetings related to fire evacuation procedures, activities and meals. A range of choices and alternatives are provided at meal times, primarily providing a range of Polish dishes. People were complimentary about the meal and menu arrangements and the cook consults with people on meal and menu arrangements on a daily basis. Meals were nutritious and well balanced. Ample provisions were available in the kitchen and storage areas in the basement. This included dry and fresh provisions. Meals are prepared and transferred to the dining area using a heated server trolley. Meals are then served from a satellite kitchen located off the dining room. The cook keeps a record of all meals served and additional records relating to food temperatures when cooked and fridge/freezer temperatures. People responding through comments cards said they liked the meal and social arrangements in the home. People are supported to attend the local Polish parish hall and participate in Polish events held at the centre. The home has Polish satellite television and Polish newspapers are available which enable people to keep themselves informed of events in the world and their local community. There was evidence of a range of activities and interests for people to pursue and staff are encouraged to plan events and have time out to speak with people they support. Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a complaints procedure which enabled people to raise concerns about any aspect of the care they received. Policies, procedures and systems were in place to protect people from harm. EVIDENCE: The information provided to people at the time of admission informed them of the steps to take if they had any concerns about the care they received. The home’s complaints procedure is available in the homes Statement of Purpose and posted on information notice boards. A written record was kept of all complaints made and included details of the investigation and any action taken. There was evidence to show that staff had received training relating to the action to be taken in the event of an allegation of abuse, ensuring the safety and well being of the residents. The manager was advised to access copies of the Local Authority adult protection procedures from Manchester Local Authority and to access any training the Authority might provide. Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 16 In addition the home is advised to evidence that staff have had the opportunity to read the guidelines produced by the Local Authority. A record should be maintained to evidence this has taken place. Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. 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 safe, clean, well-maintained and homely environment. EVIDENCE: The home is located in a residential area close to local shops and routes into the city centre. The home had a warm and welcoming atmosphere and felt comfortable and homely. All areas of the home were clean and tidy and well maintained by staff caring out domestic and maintenance duties. The grounds are secure and pleasantly landscaped. A ramped access is available to the front of the building. All garden areas are accessible to people in wheel chairs. Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 18 Bedrooms although small, were personalised to varying degrees and reflected people’s personal interests. On touring the building it was noted that none of the bedroom doors had intumesent fire smoke seals and some doors had large gaps at the base of the door when closed into the frame. This may compromise people’s safety in relation to fire and smoke containment. Advice must be sought from Greater Manchester Fire Safety Officers on this matter. Lounge and dining areas are spacious and pleasantly furnished and decorated. The lounge is used by people throughout the day for personal relaxation time and to watch Polish Television. A new wet shower was being installed to replace a bathing facility on the ground floor. There is a designated staff toilet on the first floor. A paper towel and soap solution dispenser should be located in this facility to maintain safe infection control procedures. The plastic seat on the bath chair was cracked and presented as a risk to people; the seat required replacing. Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported by a staff team who have the skills to meet the health and specific cultural needs. Recruitment procedures protected people. EVIDENCE: The manager of the home had been in post since May 2007. There were no vacancies in the staff team and a stable staff team was in place. This is supported by a number of religious sisters who provide care and reside on site. The manager plans cover in advance and the home had an appropriate number of suitably qualified and experienced staff to meet the needs of the people at the home. Staffing arrangements were planned up to the 5 January 2008. The staff team comprises of 16 contracted staff; this includes a deputy manager and three senior carers. Appropriate ancillary support for domestic cleaning and catering arrangements were in place. This also included support by administrative staff to support the running of the home. Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 20 Records of staff were examined and contained the required information relating to the person’s recruitment and selection. This included completed application forms, reference checks and Protection of Vulnerable Adults (POVA) and Criminal Record Bureau (CRB) check. Supervision sessions are held on a three monthly basis and staff meetings every two months. Good practice indicates the home should offer supervision to care staff at least 6 times a year. Training information for staff indicated that all staff had signed up to NVQ level II or above. The manager also spoke about how the home supported staff on training programmes, as their first language was not English. Supporting staff to develop English language skills was identified as an area for ongoing development especially when it was necessary to speak to health professionals and social workers about ongoing care issues. Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management and administration procedures are well established to ensure the home is run in the best interest of people living there. EVIDENCE: From discussions with the manager, staff and people living there and from observation on the day it was evident the home was run in the best interest of people. This enabled the home to realise its objectives and Statement of Purpose. The manager is in the process of completing NVQ Level IV and holds the necessary experience and skills to support people living there and staff. The Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 22 manager has also submitted an application to the Commission for registration as registered manager. The home had well maintained, orderly records in relation to maintenance and service checks in accordance with health and safety procedures. Records of tests and checks on the fire safety procedures were also well maintained. Procedures relating to the management and administration of people’s finances were established with records and receipts maintained when a transaction was carried out on behalf of a resident. The manager was advised to develop internal quality assurance procedures to evidence people and their representative had been consulted about the care they received. This consultation process should be carried out annually and the findings incorporated into the homes Statement of Purpose. The manager was advised to ensure significant events affecting the well being of people were forwarded to the Commission in accordance with Regulation 37 requirements. A sample copy of a Regulation 37 form was forwarded to the home following the inspection. The last recorded fire drill was on the 28 November 2007 and indicated a practice evacuation took place. It is recommended staff sign the register to confirm their attendance. The deputy manager is responsible for maintaining records to evidence tests and check on all fire systems and inducts and trains staff in fire procedures. Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 24 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. 1 Standard OP20 Regulation 13 Requirement An accurate record must be kept of the time of administration of medication to ensure people do not receive more medication than is safe . Stocks of medication brought forward from the previous month need to be recorded on the MAR so that a full audit of medication in the home is possible. To make sure the views of residents are actively sought and acted upon, the home should carry out a satisfaction survey. This should include formally seeking the views of residents and other stakeholders. Advice must be sought from Greater Manchester Fire Safety Officers in relation to fire containment arrangements in the home. This related to bedroom doors with no intumescent fire smoke seals and some doors having large gaps at the base of the door when closed into the frame. This may compromise people’s safety in relation to fire and smoke containment. DS0000021545.V340125.R01.S.doc Timescale for action 30/01/08 2 OP33 24 30/01/08 3 OP19 23(4) 30/01/08 Dom Polski Version 5.2 Page 25 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 OP23 Good Practice Recommendations A copy of the Local Authority adult protection procedures from Manchester Local Authority should be held at the home. The manager is advised to access training the Authority might provide. Staff should be given time to read the guidelines produced by the Local Authority. A record should be maintained to evidence this has taken place. 2 3 4 OP26 OP24 OP24 A paper towel dispenser and soap dispenser should be located in the staff toilet on the first floor. The plastic seat on the bath chair was cracked and required replacing as it presented as a risk to people. To make sure the views of residents are actively sought and acted upon, the home should carry out a satisfaction survey. This should include formally seeking the views of residents and other stakeholders. Dom Polski DS0000021545.V340125.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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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