Care Home: Hillcote

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What the care home does well Everyone living at Hillcote have the privacy of their own bedroom. Staff showed good knowledge and understanding of the needs of the people who live at Hillcote. During our visit they were observed talking to people in a polite manner and treating people with respect at all times. The service continues to employ longstanding members of staff who offer great stability to the home. Members of the staff team appeared to know people well and have formed good relationships. Some comments included, "all staff have been here a long while and know the residents well especially regarding their needs and choices....." The service has produced good information about the home which they give to people who are thinking about moving in. They have procedures in place for assessing their needs including trial visits to help people make a choice about the home. What has improved since the last inspection? The service had procedures for responding to concerns and complaints. Each person has support and access to the procedures so make their views known. There has been no cause for any visits to the service since its last routine inspection. People who live at Hillcote are able to enjoy a varied lifestyle and are supported in annual holidays with 2 people still on holiday at centre parks with staff during our visit. We had received 5 staff comment cards which were all very positive about their employment at the service some staff made comments as to what they thought the service did well, "supports the service users to do the best of .... ability, service users are always priority." "cater for all the needs of the service user at all times." What the care home could do better: Full feedback was given to the staff both during and following this site visit. To update the commission and everyone at the home regarding the management arrangements and plans to recruit a new manager so that the service has the stability of a registered manager. Staff must be provided with up to date training to make sure they are updated in their practice and able to safely and appropriately support the residents. Activities should be developed and planned with people at the service so that their needs and requests can be met and they can be given enough information to show how activities will be provided and supported. Especially when the homes minibus is being used for holidays. A maintenance and decorating plan must be developed to show what investment andwork will be carried out to make sure all areas of the environment are comfortable and of a good living standard including one bedroom which staff highlight as an area needing regular maintenance work. To produce a development plan for Hillcote and consult and include the staff and people at the service regarding the future and development of their home. For staff to have access to evidence of updated records to show the ongoing safe management of maintenance within the home. To have updated financial records in place IE "licenses", to show clear and accurate records as to how each persons monies are managed and safeguarded Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hillcote 66 Bidston Village Road Birkenhead Wirral CH43 7QT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Diane Sharrock     Date: 1 2 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Hillcote 66 Bidston Village Road Birkenhead Wirral CH43 7QT 01516700306 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Alternative Futures Limited Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Only adults with a learning disability may be accommodated. Date of last inspection Brief description of the care home Hillcote is registered to provide personal care for up to five adults who have learning disabilities. Alternative Futures Limited, a registered charity, operates the home. Alternative Housing Association owns the premises. Each resident has a single bedroom. There is easy access to toilets and bathrooms. A large dining room and lounge are available and a domestic style kitchen. The home provides a secure garden that residents are free to access as they wish. The home is located in a residential area, close to shops and supermarkets and can be accessed by public transport. The home provides a minibus, which gives residents the opportunity to go out individually or together. At the time of the inspection, the weekly cost for the service is 1130.00. pounds.Items not covered by this fee includes chiropody, television licence (if television in own bedroom), haircuts, presents, toiletries and confectionary and some activities. A service user guide and a statement of purpose, which describe the services Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 5 Brief description of the care home offered at Hillcote, are available for potential residents and their relatives and social workers to refer to. The home currently does not have a registered manager and is being managed by staff from another home within the organsiation. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that people that use the service receive a good outcome. This unannounced visit took place on the 12 Th December 2008 over a period of 5 hours. This was carried out with the help of the staff on duty and the deputy form another home within the organsiation. We ( the commission), gathered information for this inspection in a number of ways. Records that we looked at, staff comments and observations made during our visit have also been used as evidence for this report. Care Homes for Adults (18-65 years) Page 6 of 28 Case tracking was used as part of the visit to the service. This involves looking at the support and care a person gets from the staff including their care plans, medication, money and their living conditions, we also spent time meeting both staff and peole who live at the service. Inspections involve measuring a number of standards considered as important by the commission. A selection of comment cards were also sent before the inspection and we left some more to offer people further opportunity to give their opinions. We have received 5 staff comment cards and staff explained that the comment cards were not suitable for the people who live at the service to complete. The previous manager completed a questionnaire we sent before our visit. The information from this was used by us to plan this visit and in writing this report. The document was completed and well documented and was returned to the commission before this visit took place. What the care home does well: What has improved since the last inspection? What they could do better: Full feedback was given to the staff both during and following this site visit. To update the commission and everyone at the home regarding the management arrangements and plans to recruit a new manager so that the service has the stability of a registered manager. Staff must be provided with up to date training to make sure they are updated in their practice and able to safely and appropriately support the residents. Activities should be developed and planned with people at the service so that their needs and requests can be met and they can be given enough information to show how activities will be provided and supported. Especially when the homes minibus is being used for holidays. A maintenance and decorating plan must be developed to show what investment and Care Homes for Adults (18-65 years) Page 8 of 28 work will be carried out to make sure all areas of the environment are comfortable and of a good living standard including one bedroom which staff highlight as an area needing regular maintenance work. To produce a development plan for Hillcote and consult and include the staff and people at the service regarding the future and development of their home. For staff to have access to evidence of updated records to show the ongoing safe management of maintenance within the home. To have updated financial records in place IE licenses, to show clear and accurate records as to how each persons monies are managed and safeguarded If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information is given to anyone thinking about living at Hillcote. This makes sure that the service is the right place for the person to stay and that their needs can be met. Evidence: The previous manager has developed a service user guide and a statement of purpose which are available to anyone including any prospective person wanting to live at Hillcote. The guide includes good levels of information on the purpose of the service and the facilities on offer and includes visual pictures which may help some people understand the information given. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and support plans are detailed enough to show people how their needs will be met or supported while living at Hillcote. Evidence: Individual care plans were available for each of the people at the service, we looked at two of them. The care plans have been reviewed and developed following the previous inspection visit and show regular reviews are carried out by staff. The personal support plans gave enough information to show how each persons personal care and support would be met. Some care plans have enough information to show how they would be supported with their diverse needs including behaviour or communication, and gave detailed information about what each person likes and doesnt like. In discussions with staff they were able to explain the way in which people staying at Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: Hillcote make decisions and how they are able to decide for themselves, for example staff support people what they choose to do while at the service. Staff responded well to non verbal requests from people at Hillcote and showed that they were able to meet both the persons needs and choices especially when they wanted their meals and drinks. Staff were observed to be respectful and seemed to have a good rapport with each of the people at the service. The opportunity for Residents to make decisions and their needs known, relies to some extent on the Staff team understanding and responding to their non-verbal communcications. This was observed during our visit and staff had a good rapport with people living at the service. The care plans also reflected the staffs understanding and knowledge and rapport with people at Hillcote. Following the previous inspection visit staff have made developments and reviews regarding the future of one person so that there needs will eventually be met in an environment with people that are more compatible to each other. Staff explained that they used to have group meetings called circle meetings which had lapsed due to the service not having a manager at present. However staff felt they were beneficial to help communication within the service and hoped to start them again on a regular basis. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The individual needs and choices of the people living at Hillcote are identified so that staff can support them to meet those needs. Evidence: Relatives, next of kin and staff have regular meetings to discuss the running of the service. We looked at previous records which showed good discussions on everything at the home keeping everyone informed and included in the developments of their home. During our visit we met three people who live at the home as the other two people were still on their holiday with staff. Staff explained that they had organized various holidays for everyone at Hillcote and supported each of them with their trips out locally. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: They also explained that the company have a holiday budget of approximately 800 pounds for each person to use each year, although this is currently not advertised in the statement of purpose. The service has its own minibus which was in use with the people who had gone on holiday. This left the service without its own transport and staff described various problems in being unable to always access public transport due to the needs of the residents. This issue needs to be reviewed so that people are not restricted in accessing the community and always have the opportunity to go out whenever they want regardless of the minibus being in use. Daily diaries give details on what each person has done each day and in the past staff had completed activity programme to help planning support each week for each activity. Staff acknowledged they had not completed them recently but there were plans to reinstate them again. A sample of bedrooms showed that each person is supported to decorating their room with personalized belongings that refected their choices, hobbies and personalities. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People coming to live at Hillcote are supported with their health care. Evidence: The individual needs and choices of the people staying at Hillcote are identified so that staff can support them to meet those needs. Individual care plans were available for each of the people at Hillcote. We looked at two of them. The plans had been recently updated and revised and gave enough information to show how their personal care and support would be met. The plans provided staff with guidance and were appropriate instructions as to the support people required and in some cases how they chose to be supported. The health records showed good support in visiting the doctors when assistance and advice was needed. We met two of the people who lived at Hillcote and generally chatted to the staff during our visit. Most comments made were quite positive. Some comments included, all staff have been here a long while and know the residents well especially regarding their needs and choices..... In discussions with Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: staff they were able to explain the way in which people staying at hillcote make decisions and how they are able to decide for themselves, for example staff support people what they choose to do while at the service especailly in when they want to get up and go to bed and when they want to go out. Clear records are kept of medication given to people living there. We looked at a sample of the medications held and records relating to it and found them to be well maintained. The clear systems in place for dealing with medications along with staff training help to provide a safely managed systemthat helps reduce the risk of mistakes occuring that could impact on peoples health. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well protected by the homes procedure for responding to concerns and complaints. Evidence: Information about how to raise a concern or complaint is made available to the people living at Hillcote. This is good practice as it helps to increase the opportunities for people using the service now and in the future to have a better understanding of the ways in which they can raise concerns. There have been no complaints to the service or to the commission since the last visit. There have been some incidents prior to our visit wereby the staff have made referrals to the local authority safeguarding team. The staff actions showed that they had appropriately used the local safeguarding procedures well to show how they safely supported people at the service. Some of the staff we chatted to described various training that they had attended including, complaints and safeguarding and abuse awareness. However in looking at training records it was noted that some staff had not received this training or update to these subjects for quite a few years. We looked at the management of financial records for 2 residents and these were found to be accurately managed and detailed in records. The staff explained they are in the process of updating the management of residents finances and have licenses Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: which they are updating. These records once complete will give clear and transparent information on all aspects of the residents finances including their fees, benefits and appointeeship and a clear description of how their money will be managed and protected. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Hillcote provides a safe and adequate environment for people to live in. Evidence: All bedrooms are single and there are various sizes some larger than others. Some bedrooms are very personalised and reflect each persons character and personality with lots of personalised items. One bedroom was very bare and reflected the persons needs. This area would benefit from a regular input of maintenance and refurbishment due to the persons assessed needs. Staff had tried to improvise by carrying out some decoration to help maintain the persons dignity and privacy. Generally the home is decorated to an adequate standard. A sample of maintenance certificates were seen which showed up to date checks as listed in the homes pre inspection questionnaire which helped show what actions were taken to keep the home safe and well maintained. However some were out of date and staff agreed to try and review and check that all safety checks are carried out. Care Homes for Adults (18-65 years) Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported and protected by the services recruitment and selection procedures. Evidence: Records showed that before anyone is appointed to work at Hillcote a series of checks are carried out. These include obtaining written references and checking with the criminal records bureau (CRB). These checks help to make sure the people living there are safe and that staff are suitable to support them. Observation of staff and discussions with them indicate that the staff know the needs of the residents well and know their likes and dislikes. It was evident they had a good understanding of how to support people and how to make sure their needs are met and their individuality respected and catered for. We had received 5 staff comment cards which were all very positive about their employment at the service some staff made comments as to what they thought the service did well, supports the service users to do the best of .... ability, service users are always priority. cater for all the needs of the service user at all times. We spoke with staff and looked at staff training records which showed what training had been provided. Some staff were up to date. However some staff had not received Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: mandatory training and updates. Staff need updated training to help keep them up to date in their practices and help to appropriately support residents. Staff explained they mainly have long standing members of staff and rarely have new staff which showed the stability of the current staff team especially as they are without a permanent manager. Care Homes for Adults (18-65 years) Page 22 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is adequately managed and the health and safety of people at Hillcote is promoted and protected. Evidence: The home is visited on a regular basis by a representative of the organisation. These visits form part of the quality assurance process and form an opinion on the standard of care and support provided. These visits are also a requirement of the care home regulations and a report has to be produced to show evidence of these checks. We looked at a sample of these checks which showed detailed areas looked at by senior staff which helped give additional management of the standards achieved at the service. Records and certificates showed that regular checks are carried out on the building and equipment. This includes checking electrical appliances and the gas supply. These checks help to make sure that the environment is well managed and is a safe place to live and work in. However staff could not find all of the updated certificates for the Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: electrical installation and emergency lighting as they are often stored at the estates department. The service is currently without a registered manager as the previous manager has recently left. However staff explained that they had been well supported by the company and a deputy and manager from another home were providing 3 days a week of management support. They explained that steps were being taken to recruit a suitable manager and in the mean time they were trying to update and implement a number of areas to help the ongoing management of the home including the review of training, circle meetings, maintenance of the building and certificates and updating licenses and finances. Staff felt that the stability of the long standing team members had helped keep the service operating as normal and looked forward to the stability of a new manager. Care Homes for Adults (18-65 years) Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 11 To record and plan support for each social activity so its clear what resources are needed to assist people in choosing their ongoing social activities. To continue with regular meetings to help identify each persons choices and inclusion in developing activities and events at their home. To make sure that all staff have regular updated training in safeguarding adults so they are fully aware and equipped to safe guard people at all times. To have updated financial records in place ie licences, to show clear and accurate records as to how each persons monies are managed and safeguarded. To develop a planned programme of maintenace and decoration and show what steps are taking in including both people who live there and staff in the development of their home. To have a regular planned maintenance programme for one bedroom identified as needing regular investment and input in providing an adequate standard of decor. The windows should have frosted glass to help promote privacy and the bedroom needs regular redecoration with new carpet to help provide an improved standard of living space. To have a planned programme of maintenance and for staff Page 26 of 28 2 23 3 23 4 25 5 29 Care Homes for Adults (18-65 years) to have access to evidence of updated records to show the ongoing safe management of maintenace within the home. 6 35 To have updated individual training and development plans for each member of staff so they can be supported with updated training to help them with their job roles. To update the commission and everyone at the home regarding the management arrangements and plans to recruit a new manager so that the service has the stability of a registered manager. 7 37 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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