Care Home: Knowsley Road, 246

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What the care home does well There is good information about the home which is given out to people who are thinking about moving in and procedures are followed for assessing and admitting them so they can be sure it is the right place for them to live. Each of the residents had good care plans which they helped put together. Care plans which are regularly reviewed and updated provide staff with all the information they need so that they can support residents in the right way. Residents health and personal care needs are well recorded, supported and monitored to ensure they stay well. There are lots of opportunities for residents to take part in the things they like to do both at home and in the local community.Procedures followed at the home make sure that residents are protected from abuse or neglect. The home is clean and tidy and free from hazards making it a pleasant and safe place for residents to live. The home is well run in the best interests of the residents and staff. What has improved since the last inspection? There was information available to show that there is always enough staff on duty to support the residents to do the things they like to do both at home and in the local community. Since the last inspection some polices and procedures have been re written using pictures and symbols so that people with difficulties ready can understand them better. Polices are rules that people have to follow, procedures tell a person how to follow the rules. What the care home could do better: Signs which were on display in the kitchen with cleaning instructions for staff should be taken down so that the room has the same homely feel which is felt in all other parts of the home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Knowsley Road, 246 246 Knowsley Road Bootle Liverpool Merseyside L20 5DQ three star excellent service The quality rating for this care home is: 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: Janet Marshall Date: 2 7 1 1 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. They reflect the things that people have said are important to them: 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. 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Knowsley Road, 246 246 Knowsley Road Bootle Liverpool Merseyside L20 5DQ 01519226607 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): a.mockler@sky.com Expect Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: Service users to include up to 3 LD. Date of last inspection A bit about the care home 246 Knowsley Road is registered as a care home for three people with a learning disability. The property is owned by Pierhead Housing and operated by Expect Limited. Expect Limited provides and manages a number of similar care homes within the Sefton area. The home is located in a residential area of Bootle and is in keeping with other properties in the area. It is indistinguishable as a residential care home and lends itself to the principles of ordinary community living. There is a small backyard at the rear of the building that leads to a communal alleyway. The home has limited parking, as it is located on a busy main road and does not have separate parking facilities. Local facilities include easy access to rail and bus services. There are a number of local shops within walking distance of the home. The homes current fees are £318.00 per week. 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: three star excellent 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 How we did our inspection: This is what the inspector did when they were at the care home The Quality rating for this service is 3 star. This means the people living at the home experience excellent outcomes. This was a key inspection. We consider 22 out of the 43 National Minimum Standards for this type of service, Care homes for Adults (18-65) as the key standards which have to be inspected during a key inspection. The key standards are highlighted in bold in the different outcome sections of this report. A key inspection is a planned inspection and the report is put together using information gathered in a number of different ways to help us decide how good the service is. We keep all information we receive about the home in a file, we looked at all the information we have received since the last inspection. We sent out a form to the home called an Annual Quality Assurance Assessment (AQAA). The AQAA has to be filled in and returned to us by a set date usually before the site visit takes place. The AQAA was filled in and returned to us on time and provided us with all the information we asked for about the home. We carried out an unannounced visit to the home, this is when we visit the home with out any body knowing. The manager was not on duty at the time of the site visit but the staff that were on duty helped with the inspection. Discussions took place with the staff and all three residents that live at the home. Also during the site visit a selection of records and certificates which have to be kept in the home by law were looked at and checked to make sure they were up to date and accurate. Some service users were case tracked. This is a process we use to find out whether residents are receiving good quality care that meets their individual needs. It is done by talking to people, looking at results of surveys and reading the records of a sample of people that live at the home to give us a good idea of what it is like for them. Before the site visit took place we sent out surveys to people asking them about what it is like to live and work there, but none were returned at the time of writing the report. What the care home does well There is good information about the home which is given out to people who are thinking about moving in and procedures are followed for assessing and admitting them so they can be sure it is the right place for them to live. Each of the residents had good care plans which they helped put together. Care plans which are regularly reviewed and updated provide staff with all the information they need so that they can support residents in the right way. Residents health and personal care needs are well recorded, supported and monitored to ensure they stay well. There are lots of opportunities for residents to take part in the things they like to do both at home and in the local community. Procedures followed at the home make sure that residents are protected from abuse or neglect. The home is clean and tidy and free from hazards making it a pleasant and safe place for residents to live. The home is well run in the best interests of the residents and staff. What has got better from the last inspection What the care home could do better Signs which were on display in the kitchen with cleaning instructions for staff should be taken down so that the room has the same homely feel which is felt in all other parts of the home. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Janet Marshall 33 Greycoat Street London SW1P 2QF 02079792000 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 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 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 . People who are thinking about using the service are given information about the home and their needs are assessed to make sure it is the right place for them to live. Evidence: The AQQA told us that there is an information pack available at the home which is given out to people who are thinking about moving there. The AQAA also told us that some parts of the pack have recently been changed making it easier for people to understand. It was on a shelf in the hallway for people to read it if they wish and it was looked at during the site visit. It contained a Statement of Purpose and a Service User Guide which included information about the home, the staff that work there and the services and facilities people can expect to receive. All documents were in an easy read format with pictures and symbols . The AQAA told us that one resident has been admitted to the home since the last inspection. It also told us that the homes procedures for assessing and admitting the new resident were followed to ensure their needs could be met there. Admission records and assessment documentation which were looked at during the site visit showed that the homes procedures were followed with the involvement of the new resident and their family. Discussion took place with the new resident about their experience of moving into the home and they made the following comments, Yes I was given information about the home and asked if I wanted to live here. My sister came to look around too. 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 . Residents have an up to date care plan providing staff with information about how they want and need to be supported in a way that ensures their independence and safety. Evidence: The AQAA told us that each of the residents have a care plan which tells staff about how best to support their needs. As part of the case tracking process care plans for two residents were looked at in detail, this included looking at the new residents care plan. The care plans were well organised and easy to read. Case tracking showed that Information taken from assessments had been used to put together care plans. The company have introduced a more person centred care planning format. This is a type of care plan which is put together with the full involvement of the resident and other people in their lives who are important to them. A person centred care plan makes sure that people are supported in a way that gives them more choice and control over their own lives. During the site visit staff said they have received training to help them understand and complete the new care plans. Records which were looked at showed that care plans are regularly reviewed and updated with the involvement of residents and their representatives. Staff spoken with showed good knowledge and understanding of care plans. Comments made by Staff included: We use them everyday to help us support the people we look after They tell us the best way to help a person and what they like and dont like A resident said, yes I know about my care plan and I know what is in it. Care plans included information about residents preferred ways of communicating and how staff need to respond to them. Some of the residents that live at the home are unable to talk to the staff about what they want or how they are feeling. But they can Evidence: do this in other ways such as by using sounds, gestures, expressions and sign language. During the site visit residents were seen communicating with staff in these ways. They chose what they wanted to eat for lunch and decided where they wanted to go that day. The staff clearly understood what the residents were communicating and they responded positively to them. The AQAA told us that risk assessments are part of each persons care plan and they are reviewed regularly. Some risk assessments were looked at during the site visit. They provided staff with information about the safest way to support a person so that they can take part in a task or activity which is likely to pose a risk to them. 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 . Residents are active and eat well as part of a healthy lifestyle. Evidence: The AQAA told us that residents are supported and encouraged to keep in touch with their family and friends. It also told us that two of the residents go out alot to places such as local cafes, shops and pubs and they use buses and trains to get around. Care plans which were looked at during the site visit included information about the things that residents like to do and the places they like to go. A weekly activity timetable has been put together for each resident using the information from their care plans. Timetables for some residents which were looked at included a good variety of things for them to do on different days of the week. A member of staff said, If a resident doesnt feel like doing something that is on their timetable they can choose to do something else. Daily records which were looked at as part of the case tracking process showed that residents are supported and encouraged by staff to do the things that they like to do which we were told about in the AQAA. The AQAA told us that residents are treated well. During the site visit staff were seen treating residents well and they were patient and sensitive towards their needs. They spoke to them in a polite and gentle way. A member of staff was seen assisting a resident with personal care in a dignified and respectful way. They knocked on doors and made sure they were closed whilst helping the resident in their bedroom and in the bathroom. Evidence: The AQAA told us that residents are given choices about what they eat and when they eat although for health reasons residents are encouraged to eat at set times. Care plans included information about special dietary needs and records of these were available. The kitchen was clean, tidy and nicely decorated. Food stocks were checked and there was plenty nutritious food in the cupboards, fridge and freezer. Menus which were looked at included good variety of well balanced and healthy meals. A member of staff said they encourage and support residents to help with the main weekly shop as well as daily trips to the local shops for essentials such as fresh bread and milk. On the day of the site visit one resident went shopping with a member of staff to the local supermarket. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents personal and healthcare needs are very well supported and understood making sure they stay well. Evidence: Residents care plans included detailed information about their personal and health care needs and how staff need to support them. The AQAA told us that personal support is carried out in a dignified way and in private. It also told us that personal care is carried out in a way that the person prefers. During the site visit staff were seen helping residents with personal support. It was done in private and they did not rush residents. Records looked at showed residents attend regular healthcare appointments and their health is well monitored to make sure they stay well. When required residents have visited their doctors, dentists, chiropodists and attended hospital appointments. Residents with specialist health care needs receive the right support by staff who have received training and regular advice about how to manage their conditions. Staff spoken with were knowledgeable about residents individual personal and healthcare needs and they were confident about dealing with them. Staff were able to describe what they would do if a resident suddenly became ill. The AQAA told us available at the home are up to date policies and procedures about medication. Medication which was checked during the site visit was stored and recorded in the correct way. Staff spoken with during the site visit said they have taken part in training about medication. Residents care plans included information about their medication such as why they are given and the possible side effects. 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 . Policies and procedures followed at the home ensure that residents are protected from abuse, harm or neglect. Evidence: Since the last inspection no body has made a complaint to us about the home and the AQAA told us that no body has made a complaint at the home. The AQAA told us there are policies and procedures at the home to help people make a complaint if they need to, these were looked at during the site visit. As well as a complaints procedure there was also easy to follow guidelines for people to follow. All the documents, which were on display at the home were in an easy read format with pictures and symbols and step by step instructions. A resident spoken with during the site visit said they have information about how to complain and would definitely make a complaint if they needed to. Staff spoken with also knew about the homes complaints procedures they explained correctly what to do if they had a complaint or if a resident made a complaint to them. The AQAA told us that there are Adult Protection procedures at the home including a copy of Sefton Local Authorities procedures. Staff spoken with knew about these and said they have read them. Staff also said they have attended Protection of Vulnerable Adult (POVA) training and were confident about what they would do when asked about reporting incidents of abuse. Available at the home were strict procedures and processes which staff have to follow when dealing with residents money. Money and records which were checked were in good order. Residents had bank accounts in their own name and there were processes in place to enable them to safely access their own money when they want. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is well maintained, comfortable and safe for the residents that live there. Evidence: The home is located on a main road in Bootle, Liverpool. It is a popular residential area close to local shops, pubs, cafes and medical centres. The are plenty of bus stops and a train station close by with direct routes into Liverpool City Centre, Southport and other more local shopping centres. On the day of the inspection visit all parts of the home were well maintained and very clean and tidy. The decoration, fittings and furniture were of a high standard. The home was comfortable and had a really nice homely feel to it. Residents were seen using all parts of the home including their bedrooms, the lounge and kitchen. They were not stopped from using any parts of the home but for safety reasons, some residents need staff to support them while they are using certain parts of the house such as the kitchen and bathroom. The reasons for this and the support they need was recorded in the residents care plan. Some improvements have been made to the environment since the last inspection visit making the home even more comfortable for the residents that live there. We were told in the AQAA about the things which have been done since the last inspection, which included: An extra sitting room has been downstairs for residents to use. a room downstairs which was previously a bedroom is now a sitting room. the room has been decorated and furnished with new. there was a TV in the room. The lounge has been fitted with an new carpet. New TV. New Vertical blinds fitted throughout the house. The back yard has been flagged and painted and a new storage shed provided. Kitchen cleaning rota have been implemented. There were a number of signs stuck to cupboards and walls in the kitchen with cleaning instructions and rules for staff to follow this took away some of the homely feel felt through the house. It was advised that they be removed and the information passed on to staff in other ways for example transferring the information into a communication book for staff to read. The AQAA told us that there are a number of up to date policies and procedures available at the home which ensure the health safety and welfare of the residents and staff. The AQAA Evidence: also gave us the dates of when equipment and safety checks were last carried out. this showed that all the required checks have been carried out at the right time . Some H&S checks were looked at such as Fire safety tests, alarms emergency lighting, fire drills these were up to date. There were no health and safety hazards noticed at the time of the inspection visit. 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 . Strict procedures are followed to make sure that the right staff are employed at the home and they receive training which is relevant to the work they do. Evidence: There were two care staff on duty at the time of the site visit, discussions took place with them both. They were knowledgeable about the needs of the residents and showed a real commitment to ensuring the best possible care for them. Both staff said they had received a copy of their job descriptions and clearly understood their roles and responsibilities. During the inspection staff were seen being sensitive and responsive towards residents needs, they listened and communicated well with them and showed a lot of patience when helping them. On the day of the site visit there appeared to be enough staff on duty to meet the needs of the residents. Staffing rotas which were looked at showed that there are at least two staff on duty during the day and one staff at night. Staff spoken with said extra staff are brought in if they are needed and they think there is always enough staff on duty to meet the needs of the residents. Staff confirmed they receive a good level of training which is regular and relevant to their work. Staff files were not looked during this site visit. This was because they were locked away and the manager who was not on duty at the time is the only person who has a key to the cabinet were staff files are kept. However the AQAA told us that strict procedures are followed for employing new staff and that their personnel files are kept at the home and contain information to show that they are suitable for the job. Information provided in the AQAA and some training records which were looked at showed that they staff have completed or are planning to complete training which they need to have to work at the home. Staff spoken with said: Evidence: We go on a lot of training courses. The training is good and helps us alot. We are always being asked to go on training courses. 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 well managed to the benefit of the residents and staff. Evidence: There has been a change of manager since the last inspection. The company wrote to us to tell us about the change of manager and provided us with their details. Records showed that the new manager has sent an application to us to become the registered manager of the home. The AQAA told us that the new manager has the qualities and experience that they need to have to manage the home. The manager was not on duty at the time of the inspection visit and the staff that were on duty helped with the inspection. Staff spoken with were complimentary of the manager they said, she is fair, approachable and hard working. One member of staff said, I think she is doing a good job of managing the home. The AQAA told us that there are a number of processes in place at the home for checking the quality of the service. They include daily handover checks, monthly checks on the home carried out by another manager from the company who does not work there and results of questionnaires which are sent out at least twice a year to residents and their representatives. There was evidence that there are good quality monitoring processes in place at the home which ensure it is run in the best interests of the residents. The AQAA told us that there are up to date policies and procedures available at the home which ensure the health, safety and welfare of the residents. It also told us that the required checks are carried out when they should be on equipment and systems used at the home making sure they are safe. Evidence: The AQAA told us that staff receive health and safety training in subjects such as fire awareness, moving and handling, first aid and food hygiene, the staff also told us this during the site visit. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description 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 24 It is strongly recommended that signs with instructions for staff be removed from kitchen cupboards and given to staff in other ways, so that the kitchen has the same homely feel as the rest of the house. 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). 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