Care Home: Longworth House

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What the care home does well Five residents returned survey forms to the Commission for Social Care Inspection All five residents received a contract. One resident said her daughter had the contract. All five residents received enough information to make an informed choice to enter the home. One resident said she had been on respite care at the home so had plenty of information. Four residents always received the care and support needed and one usually. This person commented that she would like staff to be quicker to her assistance because she did not know if the call bell was working if they did not. All five residents thought staff listened and acted upon what they said. Four residents thought staff were always available when needed and one usually. All five residents always received the medical support they needed. One thought the chiropodist took a long time to come. All five thought there were always activities on offer. Two residents said they did not wish to attend activities. Four residents always liked the meals and one usually. Residents said, "meals are very good, no complaints and I prefer fish to meat". All five residents always knew who to speak to if unhappy. One said management. All five residents knew how to make a complaint. All five residents always thought the home was fresh and clean. The mainly positive response from people who used the service showed their satisfaction with care and staff. People who used the service were assessed prior to admission to ensure their needs could be met at this care service. Plans of care contained good details for staff to deliver effective care. One person case tracked said, "I get very good care. They treat me well and I like all of them. I tease the young ones. They are all nice". Staff were able to accurately describe the care they gave to the three residents case tracked to ensure they were meeting the needs of people who used the service. Bedrooms visited during the tour of the building had been personalised. One resident who was involved in the case tracking process said, "I have a nice room. Lots of photographs". The communal and private space was clean, warm and reasonably well decorated which provided a homely atmosphere for people who used the service.One person involved in the case tracking process said, "The gardens are lovely". Outdoor space was well presented and contained good quality furniture for people who used the service to enjoy nice weather. People who used the service said food was good. One lady case tracked said, "the food is good. Brilliant, they come around and ask you what you want. You get plenty to eat". People who used the service appreciated the food. People who used the service had access to health care specialists to ensure their care was up to date. One person who was case tracked said, "I like to knit. I am knitting a baby coat at the moment for one of the staff and have not been able to start waiting for you. I like to do word searches". There was weekly program of activities to keep residents stimulated. The registered person said visiting was unrestricted. One person who used the service said, "I have visitors and they can come any time". Visiting was encouraged for the benefit of residents. One person who used the service said, "They are private with my care. The door is locked and shut. I like the same girl to help me". Staff were observed to treat residents with privacy and dignity to ensure they were comfortable with the care they received. There was an accessible complaints procedure. Staff spoken to were aware of the complaints procedure. One person involved in the case tracking process said, "I don`t have any worries but could talk to anybody. I have not had any wrong words with any of them". People who used the service felt able to voice their concerns. Staff said they were supervised and the manager was approachable and provided a nice place to work. There were policies and procedures for the safeguarding of adults. Staff spoken to had undertaken training in the protection of vulnerable adults and this helped to protect residents from possible abuse. All people spoken to said the service was good. One person case tracked said, "They are really brilliant. Its all I can say. The staff and the place. You could not go in one much better than this. I am happy". People who used the service appeared to like it. What has improved since the last inspection? Staff had undertaken training in key subjects such as moving and handling to provide a safer service to residents. The medication for people who self medicated was stored safely to prevent errors. Staff were issued with protective clothing to help minimise the risk of cross contamination.The details in the plans of care had been improved to ensure staff knew the needs of each person who used the service. Residents and relatives were notified of changes to care to keep them up to date. The medication practices had been improved to help reduce the possibility of errors. The use of a recognised induction format ensured new staff were competent to meet the needs of people who used the service. What the care home could do better: The registered person must complete NVQ4 training or employ a manager who has the necessary experience and qualifications to meet the requirements of the Commission for Social Care Inspection. The last wishes of each person who used the service must be recorded to fully take into account their wishes at this difficult time. The quality assurance system needs to be improved by gaining the views of those who access the service and reacting to their comments. This can be demonstrated by providing a summary to stakeholders. All aspects of the plans of care are reviewed on a monthly basis to ensure any changes are passed on to staff. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Longworth House Higher Ramsgreave Road Ramsgreave Blackburn Lancashire BB1 9DJ     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: Graham Oldham     Date: 1 5 1 0 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 Older People 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 Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 Older People Page 3 of 25 Information about the care home Name of care home: Address: Longworth House Higher Ramsgreave Road Ramsgreave Blackburn Lancashire BB1 9DJ 01254812283 01254813090 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Julie Elizabeth Hayes,Mr Steven Michael Hayes Type of registration: Number of places registered: care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Longworth House is registered to provide personal care to 28 people from the age of 65 years plus. Three of these service user are also suffering from dementia. The registered persons are Mrs Julie Elizabeth Hayes and Mr Steven Michael Hayes. Mr Hayes undertakes the day-to-day management of the home. Longworth House is situated in a rural location, between Ramsgreave and Mellor, with general amenities being available in Brownhills, which is 5 minutes away by car or bus. More extensive facilities can be located in the local town of Blackburn, which is approximately 3 miles from the home. The property is detached, and stands in its own extensive, established and well-maintained grounds, with a panoramic view of the Ribble Valley from the back Care Homes for Older People Page 4 of 25 Over 65 3 28 0 0 Brief description of the care home garden. The service user guide and statement of purpose informs people who use the service of the facilities and services provided at the care home. The fees charged at the time of the inspection ranged from: £366-00 per week to £412-00 per week. Care Homes for Older People Page 5 of 25 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. This key unannounced inspection took place on the fifteenth October 2008 and included a visit to the service. Much of the information gained was obtained from talking to residents and staff members. The views of residents were obtained on a variety of topics. Three residents were case tracked. One resident case tracked was not able to supply any information and one resident chose not to. Case tracking gave the inspector an overall view of the specific care for the individual resident by checking the plans of Care Homes for Older People Page 6 of 25 care, other documentation and talking to residents and staff. Two staff members were questioned about the care of the residents case tracked. Some of the views have been reported collectively with specific comments contained within the body of the report. The inspector took detailed notes during the inspection. Staff were directly and indirectly observed carrying out their tasks and interacting with residents. Paperwork examined included plans of care, assessment documentation, policies and procedures or documents relevant to each standard. A tour of the building was conducted during the day. The care home completed a self assessment which told us what they did well and how they planned to improve their service. This document also told us how they met the equality and diversity needs of residents. What the care home does well: Five residents returned survey forms to the Commission for Social Care Inspection All five residents received a contract. One resident said her daughter had the contract. All five residents received enough information to make an informed choice to enter the home. One resident said she had been on respite care at the home so had plenty of information. Four residents always received the care and support needed and one usually. This person commented that she would like staff to be quicker to her assistance because she did not know if the call bell was working if they did not. All five residents thought staff listened and acted upon what they said. Four residents thought staff were always available when needed and one usually. All five residents always received the medical support they needed. One thought the chiropodist took a long time to come. All five thought there were always activities on offer. Two residents said they did not wish to attend activities. Four residents always liked the meals and one usually. Residents said, meals are very good, no complaints and I prefer fish to meat. All five residents always knew who to speak to if unhappy. One said management. All five residents knew how to make a complaint. All five residents always thought the home was fresh and clean. The mainly positive response from people who used the service showed their satisfaction with care and staff. People who used the service were assessed prior to admission to ensure their needs could be met at this care service. Plans of care contained good details for staff to deliver effective care. One person case tracked said, I get very good care. They treat me well and I like all of them. I tease the young ones. They are all nice. Staff were able to accurately describe the care they gave to the three residents case tracked to ensure they were meeting the needs of people who used the service. Bedrooms visited during the tour of the building had been personalised. One resident who was involved in the case tracking process said, I have a nice room. Lots of photographs. The communal and private space was clean, warm and reasonably well decorated which provided a homely atmosphere for people who used the service. Care Homes for Older People Page 8 of 25 One person involved in the case tracking process said, The gardens are lovely. Outdoor space was well presented and contained good quality furniture for people who used the service to enjoy nice weather. People who used the service said food was good. One lady case tracked said, the food is good. Brilliant, they come around and ask you what you want. You get plenty to eat. People who used the service appreciated the food. People who used the service had access to health care specialists to ensure their care was up to date. One person who was case tracked said, I like to knit. I am knitting a baby coat at the moment for one of the staff and have not been able to start waiting for you. I like to do word searches. There was weekly program of activities to keep residents stimulated. The registered person said visiting was unrestricted. One person who used the service said, I have visitors and they can come any time. Visiting was encouraged for the benefit of residents. One person who used the service said, They are private with my care. The door is locked and shut. I like the same girl to help me. Staff were observed to treat residents with privacy and dignity to ensure they were comfortable with the care they received. There was an accessible complaints procedure. Staff spoken to were aware of the complaints procedure. One person involved in the case tracking process said, I dont have any worries but could talk to anybody. I have not had any wrong words with any of them. People who used the service felt able to voice their concerns. Staff said they were supervised and the manager was approachable and provided a nice place to work. There were policies and procedures for the safeguarding of adults. Staff spoken to had undertaken training in the protection of vulnerable adults and this helped to protect residents from possible abuse. All people spoken to said the service was good. One person case tracked said, They are really brilliant. Its all I can say. The staff and the place. You could not go in one much better than this. I am happy. People who used the service appeared to like it. What has improved since the last inspection? Staff had undertaken training in key subjects such as moving and handling to provide a safer service to residents. The medication for people who self medicated was stored safely to prevent errors. Staff were issued with protective clothing to help minimise the risk of cross contamination. Care Homes for Older People Page 9 of 25 The details in the plans of care had been improved to ensure staff knew the needs of each person who used the service. Residents and relatives were notified of changes to care to keep them up to date. The medication practices had been improved to help reduce the possibility of errors. The use of a recognised induction format ensured new staff were competent to meet the needs of people who used the service. What they could do better: 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 Older People Page 10 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 25 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. The good assessment of residents ensured each persons needs were met and staff had sufficient knowledge to formulate a care plan. Evidence: Three residents were involved in the case tracking process. All three residents had been assessed prior to admission by social services, the local hospital trust and by a member of staff from the care home. Any person who wishes to enter this care home will have an assessment to ensure they are correctly placed. The care service did not provide intermediate care. Care Homes for Older People Page 12 of 25 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Plans of care were good but needed more regular review to ensure up to date information was issued to staff to deliver effective care. People who used the service were treated privately to ensure care was given in a dignified manner. Medication policies, procedures and staff training ensured the administration of medication was safe. Evidence: Three plans of care were examined during the case tracking process. Plans of care contained good details for staff to follow and deliver the care residents expected. Plans of care had not always been reviewed monthly which meant care staff were not always up to date with each residents care needs. Plans of care had been developed with the collusion of residents or their families to take account of their expectations. There were policies and procedures for the administration of medication to provide safe practice. The medication cupboard was kept in a locked room along with all the other records and were secure. The care service had recently changed to use the Boots Care Homes for Older People Page 13 of 25 Evidence: system and the person in charge said they get much better backup and training for staff. Five staff had recently attended the medication administration training and all staff who administer medication had been trained. The medication trolley was new and chained to the wall for safety. Two staff sign for hand written prescriptions and there is a staff signature list to minimise errors. There was a recognised type of controlled drugs register and an approved cupboard to store and record medication safely. There was a dedicated fridge to store some medication cool as instructed. Policies, procedures and staff training in the administration of medication helped minimise errors. Residents had been assessed and reviewed for tissue viability problems, falls and their nutritional needs. During the case tracking process plans of care showed residents had access to specialists such as dentists, opticians, podiatrists or nurses. Staff ensured the health care needs of residents was kept up to date. During the tour staff were observed treating residents privately. On one occasion the staff member closed the door to talk to a resident who requested her to keep the conversation private. No inappropriate personal care was observed. One resident case tracked confirmed care was given discreetly. The professional attitude of staff ensured residents were comfortable with the personal care they were given. During the case tracking process it was noted that two of the three residents did not have their last wishes recorded. The last wishes of a resident should be recorded to ensure they get the care they wish for at this difficult time. Care Homes for Older People Page 14 of 25 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. The suitable leisure activities offered at the care home allowed residents to lead a fulfilling life. Residents were able to make choices to help maximise their independence. The varied and good quality of food served at the care home met residents tastes. Visitors were encouraged to help residents socialise. Evidence: One resident case tracked said she attended the activities she liked but kept herself occupied with her various hobbies. There was a weekly program of activities. residents were observed pursuing interests and hobbies or walking in the garden. The leisure activities on offer were suitable for the age and diversity of residents accommodated at the home. Several people who used the service said food was good. The food served on the day of the inspection was hot, nutritious and tasty. The cook carried out environmental health checks to ensure food was served safely. The facilities for dining offered residents a comfortable and pleasant mealtime. Choice of food was offered to ensure people who used the service had a varied menu. Care Homes for Older People Page 15 of 25 Evidence: Details of each persons preferences were outlined in the plans of care. Residents were offered choices within the routines of the home to ensure life was not too restrictive. Residents were able to receive visitors when they wished to ensure they had contact with their families and friends. Care Homes for Older People Page 16 of 25 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 had the necessary information to voice their concerns. Polices, procedures and staff training helped protect residents from abuse. Evidence: A copy of the complaints procedure was available in each residents room, which contained the numbers of the Commission for Social Care Inspection and informed residents how to complain if they wished. Some staff members had undertaken safeguarding training. There was a copy of the Blackburn with Darwen Protection of Vulnerable Adults procedures for staff to follow in the event of any safeguarding issues. The care service had information, policies and procedures for the protection of adults to direct staff on how to protect residents. Care Homes for Older People Page 17 of 25 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, 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. 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 good quality of furniture and satisfactory decor provided a homely environment for people who used the care home. Disability aids and equipment ensured the care needs of people who used the service were met. Evidence: The care home was clean, warm and well maintained to provide a homely atmosphere for residents. Health and safety issues such as the control of water temperatures had been undertaken to reduce the risk of injuries. In the communal areas furniture and fittings were a good quality and were comfortable for residents. Private space had been personlised to allow each person some individual choice. There were aids and equipment to provide support for people with disabilities. The laundry was sited away from food preparation areas and contained good levels of equipment to ensure clothes were cleaned properly. Care Homes for Older People Page 18 of 25 Care Homes for Older People Page 19 of 25 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. The people who used the service benefited from a well trained staff team who were provided in sufficient numbers to meet their needs. The good recruitment of staff protected people who used the service from possible abuse. Evidence: Two staff files were examined and demonstrated the employment of staff was sufficiently robust to ensure staff were suitable to work at the care home. 85 of staff had completed NVQ 2 or better training. Two staff members were able to confirm they had or were about to undertake training in key issues such as moving and handling to ensure they were competent to carry out their tasks. Induction training ensured new staff were competent to meet the needs of people who used the service. Care Homes for Older People Page 20 of 25 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. Health and safety policies, procedures and staff training protected the health and welfare of residents and staff. People who used the service were protected from financial abuse by the sound system used. Quality assurance systems needed to be improved to demonstrate the views of people who used the service were acted upon. Evidence: The registered person managed the care home at the time of the inspection. He said he wanted to employ a manager but would undertake the required training if this proved difficult to meet the current legislation. The system used to manage service users spending money was examined and found to be safe for people who used the service. Resident and staff meetings were held on a regular basis to gain their views. Quality assurance questionnaires had been issued to residents and some other interested Care Homes for Older People Page 21 of 25 Evidence: parties but needed to be fully developed and produced as a summary. This would demonstrate management are reacting to the views of people who use the service in a positive way. There were health and safety policies for staff to follow and provide safe practice. The maintenance of electrical and gas equipment was regular to ensure it was safe. Most staff had undertaken mandatory training in health and safety issues to update their knowledge. Care Homes for Older People Page 22 of 25 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 Older People Page 23 of 25 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 1 31 10 The registered person must 23/02/2009 undertake training as is appropriate to ensure he has the skills to necessary to manage the care home. He is currently managing the service and has no qualification such as NVQ4. He wants to employ a manager and register the manager. 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 The registered person should ensure the last wishes and preferences of residents is recorded to ensure their needs are met at this difficult time. The registered person should gain the views of families and stakeholders to demonstrate a responsive service. The registered person should provide a summary of any questionnaires and provide this to interested parties. 2 3 33 33 Care Homes for Older People Page 24 of 25 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 © (2008) 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. 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