Care Home: Oval Residential Home (164A)

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What the care home does well The standards required to 50% of staff to have a NVQ2. This service has exceeded the 50% of staff required. Over 50% of staff have the NVQ2, and two of staff members also have a NVQ3. This creates a well qualified staff group. What has improved since the last inspection? Care plans are now being kept under review. This helps ensure that changing needs are identified and met. Care plans now include goals for each person who uses this service which promotes development. Information regarding health needs is now better recorded in care plans. This promotes better health care. The manager has now ensured that medication labels and MAR sheets contain the same information. This helps prevents errors in medication administration.`What has improved` continued. Secure storage has been found for any money held on behalf of people who use this service and receipts are numbered and tally with records where a significant amount has been spent. All staff have attend refresher training in the Protection of Vulnerable Adults. This helps promote staff awareness of protection issues. Training has been provided in core skills such as food hygiene. This helps protect the well-being of people who use this service. Hot water temperatures at all outlets are now recorded weekly. This will help protect against burns from overly hot water. CARE HOME ADULTS 18-65 Oval Residential Home (164A) 164a Oval Road East Croydon Surrey CR0 6BN Lead Inspector Barry Khabbazi Unannounced Inspection 11th August 2008 09:00 Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oval Residential Home (164A) Address 164a Oval Road East Croydon Surrey CR0 6BN 020 8686 9814 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) mbheecarry@hotmail.com Mrs Mercidita Bheecarry Mr Mike Bheecarry Mrs Mercidita Bheecarry Care Home 3 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (3) of places Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th August 2007 Brief Description of the Service: 164 Oval Road is a terraced house located in a residential street a few minutes walk from East Croydon Station. It is a small care home registered for three adults with mental health problems and learning disabilities. Local amenities are within walking distance from the home. Bus and tram services also serve the local area. Information about the service is available in the Statement of Purpose and Service User Guide. Fees are currently from £411 to £587 per week. Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating of the service is 2 star. This means the people who use this service generally experience Good outcomes. Although shortfalls have been identified these were not of a significant enough nature to effect the overall ‘good’ outcome rating for the service. This inspection was unannounced. As the people who use this service go out early in the day, the inspection started early to allow the people who use this service to be met and so involved in the inspection. The manager was interviewed, and records, policies, care plans, and the building were examined. The manager’s latest self-assessment {AQAA} was used to support findings in this inspection. The people who use this service told us they were happy at the home, liked their rooms and that the food was great. Staff were seen to be supportive and responsive to residents’ needs. What the service does well: What has improved since the last inspection? Care plans are now being kept under review. This helps ensure that changing needs are identified and met. Care plans now include goals for each person who uses this service which promotes development. Information regarding health needs is now better recorded in care plans. This promotes better health care. The manager has now ensured that medication labels and MAR sheets contain the same information. This helps prevents errors in medication administration. Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 6 ‘What has improved’ continued. Secure storage has been found for any money held on behalf of people who use this service and receipts are numbered and tally with records where a significant amount has been spent. All staff have attend refresher training in the Protection of Vulnerable Adults. This helps promote staff awareness of protection issues. Training has been provided in core skills such as food hygiene. This helps protect the well-being of people who use this service. Hot water temperatures at all outlets are now recorded weekly. This will help protect against burns from overly hot water. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2: People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Prospective placements have their needs assessed so can be confident they can be met. EVIDENCE: Standard 2 was assessed as met at previous inspections. The home has not had a new admission for some years. A completely new placement will need to be made before Standard 2 can be fully re-assessed. It was therefore not possible to re-assess Standard 2 at this time. All previous requirements under this section have been met and are recorded under Standard 6. Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 6, 7, and 9: People who use this service experience adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Not all of the needs of people who use this service recorded. This is needed so that staff know and can therefore meet all these needs. People who use this service are supported to make decisions about their lives to maximise their independence and choices. People who use this service are supported to take risks as a part of an independent lifestyle. EVIDENCE: The last inspection report recorded that assessment must be kept under review and that care plans must include goals for each resident. This had occurred by the time of this inspection and all related requirements are now met. Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 10 However, care plans did not contain information regarding educational, employment, cultural, and religious needs. These must also be recorded in care plans to ensure that all needs are known and met. The following new requirement is now set to address this: Educational, employment, cultural, and religious needs must also be recorded in care plans. People who use this service are consulted through one to one discussions, contact with relatives and advocates and the home’s quality assurance programme. See also Standard 39 ‘Quality Assurance’. Risk assessments were available to confirm that risks had been identified, analysed and strategies established. Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 12, 13, 14, 15, 16, and 17: People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use this service receive sufficient access to activities to maintain a stimulating life. People who use this service are participating in the local community, with the aim of maximum integration and challenging discrimination. People who use this service are supported in maintaining appropriate relationships, so that their social lives are maximised within chosen boundaries. The daily routines and house rules do generally promote the rights of people who use this service, to ensure that all rights are enjoyed by all. Dietary needs are catered for and a balanced diet is provided with informed choice taking priority. This ensures enjoyment of food. Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 12 EVIDENCE: Basic money awareness training occurs during shopping trips and budgeting skills are taught. Activities includes independent living skills, gardening, card games, snooker, bingo., board games and puzzles, keep fit sessions, barbeques 3 or 4 times a year, and the celebration of events. Most people who use this service are fairly independent and engage in their own activities. One person who uses this service said they go out all the time. Access to the local community includes the local pubs, parks, restaurants, cafes, church, and shops. Staff are available to support people who use this service while accessing the community and this occurs at least two times a week and in the evenings as well as during the daytime and at weekends. Trips out to the coast take place and holidays in the UK and abroad. Holidays are not currently funded through the home by the placing authority. Acquiring this additional funding will improve the quality and number of holidays that people who use this service can enjoy. The following recommendation is now set to address this: Each person who uses this service should be offered a seven-day holiday paid for as part of the contracted price. The daily routines and house rules do generally promote the rights of people who use this service, to ensure that all rights are enjoyed by all. There is an open visitors policy and people who use this service are supported to meet friends in and out of the home. The home’s self assessment {AQAA} reccorded the following: ‘Service users have better communication and visits from relatives. Their rights are respected and responsibilities which are recognised in their daily lives. Service users are able to contribute in planning menus and running the Home on a day to day basis. They engage in leisure activities of their choice.’ This was confermed throgh discussions with the people who use this service. One person who uses this service said the food is great here. Menus were examined and although nutritious options were available, the people who use this service generally choose not to have the most nutritious options with lots of sausages being used for example. The choice of those who use this service is paramount and as the service also provides training in healthy eating weekly, the choices made are informed choices and therefore appropriate even if it is not the healthiest of diets. Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 18, 19, 20: People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The personal care needs and physical and emotional health needs of people who use this service are met by this home. This ensures that physical and emotional health is maintained and therefore the quality of life experienced is also maximised. The medication for people who use this service is also well managed to ensure maximised good health. EVIDENCE: The last inspection report contained the following requirement : So that residents’ health needs are fully met, information in care plans must be more detailed and specific to each resident. A specific health section has since been added to care plans. This requirement is therefore now met. Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 14 At this inspection we saw that the people who use this service were treated with dignity and respect while receiving assistance. The people who use this service are registered with a local G.P. They are able to access community health facilities such as opticians, chiropodist and district nurses as required. The people who use this service are supported to attend outpatient appointments and other medical appointments as required. Medication profiles and medication administration record sheets were seen in records sampled. Medication is kept securely in a locked metal cabinet fixed to the wall in the office. Medicine admistration sheets were in order. The last inspection report contained the following requirement : To prevent maladministration, medication labels and MAR sheets must contain the same information and be updated immediately following any change in dosage. This had occurred by the time of this inspection and this requirement is therefore now met. There were no lockable spaces in one person’s bedroom to help keep any medication they were managing themselves or money securely. This has been dealt with a requirement under Standard 26. Please see that Standard for details. Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 22 and 23: People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The service manages complaints well, so that people who use this service feel their concerns are listened to. Policies and procedures relevant to this Standard currently promote protecting people who use this service from abuse. EVIDENCE: The service has a complaints procedure that meets all the elements required including a minimum response time of less than 28 days, details of the Commission. The service also has a copy of Croydon’s Vulnerable Adults Policy and training in this area has occurred. There is also a Whistle Blowing Policy and a Wills Policy. The last report contained the following requirement: So that residents are fully protected, all staff must attend refresher training in the Protection of Vulnerable Adults. This had occurred by the time of this inspection and this requirement is now met. Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 16 The last report also contained the following requirement: To protect residents’ financial interests, secure storage must be found for any money held on their behalf and receipts must be clearly numbered and tally with records. Money must not be lent to residents. Secure storage has now been established for money held on behalf of people who use this service in a metal lockable cupboard fixed to the wall. Receipts are also now numbered as required. Money is lent to residents but only where they have not brought enough money out with them on a trip and want to buy additional items. As people who use this service do have access to their money and receive budgeting training where appropriate, and this is only occurring occasionally, this and the rest of the requirement will be considered met. Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 24, and 30: People who use this service experience adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The environment and furniture generally meet the residents’ needs, and the environment promotes the residents’ well being. The home is and clean and comfortable. This environment therefore facilitates the health and emotional well-being of the people who use it. EVIDENCE: The managers self assessment {AQAA} reccorded the following: ‘Service users are always involved in planning the arrangement and decorating of their room i.e. choosing the colour of the paint, frames, etc.’ The communal areas were in the process of being re-decorated at the time of this inspection. The following recommendation is now set: The manager should continue with the current re-decoration of the home. Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 18 The lounge could have been more homely with curtains up. The manager told us that the curtains were being washed: The following recommendation is also now set: The curtains should be put back in the lounge once washed. Bedrooms did not contain a lockable space so that people who use this service can keep their money and medication securely. The following requirement is set to address this shortfall: Bedrooms must contain a lockable space so that people who use this service can keep their money and medication securely. At the time of this inspection the building was clean and tidy and rooms were generally free of offensive odours. Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 32, 34, and 35: People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The people who use this service are supported by appropriately qualified staff, which raises the quality of staff and their practices. This Standard is exceeded. The home’s recruitment procedures protect the people who use this service through vigorous staff vetting. An induction training programme is in place which meets the required standards. However, there have been no new staff to undertake the induction, which limits our ability to fully assess the effectiveness of this process. EVIDENCE: The standards required to 50 of staff to have a NVQ2. The service has exceeded the 50 of staff required. Over 50 of staff have the NVQ2, and in addition, two of these staff members also have a NVQ3. This creates a well qualified staff group. Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 20 All elements of Schedule 2 {staff files} are kept securely on site and are available for inspection. This includes CRB checks, references and records of staff disciplinary action. There have been no new staff since the last inspection where staff files were examined. At that time all the information required was present and this Standard was met. As no new staff had started, staff recruitment files were not re-examined at this inspection. An induction training programme is in place which meets the required standards. However, there have been no new staff to undertake the induction, which limits our ability to fully assess the effectiveness of this process. This area will be fully re-assessed once a new member of staff is recruited. The last inspection report contained the following requirement: So that staff have the skills they need to carry out their jobs, training must be provided in core skills. Staff have recently had training in Food hygiene, medication, adult protection, and infection control. This requirement is now met. Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 37, 39, and 42: People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The home is managed by an experienced and qualified manager who ensures a quality service. There is a quality assurance system, which involves the people who use this service and provides a way for them to measure improvements in quality for themselves. The home generally promotes the health and safety of the people who use this service, so that practices and the environment do not place their health and safety at risk. Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 22 EVIDENCE: The home has a registered manager who is a qualified nurse and has many years experience in this field. As well as a nursing qualification the manager also has the Registered Managers Award. The managers self assessment {AQAA} reccorded the following under the area ‘what do you think you do well’: ‘Good staff turnover. No relapse and admission of service users in hospital. Good quality care. Good relationship between staff, management and clients.’ The service has a quality assurance system and an annual development plan, with both involving people who use the service. The results of the user/relatives satisfaction surveys are incorporated into the annual development plan that is open to the people who use this service, to fully involve them and allow them to measure achievement in improving quality for themselves. We saw that all of the health and safety policies and procedures relevant to this Standard were present. Moving and Handling, Fire Safety, First Aid, Food Hygiene, Infection Control, and Handling and Disposal of Clinical Waste policies are all also included in staff induction. Control Of Substances Hazardous to Health policies and data sheets are also present and all these items are locked in the storage cupboard. We saw that all of the procedures and testing of systems required were also present. These included for example, fire fighting equipment testing, Portable Appliance Testing, and gas testing. The last inspection report contained the following requirement: To make sure the environment is safe for residents, hot water temperatures at all outlets must be recorded weekly. This is now occurring and the requirement is now met. At this inspection one smoke detector was bleeping with an error or low battery warning. The following new requirement is now set to address this: All smoke detectors must be working properly and not bleeping with error or low battery warnings. Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 4 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 2 x Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 24 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 12 (4) (b) Requirement Educational, employment, cultural, and religious needs must also be recorded in care plans. Bedrooms must contain a lockable space so that people who use this service can keep their money and medication securely. All smoke detectors must be working properly and not bleeping with error or low battery warnings. Timescale for action 01/10/08 2. YA26 12(1)a, 16(2)c 01/10/08 3. YA42 12 01/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA24 YA24 YA14 Good Practice Recommendations The manager should continue with the current redecoration of the home. This will improve the environment. To make the lounge more homely the curtains should be put back in the lounge once washed. Each person who uses this service should be offered a DS0000025825.V368594.R01.S.doc Version 5.2 Page 25 Oval Residential Home (164A) seven-day holiday paid for as part of the contracted price. Oval Residential Home (164A) DS0000025825.V368594.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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