Care Home: Pennyghael Residential Home

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What the care home does well Pennyghael is a homely and domestic environment for older people. Anyone moving in to the home has to tell someone of the help they need so that the staff will know what to do when they are admitted. Someone living in the home said `they took me all the way round to make sure it was suitable. I receive the care and support I need and staff listen to what I have to say` People living in the home said that the manager is approachable and they had confidence that she would deal with any concerns they may have properly. Staff also said that the manager was approachable and supportive with their role. Feedback received from relatives said `Care home is excellent in meeting my relative`s needs. I am kept up to date with important issues. The staff have the right skills to do the job` and `they always have entertainment that makes the residents very happy. In my view there is nothing that can change it is spotless and very clean.`During the inspection the staff interactions with the people in the home was seen to be relaxed, friendly and respectful. The manager is in the home on a daily basis so knows the people who live in the home and their relatives and friends. What has improved since the last inspection? Since the last inspection all the care staff have completed a Distance learning course `Dementia Awareness` What the care home could do better: CARE HOMES FOR OLDER PEOPLE Pennyghael Residential Home Westbourne Grove Selby North Yorkshire YO8 9DG Lead Inspector Pauline O`Rourke Unannounced Inspection 3rd October 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pennyghael Residential Home Address Westbourne Grove Selby North Yorkshire YO8 9DG 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) 01757 210204 Mr Steven William Saltmer Mrs Penelope Alison Saltmer Miss Anita Yvonne Butterfield Care Home 16 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (16) of places Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th October 2006. Brief Description of the Service: Pennyghael is registered to provide residential, social and personal care to 16 people over the age of 65 with dementia. Mr Steven and Mrs Penelope Saltmer own the home; the Registered Manager is Miss Anita Butterfield. The home is situated very close to Selby town centre with good access to the town’s services and amenities. The accommodation is provided on two floors that are serviced by a stair lift. There is a conservatory that overlooks extensive gardens, which provide a safe area for the residents to walk about. A copy of the service users guide to the home is given to potential service users and their relatives. A copy of the latest Commission for Social Care Inspection Report is also available for prospective service users and their relatives to read. The weekly fee on the 27th September 2007 was £380 per week. Additional charges are made for chiropody and hairdressing. Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection has used information from different sources to provide evidence for this report. These sources include: • • • • Reviewing information that has been received about the home since the last inspection. Information provided by the registered person on an Annual Quality Assurance assessment form. Comment cards returned from one person living in Pennyghael, three health care professionals, one care manager and two relatives. A visit to the home carried out by one inspector that lasted five and a half hours. During the visit to the home five residents, and two staff were spoken with. Care records relating to four people, three staff members and the management activities of the home were inspected. Care practices were observed, where appropriate, and time was also spent watching the general activity within the home. This enabled the inspector to gain an insight of what life is like at Pennyghael for the people living there. The manager was available to assist throughout the visit for feedback at the close. What the service does well: Pennyghael is a homely and domestic environment for older people. Anyone moving in to the home has to tell someone of the help they need so that the staff will know what to do when they are admitted. Someone living in the home said ‘they took me all the way round to make sure it was suitable. I receive the care and support I need and staff listen to what I have to say’ People living in the home said that the manager is approachable and they had confidence that she would deal with any concerns they may have properly. Staff also said that the manager was approachable and supportive with their role. Feedback received from relatives said ‘Care home is excellent in meeting my relative’s needs. I am kept up to date with important issues. The staff have the right skills to do the job’ and ‘they always have entertainment that makes the residents very happy. In my view there is nothing that can change it is spotless and very clean.’ Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 6 During the inspection the staff interactions with the people in the home was seen to be relaxed, friendly and respectful. The manager is in the home on a daily basis so knows the people who live in the home and their relatives and friends. What has improved since the last inspection? What they could do better: Whilst the care at Pennyghael meets the needs of the people living in the home the written assessments carried out by staff should contain more detailed information, this allows for the care plan to fully reflect the level of support required by people in the home. Currently the case files contain a lot of useful information but it is in no particular order and would benefit from being re-organised. This would allow for the care needs information to be clearly identified, and would aid staff to find the information more readily and it would mean that the files would also be easier to review. On a tour of the building the following areas were identified as requiring attention or updating: • • • • • • • Room A the bedroom furniture is tatty and missing handles. There is a small chip out of the board on the wall. Room 11 there is a stale odour in this room, the metal window frames are tatty and require painting. Cupboards in the rooms are missing handles. Room 1 neither the over sink light or the main light was working again draws were missing handles. Room 6 the carpet is a tripping hazard and needs stretching or replacing. Room 10 had a malodour and this needs to be removed. There were no locks on the door on the toilet doors on the first floor. The wooden fire escape to the rear of the building also needs work to prevent people slipping on the wood in the event of a fire. The escape has lost all its protection from paint or preservative and this has allowed mossy areas to develop following wet weather Whilst some of these issues present health and safety risks others do not promote dignity and respect in the home. In a discussion with the manager it was discovered that the simple quality assurance system had been dropped due to the lack of responses from the Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 7 questionnaires and surveys. The Registered Manager should look at different ways to re-implement these systems so that people who use the service and those who visit it can express their opinion on how their experience of Pennyghael was. This will allow any comments to be incorporated in to a development plan for the home and ensure the service provided continues to improve. 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. Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, standard 6 does not apply. People who use the 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 want to live at Pennyghael have an assessment of the support they require to ensure the staff can provide the help they require. EVIDENCE: Four case files were seen and all of them contained an assessment of need carried out by the registered manager, this was alongside any assessments provided by the funding authority. The Registered Manager was clear about the importance of completing a full assessment not only to make sure the persons needs could be met within the home but it also allowed them to ensure the balance of people in the home was good as well. This assessment was supplemented by a further assessment of need once the person had been admitted to the home. A supervisor carried this out. The information in this document required more detail as it made general comments such as ‘some help required’ but did not give any detail. There was also a brief personal Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 10 history, likes and dislikes, preferred name and personal contacts. A member of staff said that the information provided before someone came in to the home ensured they were aware of the support that person required. It also allowed staff to introduce them to the other people in the home Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the 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’s healthcare needs are met safely in a way that promotes their dignity and respect. EVIDENCE: Four case files were seen and each of them contained a care plan pertinent to the needs of the individual. The information in the case files was organised in a way that did not allow for easy access by the carers and it is recommended that the Registered Manager looks at making the files easier to follow and maintain. People spoken with were not aware of these plans but said that they received the help and support they required. A member of staff said that the plans are reviewed monthly. A daily record is completed at every change of shift and this information was used as part of the review. People spoken with said that they were registered with their own GP and were able to see the doctor on request. There was evidence in the case files of Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 12 when the doctor or district nurse had last visited. Evidence was also available to show that people had accessed, dental, chiropody, optical services and support from the local community psychiatric nurse as necessary. Medication is dispensed by a local surgery in monitored dosage boxes. The medication was found to be stored securely and the staff that dispense the medication have received training in the Safe Handling of Medicines. Controlled drugs are stored separately and records for all the medication were found to be accurate and an audit trail could be followed. Feedback from one of the GP’s indicated that the Registered Manager sometimes altered medication before consulting with him. On discussion with the Registered Manager it was found that this only occurs where she feels a person has been over sedated and she said she stops this medication and consults the GP at the earliest convenience. The GP indicated in his feedback that the times this happened it was the right course of action to have taken. Throughout the visit staff were observed treating the people in the home with respect, using their preferred names and talking to them discreetly about their personal care needs. The people in the home said ‘the staff here are wonderful’. The interactions were relaxed and friendly and it was clear that all staff respected them. Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to make decisions about their daily life and staff provide appropriate support and encouragement for them to remain independent EVIDENCE: People in the home are able to follow their own routine and this was evident throughout the visit. Activities are organised by staff on a daily basis but people did not always want to join in. Some of the activities were, armchair exercises with a physiotherapist, two singers come to the home and staff take people out when the weather allows it. During the inspection staff were able to sit and talk to people in the home and encouraged them to do jigsaws and activities that require dexterity. The hairdresser also comes to the home each Wednesday. Activities are planned but are only done in short bursts as the people in the Home have memory impairments or dementia and cannot concentrate for too long. Feedback for a relative said ‘They always have entertainment that makes the residents very happy’. Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 14 There is a visitor’s policy in place, and they are welcomed anytime. Two visitors spoken with said that they are always welcomed and kept informed of what is happening with the person they visit. The meals are planned weekly with suggestions from people in the home incorporated in the meals. An alternative is offered rather than a full choice and the people spoken with said that they enjoyed the food. The mealtime observed was relaxed and the meal was well presented and looked appetising. Staff offered assistance and prompts in a discreet and respectful manner. Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the 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 live at Pennyghael and their representatives are able to express their concerns through the complaints procedure and are protected from abuse, so their rights are protected. EVIDENCE: There is complaints policy in place and people in the home and the staff are aware of what to do if they are unhappy with something. The complaints policy is displayed in the entrance hall and in all of the bedrooms. There have been no complaints received by the home or the Commission of Social Care Inspection since the last inspection. Feedback from a relative said ‘If I was unhappy I would speak to Anita and she has always responded to any of my concerns’. There is an adult protection policy in place. Staff were aware of their responsibilities if they suspected any form of abuse taking place. People are further protected through the recruitment policy as no one starts their employment until their Criminal Records Bureau disclosure forms are returned. Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment within this home provides people with a homely place in which to live, although would benefit from being updated to ensure their health and safety is not compromised. EVIDENCE: Pennyghael is situated just out of Selby town. It is in a residential area and benefits from having parking to the front of the building and large grounds to the rear and side of the property. The communal areas seen were well decorated, warm and odour free. A tour of the bedrooms found the following areas that need updating: • Room A the bedroom furniture is tatty and missing handles. There is a small chip out of the board on the wall. DS0000065116.V349930.R01.S.doc Version 5.2 Page 17 Pennyghael Residential Home • • • • • • • Room 11 there is a stale odour in this room, the metal window frames are tatty and require painting. Cupboards in the rooms are missing handles. Room 1 neither the over sink light or the main light was working again draws were missing handles. Room 6 the carpet is a tripping hazard and needs stretching or replacing. Room 10 had a malodour and this needs to be removed. There were no locks on the door on the toilets on the first floor. Room 6 housed the hot water tank. The cupboard this was in was unlocked and the tank was not insulated. This presented a risk to the occupant of the room who has a confusional state. The manager had rectified this before the end of the inspection. The wooden fire escape to the rear of the building also needs work to prevent people slipping on the wood in the event of a fire. The escape has lost all its protection from paint or preservative and this has allowed mossy areas to develop following wet weather. Staff need to be more proactive in detecting possible health and safety risks to the people in the home. Other rooms seen were tired and would benefit from some updating. The laundry was suitable to the needs of the people in the home. Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff that have been thoroughly vetted prior to the commencement of their employment support people. They receive training and are in sufficient numbers to provide the support required by the people in the home EVIDENCE: The home is adequately staffed over a twenty-four hour period. The proprietor is an equal opportunities employer and this was evidenced in the current staff team employed. Currently there are 100 of the staff team who have or are working towards the National Vocational Qualifications in Care level two. Staff receive the statutory required training and have recently completed a Dementia Awareness Course. Staff would also benefit from training in other age related illnesses. Four staff files were seen and they contained evidence of the recruitment procedure. They all had an application form, two references, and a Criminal Records Bureau disclosure. The files also contained evidence of training. Supervision is carried out but on an informal basis and no records are kept. Feedback from a relative about the staff said ‘Care home is excellent in meeting my relative’s needs I am kept up to date with important issues. The staff have the right skills to do the job’. Visitors spoken with said ‘the staff are Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 19 always welcoming and friendly’ and ‘they never seem harassed with those people who are more confused’. A health care professional also said ‘Individual needs are met as far as possible and the staff seem to have a high regard for the residents’. Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use the 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 live in a home that is well managed and systems are in place to protect their health and safety. EVIDENCE: The Registered Manager is experienced and competent to run the home. She works with the proprietors. People said ‘the manager knows what she is doing’ and staff spoken with said that they could take any issues to her and they had confidence they would be dealt with. The manager works along side the care staff and so becomes aware of any problems or concerns quickly and deals with them appropriately. Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 21 The quality assurance system has lapsed due to the lack of responses to the questionnaires and surveys used. In discussion with the manager it was recommended that she restart this system and try other methods of obtaining the information she requires. People who come in to Pennyghael look after their own finances, or they have assistance for their families and/or a solicitor. The manager does not look after anybody’s personal monies. The health and safety records were checked and all were found to be up to date, with the exception of the gas safety certificate. However evidence was seen that the engineer is calling 11th October to carry out this check. Risk assessments for fire, the environment, COSHH and people who live in the home. All accidents and incidents are recorded and when necessary they are reported to the Commission of Social Care Inspection. Whilst the accidents are reviewed on a regular basis it was suggested to the manager that they incorporate these in to the monthly reviews carried out. This might then show any patterns of incidents and allow staff to alter the care plan accordingly Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations The assessments carried out by staff in the home should contain more detailed information, this allows for the care plan to fully reflect the level of support required by people in the home. The case files would benefit for being re-organised to allow for the care needs information to be clearly identified, this allows for staff to find information easier and the files would also be easier to review. On a tour of the building the following areas were identified as requiring attention or updating: • Room A the bedroom furniture is tatty and missing handles. There is a small chip out of the board on the wall. • Room 11 there is a stale odour in this room, the DS0000065116.V349930.R01.S.doc Version 5.2 Page 24 2 OP7 3 OP19 Pennyghael Residential Home • • • • • metal window frames are tatty and require painting. Cupboards in the rooms are missing handles. Room 1 neither the over sink light or the main light was working again draws were missing handles. Room 6 the carpet is a tripping hazard and needs stretching or replacing. Room 10 had a malodour and this needs to be removed. There were no locks on the door on the toilets on the first floor. The wooden fire escape to the rear of the building also needs work to prevent people slipping on the wood in the event of a fire. The escape has lost all its protection from paint or preservative and this has allowed mossy areas to develop following wet weather Whilst these issues do not present health and safety risks they do not promote dignity and respect in the home. 4 OP33 The Registered Manager should re-implement the quality assurance systems so that people who use the service and those who visit it can express their opinion on how their experience of Pennyghael was. This will allow any comments to be incorporated in to a development plan for the home. Pennyghael Residential Home DS0000065116.V349930.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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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