Care Home: Priestley Rose

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What the care home does well Professional nursing care is provided in a comfortable, homely environment, by staff who respond willingly and effectively to the assessed care needs, and preferences, of resident`s. Care provision is clearly resident focused. This perception is supported by comments made during the inspection by residents and by visiting relatives, and included comments such as:- "I am very happy with all aspects of the care and service my relative receives"; "the staff are very welcoming"; "the home is always clean and tidy"; "(my relative) is treated like an individual"; (my relative`s) thoughts are always respected". What has improved since the last inspection? Four requirements made at the previous inspection have all been satisfactorily addressed. These related respectively to:- a need for bed rails of an appropriate size to always be used to ensure resident`s safety a need for the home to have systems in use to enable residents, whose first language is not English, to be able to understand what the home offers and to be able to communicate with staff a need to ensure all concerns/complaints are reported and recorded, and to that staff learn from such incidents, so as to prevent further occurrences a need for all staff to undertake training in respect of basic food hygiene, infection control, moving and handling, fire safety and safeguarding of adults to ensure a safe environment for residents. What the care home could do better: The positive response in meeting all four requirements made at the previous inspection is noteworthy, as is making good progress in addressing many of the recommendations. However, still outstanding is the need to continue the process of improving the environment - specifically in respect of refurbishing/repainting outside window frames. Whilst the windows in question appear to be effective in keeping the outside elements at bay, the home`s overall appearance would benefit from attention to this area of maintenance. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Priestley Rose 114 Bromford Lane Erdington Birmingham West Midlands B24 8BY     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: Keith Salmon     Date: 0 5 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for 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 © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Priestley Rose 114 Bromford Lane Erdington Birmingham West Midlands B24 8BY 01213730134 01213865153 adrian@macccare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) MACC Care Limited Type of registration: Number of places registered: care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: That the home may accommodate up to five service users between 60 - 65 years of age for the reason of nursing care. The home is registered to accommodate 45 older people. Registration category 45 OP. Date of last inspection Brief description of the care home Priestley Rose is a large two storey detached property, built in the 1940s, since extended and converted to provide accommodation for 42 elderly residents who require nursing care. The home is situated on a main route into Birmingham City centre with easy access to bus routes. At the rear of the property is an area which provides car parking and an enclosed garden accessible to wheelchair users. Personal accommodation comprises both single and twin bedded rooms over two floors; all bedrooms are equipped with call bell and wash hand basin, with three of the single rooms offering ensuite toilet facilities. There are three lounges, a dining room and a Care Homes for Older People Page 4 of 25 Over 65 45 0 Brief description of the care home well equipped snoozlem room, which is used for relaxation purposes. A passenger lift enables easy access to the second floor, and there is a range of specialist equipment for assisiting residents with mobility problems. A copy of the previous Inspection Report is available in the entrance hall. The service user guide does not include information about fees, this information must therefore be obtained direct from the home. 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: Unannounced key inspections address all essential aspects of operating a care home, and seek to establish evidence, which shows safety and positive outcomes for residents. The inspection was conducted over one day commencing at 9.30 am, completed at 4.45 pm. No one at the home was aware of the inspectors visit prior to arrival. The manager was present for the duration of the inspection. Information for the report was gathered from a number of sources including an inspection tour of the building, examination of records relating to care provision, and general management, of the home. We had conversations with five residents, three visiting relatives, the manager, and other staff. When residents were unable to communicate their views the inspector relied on observation and, where possible, through discussion with relatives. The five Care Homes for Older People Page 6 of 25 residents we talked with were part of a case tracking approach to information gathering. This involves finding out about each persons experience of living in the care home, by focusing on outcomes for them. We do this through meeting with them, and where possible with their relatives, to discuss their experiences at the home, as well as observing the care they receive. Alongside this we take a through looking at each persons care files. The report also uses information from the homes Annual Quality Assurance Assessment (AQAA). This document, completed by the home, is submitted to CSCI, prior to the inspection. It tells us how well the home thinks they are doing, and includes information relating to the homes policies, procedures, achievements and plans for improvements. Together with information gathered by ourselves on the day of inspection this provides a useful framework for us to evaluate quality of service and progress made. What the care home does well: What has improved since the last inspection? 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 8 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 9 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. People considering a move into the home can readily access information relating to the home, which is easy to understand and up to date, thereby helping them make an informed decision about entering the home as a resident. Evidence: Review of documentation relating to five residents showed all had care needs assessed, prior to decision to offer a place at the home, by the manager or by a Registered Nurse. We also noted that whilst residents or relatives receive a letter advising of acceptance for admission, this does not specifically indicate the homes capability to meet assessed care needs. It was agreed the the home will commence using a reworded letter to indicate that information. A requirement was made at the previous inspection in respect of enabling communication with residents whose first language is not English. Also a Care Homes for Older People Page 10 of 25 Evidence: recommendation was made in respect of making the service user guide available in alternative formats, so that it is accessible to all residents. We saw that the home now has updated and reissued these documents, to residents, in forms which now include versions written in English, Chinese, and in large print. Chinese and Polish residents, and their relatives, told us they are always able to communicate there wishes to care staff. It is considered the requirement, and recommendation, are met. Care Homes for Older People Page 11 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. Residents can be confident their assessed care needs will be effectively and safely met, and their privacy and dignity respected. Evidence: Following admission to the home, nursing assessment and risk assessments are completed, in order to obtain adequate information to write a care plan. Documentation is comprehensive with relevant and informative entries. Sampled records, including care plan and daily record, showed a good standard of clearly written, and informative entries. Care plans are developed wherever possible with involvement of the resident and/or relative and reviewed on at least a monthly basis. A named nurse/key worker system is in place - this means individual nurses and care staff have additional responsibility for a small group of identified residents. This may for example mean they take a particular interest in the social care aspects of a residents daily life. The home has a good range of well maintained specialist equipment including, hoists, stand aids and wheelchairs. Care Homes for Older People Page 12 of 25 Evidence: All residents have opportunity to be registered with a local GP practice of their choice. There are regular visits by the chiropodist, dentist and optician, and staff liaise with other health professionals e.g. physiotherapist, dietitian, speech and language therapist as required. It was recommended at the previous inspection that concerns about the safety of some of the bed rails in use be addressed. The home has done this and residents can be sure of their safety in respect of bed rail use. A requirement made at the previous inspection was that the home ensure that records regarding the administration of medicines are properly maintained. A full review in respect of the homes medicines administration practices found these to now be in accordance with accepted good practice, and also now include regular audit by the manager and registered nurses. The requirement is considered met. A recommendation at the previous inspection, that nurses should undertake training in respect of of the use of syringe drivers, has resulted in nursing staff attending a suitable course. Observation during tour of the home suggested residents privacy and dignity is respected at all times. This was reflected in comments made to us on the day of inspection and included; My (relative) is always listened to..., My (relative) is treated like an individual, The staff always take their time with us - never hurry us. Care Homes for Older People Page 13 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. Those residents who are able, choose their lifestyle, social activity, and pursue religious preferences, as they wish. Those who are not able to do so are supported by programmed care which helps them reach their potential. Opportunities for contact with family, friends, and the wider community, are established and encouraged. Evidence: Residents are able to make choices and spend time as they wished e.g. they could get up and go to bed when they wished, spend time in their own rooms or in communal areas. Visiting times at the home are flexible enabling residents to maintain contact with friends and relatives. Residents are able to bring items of furnishings and other personal possessions into the home to reflect their personal taste and interest - this fact is reflected in many bedrooms which had been personalised providing a homely environment. There are opportunities for active involvement of relatives in helping determine the way the home is managed through attendance at the residents/relatives meetings and easy access to the manager. The dining room was light, airy, pleasantly decorated and tables laid with tablecloths, Care Homes for Older People Page 14 of 25 Evidence: menus and condiments. The lunchtime meal observed seemed satisfactory - food was attractively served, and residents told us the food was hot and up to the usual standard, that is very good. Transfer of residents to the dining room, and attention to those needing assistance, was unhurried. A choice is available at all mealtimes, with arrangements for those wishing something not on menu that day, and there is provision for special meals such as diabetic and pureed food. The home has a new chef, who has revised the menu, which follows a four weekly cycle and has been developed with input from the residents meeting. One aim of the revised menu has been to incorporate five-a-day fruit or vegetables and there is opportunity for ethnic minority food if required. Residents said they liked the meals provided, one resident commenting The food is the sort of thing I like, traditional, nicely presented, the right amounts for me. At the last inspection it was identified that there was very little in respect of activities or stimulation for residents. Since that inspection the home has recruited an experienced social activities coordinator who works 30 hours per week, Monday to Friday. The activities programme, developed with input from the residents meeting, is advertised on the notice board in the entrance hall. Previous events are recorded on photographs also displayed in the entrance area. Activities recently offered include; crafts e.g. picture framing and making Christmas cards, word searches and quizzes, jigsaws, bingo, gardening, picnics, pub outings, a visit to the Birmingham Botanical Gardens during the Summer, and recently a visit to the local pantomime. The home also has visits from singers/entertainers including local school choirs. The home has visits from the Pets as Therapy group - the dog who attends, Jazz, being very popular with residents. Residents and visitors told us they appreciated the increase, and improvement in the range, of activities now offered. Staff also told us they are now more involved in joining with activities. Birthdays and anniversaries e.g St. Georges Day, St. Patricks Day, Chinese New Year, Mothering Sunday and Fathers Day are treated as special events which involve everyone. The home also has a sensory room with lighting effects and a range of music. We were told this facility has seen more use as part of the increase in activities. The hairdresser visits the home on a weekly basis. With regard to residents spiritual needs ministers of various religions attend the home as required, for example one resident told us that the minister visited and gave communion each week. Care Homes for Older People Page 15 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 and their relatives can be confident their views are listened to and acted upon, and that residents are safe and protected from abuse. Evidence: The home has a well-organised, well documented system for receiving and responding to complaints. The complaints procedure is contained within the service user guide, a copy of which is located in each residents bedroom. Residents and visitors told us they knew who to raise any concerns or complaints with, and that they were confident issues raised would receive thorough and effective attention. A requirement was made at the previous inspection in respect of staff ensuring that all concerns/complaints are reported and recorded, to ensure issues are addressed, and learning is achieved in order to prevent further occurrences. Staff were interviewed regarding this and all were able to describe action they should take if they received a complaint or observed abuse of a resident. The homes incidents and accidents records were also examined and appeared up to date, and nothing was seen which caused us concern.The requirement is considered met. Care Homes for Older People Page 16 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 environment in which residents live is pleasant, safe, and clean, with satisfactory standards of hygiene. The home has specialist equipment consistent with providing necessary care. Evidence: A tour of the home, which included all communal rooms and corridors, toilets and bathrooms, laundry, and a random selection of bedrooms, showed the home provides a safe, pleasantly decorated, and generally well maintained environment in which to live. Most furnishings were homely and in good order. Evidence was seen of improvements to physical standards at the home. This is being achieved through an ongoing programme which includes repainting of bedrooms as they become available, new carpets and curtains, and deep cleaning and redecoration of the kitchen - a recent visit by the Environmental Health Officer provide a favourable report. There is a small garden to the rear of the premises with wheelchair access. This has some benches, which have recently been sanded and re varnished, some bird feeders, and a vegetable patch, which is partly cared for by interested residents. The Home has good provision of specialist equipment, consistent with meeting the assessed care needs of service users, and the demands of tasks carried out by Care Staff. During recent months the home has purchased some additional specialist beds Care Homes for Older People Page 17 of 25 Evidence: and mattresses. Records demonstrated maintenance and servicing of care related equipment, such as the passenger lift, hoists, wheelchairs, and call bells, is regularly undertaken, and appropriately documented. The laundry is well run by dedicated laundry staff. Clothes are labelled for each resident, thus ensuring laundered items are returned to the rightful owner. This was reflected in residents being dressed in well-fitted, clean clothes. We found the home to be clean and hygienic; a view supported by residents and visitors, whose comments included The home is always clean and smells nice. The domestic staff come to my room every day and do a thorough job. My relative has been in other homes and this is the cleanest we have found. Care Homes for Older People Page 18 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. Residents can be confident staff numbers on duty, and skill-mix, are sufficient to meet their assessed care needs, and that recruitment and employment practices are consistent with safeguarding them from abuse. The commitment of the Home in providing training for care staff is good, and in accordance with individual staff members learning needs. Evidence: A review of recent duty rosters, and also staff numbers and skill-mix at the time of the Inspection, demonstrated staffing to be sufficient to meet the assessed care needs of current residents. Furthermore, the Manager is usually supernumerary and there is good support from the activities coordinator, kitchen staff, domestic staff and the fulltime maintenance man. Examination of staff employment files, and conversations with staff, showed recruitment practices help ensure the safety of residents. Staff described the robust recruitment process they had gone through prior to appointment, and commencing work at the home. All said they enjoyed working at the home and were able to give a detailed account of their initial orientation/induction and subsequent training. Staff records showed that all new staff now undertake a comprehensive training programme. This is provided, at the home, by an accredited outside agency. Training includes; lifting and handling, safe food handling, fire safety, infection prevention and Care Homes for Older People Page 19 of 25 Evidence: control, health and safety, adult protection, care of people with dementia. Staff also all have opportunity to undertake National Vocational Qualifications (NVQ) with the current level of attainment of NVQ Level 2 being above the expected minimum of 50 of care staff. In addition the manager is a qualified first aid trainer, one of the nurses is a qualified manual handling trainer, and the manager from the organisations other home is a qualified trainer in respect of safeguarding adults. The above arrangements mean that a requirement made at the previous inspection stating that all staff must complete the core training, to ensure staff have suitable knowledge and skills to care for residents, is considered met. 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. Residents benefit from effective management which ensures the main focus of care provision is in meeting individual residents care needs, and enabling realisation of their aspirations, wherever possible. Residents and their relatives can be confident their views on the provision of service quality will be sought and, where possible, acted upon. Residents, relatives, other visitors to the home, and staff, can be confident their health, safety, and welfare are safeguarded. Evidence: The Manager, is a well qualified and experienced person. Following what is a fairly recent change in management, there is evidence of improvement in the delivery of care at the home, including a strong focus on addressing equality and diversity issues. This was reflected in the views of residents, relatives, and staff, also in care practices observed, record keeping reviewed, and ongoing improvements to the environment. There has also been good progress in addressing requirements and recommendations Care Homes for Older People Page 21 of 25 Evidence: made at previous inspections. In summary a picture suggesting thorough, thoughtful and effective management, which is supported in comments by residents, relatives and staff; these include - Since the new manager came in things have started to happen. (from a relative); and comments made by staff including, The manager is doing a wonderful job and is always helpful and supportive.; Its a wonderful nursing home to work in. Since the previous inspection all required policies/procedures have been reviewed and rewritten as necessary. It appears also that the manager receives good support from the proprietor who attends on at least a monthly basis to undertake the visits required by the care home regulations, and completes the necessary report on his findings. The home has commenced a more structured approach for gaining the views of residents, relatives, friends, through use of in-house questionnaires. The Home also holds regular residents meetings, the minutes from which showed residents are able to effect the kind of care they receive. Examples of this are seen in changes to the menus and to the activities programme. A review of staff personal files, and related records, demonstrated Staff are subject to regular supervision. Staff told us they find this very helpful to them as they develop their own skills in caring for people. RGNs found the process supportive and again important for their development. Accidents are reported appropriately and there are risk assessments in place for ensuring safe working practices. Observation and review of relevant records provided evidence that Health and Safety Policies/Procedures/Practices are satisfactory, maintenance and servicing of equipment regularly undertaken, and appropriately documented, and all COSHH requirements met. Other health and safety records examined, including those related to fire risk management, lighting, nurse call bells, Legionellae, portable electric equipment, hoists, and safe hot water temperatures, were all found to be satisfactory. 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 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 19 Windows that have been identified as in need of repair or repainting are attended to in order to enhance the residents environment. Continue with the programme of refurbishment so the environment is further enhanced. 2 19 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 © (2009) Commission for Social Care Inspection (CSCI). 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