Care Home: Prospect Hill (12)

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What the care home does well The people who live in the home have a care plan and this is reviewed every month to make sure it still meets their needs. The key workers work closely with people and help them to do the things they want to do. People can move around the home freely and staff will always help them. It was clear that the staff have a detailed knowledge about the people in the home and the relationships observed were friendly and relaxed. The manager and staff work closely with other professionals to ensure that people are getting all of the help and support they require. The staff help the people in the home to maintain contact with their families and if necessary arrange for an advocate to support for them. The staff that work at the home are thoroughly checked before they start their employment and they receive support and training to ensure they have the skills needed to do their job. What has improved since the last inspection? Whilst the staffing levels remain as they were at the last inspection the manager is much better at reviewing the staffing levels in relation to the needs of the people who live at Prospect Hill. The staff who do sleep in duty are situated close to the most dependent people in the home and at this time this appears to be sufficient. The key workers now review the care plans and keep a record of this. The issue of transport has been partially solved as a larger vehicle has been obtained and everyone who wants to go out can now be accommodated on it. However the manager is still hampered by the lack of staff that can drive. The manager of their sister home has been nominated to carry out the monthly visits and a report is now kept on these. What the care home could do better: Whilst nothing has been identified as a recommendation or requirement the manager must regularly assess the needs of the people in the home and the staffing levels. As the people get older their needs may increase and staff should be available to assist everyone throughout the day and night. The manager should also look to get staff training in the aging process to enable them to have a greater understanding of the issues they may face in the future. CARE HOME ADULTS 18-65 Prospect Hill (12) 12 Prospect Hill Whitby North Yorkshire YO21 1QE Lead Inspector Pauline O`Rourke Key Unannounced Inspection 28th November 2007 09:30 Prospect Hill (12) DS0000067654.V349927.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 Prospect Hill (12) DS0000067654.V349927.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. Prospect Hill (12) DS0000067654.V349927.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Prospect Hill (12) Address 12 Prospect Hill Whitby North Yorkshire YO21 1QE 01947 604606 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) Prospect Care Limited Mrs Audrey Mary Boyes Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (8) of places Prospect Hill (12) DS0000067654.V349927.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 30th November 2006 Brief Description of the Service: 12 Prospect Hill is registered to provide care and accommodation for up to 8 younger adults and 8 older people who have a learning disability. The manager is Mrs Audrey Boyes and Prospect Care Limited owns it. It is a Victorian mid-terraced property situated in a residential area of Whitby. It is conveniently located for all of the main community facilities including the public transport network. The property has parking for several vehicles at the rear. The property has four floors with the service users accommodation being located on the ground and upper floors. The lounge, dining area, kitchen and laundry are situated on the lower ground floor. The property can be access by either the ground or lower ground floor. The property does not have a passenger lift and consequently it is only considered suitable for use by service users who are fully ambulant. A Statement of Purpose and Service User Guide are available in the home and on request. The fee level advised on 28th November 2007 was £780.22 per week depending on assessed needs and level of care required. Prospect Hill (12) DS0000067654.V349927.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 Comment cards returned from people who use the service at Prospect Hill, health care professionals and relatives. A visit to the home by one inspector that lasted five hours. During the visit to the home, 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 Prospect Hill for people who use this service. The manager was available to assist throughout the visit and was available for feedback at the close. What the service does well: The people who live in the home have a care plan and this is reviewed every month to make sure it still meets their needs. The key workers work closely with people and help them to do the things they want to do. People can move around the home freely and staff will always help them. It was clear that the staff have a detailed knowledge about the people in the home and the relationships observed were friendly and relaxed. The manager and staff work closely with other professionals to ensure that people are getting all of the help and support they require. The staff help the people in the home to maintain contact with their families and if necessary arrange for an advocate to support for them. The staff that work at the home are thoroughly checked before they start their employment and they receive support and training to ensure they have the skills needed to do their job. Prospect Hill (12) DS0000067654.V349927.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Prospect Hill (12) DS0000067654.V349927.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 Prospect Hill (12) DS0000067654.V349927.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): 2 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 decide to use this service can be assured their needs will be met. EVIDENCE: There have been no new admissions to prospect Hill since 2003. The records show that there is a pre-admission assessment process in place. This ensures that adequate information is obtained on someone who wants to live at Prospect Hill. This allows the registered manager to make a considered decision as to the appropriateness of the proposed placement. According to the registered manager this process was followed regardless at to whether a placing authority is involved. The admission process involves, where possible, a ‘phased’ introduction so that a new person can meet the existing people in the home and become familiar with their new environment. Prospect Hill (12) DS0000067654.V349927.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): 6, 7, and 9 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 provided with care plans that form the basis of good care and ensure that all of their assessed needs are met. EVIDENCE: Four case files were seen and each of them contained a pertinent care plan for the individual concerned. The information was detailed and outlined the actions needed by staff to ensure the care plans were followed. People spoken with during the inspection had a limited understanding of their care plan and it was not always possible to include them in the planning and development of these plans. The more able people in the home were not interested in these plans although they were aware of them. There is a key worker system in place and the key workers review the care plans every month and any changes identified are implemented immediately. Prospect Hill (12) DS0000067654.V349927.R01.S.doc Version 5.2 Page 10 There is a diverse range of needs within the current people living at Prospect Hill. Some require assistance with all of their personal and social care whilst others require minimum input from staff. Throughout the day people were seen making their own choices and staff were supportive of this. Personal care offered during the day was done so in a discreet manner and did not undermine the dignity of the person receiving support. All of the case files contained risk assessments and clearly identified strategies in place to minimise risk whilst maintaining a balance between safety and the persons’ independence. Prospect Hill (12) DS0000067654.V349927.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): 12, 13, 15, 16 and 17 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 provided with a range of social activities both within and outside of the home as an integral part of their life skills training. EVIDENCE: The case files contained evidence to show that the people who live at Prospect Hill are actively involved in their community. During the inspection those who were able told of the party they had organised and attended to celebrate the 80th birthday of one person. They continue to go to a caravan for holidays in the summer. There is no set programme of activities but staff offer appropriate activities to individuals on a daily basis. Several people attend local day centres and one person has a support worker provided by social services to enable them to get out at least once a week. The population in the home is aging and staff take this in to account when organising activities. Where possible good contact has been developed and maintained with the families of most of the people who live at Prospect Hill. Prospect Hill (12) DS0000067654.V349927.R01.S.doc Version 5.2 Page 12 The home is domestic in style and character and people are encouraged to live life at their own pace. Whilst several have slowed down and take more time to do things the staff are supportive of this. Similarly where people want to go out the staff enable them to do this as well. One person goes out every morning to a local café and clearly enjoys this. They said ‘ in December they put whisky in my tea as a treat’ and the manager confirmed when this person had missed a few weeks of going out members of the local community asked about their well being as they had missed them. There is some structure to the day around getting up and going to bed times but these have been developed with health professionals to ensure people benefit from good rest. One person said ‘I like it here and the staff are very nice’. One person sees him or herself in a supervisory role and offers assistance to at least one other person in the home. Staff monitor this to ensure neither party is at risk from this assistance. The home continues to share transport with its sister home in Robin Hood’s Bay but the vehicle is able to take all that want to go from one home out in one trip. The trips are limited as there are only a few members of staff who can drive. From observation of the staff and people in the home it was apparent that a close but professional relationship existed. People responded well to the staff and were not reticent in asking for assistance. The staff provided assistance for them with patience and understanding. They gave them respect by speaking to them in an adult manner, by including them in general conversations and by gaining their permission before entering their bedroom. When staff needed to be directive or firm with someone it was done in a respectful manner so not to embarrass the person concerned. The menus indicated that the meals were varied and nutritional. The meals were prepared and cooked by the staff. One member of staff had considerable experience working in the catering industry and consequently had good knowledge of food preparation. The main meal of the day was generally eaten in the evening during the week to take into account of people’s activities and appointments. The mealtimes were reasonably flexible. Several people confirmed this. As part of the nutritional monitoring process the service users had been regularly weighed. Prospect Hill (12) DS0000067654.V349927.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): 18, 19 and 20 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of people in the home are well met through excellent support from the staff and good levels of input from health and social care professionals. EVIDENCE: The care records detailed the support required by people living in the home and these had been tailored to meet their individual needs and wishes. This meant that the people are treated as individuals. The provision of the high standard of care is dependent upon a close relationship between the staff and the people who live at Prospect Hill. This was particularly important for four of the people who had limited verbal communication skills. It was apparent that the people were relaxed and felt at home in their environment. This provided them with a degree of ownership over it. They appeared to relate to the staff as equals and were not reticent in voicing their views. The staff demonstrated a good understanding of peoples needs as individuals and also understood their idiosyncrasies. One person enjoys unravelling Prospect Hill (12) DS0000067654.V349927.R01.S.doc Version 5.2 Page 14 woollen objects whilst another appears quite independent however they require quite a lot of support. Staff are able to provide this support without compromising their dignity. The records showed that people’s health care needs are met, all of them are registered with a local surgery. The files showed that advice is sought regularly on dietary issues, speech therapist and advice about epilepsy. A record is maintained of this person’s seizures to assist healthcare professionals in minimising the frequency and effect of the seizures. The home continue to use a monitored dosage system for the administration of the bulk of people’s medication. Those staff responsible for the administration process had been appropriately trained. The medication was appropriately secured. Arrangements were in place for the use of controlled drugs although none were in use at the time of the inspection visit. A member of staff described the administration process. It was evident that it was efficient and minimised the chance of error. The medication records were complete and up to date. None of the people in the home were assessed as being capable of safely self-administering their medication. Prospect Hill (12) DS0000067654.V349927.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): 22 and 23 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. The network of internal and external support provided for people ensures that their welfare and safety is appropriately safeguarded. EVIDENCE: There is a clear complaints policy available to both people who live in the home and visitors. The literacy skills of people in the home means that they have to rely on someone else to help them make a complaint. The key workers act as advocates and an external advocate have been provided for at least one person in the home. During the inspection people said that they would either tell the manager of this home or the manager of the sister home if they were unhappy about anything. Alternative forms of communicating their wishes have been tried such a pictorial complaints form but they still require a lot of support from staff. The staff spoken with during the inspection were clear that if they felt someone was not happy with something then they would assist them with a complaint. The home or the Commission has received no complaints since the last inspection. All of the staff had received training on Adult Protection procedures that included the types and indications of abuse. The staff demonstrated a sound understanding regarding the action they should take should allegations (or indications) of abuse, be made. People in the home are also protected by the recruitment procedure as all new members of staff are rigorously checked prior to the commencement of their employment. Prospect Hill (12) DS0000067654.V349927.R01.S.doc Version 5.2 Page 16 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): 24 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. The premises provide people with a pleasant and comfortable place in which to live. EVIDENCE: 12 Prospect Hill is a large terraced property split over four floors. The lower ground floor has a lounge, dinning room, kitchen and laundry and this is where most of the people in the home spend their waking time. The other three floors has peoples bedrooms. Each of the rooms seen had been personalised by the occupant and there is only one shared room. There are sufficient bathrooms and toilets on all floors for the people who live in the home. The manager did say they were looking at installing a stair lift, as there isn’t a passenger lift in situ and their mobility is not as good as it was. The overall effect of the home is that it is domestic in style and character and to the people who live there it was clearly home. The employment of a handyman gardener has helped to make sure that the maintenance of the property is kept up to date. Prospect Hill (12) DS0000067654.V349927.R01.S.doc Version 5.2 Page 17 All areas of the home were seen and with the exception of the ground floor carpet and ground floor toilet, they were clean, odour free and warm. The manger is aware of both of these and she is awaiting quotes for the necessary works to be completed. Prospect Hill (12) DS0000067654.V349927.R01.S.doc Version 5.2 Page 18 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): 32, 34 and 35 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 supported by a competent and experienced staff team who, enable them to lead meaningful lives. EVIDENCE: The rota’s seen showed two members of staff on duty over a twenty-four hour period. The manager was extra to the staff. Staff spoken with said that this was sufficient to meet the needs of the people in the home. During the day the people who live at Prospect Hill generally stay downstairs in the lounge but on a night two carers have to supervise four floors without the assistance of a lift. Currently there is only one person who requires assistance form two staff but as people get older this situation may change. This situation was reviewed after the last inspection and the manager felt the staffing levels remained appropriate, however this situation should be continually assessed. The staffing level also had a direct impact on the frequency of external activities that could be provided for the service users. To an extent this had been overcome through the use of an external support worker for one service user. Prospect Hill (12) DS0000067654.V349927.R01.S.doc Version 5.2 Page 19 The manager and staff also receive support form their sister home in Robin Hoods Bay. The staff files seen contained evidence of the recruitment process. All of them contained and application form, two references and a Criminal Records Bureau disclosure. There was also evidence of training and all staff are now qualified to at least National Vocational Qualifications level two in care. Other training provided included fist aid, safe handling of medication, health and safety in the work place and planned training includes Equality and Diversity. The manager was advised that given that people in the home were getting older then staff should have some training in the aging process. All staff have formal supervision and records were seen to confirm this. Staff spoken with said that they found this time to be useful. Staff meetings are held on a regular basis and at the end of each shift a full handover is given. The staff spoken with said that the manager was ‘approachable and easy to get on with’ and they both expressed confidence in her ability to deal with any issues or problems they may have within the work place. Prospect Hill (12) DS0000067654.V349927.R01.S.doc Version 5.2 Page 20 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): 37, 39 and 42 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 well managed home where the administration of the home is based on openness and respect. This allows people to retain their individuality and independence. EVIDENCE: The Registered Manager is in the process of completing the registered managers award and is an experienced manager. The manager from their sister home supports her. The staff said that she operates and open door policy and she works with the staff. The staff said that she asks for their ideas and opinions on issues and listens to what they say, but they also said that if she needs to make a decision she does. On the day of the inspection people who live in the home and staff were seen approaching her without hesitation to ask a question or tell her something. Prospect Hill (12) DS0000067654.V349927.R01.S.doc Version 5.2 Page 21 There is a limited quality assurance system in place it relies on annual surveys given to the people in the home and visitors including other professionals. Information from the staff meetings and the reviews of the care plans also feed in to this process. The manager then uses this information to plan any improvements to the service or training for staff in to the annual development plan. The records seen during the site visit were maintained to high standard and contained detailed and pertinent information. They were stored securely and the staff could access them when necessary. The records for the people’s monies were found to be accurate and up-to-date. All the working practices within the home are safe and staff keep accurate accident records, this information is used to inform the care plan and in requesting specialist input if necessary. Staff has received training in the health and safety procedures and all the policies are read by the staff. The records relating to health and safety issues that were seen during the visit were up to date. A health and safety management consultancy have been engaged by the home to ensure their standards do not drop. Prospect Hill (12) DS0000067654.V349927.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 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 3 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 3 3 X 4 3 LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 4 X 3 X X 3 X Prospect Hill (12) DS0000067654.V349927.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. Refer to Standard Good Practice Recommendations Prospect Hill (12) DS0000067654.V349927.R01.S.doc Version 5.2 Page 24 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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