Care Home: Richmond House

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What the care home does well What has improved since the last inspection? Many areas of the home have been redecorated and re-carpeted. New dining and lounge furniture has been provided. Security around the home has been improved by the fitting of keypad locks on several of the doors. A training chart is now in use that is used to show any gaps in staff training and to show when training needs to be updated. What the care home could do better: Management should keep the staffing levels continually under review to make sure that the residents` needs continue to be met. To reduce the risk that people may `run out` of medicines arrangements need to be made to more promptly order medicines needed outside the normal monthly delivery. CARE HOMES FOR OLDER PEOPLE Richmond House Mitchell Street Leigh Lancashire WN7 4UH Lead Inspector Grace Tarney Unannounced Inspection 5th March 2008 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 Richmond House DS0000005694.V360549.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. Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Richmond House Address Mitchell Street Leigh Lancashire WN7 4UH 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) 01942 682772 01942 682774 richmondhouse@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd Lorraine Scholey Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48), Physical disability (10) of places Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 48 Service users, to include : Up to 48 service users in the category of OP (Older People) Up to 10 service users in the category of PD (Physical Disabilities under 65 years) 26th March 2007 Date of last inspection Brief Description of the Service: Richmond House (part of Southern Cross Healthcare Services Ltd.) is a twostorey, purpose built care home located in a residential area of Leigh and is close to the main bus route. Local shops and a local pub are close by. It is pleasantly situated in its own grounds and has attractive gardens, there is ample car parking to the front of the Home. Level access to the Home is provided and a passenger lift ensures access to both floors. All bedrooms are single and have en-suite facilities. There is a dining room and lounges on each floor and each level is provided with bathrooms and toilets and there is a shower room on the ground floor. The home provides care to older people with nursing and social needs and to younger people with physical disabilities and because of this 24 hour qualified nurse cover is provided. The Manager informed the inspector that the fees within the home ranged from £380.51 to £689 per week. The fees charged depended on what care the residents needed. Additional charges are made for private chiropody, hairdressing and newspapers. This information was received on the 5/3/2008. A copy of the most recent inspection report is displayed in the entrance hall. Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The home was not told that the inspection was to take place. The site visit by an inspector and a pharmacy inspector took place over 7 hours. Several weeks before the inspection we (The Commission) asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they did at present, what they felt they did well and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we do. During our time at the home we looked at care records and medicine records to make sure that the health and care needs of the residents were being met. We also looked around the building at some of the bedrooms, bathrooms, toilets and sitting areas to check if they were clean, warm and well decorated. We also looked at the menus in detail, to check what the residents had for their breakfasts, lunches and evening meals. We also checked how many staff were provided on each shift to make sure the residents’ needs were being met, and also looked at how the staff are trained to do their jobs properly. How the home manages the residents’ spending money was also looked at. In order to get further information about the home we also spent time speaking to 4 residents, 2 visitors, 2 qualified nurses, the administrator, the activities organiser and the cook What the service does well: The Manager makes sure that the staff only care for those people whose needs they can meet. The residents’ care plans contain a lot of important information about what they need help with, and how they are to be cared for. Residents feel that they are well looked after by the staff. Residents and relatives made the following comments: • I like it here. Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 6 • • They are all very good. They always make us feel welcome. The meals provided are varied and nutritious and the residents have a good choice of menu. The Company is making sure that the staff are properly trained and is providing the care team with the knowledge and skills they need to protect and meet the needs of the residents. 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. Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 7 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 Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 8 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are properly assessed before they are admitted to the home and this gives an assurance to everybody that a person is only admitted if the staff can meet their needs. EVIDENCE: Before any resident was admitted to the home a senior member of staff from the home, normally the Manager, undertakes an assessment of their needs. The assessment looks at what help and support the prospective resident needs in all aspects of daily life. The 2 assessments looked at were detailed and gave a clear indication of the residents’ needs and what they could and could not do for themselves. Standard 6 does not apply. The home does not provide Intermediate Care. Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 9 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 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans ensure that the care needs of people are fully met. Arrangements need to be reviewed to ensure enough stock is available for people’s medicines to be safely administered. EVIDENCE: Individual care plans were in place for each resident. The care plans of 2 of the residents were looked at. One of these residents had extensive nursing needs and the care plan contained detailed information about the care needed and the involvement of other health care professionals. The other care plan was detailed and gave very clear guidance on how the resident was to be cared for. The staff looked at and they wrote down whether or not there was any risk in relation to the residents developing pressure sores and also if they were at risk due to problems with their diet and fluid intake. They also looked at how any resident was to be assisted with being moved around and by how many Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 10 members of staff and what equipment, if any, was to be used to assist in safe moving and handling. The care plans were looked at and updated regularly so that any change in their condition could be identified and appropriate action taken. The care plans detailed any religious and cultural needs of the residents. At the time of the inspection there were no residents of any ethnic minority. There was nobody who needed any special diet due to his or her religious or cultural beliefs. The following were some of the comments made by relatives and residents: • • They are very good. They do not let the grass grow under their feet. The staff are great. For the purpose of this inspection we looked in detail at how the staff managed to keep the residents clean and comfortable, with a particular emphasis on how they deal with incontinence. We saw that the practices the staff put in place were good. Enough aids and equipment were in place to help deal with incontinence. This helped to preserve the residents’ dignity. We saw that the person who is responsible for the continence assessments did not have any formal training on how to do this. Following a discussion with the manager she agreed to make sure that the staff member received training from a specialist nurse. Staff confirmed that the importance of ensuring privacy, respect and dignity is part of their initial training. The residents looked clean and comfortable and were suitably dressed. Staff were discreet when providing assistance to the residents. They were seen knocking on bedroom doors before entering and speaking to residents in a quiet and respectful way. Medicines were generally handled safely, the service showed good practice in some areas. Regular checks are carried out to make sure that medicines are handled in accordance with procedures. Records were good for the receipt of medicines into the home and for the safe disposal of unwanted medicines. However, it was of concern that there were weaknesses in the ordering of medicines needed outside the ‘normal’ delivery time that meant people were at risk of missing doses of their medicines because there were none to give. It was evident that staff were ordering needed medicines and ‘chasing them up’ but this could have been done more quickly. This needs to be addressed to ensure continuity of treatment. A sample of medicines was counted and compared with the records to check that they were given at the prescribed dose. We saw that medicines had mostly been given correctly but sometimes medicines were missed because there were none to give. For example, one person had no painkillers for four days and no antihistamine for five days. Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 11 The medicines administration records were mostly clearly completed but there were sometimes mistakes, for example one person’s records showed too many doses had been given, when a stock check showed this was not the case. Records in the controlled drugs register did not always match those made on the administration record. To support the safe administration of medication and reduce the risk of mistakes the administration records need to be accurately completed. Records for communication with doctors were mostly clear and most but not all changes to medication could be tracked. To ensure medicines are given correctly records should always be made and followed-up when verbal changes are made to peoples medicines. Qualified nurses administer all medicines. We observed part of the morning medicines round. Staff were courteous and when needed offered support to help people take their medicines. We saw that there was some flexibility in the times medicines were given for example, for one person chose to have their morning medicines when they returned from church. However, it was of concern that on the visit day the morning medicines rounds finished quite late in the morning. The times the rounds are carried out needs to be kept under review to make sure that where medicines are repeated later in the day, enough time is left between each dose. Residents’ health could be at risk if medicines are given too close together or if doses have to be missed because of the short time interval resulting in inadequate treatment. Medicines including controlled drugs were correctly stored and safely locked away. Arrangements were in place for the safe disposal of unwanted (waste) medicines but these are kept behind a ‘key pad’ lock. To reduce access to these medicines they should be locked away behind a ‘proper’ key lock. Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 12 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 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a choice in how they spend their day and find enjoyment with the activities available. The choice and variety of the food provided ensures that the nutritional needs of the residents are met. EVIDENCE: The residents’ routines of daily living and their social interests were recorded in their care plans. Two of the residents told us that they liked to stay in their room and watch their own television. They are also about to install Sky TV so that they can enjoy television even more. The home employs an activities organiser who works sixteen and half hours each week and organises a programme of activities for the residents. A wide range of activities is offered at the home including table and floor games, and various arts and crafts. The activities were displayed on a notice board in the reception area. The home also has a well-equipped activities room. The residents had been making things for Easter. The activities person told us that she was the only person in the home insured to drive the company mini bus. She was used to taking the residents out for trips to local garden centres, shopping or the seaside. She told us that, along Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 13 with other staff, she takes the residents to Blackpool or Southport where they all have fish and chips and a small glass of shandy. She told us that the residents love this as they are all socialising together. One resident told us that her family visit regularly at different times of the day and are made very welcome. We also spoke to 2 visitors who told us that they are always offered tea and sandwiches when they visit. They felt that the staff were very good and always welcoming. Residents told us that they could bring in pictures, photographs and ornaments. The bedrooms that we looked at were very personalised. A 4 weekly menu was displayed in the hall. We did not eat with the residents but saw what they were having for lunch. The residents have a choice of food at breakfast, lunch and teatime. We saw that the meals served that day corresponded with what was on the menu. Looking at the choice lists that are given out to the residents the day before, it was evident that there was even a further choice of food if they did not like the alternative meal on offer. A discussion with the cook and residents showed that they could always have a salad, jacket potatoes with a filling of their choice, sandwiches or whatever they fancied. The dining room was a very pleasant area and the tables were nicely set. Hot and cold drinks were served during the meal and throughout the day. Residents made the following comments: • I enjoy the food. • The food is good. • They know what I like. Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 14 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 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People know how to complain and staff have a good knowledge and understanding of what abuse is, thereby reducing the possible risk of harm to residents. EVIDENCE: A detailed complaints procedure was in place and was displayed in the reception area. The complaints procedure was also included in the Service User Guide. It is easy to understand and gives an assurance that complaints will be responded to within 28 days. A record is kept of any complaint made and includes details of the investigation and any action taken. One complaint has recently been made to us and it is in the process of being looked at. A resident told us that if she had any concerns she knew she could speak to the manager. A discussion with staff showed that they were very aware of the procedure to follow in the event of any allegation of abuse. Training in the protection of vulnerable adults has been undertaken by some staff and is ongoing. Records of training were kept on file. Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 15 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 20 21 24 25 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in suitably adapted, safe and comfortable surroundings. EVIDENCE: There is a lounge and dining room on each floor as well as bedrooms, bathrooms and toilets. The lounges and dining rooms were clean, warm and suitably furnished. The corridors are wide and had recently been redecorated. There were enough toilets and bathrooms to meet the needs of the residents. Toilets were close to bedrooms and living areas. Each toilet and bathroom had a lock on the door to ensure privacy and the facilities were clearly marked as such. The bedrooms were centrally heated and had a safety overriding door lock and a lockable space to store anything that is of value to the resident. They were clean and warm. The bedrooms looked at had been redecorated, carpeted and Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 16 newly furnished. The manager told us that several more had been redecorated and re-carpeted. One resident told us that she really liked her room now that it had been newly decorated. The manager informed us in the AQAA that improvements had been made in the home. We were told that there had been an improvement in the security of the home with keypads being fitted on stairwells, and that an area of the garden had been fenced in, making it secure. Radiators were suitably guarded to prevent any risk of accidents. The home was clean and free from odours. Hand washing facilities were in place in bedrooms, bathrooms and toilets and clinical waste was handled safely. The laundry was not inspected during this visit. Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 17 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 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitably trained and experienced staff meet the needs of the residents. EVIDENCE: A discussion with the manager, inspection of the duty rotas and comments from staff indicated that there was just the minimum amount of staff on duty during the day. During the inspection we saw that the residents needs were being met but this was down to the hard work of the staff. The staff was kept very busy throughout the day. Management should keep the staffing levels constantly under review to ensure that the home is staffed according to the dependency and needs of the residents and not according to the number of residents in the home. Inspection of the duty rotas showed that the manager does not write down the hours that she works. She was strongly advised to do this so that people will know when she is available. It was also noted that the full names of the occasional/bank staff were not written down. So that there is an accurate record of exactly who is, or was, in the home at any one time and therefore accountable, their full names should be on the duty rota. The information received from the AQAA document showed that management provide a staff induction programme for all newly employed staff. This is to Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 18 make sure that they understand what is expected of them and that people are cared for properly and safely. The information from the AQAA also showed that 50 of the staff had obtained their NVQ level 2 in care. This is good progress. Information from the AQAA and the previous inspection report showed that the staff were properly and safely recruited. This helps protect residents from being cared for by unsuitable people. Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 19 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 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and practices ensure the safety and wellbeing of the residents. EVIDENCE: The manager is a Registered General Nurse (RGN) and has a lot of experience working within the private sector. She has been the manager of the home for several years and has also obtained the Registered Managers Award. She keeps herself updated by attending various courses. On the day of the inspection she was not present in the home when we first arrived, as she was on a training course. Although it was not necessary that she did so, the manager left the training course to return to the home so that she could be involved in the inspection visit. Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 20 Information from the previous inspection report showed that the company has its own Quality Assurance system in place. The Manager has to do a monthly check of lots of things in the home. She has to check the records about care, medicines and any accidents that have happened. Comment cards are also sent out to residents and their relatives every 6 months asking what they think about the care and services provided. Management also holds regular meetings with the residents, their relatives and staff. The systems for the safekeeping of residents’ money were looked at in detail. They were very safe and protected the financial interests of the residents. Individual computer records are made of all transactions and balances, and only the administrator and manager have access to the money. The administrator has a system for managing any money deposited by relatives. This is known as their personal allowance. Relatives are given receipts for any money deposited and this information is entered into the computer system. Receipts are held for any purchases made and the information about purchases is also entered into the computer records. When the money deposited reaches a certain amount it is then deposited into a residents’ bank account. There is also a good system in place for receiving and recording the “petty cash”. Whenever anything is spent it goes on to the computer records. Only the administrator and manager have access to this money although some money is made available but secure, for the qualified nurses to use for “out of hours” emergencies. Information from the AQAA and the last inspection report showed that the home is safely maintained and fire precautions tests are undertaken on a weekly basis. Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 21 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 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 x x 3 3 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 3 x 3 x x 3 Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement To ensure peoples medicines are safely administered as prescribed; medicines records need to be accurately maintained and, the ordering procedures such that medicines do not ‘run out’. Timescale for action 07/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP8 OP9 Good Practice Recommendations The staff member responsible for continence assessments should have formal training from the specialist continence nurse. To help ensure enough time is left between doses of the same medicine the times that the medicines rounds are carried out should be monitored and arrangements changed if needed. The staffing levels should be kept continually under review to ensure that the home is staffed according to the dependency and needs of the residents. DS0000005694.V360549.R01.S.doc Version 5.2 Page 23 3. OP27 Richmond House Richmond House DS0000005694.V360549.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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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