Care Home: Riverside House

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What the care home does well There is a Statement of Purpose and resident guide, both of which provide information about the facilities on offer at this service. These documents are on display in the hall and a copy of the last inspection report is available for anyone who wishes to read it. The information contained in these documents is such that an informed choice about whether or not to move in can easily be made. Copies in different formats can also be supplied to meet differing needs of those wishing to move into the home. Any prospective resident is fully assessed prior to a place being offered. The manager is always mindful of the needs of those already living in Riverside House when the assessments are carried out and there is a trial period before the placement is made permanent. This is seen as a safeguard to all concerned. All those using this service have a full plan of care that is generated from the initial assessment of needs. These are updated regularly to meet any changing needs. Medication records are kept in an appropriate way ensuring the safety of those living in the home. Recreational activities are provided for those wishing to join in and a varied nutritious diet is provided. Environmental standards within the home have improved ensuring the home is safe, warm and comfortable. There is an experienced and well-trained staff team providing a good level of care and support. The recruitment policy means that those using this service are safeguarded at all times. Staff training is in place with training courses currently being organised by the manager. The manager is ensuring that the staff that support those living in the intermediate care unit are seen as an integral part of the staff team. What has improved since the last inspection? There have been improvements to the environmental standards with new carpet purchased for lounges, corridors and bedrooms. New carpet has also been laid in the intermediate care unit. Internal decoration has been completed in bedrooms and on corridors. Staff training is being brought up to date and three members of the night staff have started their National Vocational Qualification (NVQ) in social care. What the care home could do better: There were no requirements made and only 2 recommendations made as a result of this inspection. We are confident that the manager will carry on with the improvements already put in place and continue to provide the positive level of care and support already given. CARE HOMES FOR OLDER PEOPLE Riverside House Wattsfield Road Kendal Cumbria LA9 5JL Lead Inspector Mrs Margaret Drury Key Unannounced Inspection 1st May 2008 10:15 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 Riverside House DS0000036514.V361039.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. Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Riverside House Address Wattsfield Road Kendal Cumbria LA9 5JL 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) 01539 773090 01539 773512 www.cumbriacare.org.uk Cumbria Care Care Home 34 Category(ies) of Dementia (34), Old age, not falling within any registration, with number other category (34) of places Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 34) Dementia - Code DE (maximum number of places: 34) The maximum number of service users who can be accommodated is: 34 Date of last inspection 24th July 2007 Brief Description of the Service: Riverside House is a purpose built home registered to provide care and accommodation for up to 34 older people, 11 of whom may have various forms of dementia. The home is situated in a residential area on the outskirts of Kendal approximately a mile from the town centre and general amenities. It is set back from the road overlooking the river and has its own private gardens and lawns. Riverside House is made up of four units, over three floors, served by a passenger lift. The units are named; Kentmere, Howgill, Farleton and Romney. All the bedrooms are for single occupancy. The Romney unit provides shortterm intermediate care, in partnership with Social Services and the local NHS Trust, to help people return to their own homes as soon as possible after their discharge from hospital. The home provides a statement of purpose and terms and conditions that give any prospective resident and/or their families details of the facilities on offer. There is also a copy on display in the hall. Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 5 The fees in this service range from £337.00 - £449.00 per week as at the date of the visit. There are extra charges for Chiropody, hairdressing, newspapers, toiletries and taxi fares. Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This site visit that forms part of the key inspection took place over two days in April/May and we (The Commission for Social Care Inspection - CSCI) were in the home for a total of eight hours. Information about the service was gathered in different ways: • Annual Quality Assurance Assessment document completed by the manager • Survey questionnaires returned by residents, staff and family members. • Interviews with residents, visitors and staff on the day of the visit. • Looking at any information received from other professional agencies • Details of monthly visits made by the operations manager since the last inspection. We looked at care planning documentation to ensure the level of care provided met the needs of those living in the home and a tour of the building to inspect the environmental standards was undertaken. Medication records were examined and staff training records and personnel files were also inspected. Discussions with the manager took place on the second day of the visit about the running of the home, staffing and the dependency of those living in Riverside House. What the service does well: There is a Statement of Purpose and resident guide, both of which provide information about the facilities on offer at this service. These documents are on display in the hall and a copy of the last inspection report is available for anyone who wishes to read it. The information contained in these documents is such that an informed choice about whether or not to move in can easily be made. Copies in different formats can also be supplied to meet differing needs of those wishing to move into the home. Any prospective resident is fully assessed prior to a place being offered. The manager is always mindful of the needs of those already living in Riverside House when the assessments are carried out and there is a trial period before the placement is made permanent. This is seen as a safeguard to all concerned. Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 7 All those using this service have a full plan of care that is generated from the initial assessment of needs. These are updated regularly to meet any changing needs. Medication records are kept in an appropriate way ensuring the safety of those living in the home. Recreational activities are provided for those wishing to join in and a varied nutritious diet is provided. Environmental standards within the home have improved ensuring the home is safe, warm and comfortable. There is an experienced and well-trained staff team providing a good level of care and support. The recruitment policy means that those using this service are safeguarded at all times. Staff training is in place with training courses currently being organised by the manager. The manager is ensuring that the staff that support those living in the intermediate care unit are seen as an integral part of the staff team. 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. Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All those wishing to use this service are fully assessed prior to admission. This ensures their needs are recognised and fully met. EVIDENCE: Comprehensive needs assessments are completed before anyone is admitted to Riverside House to ensure that the home is suitable and able to meet any requirements in an appropriate manner. When we were discussing the assessment procedure the manager confirmed that she always takes into account the needs of those already living in the home before finally offering accommodation. We looked at the assessments and care plans of four residents and found the documentation to be relevant and informative. This information is then used when drawing up the initial care plan after admission. Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 10 No resident is admitted without an assessment/care plan received from Social Services after which the manager meets with the prospective resident and family members if this is considered appropriate. Riverside House has a five-bed intermediate care unit that provides care and support for those discharged from hospital, wishing to return home after a short period of rehabilitation. We spoke to those staying in the unit and they told us how useful their period of support was proving. The member of staff who was on duty has worked in the unit for some time and is experienced in providing the level of support required to ensure people are able to return to their own home. Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. The standard of health and personal care people receive is based on their individual needs, with the principles of respect, dignity and privacy maintained at all times. EVIDENCE: We examined the care plans for four residents, two of whom were admitted only 3 months ago. All the care plans were up to date and relevant to the individual. They identified the assessed needs and the assistance required whilst maintaining independence as far as possible. The care plans follow Cumbria Care’s corporate format, which has recently been completely reviewed and updated to include a more person-centred approach to social and personal care. This format will mean much more input from and discussion with those using this service when the plan of care is being drawn up. The manager and Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 12 one of the supervisors have already completed the relevant training and the remaining senior staff will be completing this in the near future. The plan will be a working tool that will include an admission assessment, risk assessment and a full dietary and nutritional screening and assessment tool. The plan puts emphasis on what is important to the individual and how best their needs can be met. As new residents are admitted the new format will be used. For those already living in Riverside House information will be transferred to the new documentation via a rolling programme. All records viewed during this visit indicate that people living at the home have access to health care professionals such as doctors, community nurses, podiatrists/chiropodists, opticians and are assisted to attend hospital appointments where necessary. It is difficult to locate dental treatment for any new residents but any treatment required is provided by the local hospital. There is a medication policy and procedure in place at the home. Staff have received training in safe handling of medication to help ensure that this is administered safely. We looked at a sample of medication records and found them to be correctly and neatly completed. All medication is stored correctly and any controlled drugs are recorded in the appropriate way. The manager conducts regular checks on the records and, will in future ensure these check are recorded. There have, in the past, been some medication errors but the manager has now put in place measures to ensure these are kept to an absolute minimum. During the visit we observed the way that staff interacted with those living in the home. There was a warm and friendly atmosphere and the staff were heard to laugh and joke with the residents in a respectful manner whilst still preserving their dignity. We spoke to residents and family members during the visit and heard comments such as, “ The staff are marvellous” (resident and daughter), “ I am always made very welcome” (visitor), “I love it here and settled down right away” and “Janet (manager) is wonderful”. (Resident) Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. Routines are sufficiently flexible to meet changing needs and some activities are available for those wishing to participate. EVIDENCE: We discussed with the manager, supervisor and care staff the activities arranged for those living in the home. Although there is no organised programme as such the staff do all they can to encourage residents to take part in whatever is organised for them. All are given the choice and those we spoke to during the visit said there was usually something going on for them to join in. One lady likes to play scrabble but complained that no one would play with her. The manager purchased the game and arranged for one of the senior pupils to come from Serburgh School to play with her each week. Quizzes are very popular and there are dominoes and bingo also available. Some residents have made particular friends and visit each other in their rooms. We were able to speak to two ladies who were admitted from the same hospital ward on the same day who have become firm friends. Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 14 The new care planning format places emphasis on information about the lifestyle of those living in the home, which will make it easier to tailor the activities to individual needs and skills. Independence is encouraged at all times and there are aids and adaptations around the home to assist with mobility. Visitors are encouraged and welcomed at any time. We were able to speak with one lady who was visiting her mother. Her comments included, “ I am always made very welcome and I visit on most days”, “The staff are marvellous” and “ Janet (manager) is wonderful”. All the residents we spoke to during the visit were extremely complimentary about the cook and the meals they received. One lady said, “We can always tell when our own cook is on her day off or on holiday”. We spoke at length to the cook discussing the menus and the likes and dislikes of those living in the home. It was obvious that she knew the residents very well and went out of her way to produce meals they all enjoyed. The menus were nutritious and the meals we observed looked appealing and were served in a relaxed manner. The kitchen area was clean and all the required records were kept and up to date. Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place with ‘protection of adults’ training provided. This helps to demonstrate that people are protected as much as possible from harm or abuse. EVIDENCE: Riverside House has a complaints procedure in place and all concerns and/or complaints are recorded and dealt with within the stated timescale. We were able to confirm this by checking the written records. The residents and visitors we spoke with during the visit all confirmed that they knew who to speak to but had not had reason to complain about anything. We (CSCI) have not received any complaints since the last inspection. Riverside House uses the corporate policy to deal with a suspicion or allegation of abuse. We spoke to members of staff who were fully aware of the procedure to follow if there was any suspicion or allegation, although one said she had not received any further training since her induction. They were confident in the process and would not hesitate in speaking to the manager or supervisor if it was necessary. Three members of staff were to attend a training course in this subject shortly and we were shown details of the date of attendance. The home has a copy of Cumbria council’s guidance available for staff to read. Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 16 Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 17 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): Standards 19, 20, 23, 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 home is clean, hygienic and reasonably well maintained, helping to ensure that people live and work in a safe and comfortable environment. EVIDENCE: Riverside House is a purpose built home set over three floors with access to the upper levels via a passenger lift. On the ground floor is an intermediate care unit providing rehabilitation and support to allow people to return home after a spell in hospital. A tour of the building took place to look at the environmental standards and the home was found to be clean and hygienic throughout. All the rooms are for single occupancy and although some are small the residents we spoke to were all pleased with their own rooms, particularly if they overlooked the river at the Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 18 front of the building. All rooms were personal to each resident with personal possessions and small items of furniture brought from home if space allowed. During the visit we were able to speak to the Estates Manager who discussed with us the work already completed since the last inspection. New carpets have been laid to some of the bedrooms, corridors and rehabilitation unit. The lounge on the ground floor has been decorated and some of the corridors have been painted. Cumbria Care has had financial restrictions in the past but money has been made available to cover the cost of the environmental improvements to the home. The Estates Manager confirmed that he would like to do more but he has to work within the budget of a large organisation that has many claims on its finances. Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 19 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): Standards 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. The staff team have been correctly recruited and have the necessary skills and experience to provide a good standard of care to older people. EVIDENCE: The staffing levels and the rotas were checked and generally found to be adequate. There are, however, vacancies for care staff in particular at the weekend. Agency staff are used to ensure staffing levels remain at the appropriate level to meet the assessed needs. Discussions with the manager confirmed that she has applied to the human resources department at head office for adverts to be placed to recruit the necessary staff to bring the numbers up to a full complement. We observed, during our visit, the interaction between staff and residents and staff and visitors. We found there to be a caring, sensitive, dignified and respectful approach at all times, with residents responding positively to the members of the care team. Comments from residents about the staff included, “the staff are wonderful and so caring”, “the girls are great” and “all the staff are marvellous”. There is a thorough recruitment process in place, with staff files containing evidence that all legal checks had been carried out with staff only employed on the satisfactory completion of these checks. References are obtained prior to Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 20 employment starting thereby helping to ensure that those living in the home are protected and safeguarded by the robust recruitment and selection process. There is a training programme in place but as the home has been without a registered manager for some considerable time the records were not completely up to date. The manager was, however, able to confirm that training had been completed in the following disciplines, palliative care, moving and handling and the medication policy. Three members of night staff have started their National Vocational Qualification (NVQ) in social care and three other members of staff are booked to attend adult protection training in May of this year. Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 21 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, 32, 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 ensuring as much as possible that those living in the home are safe and receive good quality care. EVIDENCE: The manager was appointed to Riverside House in August of last year having previously worked as a manager in another Cumbria Care Home. She is currently awaiting registration with CSCI. She has completed the registered manager award and is working towards her NVQ level 4 in care. She is very experienced in the care of older people and is committed to ensuring those living in the home are provided with the highest possible standard of care. Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 22 In discussion with staff and residents there was the general feeling that she is approachable and fair. She has a high profile in the home and makes sure she speaks to every resident whenever she is on duty. The supervisors on duty during the visit told us how they appreciated all she has done since taking up her post and the support she has given to staff and residents. A comment made by one of the visitors was “ Janet is wonderful and you can speak to her at any time, she is never too busy”. She has a warm and open style of management that is appreciated by those who live and work in Riverside House. Riverside House does hold personal monies on behalf of some of the people who live there and the records were checked during the visit. There are procedures in place and the records were appropriately and adequately kept. All income and expenditure is recorded and signed by 2 members of staff with a monthly audit completed. Receipts for all expenses are held for each individual resident. All equipment is serviced via annual service level agreements and staff training is in place on respect of fire safety. The organisation’s health and safety officer completes an annual audit highlighting any work to be completed. All risk assessments are in place, which demonstrates the health and safety of those living and working in the home are always under review. Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X x 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP27 Good Practice Recommendations It is recommended that consideration be given to staffing numbers throughout the home and to filling the vacancies as soon as possible It is recommended that the medication audits completed by the manager are recorded as a further safeguard. 2 OP9 Riverside House DS0000036514.V361039.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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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