Care Home: Rockingham Road

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What the care home does well The home gives the residents a clean and well -maintained home to live in. The staff are very caring and committed to the care of the service users. The staff are very well trained to look after the service user group.There is a very good admission process to make sure that the service users needs are known and that they can be provided by the home. What has improved since the last inspection? This was the first `key ` inspection of a new service. What the care home could do better: Consideration should be given to those service users with a challenging behaviour to improve their lifestyle and reduce the effect on the other service users by the time that the staff need to give to them. Occupations and activities should be found which reflect the needs of the individual service user, to make sure that they have the best possible quality of life. Consideration could be made to reduce the isolation of the service users in the coach house. The environment should be made more homely and welcoming to make sure that the service users and visitors are comfortable using it. The service users should be helped to make their bedrooms more personal and to reflect their interests. Staffing levels should be reviewed to make sure that all the service users are able to receive the amount of time that they need. CARE HOME ADULTS 18-65 Rockingham Road Rockingham Road Corby Northamptonshire NN17 1EB Lead Inspector Thea Richards Unannounced Inspection 20th August 2007 04:00 Rockingham Road DS0000069757.V340707.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 Rockingham Road DS0000069757.V340707.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. Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rockingham Road Address Rockingham Road Corby Northamptonshire NN17 1EB 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) Voyage Ltd Martin Hirst Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. No person to be admitted to Rockingham Road (Main House) within the category of LD when there are are 12 persons in total already accommodated within that category. No person to be admitted to Rockingham Road (The Coach House) within the category of LD when there are are 4 persons in total already accommodated within that category. The maximum number of persons to be accommodated within Rockingham Road is 16. New Service Date of last inspection Brief Description of the Service: Rockingham Road is a purpose built home divided into two areas, the main home has twelve bedrooms and the coach house has four self -contained flats. It is a home providing personal care and accommodation for 16 people with a learning disability. The Registered Providers Voyage Ltd, who have many care homes catering for people with a learning disability, owns the home. The main house is designed in two wings, each with a lounge, kitchen/dining room, a sensory room and six bedrooms with en-suite facilities. The coach house has four self-contained flats, each with a large kitchen/dining/lounge area and a bedroom and a bathroom. The ground floor flats have access to an individual patio area. There is a well- maintained garden, with tables and chairs, which is easily accessible for the service users in the main home. The home is situated on the outskirts of Corby, within reach of local shops and other facilities. It is easily accessible by car or public transport and there is parking available in the grounds. The current registration certificate from the Commission for Social Care Inspection is displayed in the reception area. The home can be contacted by telephone or email. The level of fees is individually assessed and currently ranges from £1800.00 Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 5 to £2000.00 pw. There are extra charges for hairdressing, chiropody, newspapers and personal items. Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection of a care home for people with a learning disability, which ended with an unannounced visit to the service. Before the visit the inspector spent five hours reviewing information received by the Commission for Social Care Inspection (CSCI) since the homes’ registration on the 30th March 2007. The visit took place on the 20th August 2007 and lasted five and a half hours. During the visit the inspector checked all the ‘key’ standards as identified in the National Minimum Standards. This was achieved through a method called ‘case tracking’. Case tracking means that the inspector looked at the care provided to two of the service users. To achieve this, the service users were spoken with. The inspector spoke with the staff supporting their care and looked at the records relating to their health and welfare. With their permission the service users’ bedrooms were looked at. The inspector also checked how the home was run and organised. This included looking at staff records, training and how the staff are organised. The inspector looked at health and safety records, menus, minutes of meetings and the quality audit. The policy for handling complaints and how the home dealt with them were looked at. The inspector looked at how prospective service users and their families are given information about the services the home can offer and whether they are suitable for them. During the visit the inspector spoke with the deputy manager, staff and the service users. What the service does well: The home gives the residents a clean and well -maintained home to live in. The staff are very caring and committed to the care of the service users. The staff are very well trained to look after the service user group. Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 7 There is a very good admission process to make sure that the service users needs are known and that they can be provided by the home. 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. Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 8 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 Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 9 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, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users’ needs are assessed before moving into the home by a preadmission assessment, visits to the service user and by visits to the service. This makes sure that the service users and their families know that this will be the right home for them. EVIDENCE: The care plans looked at confirmed that the service users had received a Statement of Purpose and a Service Users guide. The Statement of Purpose and Service Users’ Guide provide all of the information about the services offered and the Terms and Conditions in the home. Providing a thorough Statement of Purpose and Service Users’ Guide gives good information for the service users, making sure that they can get the most suitable care. This information can be provided in different formats such as large print or symbols. Completed assessments were present in the files, identifying the service users’ care needs, before they were admitted to the home. Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 10 There is a good process in place to make sure that the service users needs can be met and that the staff are aware of all of them. Where possible, this includes visits to the home by the service user and their families and 24 hour visits to the service user by a senior member of staff and the peson who will be their ‘keyworker’. Care plans showed that they contained the needs of the service user which had been shown in the original assessment. The current registration certificate from the Commission for Social Care Inspection (CSCI), and up to date details of insurance cover were displayed in the reception area. This makes sure that prospective service users know that the home is registered to look after their needs. Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 11 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, 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff make sure that the service users have activities both inside and outside the home. There is little evidence present to make sure that they are making their own decisions about activity and occupation. EVIDENCE: The care plans looked at all showed the individual needs of the service users for personal care, health care and daily routines. There was limited information about the activities that the service users were taking part in. It was explained that the service users had not been in the home for very long and a complete programme of activity had not yet been arranged. This should be looked at as soon as possible to give the service users a good quality of life with occupations that suit their needs. Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 12 Consideration should be given to giving more time for each admission to make sure that there is time to put choices of activities and occupation in place. There are two sensory rooms in the home where the service users spend time, these have lights and sounds, which relax the service user and stimulate their senses. The service users are involved in choosing meals and going out with the staff to buy the food. Those in the main house were seen to be enjoying their meal at suppertime. The service users in the coach house had their meals taken across to them and did not have the social interaction that those in the main house enjoyed. There are risk assessments in place where there may be a risk to the service user, either in an activity or in the environment. This allows the staff and the service user to be aware of the possible risk and protects them whilst allowing the service user to continue with the activity. The daily records of the service users were looked at. These contained information, which confirmed that they were taking part in some activity within the home and on outings. The service users spoken with indicated that they were able to do what they wished to in their lives. The service users have regular meetings to discuss choices in the home such as activities and menus. Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 13 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, 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users enjoy some activities and interests, but are affected by the amount of time having to be given to those service users with challenging behaviour. EVIDENCE: There was evidence of some occupation and leisure activity being provided for the service users. On the day of the visit all of the service users were in the home and did not appear to be involved in any activity. One told the inspector that he had been out to the shop that morning and that he occupied himself with the guitar, with puzzles and with painting. The service users visit local shops with members of staff, they are also taken out in the homes vehicle to local woods and other attractions. Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 14 The different needs such as food likes and dislikes, religious choice and cultural differences are catered for and are documented in the careplans. The challenging needs of some of the service users means that they are isolated in their accommodation and need considerable staff time which has an effect on the service users in the main home. Consideration should be given to placing those service users in a more appropriate part of the home, which will reduce their isolation. The staffing levels should be reviewed to make sure that all the service users receive a good quality of care and adequate time, particularly as more are admitted. Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 15 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, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff meet the care needs of the service users as identified in the care plans, have good knowledge of their individual care needs, making sure that they are looked after in the right way. EVIDENCE: The care plans ‘case tracked were found to contain good individual evidence of care, which reflects that which is being given to the service user. This includes a regular assessment of the service users’ weight and their nutritional needs. There are records of the involvement of G.P.s and other health professionals present, giving evidence of thorough health care being provided for the service users. A service user spoken with said that he was happy with the health care that was provided. The daily record of care is up to date which makes sure that the service users Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 16 have the right care and the staff know what has happened to them at any time during the day or night. The home, with the service user, is developing a profile of the service users life, their wishes and what they would like to do in life. The inspector was not able to speak with any of the families as there were none visiting on the day of the visit. The care plans are written and agreed with the service users or their families. Parts of them are in an easy to read and understandable form, which makes sure that the service users, can understand the care that is being given. The service users and their families will be involved in the review of the care plans with their ‘key workers’. Key workers are members of staff who have particular responsibility and interest in an individual service user. They should make sure that they have all that they need and that they have the activities and work or education needs met. Medication records for the case tracked service users were in order. Medicines are provided by Boots chemist in ‘blister’ packs which means that the staff can give all the medicines for a particular time of day out of one pack. The deputy manager and staff spoken with were knowledgeable about the medicines and where to obtain information. They were also aware of the requirements for the receipt, storage and disposal of medicines. Medicines are stored in a locked cupboard in the home. The above makes sure that the service users are protected with the correct medicine administration. The home has a policy for service users to look after their own medicines, however there are none able to do at this time. Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 17 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): 22,23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are systems in place to support and protect service users and staff are aware of the processes. EVIDENCE: There is a complaints policy in place which gives the details of how to complain and who to complain to if the service users or their families needed to. The complaints book was looked at and there are no records of any complaints having been received since the home was registered on 30th March 2007. The Commission for Social Care Inspection has not received any complaints during this time. The deputy manager said that the complaints policy was available in an easy read format, however this was not available on the day of the visit. The company has a system of ‘complaints cards’ for people to contact head office if they have a complaint that they do not wish to discuss in the home. Service users will be given help to find an advocate to help them with any issues that they might have. The service users spoken with were happy that they would speak to the manager if they had a problem and that it would be dealt with. Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 18 The staff have all received training in safeguarding adults from abuse and are given a copy of the General Social Care Council (GSCC) codes of practice, which tells them what their responsibilities are in making sure that the service users are kept safe. The deputy manager, the staff spoken with and by the records held in the staff files, confirmed this. Personal allowances for the service users are held in the home for incidental expenses and transactions are recorded and signed for. The records seen confirmed this and were found to be in order. Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 19 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, 25, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users are protected by the policies and procedures in the home to provide a safe, clean and well maintained environment to live in, which lacks personalisation. EVIDENCE: The registration certificate from the Commission for Social Care Inspection (CSCI) and a current insurance certificate were displayed in the reception area. Rockingham Road is a new purpose built home situated on the outskirts of Corby. It is well decorated and carpeted, but as yet has not got a homely feel to it. As more service users are admitted and it is personalised, this should improve. The home was clean and well maintained throughout. Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 20 The communal bathrooms are clean and free from inappropriate items, which could present a hazard for the residents. With their permission the case tracked service user’s bedrooms were looked at by the inspector. They provided good accommodation with an en-suite bathroom with a shower. One service user’s accommodation, which was in the coach house, had been personalised with belongings which showed what interests he had. The other bedroom seen was very impersonal and only had one chair in it, which could make it difficult to have friends or family in his room. All the bedrooms either have overhead tracking, or the provision to put it in, to assist with moving the service users if it became necessary. The dining rooms and kitchens were clean and well maintained. The lounges were well decorated, but lacked a homely feel, which may improve when there are more service users in the home. There are two sensory rooms in the home which provide sight and sound stimulation for the service users. There is a large level garden outside,which is easily accessible for the service users from the main home. The service users, with challenging behaviour in the coach house, have very little access to outside space, which restricts them and increases their isolation. The staff have received training in how to use and to store chemicals and have data sheets with all this information on them. Chemicals are all stored in locked cupboards. Fire and health and safety records were in place and found to be up to date. There were no outstanding safety or maintenance issues noted on the tour of the premises. Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 21 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, 33, 34, 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are recruited with a thorough recruitment process and given the appropriate training. This makes sure that the service users receive safe care given by properly trained staff. EVIDENCE: The staff on duty on the day of the visit reflected the duty rota, however consideration should be given to reviewing the staff levels to cope with the needs of the service users. Two staff files were looked at by the inspector and the required information was complete in both of them. This included evidence of identification, adequately completed application forms, two written references and Criminal Records Bureau checks. There was evidence of staff training recorded in the files, which was confirmed by the manager and by the staff spoken with. Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 22 There was a good range of training provided in areas such as first aid, food hygiene, moving and handling and included training for the particular needs of the service users. Staff from a variety of ethnic and cultural backgrounds have been employed to be able to relate to the service users. 50 of the staff hold a National Vocational Qualificationat level 2 or above. The manager holds the registered managers award. The National Vocational Qualification is a qualification for care staff to ensure that they receive appropriate training in the needs of the service user group whom they are caring for. There was evidence of regular staff supervision taking place and was well within the frequency required by the Commission for Social Care Inspection regulations. This process gives the staff and their ‘line manager’ the opportunity to have individual discussions about work and training needs. Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 23 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, 39,42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home gives personal and individual care, in a safe environment whilst making sure that all the service users have their views heard and put in place. EVIDENCE: The deputy manager was available throughout the visit. The manager of the home has eight years experience in residential services for learning disability and is registered with the Commission for Social Care Inspection. This process makes sure that the manager is a fit person to manage the service. Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 24 He has completed the registered managers award and several courses for the specific needs of his service users. The and The had service users have regular meetings with the manager when their views areas such as meals and activities are discussed. service users spoken with said that they could always talk to him if they a problem and he would sort it out for them. The manager will give the service users and their families a quality questionnaire every year, which looks at all the areas of care and the general opinion of the home. The manager sends an information letter out every year to give families information about the home. Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 25 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 3 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 2 25 2 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 3 X X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 X 16 3 17 3 PERSONAL AND HEALTH3CARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? New service 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 2 3 4 5 6 Refer to Standard YA7 Good Practice Recommendations Consideration should be given to the service users with challenging behaviour to improve their lifestyle, whilst reducing the impact of their needs on other service users. The service users should be helped to find activities and occupations, to improve their quality of life. Consideration should be made to reduce the isolation of those service users with a challenging behaviour. Efforts should be made to make the premises into a comfortable and homely environment for the service users. The service users should be helped to personalise their Bedrooms to reflect their interests and personalities. The staff numbers should be reviewed to provide sufficient hours for all the service users to have the time that they need. YA12 YA16 YA24 YA25 YA33 Rockingham Road DS0000069757.V340707.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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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