Care Home: Seddon Court Elderly Persons Home

What the care home does well Seddon Court provides a good and safe service for people with dementia although some improvements are required to maintain this standard. All people living in the home who were spoken to were happy with their care with comments such as "very nice people" and "look after me all right". This was confirmed by contact with families with typical comments being "very happy" and "I am very pleased with the care". The home has a full range of policies and procedures to underpin practice and has a very experienced and well qualified workforce to care for people living there. After a period of disruption, the management arrangements have been stabalised as has the workforce allowing for a greater amount of continuity in the care provided. The premises are adequate for their purpose and the home provides a good quality food. Care is based on an individualised approach resulting in a personalised service and care plans to meet specific needs. What has improved since the last inspection? Since the last inspection, the number of training opportunities have been increased for staff. Practice in the area of medication has been improved to promote good practice. Risk assessments are now up to date to ensure the safety of people living there. The home now receives full assessment material on which to base its work and make it more relevant. There has been increased communication with families so that they feel more informed about events surrounding the home and their relatives. What the care home could do better: The home provides care plans but these should be reviewed more regularly, with greater detail, so that they remain up to date. Care workers continue to engage people who live in the home in activities but this would be improved by more specialist activity staff to address this more thoroughly. The home is adequate for its purpose but is showing signs of wear and tear which should be addressed to improve living conditions for the people living there. The premises are safe but this would be enhanced by an up to date health and safety audit of them. Involvement of families has been increased and some elements of quality assurance are in place but this needs to be widened to provide a structure for increasing improvement to the home. There is good management of the home but this needs to be formalised through the registration of a manager with us and we need to be notified of any relevant matter to monitor the performance of the home. Training has been improved but this needs to be formalised into a training plan to ensure that all staff are regularly refreshed in the required subjects, including medication, and so remain up to date. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Seddon Court Elderly Persons Home Prescot Road St Helens Merseyside WA10 3UU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: John Mullen     Date: 0 8 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Seddon Court Elderly Persons Home Prescot Road St Helens Merseyside WA10 3UU 01744677515 01744677517 jimphilbin@sthelens.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): St Helens Metropolitan Borough Council Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 30 Number of places (if applicable): Under 65 Over 65 30 dementia Additional conditions: 0 Service users to include up to a maximum of 30 DE(E). The Service may accommodate up to a maximum of 2 service users aged 60 years and over. Date of last inspection Brief description of the care home Seddon Court is a thirty-bedded home for the accommodation and care of older people with dementia. It is owned and managed by St Helens Council. The position of registered manager is currently vacant although there is an acting manager in place who is to make application for registration. The home has twenty-seven permanent beds and three respite ones. Seddon Court is divided into three units of ten, although people who live in the home can and do move between units freely. The home does not provide nursing care but calls upon the community nursing services when necessary. The fees charged range from 44.38 per week to 773.00 per week depending on an assessment of the financial means of people who use the service. Care Homes for Older People Page 4 of 27 Brief description of the care home The premises are purpose-built and were opened in 1988. The area used by residents occupies the ground floor. Here, in addition to the residents units, is located a kitchen, laundry and hairdressing room as well as office accommodation. The first floor is used exclusively by staff and contains a meeting room as well as sleeping-in accommodation. All bedrooms are for single occupancy. The home has a very pleasant communal area as well as a garden facility extensively used by both residents and their families. Appropriate aids and adaptations assist disabled residents manage the premises and the home has a full call system in place. Seddon Court is located within close reach of local facilities and can be easily visited via public transport. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means that people who use the service experience good quality outcomes. This was a key unannounced inspection of Seddon Court Care home which included a visit to the service. All key standards were assessed in addition to a selection of other standards. This inspection encompassed information received since the last inspection including an Annual Service Review on 19th June 2008. In addition it included information provided by the agency through its Annual Quality Assurance Assessment document (AQAA). The AQAA gives information on the overall performance of the agency as well as Care Homes for Older People Page 6 of 27 factual information about the service. Interviews took place with the acting manager, two assistant managers, a cook, a member of the domestic staff and three care workers. Four people living in the home were case tracked; that is their support was examined in detail including interviews with them and contact with two of their family members. In addition other people living in the home were observed and spoken to during a tour of the premises. Comment cards were also sent to a selection of family members. The premises were inspected and a large amount of documentation examined. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 27 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home bases its work on full information so that the care is appropriate. Evidence: An interview with the acting manager confirmed that there has been an improvement to newer admissions with the involvement of the Review and Support Team resulting in more detailed information on which to base the work. This was confirmed by interviews with two assistant managers who felt that, generally, there had been an improvement in the information available on people living in the home, including those receiving respite care, so that staff are better informed. An examination of a selection of service user files confirmed that this was the case with, in all cases, assessment material present to direct staff. With recent admissions, there was very detailed background material to give full information on the needs of users of the service. Staff interviewed felt that they were well informed about the needs of service users so that they could work in a positive and appropriate manner. Care Homes for Older People Page 11 of 27 Evidence: The home does not provide intermediate care and therefore, this standard was not assessed. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a good standard of personal care based on an individualised approach underpinned by good practice. Evidence: Interviews with managers confirmed that the plans for people who live in the home were in place to direct staff and that they were being reviewed in detail on a six monthly basis and in summary on a monthly basis, to confirm relevance. An examination of care plans in the home found that this was generally the case although there were some shortfalls in the monthly review which detracted from the process. Interviews with staff found them positive about the care planning process which they felt gave them good direction in the work to be undertaken. The AQAA confirmed that the home continued to meet the health needs of people living there both in terms of their physical and mental needs, so that they are fully met. Interviews with assistant managers showed that there was a positive relationship in the home with the general practitioner service, the psychogeriatric service and other Care Homes for Older People Page 13 of 27 Evidence: providers of healthcare provision so that all needs are met. No concern was expressed by them or by care workers about their access to services in this area. An examination of the files of people who live in the home found that for permanent users of the service there was a separate file for each, recording their contact with medical services so that there is a complete record kept. Contact with with people who use the service and their families revealed no concern about the access to healthcare provision by the home. Interviews with the acting manager and two assistant managers showed that there had been an increase in the monitoring of medication taken in the home to meet previously identified shortfalls. The home has a full medication policy and proper facilities for the safe storage of medicines. An examination of the medication sheets of those people who live in the home who were case tracked showed, that with one exception, the sheets had been correctly completed to confirm safe practice. The managers confirmed that medication training has been recently arranged for some staff to update knowledge. Training documents seen and interviews with staff found that approximately 50 had received such training to improve practice. The AQAA showed that a high proportion of staff have had vocational training so that practice can be underpinned by good principles. Interviews with people living in the home found them happy with the care they are receiving with comments such as they look after me all right and very nice people. Family members were very happy with the quality of care their relatives were receiving. One commented on the improvement in her mother since she was admitted to the home. Observations during the visit to the home found a friendly and pleasant atmosphere which reflected the good relationships seen between staff and people living there. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home attempts to provide a varied and appropriate lifestyle for people living there. Evidence: There has been concerns expressed by relatives in the past about the lack of activities in the home to occupy people living there. An interview with the acting manager confirmed that the home attempts to occupy service users on the units so that they are pleasantly diverted. A tour of the premises found that people living there were primarily enjoying music, which they seemed to appreciate. In addition, the home provides set activities although staff interviewed felt they were limited in effect. Care workers interviewed felt that they had difficulty in combining the roles of personal carer and activity provider meaning that the latter was less effective. Both the managers and care workers regretted the absence of specialist activity staff so that this matter could be addressed more fully. A tour of the premises did not find activities to be recorded or publicised which confirmed that they are being managed in an informal manner. A tour of the premises confirmed that there is an open visiting policy and this is publicised within the home for relatives information. The AQAA stated that the home Care Homes for Older People Page 15 of 27 Evidence: was attempting to involve families more in the review of cases and this was confirmed by contact with the latter who felt that communication has been improved in the recent past. On the day of the visit to the service service users were seeing relatives in pleasant surroundings which helped the process of visiting. The nature of illness of people living in the home invariably means that their ability to exercise autonomy and choice is limited. However, the AQAA clearly stated that the home attempts to promote these values within a safe context, so that individual choices are respected. Interviews with managers, confirmed by care workers, showed that the individual likes and dislikes of many people living there are well known and are acted upon accordingly. A tour of the premises found people living there smartly and individually dressed and freely able to express their opinions about their preferences and choices. An interview with a cook showed that the home is providing a nutritious diet based on good practice. It further showed that alternatives are available if requested so that individual preferences can be met. The cook could demonstrate that the home could meet individual needs including those of a Muslim resident whose food needs were met by the cook acquiring literature on the subject and consulting with his family. Those service users expressing opinions about the food were positive about the quality. The observation of a lunchtime meal found it pleasant and relaxed, and in which people participating in appeared to enjoy. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home protects people accommodated through appropriate policies and procedures. Evidence: The AQAA stated that the Service User Guide has been given to all users of the service and families which contains the complaints procedure so that this information is easily available. The AQAA also stated that there had been no complaint and this was confirmed by a review of evidence which revealed no issue has been brought to our attention. The complaints book confirmed the lack of any recent complaint but also showed that this was regularly monitored by the service manager to ensure that any matter has been dealt with appropriately. The AQAA showed that there had been three safeguarding issues dealt with by the home over the last twelve months. An interview with managers showed that only one directly related to the home and this is currently being investigated in terms of established procedures. However, an interview with the acting manager revealed that this has not been notified to us as required, to ensure that matters are dealt with correctly. The home has a full and appropriate safeguarding policy which is in accordance with good practice. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is increasingly showing the effects of wear and tear resulting in a detraction in its appearance. Evidence: Seddon Court was opened in 1988 and, although it was a modern facility at that time, it is now showing signs of wear and tear as a result of its age. The Annual Service Review held on 19th June 2008 was essentially favourable to the home but some families did describe the decor as tired. The AQAA also commented on the need for a more effective repair schedule to maintain standards. A tour of the premises found it remains fit for purpose with pleasant living areas and adequate bedrooms. It did however also show a need for a programme of planned maintenance and redecoration to maintain and improve the living conditions. A review of evidence revealed a letter from the service manager on 11th November 2008 which revealed that St Helens Council is considering the redesign of the home to include short breaks, day support and provision for early onset dementia, which will require extensive changes to the premises. However, a date for this has not been set which means that there is some uncertainly about the present situation. Managers interviewed felt that this could have some bearing on the unwillingness of the council to commit money to the upkeep of the premises. There remains a need to establish a refurbishment programme to maintain standards in the interim period. Care Homes for Older People Page 18 of 27 Evidence: A tour of the premises found the home to be clean and hygienic in appearance. The home employs nine domestic staff, which, according to staff, is sufficient to maintain standards. One member of the domestic staff spoken to confirmed that the work has become more difficult as a result of the increasing disabilities of people living in the home but also confirmed that they are able to maintain standards. A tour of the premises found they were fully equipped to assist in maintaining the cleanliness of the home, including a fully equipped laundry. Care workers spoken to confirmed that the cleanliness found on the day of the visit to the home was normal and reflected the good standards kept in the home. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Both in terms of numbers and experience, the home has sufficient staff. Evidence: An interview with the acting manager confirmed that the home is now fully staffed and has a more settled workforce following a period of change. Interviews with care workers confirmed they were highly experienced in their work and generally positive about the home although some felt the work was harder as a result of deterioration in the physical and mental condition of people living in the home. The AQAA confirmed a high level of trained members of the care staff and this was confirmed by interviews, thus providing a sound foundation for the delivery of care. Observations during the visit to the home confirmed that an appropriate number of staff were on duty, both in the area of care, domiciliary and ancillary support, allowing the home to fulfill its purpose. The interviews with managers showed that there had been no outside recruitment to this home for a number of years which meant that recruitment policies have not been tested recently. All recent appointments have been a result of the internal transfer of staff which did not necessitate use of the full procedures. The AQAA however did confirm that full and correct policies and procedures are in place when necessary to ensure the correct appointment of staff. Very little recruitment material is kept at the Care Homes for Older People Page 20 of 27 Evidence: home but is stored centrally for the easier access to information. All previous contacts with St Helens Council have revealed no concern in the recruitment and selection procedures which meant that no matter has been referred to us in this area. The acting manager showed that she has taken steps to arrange extra training for staff to meet deficits in the process. In addition, she is reorganising the recording of training to show a clearer picture of what has been achieved. Documents seen during the visit to the home included one from an assistant manager who has identified the training needs of his staff through the appraisal process. However, this process is not universal and is at present dispersed so that an overall picture of training needs and plans to meet them is not easily available. Interviews with care workers felt that training opportunities had generally increased in the recent past although this was not a universal view, confirming the lack of consistency in this area. This was confirmed by training documents seen which showed a strong variation in the training given to staff. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Seddon Court is well managed to produce a safe environment for people living there. Evidence: Since the last inspection the registered manager has been seconded to another post in the council and this has now become permanent, meaning that that the post of registered manager is now vacant. A review of evidence confirmed that we were informed of this and of the appointment of an acting manager in May 2008. An interview with the acting manager confirmed that she has good experience in this field and has acquired the relevant qualifications to undertake this role. However, she has not yet applied to be registered with us which is necessary to meet legal requirements. The interview confirmed her positive and appropriate approach to her post and that she has made improvements to enhance the performance of the home. Interviews with other managers and care workers all revealed confidence in the manner in which the home is being managed. Care Homes for Older People Page 22 of 27 Evidence: The AQAA confirmed that the home is attempting to involve families more, although it also stated that this was not entirely successful given the reluctance of some to become involved. Contract with families confirmed that there has been an increased attempt to involve them in the home, particularly through attendance at reviews. However, an interview with the acting manager confirmed that there is a lack of an overall quality assurance method by which the home can measure its performance and improve its service. A review of evidence since the last inspection, including the Annual Service Review, found no concern in the area of the management of service users monies thus confirming a safe service. The managers reported that due to the illness of people accommodated in the home, their finances are managed either by their families or by the council. An examination of the financial records for those service users case tracked confirmed that individual accounts are kept with full recording to ensure a clear audit trail is maintained. Interviews with managers confirmed there was a clear supervision policy in place so that staff can be directed in their work. This was confirmed by interviews with care workers who felt that they were well supported in their work, including through supervision and appraisal, so that they can obtain help when required. An examination of staff records confirm supervisions and appraisals of staff are taking place at an increased interval to confirm improved practice in this area. A tour of the premises found the home a safe environment for the accommodation of people using the service. Documents seen during the visit to the home showed that there is a regular check on the safety of utilities and that water temperatures are being maintained at the right level. The home undertakes a health and safety audit, although this needs to be repeated to ensure that it is up to date. Training records seen confirmed that staff are being trained in appropriate subjects including a high level in the prevention and control of infection to maintain standards in this area. Interviews with managers confirmed that they have a strong commitment to maintaining Seddon Court as a safe environment for the care of people living there. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 37 Any matter of concern must be referred us. So that monitoring of these matters is complete. 03/08/2009 2 31 18 A training plan needs to be compiled. So that training can be structured more effectively. 01/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 7 12 The monthly reviews of care plans should be more detailed and more up to date to reflect the current situation. The home should consider providing specialist activity staff so that a more structure approach to activities can be arranged. A programme of refurbishment is required to maintain the standards of the home. An application for registered manager is required to ensure that this post is filled as required. A full quality assurance system needs to be developed so Page 25 of 27 3 4 5 19 31 33 Care Homes for Older People that the home can demonstrate its commitment to continuing improvement. 6 38 The health and safety audit needs to be repeated to further ensure that all relevant matters are being attended to. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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