Care Home: Shirebrook Lodge

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What the care home does well Information relating Shirebrook Lodge is contained within a Service Users Guide (SUG) and residents have their own copy. A pre-admittance assessment process is performed to make sure the needs of potential residents can be identified and met. Residents assessed needs and personal goals are reflected in individual plans. Residents are encouraged to make decisions about their lives and supported to take risks as part of an independent lifestyle and can participate in a range of social activities. Resident`s rights and responsibilities are upheld and they can maintain contact with their family and friends. A well-balanced menu is provided and residents are encouraged to be actively involved in the selection and preparation of meals. Resident`s health and personal care support is of a good standard. Medicine management is safe. The home is comfortable, safe and very clean and hygienic. Competent staff support residents and recruitment practices are effective in promoting safety. The Home is well run and the health, safety and well being of the residents is promoted. What has improved since the last inspection? This is the first unannounced inspection since Shirebrook Lodge registered with CSCI in April 2007. What the care home could do better: The registered provider could keep under review and, where appropriate, revise the Statement of Purpose and the Service User`s Guide to include correct information in relation to the manager at the home. The registered provider could register a manager for the care home with CSCI and could give notice to CSCI of the name of the person appointed which will include the date on which the appointment is to take effect. CARE HOME ADULTS 18-65 Shirebrook Lodge 2 Sandown Road Sutton in Ashfield Nottinghamshire NG17 4LW Lead Inspector Steve Keeling Unannounced Inspection 3rd July 2007 09:00 Shirebrook Lodge DS0000068265.V340676.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 Shirebrook Lodge DS0000068265.V340676.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. Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shirebrook Lodge Address 2 Sandown Road Sutton in Ashfield Nottinghamshire NG17 4LW 01623 442333 01623 442777 shirebrooklodge@shirebrookcaregroup.co.uk 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) Shirebrook Care Limited Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Shirebrook Care Limited is registered to provide accommodation and personal care to service users whose primary care needs fall within the following category Learning Disability (LD) The maximum number of persons to be accommodated at Shirebrook Lodge care home is 6. This is the first inspection since registration. Date of last inspection Brief Description of the Service: Shirebrook Lodge is a two storey building that has been adapted from two houses to create a residential home for six persons with mild to severe learning disabilities. The home is situated in a quiet residential area close to the town centre of Sutton in Ashfield, which provides a variety of shops and recreational facilities. The first floor has six single bedrooms, all with en-suite facilities and a larger bathroom is located on the ground floor. The home is not equipped with a passenger lift to access the first floor of the building and people with restricted mobility are not accommodated at the home. There is a large well-equipped kitchen area, dining room, two lounge areas and a laundry facility on the ground floor. A large secure garden and patio area is located at the back of the building. The registered provider makes a Statement of Purpose and Service Users Guide available to all residents or their representatives, which provides information relating to the facilities at the home. The fees currently charged at the home are £1800 per week with no additional charges. Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. One inspector conducted the unannounced visit. The main method of inspection used was called ‘case tracking’ which involved selecting one resident and looking at the quality of the care he received by speaking to him, observation, reading his records and asking staff about the residents needs. The acting manager and one member of staff were spoken to as part of this inspection. Documents were read as part of this visit and medication management was inspected to form an opinion about the health and safety of residents at the home. A partial tour of the building was undertaken which included a sample of bedrooms to make sure that the environment is safe and homely. Information received from the resident in response to a pre-inspection questionnaire was also used to determine the outcome of this visit As part of the inspection process the registration certificate was reviewed with acting manager. Details relating to the registered manager were incorrect and the centralised registration team at CSCI will issue a new certificate. What the service does well: Information relating Shirebrook Lodge is contained within a Service Users Guide (SUG) and residents have their own copy. A pre-admittance assessment process is performed to make sure the needs of potential residents can be identified and met. Residents assessed needs and personal goals are reflected in individual plans. Residents are encouraged to make decisions about their lives and supported to take risks as part of an independent lifestyle and can participate in a range of social activities. Resident’s rights and responsibilities are upheld and they can maintain contact with their family and friends. A well-balanced menu is provided and residents are encouraged to be actively involved in the selection and preparation of meals. Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 6 Resident’s health and personal care support is of a good standard. Medicine management is safe. The home is comfortable, safe and very clean and hygienic. Competent staff support residents and recruitment practices are effective in promoting safety. The Home is well run and the health, safety and well being of the residents is promoted. 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. Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1-2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Details relating to the registered manager within the SUG are not correct which could compromise the residents, or their representative’s ability to establish the suitability of the service in meeting their needs. A pre-admittance assessment process is performed to make sure the needs of potential residents can be identified and met. EVIDENCE: The resident’s pre inspection survey asked the resident, “did you receive enough information about this home before you moved in, so you could deicide if it was the right place for you?” the residents response was “yes”. A SUG is available to all potential residents or their representatives so they can decide on the suitability of the service in meeting resident’s needs. The previous registered manager resigned in April 2007 but the guide had not been updated to reflect the service does not have a registered manager in post. Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 9 Only one resident has been recently admitted since the home was registered with CSCI in February 2007. Records showed that the acting manager had obtained a full needs assessment from Social Services departments prior to the person gaining residency. The assessment records are detailed, and provide good information about the background, support needs and lifestyle preferences of the resident. Staff confirmed that they are provided with the opportunity to examine the needs assessments and demonstrated a good knowledge of the needs and aspirations of the resident. Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 10 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 good. This judgement has been made using available evidence including a visit to this service. Residents assessed needs and personal goals are reflected in individual plans of care. Residents are encouraged to make decisions about their lives and supported to take risks as part of an independent lifestyle. EVIDENCE: The needs of the resident were identified within records provided Social Service and staff confirmed that they had full access to the records. Care plans were being formulated at the home as the staff got to know the resident and a care plan for promoting the residents safety provided sufficient details to inform staff at the home. Records showed that the residents care planning records were due to be reevaluated the day after our visit and a representative from a Social Services department would visit the resident to aid the process. Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 11 Records showed that risks to the resident’s safety are identified and care plans formulated by the acting manager documented how the risks are addressed. For example, the resident having to be accompanied at all times whilst in the community to promote his safety. The resident said that he is able to make independent decisions about many aspects of his life and that staff at the home respects his decisions. We observed that the resident is supported to exercise his person choices and had control of his life. For example, the resident wished to make some cookies, the staff provided appropriate guidance and encouragement and the resident was very proud that he had made the cookies independently. A “key Worker” system is in place and the resident’s key worker reported spending time with the resident to determine his likes and dislikes in relation to his daily activities and meal preferences. A recognised communication system is in place to enable the residents to communicate their own choice. The “Makaton System” provides a visual representation of language, which increases understanding and makes communication easier between residents and staff. Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 12 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 good. This judgement has been made using available evidence including a visit to this service. Residents can participate in a range of activities. The resident’s rights and responsibilities are upheld and they can maintain contact with their family and friends. A comprehensive well-balanced menu is provided. EVIDENCE: The resident’s pre inspection survey asked the resident, “do you make decisions about what you do each day?” the residents response was “yes”. Records show that the resident’s social interests are identified and documented within care plans and daily progress records. The resident’s key worker reported that as he had got to know the resident over the past three weeks he had been able to provide activities, which the resident particularly enjoyed. Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 13 The resident confirmed that his personal interests, which include swimming, ice skating, going to the local park and shops are provided for. The resident also confirmed that he attend a local college on Monday evenings. During the course of the visit the resident was participating in activities in the morning, which included football in the garden and a short walk within the local community. In the afternoon it was planned that the resident would go swimming with his key worker but the resident decided not to go, and his key worker respected the residents choice. A four weekly menu is in place, which includes variety of healthy nutritious meals. The resident said he was looking forward to his lunchtime meal and said the meals are great. We observed staff assisting the resident to prepare his own meals, the interactions were respectful and promoted the resident’s choices and independence at all times. Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 14 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. Resident’s health and personal care support is of a good standard. Medicine management promotes the residents safety. EVIDENCE: As mentioned earlier in the report (YA 7) the resident’s key worker is proactive in identifying the resident’s needs and aspirations. The resident said that he is very happy with all aspects the care at the home and confirmed that the staff always respect his decisions as to when he retires to bed and when he gets up. The resident also said that he has an interest in animals and had a pet Hamster in his room which he looks after independently, saying “its great to have a pet”. The resident also had his own mobile phone so as to maintain regular contact with his family and friends. Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 15 The resident confirmed that staff encourage him to clean his own bedroom and perform domestic duties, whilst being supervised, to further promote his independent living skills. Shirebrook Lodge uses Boots (The Chemists) Monitored Dosage System (MDS). The resident’s records relating to administration of medicines were maintained well. The medication room was not being used to store medication as the acting manager was awaiting a lockable cabinet from Boots (The Chemist). The resident’s medication was being stored securely in the managers office, which the Pharmacist from Boots had assessed as safe practice. We contacted a representative from the Chemist, it was confirmed that the cabinet would be delivered within the next week. The representative also confirmed that the staff at the home would receive additional medication management training from the Pharmacist. At the time of the inspection no resident’s were responsible for the selfadministration of medicines. The acting manager stated that should a resident wish to be independent in the administration of medicines a risk assessment would be performed. If the resident were assessed as safe, the resident would be supported to be independent in this area. Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 16 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. Residents are assured that their complaints, concerns and allegations are taken seriously and acted upon. EVIDENCE: The resident’s pre inspection survey asked the resident, “do you know how to make a complaint?” The resident’s response was “yes”. The residents said, “I feel safe and the staff are nice” he confirmed that he would speak with the acting manager if he had concerns about anything, and he felt confident that it would be followed up properly. A complaints procedure is displayed in a prominent position in the foyer of the home to enable residents or their representatives to access it. The procedure is also provided to all residents within the Service Users Guide. The complaints procedure clearly identifies whom the complainant should contact and specifies times scale in which the complainant will receive a response. A Whistle blowing and Safeguarding Adults policy was evidenced in the homes policies and procedures file and staff confirmed that the policies had been discussed at induction. Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 17 The acting manager said that no complaints have been received. CSCI has not received any concerns or complaints about the service and no safeguarding adults investigations are in progress. Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 18 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): 24-30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a homely, comfortable and safe environment, which is kept clean and hygienic. EVIDENCE: The resident’s pre inspection survey asked the resident, “is the home fresh and clean?” The resident’s response was “yes”. All areas throughout the home are maintained to a high standard of cleanliness. Resident’s bedrooms are clean, homely, well decorated and have en-suite facilities to promote the residents privacy and independence. The resident had many personal possessions within his bedroom such as family pictures, posters, compact disc player, television and the resident said his bedroom meets his needs. Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 19 All radiators are enclosed and hot water outlets are temperature monitored to minimise to risk of scalds, windows have opening restrictors in place to promote the safety of residents. Residents can use a secure garden area to the rear of the property, which is tidy and well maintained. It is planned that the area will be equipped with garden furniture in the near future. Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32-34-35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Competent staff supports residents and recruitment practices are effective in promoting the residents safety. EVIDENCE: The resident’s pre inspection survey asked the resident, “do staff treat you well?” The resident’s response was “yes”. An examination of the staff rota and a discussion with the acting manager confirmed that the current staffing ratio is two care staff to one resident as only one resident is accommodated at the home. Records showed and staff confirmed that an induction programme is provided when staff commence employment. Information supplied by the registered provider within the AQAA evidence that resident’s health and wellbeing is promoted as 83 of the care staff have an Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 21 National Vocational Qualification (NVQ) level two and the residents key worker had recently enrolled on NVQ level three in care. The acting manager said, and staff confirmed, that in addition to the NVQ qualifications it is an expectation that care staff complete additional video based training packages in food hygiene, moving and handing, medication management and fire prevention. The acting manager confirmed that staff had only completed the moving and handling element of the training package as the home had only been operating for approximately three weeks. Records also showed that training relating to the management of aggressive behaviour was booked in July 2007 and staff confirmed they were aware of the training event. Recruitment practices are effective in promoting the residents safety. Records showed that members of staff had undergone appropriate Criminal Record Bureau (CRB) checks and had provided two written satisfactory references prior to employment. Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 22 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 is well run and the health, safety and well being of the resident is promoted, although a manager has not been registered with CSCI. Professionals are involved in monitoring the resident to ensure the service is suitable in meeting the resident’s needs. EVIDENCE: The acting manager confirmed that the previous registered manager resigned his position in April 2007 and a registered manager application has not been forwarded to CSCI. Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 23 The current acting manager holds a nursing qualification and is currently studying for a degree level NVQ qualification in management. The acting manager showed that quality-auditing procedures are to be performed on a monthly basis. As the home had only been operating for a short period of time the documentation had not been used. Comprehensive policies and procedures have been developed and staff confirmed that they are examined at induction and they have access to them at all times for reference and guidance. The resident said that he feels involved in any developments within the home and said, “they always tell me what’s happening”. Information within the Service Users Guide states that residents and their representatives will be involved in quality monitoring, as regular residents meetings will be performed. As yet the meetings have not started CSCI will determine the quality of the resident’s consultation process at the next unannounced inspection. Information supplied by the registered provider within the AQAA evidenced that resident’s health and wellbeing is promoted by effective routine maintenance. Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 24 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 2 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 x 3 x x 3 x Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 5 Requirement To ensure residents and their representatives can determine the suitability of the service in meeting residents needs the registered person must keep under review and, where appropriate, revise the statement of purpose and the service users guide to include correct information in relation to the manager at the home and notify CSCI and service users of any revisions within 28 days. To promote the safety of residents the registered provider must register a manager with CSCI and shall give notice to CSCI of the name of the person, which will include the date on which the appointment is to take effect. Timescale for action 31/10/07 2 YA37 8 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 26 No. Refer to Standard Good Practice Recommendations Shirebrook Lodge DS0000068265.V340676.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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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