Care Home: Solway House

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What the care home does well The manager and staff take time to help people settle into the home and make sure it suits them and detailed information is readily available to help people decide about living in the home. One person living there told us that the home " suits me perfectly". Care planning and care practice is now person centred and supports people`s choice and independence. The service does regular audit work across all systems in the home to monitor the quality of the service and makes changes if needed. The environment is homely, clean, fresh smelling and comfortable and relatives and residents commented on the high standard of cleanliness. There are good systems for handling medication to make sure medicines are managed safely and that residents receive the correct treatment. There is good communication with residents` doctors so that health care needs are met promptly. The district nursing service visits the home when required. Staff are motivated to work to a high standard, and are well supported and supervised. Training and staff development is given a high priority in the home. As a result of this staff are motivated to provide a high level of personal and social care. They are aware of the residents` needs and work closely with the relevant health care professionals to maintain an appropriate service for those living in the home. The service has suitable recruitment systems in place to ensure they get the right staff and promote the safety and wellbeing of people living there. What has improved since the last inspection? The care planning system has been revised in order to provide a much more person-centred approach with in-depth details about the residents` needs and capabilities. New carpeting has been laid in the hall and stairs leading to the first floor. New dining and lounge chairs have been purchased. There is an ongoing programme of redecoration. A new patio to the front of the building has been created, which is very popular with the residents. A new passenger lift has been installed. CARE HOMES FOR OLDER PEOPLE Solway House Solway Terrace Sea Brows Maryport Cumbria CA15 6EL Lead Inspector Mrs Margaret Drury Unannounced Inspection 4 January 2008 10:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Solway House Address Solway Terrace Sea Brows Maryport Cumbria CA15 6EL 01900 817651 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) solwayhouse@fsmail.net Solway House Limited Ms Mary Hoskins Care Home 18 Category(ies) of Dementia - over 65 years of age (9), Old age, registration, with number not falling within any other category (18) of places Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 18 service users to include: up to 18 service users in the category of OP (Old age, not falling within any other category) up to 9 service users in the category of DE(E) (Dementia over 65 years of age) 18th May 2006 Date of last inspection Brief Description of the Service: Solway House is registered with the Commission for Social Care Inspection to provide accommodation for up to eighteen older people, some of whom may have varying forms of dementia. The home is owned by Solway House Limited with Ms Mary Hoskins responsible for the day-to-day running of the home. Solway House is situated in a residential area of Maryport, close to the town centre, and has views over the sea and harbour. It is an older style property that has been adapted for use as a care home. Accommodation is provided on the lower ground, ground and first floors. On the lower ground floor there is one bedroom, a lounge, laundry and office. The ground floor consists of a large sitting room with dining area, sun lounge, bedrooms, toilets and a bathroom. On the first floor there are further bedrooms, a bathroom and toilets. The first floor is accessed by a passenger lift and there is a stair lift between the ground and lower ground floors. There are handrails, grab rails and other equipment to assist people to move around the home. The home provides sixteen single bedrooms and there is one double bedroom which two people can choose to share. There are appropriate toilets and bathrooms close to all the accommodation used by residents. There are pleasant gardens with seating to the rear of the home and an enclosed courtyard with seating that is accessed from the lower ground floor. The home provides a statement of purpose and terms and conditions that give any prospective resident and/or their families details of the facilities on offer. The fees in this service range from £373.00 - £434.00 per week as at the time of the inspection. There are extra charges for private chiropody and hairdressing, extra newspapers and some personal toiletries. Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit to Solway House that forms part of the key inspection took place over two days and we were in the home for a total of six and a half hours. During the first visit to the home we were able to speak to one of the residents who agreed to act as a link resident and speak with members of staff and people living in the home in order to ask their opinions about the facilities on offer and the level of care provided. Information about the service was also gathered in other ways: • The completed Annual Quality Assurance Assessment document. • Survey questionnaires returned by residents • The service history • Interviews with residents, visitors and staff on the day of the visit. We looked at care planning documentation to ensure the level of care provided met the needs of those living in the home and a tour of the building to inspect the environmental standards was undertaken. Staff personnel files were also examined. What the service does well: The manager and staff take time to help people settle into the home and make sure it suits them and detailed information is readily available to help people decide about living in the home. One person living there told us that the home “ suits me perfectly”. Care planning and care practice is now person centred and supports people’s choice and independence. The service does regular audit work across all systems in the home to monitor the quality of the service and makes changes if needed. The environment is homely, clean, fresh smelling and comfortable and relatives and residents commented on the high standard of cleanliness. There are good systems for handling medication to make sure medicines are managed safely and that residents receive the correct treatment. There is good communication with residents’ doctors so that health care needs are met promptly. The district nursing service visits the home when required. Staff are motivated to work to a high standard, and are well supported and supervised. Training and staff development is given a high priority in the Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 6 home. As a result of this staff are motivated to provide a high level of personal and social care. They are aware of the residents’ needs and work closely with the relevant health care professionals to maintain an appropriate service for those living in the home. The service has suitable recruitment systems in place to ensure they get the right staff and promote the safety and wellbeing of people living there. 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. Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who wish to use this service and their families are given the information required to choose a home that will meet their needs. EVIDENCE: The home provides a pack to all who visit to look for, or enquire about, accommodation for friends or relatives. This contains an illustrated brochure, statement of purpose and a copy of the terms and conditions of residency and residents rights. There is sufficient information available in order that an informed choice can be made about whether or not to move into the home. All family members and/or advocates are encouraged to visit the home to look at the available rooms before the resident moves in. This also gives opportunity to meet the staff and some of the residents already living in Solway House. Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 9 The admission process is led by the individual’s needs and includes the family in the support offered. A full needs assessment is completed prior to admission and this assessment is continued during the six-week settling in period. One resident said, “ The staff have enabled me to settle in well here and encouraged me to talk to others and make friends”. Time is also spent gathering information with new residents and their families for developing their individual personal profiles with them. The manager and deputy are also speaking with families and friends of residents who have lived in Solway House for some time in order to gain as much personal history as possible to facilitate the new care plan format that is being introduced. Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 & 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ health needs are met through a detailed care planning system. Privacy and dignity are upheld at all times. EVIDENCE: All those living in Solway House have a comprehensive plan of care based on the original assessment of needs. We looked at the care plans for four people and found that they were well detailed and up to date, with evidence that they are regularly reviewed and contained relevant information and guidance on how to meet the individual care needs. The care plans covered areas such as mobility, diet, health and personal care and, wherever possible signed by the resident. All families are involved in the initial care plan and are encouraged to have input into the ongoing care planning process and some have taken this opportunity. Wherever possible residents are included in the care planning process, which demonstrates that those living in the home are encouraged to participate as much as possible in the monitoring of their care needs. During the visit the manager advised us that the home is in the process of upgrading the care plan format to include even more personal information and past Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 11 history about the residents. This will make the care plans more personal to each individual and improve even further the level of care provided. We looked at those that had been completed and found them to be comprehensive and easy to understand. Changes identified at reviews are incorporated into care plans and needs assessments and the plans are focused on outcomes for people living in the home. There is evidence of timely referral to health care services and the actions taken following their involvement. Resident’s health care needs and reviews are being promptly attended to and the home works well with other agencies and health professionals to meet identified needs. This was evident when we observed a visit to one of his patients by the doctor who had called to undertake a routine procedure. It was evident that the patient was well known to him and that the doctor was on extremely good terms with the manager and staff. Medication is received monthly in a monitored dosage system and we looked at medication handling and practices and found there were good systems in place for ordering and double-checking medication to make sure that any errors are found and dealt with quickly and before administration to residents. Medication that was looked after on behalf of residents was handled safely and administered accurately to protect their health. Medicines could be accounted for at all times and this showed that residents received treatment in the prescribed doses at the correct time. All records relating to medicines were well kept and accurately showed the treatment that had been administered. Residents spoken with said their privacy was respected and felt their dignity upheld. Observation during the inspection, including mobilising and assistance with eating and drinking, suggests that resident’s dignity and independence are promoted in accordance with their plans. We observed that all the staff addressed the residents in a respectful manner and that the staff at the home showed a good understanding of the residents and their needs and communicated well. It was obvious that there was an extremely good rapport between the staff and those living in Solway House. Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service are able to make choices about their life style and are supported in this by the care staff and flexible routines that meet their needs. EVIDENCE: This service has a strong commitment to enabling people to retain their independence and skills at their own pace. Although there is no appointed activities co-ordinator, members of the care staff do support the residents to join in whatever activities are available. When we spoke to residents during the visit we were told that they liked “nothing better than a chat and a cuppa with the girls”. The manager ensures the deployment of staff is such that there is time in the afternoons for staff to spend time on a one to one basis with the residents. One resident likes doing jigsaw puzzles and remarked that “very often one of the girls sits down for a moment and pops a piece or two in the puzzle”. Entertainers visit the home on a regular basis and many of the residents said they were just getting over all the events that took place over the Christmas period and were glad of a rest. Some residents spend time in their rooms and one lady told us that this is what she likes as she always has letters to write and she also has many visitors she likes to see in her room. Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 13 She added, “I am so happy here because I can please myself and the girls, who are wonderful, don’t mind a bit”. Since the last inspection a new patio area at the front of the home has been completed and the residents told us they use it a lot during the summer and sit and watch what is going on in Maryport Harbour. The garden area is also popular with the residents when the weather permits. Monthly church services are held and Communion is provided for those who wish to take it. Visiting times are unrestricted and the families always attend any special events organised for those living in the home. Menus are varied and nutritional with a choice at every meal. As it was the cook’s day off the residents were pleased to tell us that they were “having fish and chips, or whatever else we want from the shop”. They consider this a weekly treat. Speaking with the residents during the visit it was obvious that as far as food was concerned, nothing was too much trouble. Those we spoke to said, “we can have just what we want even if it is not on the menu”. We observed lunch being served and this was a happy relaxed time with residents chatting to each other and the staff who were serving them. Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 16 & 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use this service are able to express their concerns knowing they will be listened to and acted upon. EVIDENCE: There have been no complaints to record for over two years and The Commission for Social Care Inspection (CSCI) has not received any. The manager has a high profile in the home and a very open style of management. This means that she is always around to speak to the residents and/or their families and deal with any issues that may be raised. The home has a clear complaint procedure that is displayed and available throughout the home. Additionally, there is a copy of the complaints procedure in residents’ rooms. Two of the staff have attended adult protection training organised by Social Services and have devised an internal training course which has been passed on to each member of staff. Members of staff who spoke to us were aware of the procedure to follow and what to do if they suspected abuse. The home has its own policies and procedures in place for adult protection; identifying and reporting abuse and whistle blowing. These are in line with the current multi agency guidance and there is a copy of this available in the home. Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 23, 24 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical layout of the home enables residents to live in a safe, wellmaintained and comfortable environment. EVIDENCE: The home is well maintained with a high standard of decoration throughout that provides a clean, tidy and homely environment for residents. Attention is paid to detail and making the environment welcoming and homely. The lounge/diner is arranged in a way that promotes groups rather than being institutional. The communal areas are spacious, comfortable and well furnished with good lighting and seating. The conservatory at the front of the home is particularly popular as it affords open views of Maryport harbour and over to Scotland. The home has a rolling programme of redecoration and upgrading of bedrooms and Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 16 communal areas. New carpet has been laid to the ground floor hall and staircase. A new passenger lift has been installed since the last inspection visit. People who use this service are encouraged to see Solway House as their own home and as it is well known in the community many of the residents are from areas close by. Opportunities are given to meet with relatives in the lounge or in the privacy of the resident’s own room. Residents are encouraged to personalise their rooms and this they have done with pictures, ornaments and photographs. The home is well lit, clean and tidy and smells fresh. Staff have received training in infection control and there is protective clothing available. There are designated domestic staff employed to ensure the home is kept clean and fresh at all times. Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff in the home are well trained, experienced and in sufficient numbers to support the residents and provide a consistently high standard of care. EVIDENCE: Staff rotas and observation during the visit indicate the home has sufficient staff on duty with a range of skills and experience to provide a consistently high level of individual care. This, and an extremely low staff turnover, provides continuity of care and support for residents during the day and night. Staff spoken with enjoyed their work, felt valued and supported by their manager and the organisation they worked for. Consequently morale was good in the home with staff feeling very motivated to maintain high care standards and develop professionally and personally. There was a warm friendly atmosphere throughout the home and all the staff agreed that they worked together as a team in order to care for the residents. There are three carers plus the manager and/or deputy on duty during the day and two waking night staff. There are also ancillary staff to support the carers and the running of the home. There is a comprehensive induction programme spread over 12 –14 weeks. Modules are completed with booklets filled in and signed off by the manager or her deputy. Staff training is given a high profile in the home with currently Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 18 96 of the staff qualified to National Vocational Qualification (NVQ) level 2 or above. There are currently two members of staff completing their qualification. This will then give 98 of the staff qualified and experienced. Training courses recently completed include, health & safety, adult protection manual handling and food hygiene. Arrangements are in hand to provide updates in medication and infection control. Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 37 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The management and administration of this home is based on openness and respect. This ensures the home is run in the best interests of those living there. EVIDENCE: The manager has worked at Solway House for a number of years and is both qualified and experienced. She has an open style of management, gives the interests of the residents the highest priority and ensures the home always meets its states aims and objectives. She works closely with her deputy and the owner of the home to ensure financial stability and demonstrates effective financial planning. She has a clear vision for the home based on her own high values and standards and works with the deputy and other staff to ensure her Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 20 vision and values are fulfilled. She knows the home well and the expectations of the residents and their families. Residents, visitors and staff spoke highly of her warmth and management skills. Comments from staff included “Mary (manager) is always around for help and support” and She gives as much information as possible about the residents and this helps the staff to give good care”. Comments from relatives included, “the manager does a wonderful job” and “the manager sets a wonderful example to all the staff”. In discussions with some of the staff members it was agreed that she was approachable and fair. She constantly looks for ways to improve the level of care provided and has recently, together with the deputy, reviewed all the policies and procedures. There is documented evidence that staff receive mandatory training including: moving and handling, food hygiene and infection control. Adult protection has also been provided for all staff and will continually be updated in line with multi-agency guidelines. Arrangements have been made to access updates in infection control and safe handling of medicines. Annual quality assurance questionnaires are sent to residents, families/advocates and staff. When these are received back the manager prepares an analysis and discusses any requirements with the owner, putting in place those that will benefit those living and working in the home. All inspection certificates were in place and up to date and fire safety training is provided regularly to all staff. There was sufficient evidence to demonstrate that the health and safety of residents and staff is promoted as much as possible to help to ensure that people live and work in a safe environment. There were procedures in place regarding residents’ personal finances with appropriate and adequate records kept to ensure people’s finances are safeguarded. Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 4 3 3 X X 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 X 4 3 Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Solway House DS0000022613.V353138.R02.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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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