Care Home: St Philips Close

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What the care home does well The home provides people with a comfortable environment that presents a domestic ambiance. Staff spoken to showed an interest in their work and commitment to the ethos of the home and interest in promoting person centered approach to people`s care, which gives a positive outcomes for people. Care was seen to be carried out in accordance with detailed care plans . Staff are well supported by the manager and the organisation with a good level of training provided, to improve their skills, knowledge and outcome for people. People`s relatives are encouraged to be involved in their care. One person`s survey said that her mother advocates on her behalf. What has improved since the last inspection? At the last key inspection a requirement was made for the home to have written guidelines in place for the use of homely remedies. To make sure people are safe at all times . We saw that a procedure has been put in place and staff have been made aware of the guidelines they must follow. Following some medication errors, the organisation has improved their safe handling of medication procedures. There is now a flow chart that staff follow when an error occurs. The organisation has taken into account the need for mandatory training and have extended staff training plan to accommodate these courses. What the care home could do better: Although it is acknowledged that the home makes sure they get extensive information about people before they move in, so that none of their care and support needs gets missed. Maybe some consideration should be given to make sure that when care plans are written, staff can easily access to information that they can use to deliver people`s care . Application for registration of the manager should be submitted to the CQC Care Quality Commission for the manager to be registered. The administration of the home could be more effective with the help of effective Information technology ITT equipment. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: St Philips Close 3 St Philips Close Middleton Leeds West Yorkshire LS10 3TR     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: Valerie Francis     Date: 0 7 0 4 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 Adults (18-65 years) 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 Adults (18-65 years) Page 2 of 28 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 Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: St Philips Close 3 St Philips Close Middleton Leeds West Yorkshire LS10 3TR 01132778068 F/P01132778068 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Milbury Care Services Ltd care home 4 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 4 3 St Philips Close is a purpose built bungalow located in a residential area of Middleton close to local amenities and public transport routes. There is roadside parking to the front of the home. There are well maintained gardens to the rear of the property that are accessible to service users. The home is registered to provide personal care for four people with learning disabilities. The accommodation includes four single bedrooms, a lounge, combined kitchen and dining room, a communal bathroom and toilet, a domestic style kitchen and separate laundry room. Care Homes for Adults (18-65 years) Page 4 of 28 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was carried out over one day by one inspector who assessed the home performance against the key National Minimum Standards for Younger Adults. The evidence was drawn from a number of sources and included tracking the care of two of the four people that live in the home. This involved looking at their records and all related documentation in respect of their care and cross referencing this with outcomes, by observing practices, discussion with the manager and staff. Due to their learning disability some people living in the home were not able to verbally communicate their opinion about the home. However, we were able to speak to one person. The home sent us the completed (AQAA ) Annual Quality Assurance Assessment, which is a self assessment form, telling us what the service do well, how they have improved since the last key inspection and what they could do better. We Care Homes for Adults (18-65 years) Page 5 of 28 sent surveys to people and staff for their views on the service provided at the home. The current scale of charges at the home is as follows one thousand and thirty two pounds and fifty one pence, per month. Additional charges are made for toiletries, magazines, outings, activities and taxis for college. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. 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. 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 Adults (18-65 years) Page 7 of 28 Care Homes for Adults (18-65 years) Page 8 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. People who want to use the service and their representatives are given good information about the home, that is sufficient to allow them to decide if the home can meets their needs. Admissions are not made to the home until a full needs assessment has been undertaken. Evidence: We looked at the Statement of purpose and service user guide, both documents had recently been updated with current information. Peoples care and support needs are assessed by an experienced member of staff who would carry out assessments professionally and sensitively involving the person, their family or representative. The home also get up to date information from the referring agency and health and social care professionals. Prospective people looking to use the service have their needs and aspirations assessed. We were told that prospective people wanting to use the service are given the opportunity to spend time in the home with a day visit extending to an overnight stay. Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: We looked at the care file of the last person who was admitted to the home. However, since this persons admission the organisation has changed the format to record peoples assessment, which helps to prompt the person carrying out the assessment to get extensive information about the person and their care and support needs. The manager showed us a copy of the new assessment document that was used for someone who wanted to move into the home. We saw that pre assessment information was gathered before an admission and that information from the referring agency obtained is also used as part of the assessment. We saw that the home try to get background information about the person, although staff felt this could be more detailed with information about peoples life history and their illness. Staff said this would help them when they deliver peoples care and support. We also found that the home had information on how people spend their time. For example one person went daily to the day centre and spent weekends with their family. We saw information that people have their dietary needs met. One person had their meals liquidised. The manager told us that people are shown photographs of meals and staff observe their body language for their choice. These choices are then put into the weekly menu. People also take part in the weekly food shopping for the home. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Each person have a care plan which is made from their assessment and information from their representative. People are encouraged to take a degree of risk as part of their daily living and lifestyle, reflecting their abilities and choice. Evidence: Staff told us that they have had person centred care training. They also told us that over the last few months peoples care has developed into a more person centered approach. Which means that peoples care approach is about them and how the individual would like their care delivered. Although there was evidence that one persons relative is involved in their care, the care plan was not signed to indicate this. The care plans seen were detailed in respect of all areas of peoples care and support needs. From discussion with staff and the manager and from information seen in people care files, it was clear that staff have access to comprehensive information about peoples care and support needs and how they should deliver their care. However, it was noted that the amount of information could mean that staff may not Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: have time to read all the documentation before delivering peoples care. Therefore some consideration should be given to condensing the information, so that staff can easily access information that they can use to deliver peoples care and support. There was evidence of regular reviews of peoples care and support plans by staff and the involvement of multi- disciplinary agencies involved in that person care. Where there are limitations these are recognised through risk assessments. The limitation of one person was clearly documented, showing how the risk would be managed. For example one person had a problem swallowing and there was a risk assessment in place for the action staff must follow to manage and minimize the risk, such as making sure this persons meals are liquidised. Staff told us that there are plans in place for regular key workers meetings when peoples care are discussed, so that any changes are quickly identified and an action plan put in place. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. People are encouraged and supported to make choices about their lifestyle and maintain and develop their life skills. Evidence: We found throughout the visit that staff encouraged people to access activities outside and inside the home. We were told that the home promotes individual rights to live an ordinary and meaningful life both in the home and in the community, and enjoy, where possible the rights and responsibilities of citizenship. From discussion with the manager and staff it was evident that they understood the importance of enabling people to maintain their independence and exercise their choices. This allows people to achieve their goals, follow their interests and be integrated into community life and leisure activities. They do this by assessing the likes and dislikes through reactions to situations by observation of body language for those people who have no speech. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: People are supported to take part in household chores such as cooking, cleaning, doing the household shopping and doing their laundry if this is what the person wanted. We saw one person taking their dirty laundry to the laundry room. It was apparent from discussion with staff that they have a good grasp of what individuals body language and behaviour indicates. This is used to deliver peoples care. We saw that one person had taken herself to the sitting room away from the group who were all sitting in the dining room, because she wanted to be alone. Pictures of food are shown to people and staff observe their reaction which help them to plan the menu. Staff make sure that peoples likes and dislikes are documented so that their likes are reflected in the menu. Meals are well balanced with an emphasis on a healthy diet. We were told that nutritional risk assessments are only carried out if there was an issue with that persons nutritional needs. We saw that staff had their meals with people to support them to eat. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. People who live in the home have their personal care and health care needs met in a way that takes in account of their wishes and respect their rights to privacy and dignity. The homes arrangement for administering medication makes sure that people receive their medication and they are safe. Evidence: We saw that peoples care and support plans identify their individual health and personal care needs. Discussions with one person and staff confirmed that people and or their relatives are involved and consulted about their care. One person told us that he had a care plan which describes how he wanted to be cared for. The home told us in the AQAA that people are supported to attend appointments to relevant health care professionals and any recommendations acted upon. We were also told that key workers are chosen by people or in the best interest for those who do not have the capacity to do so. We observed staff supporting people, which we found to be friendly and patient. Staff were seen to treat people with dignity and are sensitive to their Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: change in needs. Staff told us. Care is now given in a person centred way, more choice for people, staff are willing to give people choice and support people more. Staff have access to training in healthcare matters and are encouraged and given time to attend training courses. We were told that staff are given information about peoples illnesses. Staff indicated that although they have access to good information about people and how to meet their basic needs, they felt they could further support people if they had training from professionals on peoples specific illness. This would give them clear direction on how best to meet the needs of the person. The home has an efficient medication policy supported by procedures and practice guidance which staff understand and follow. Such as, when an error occurs. Medication records are fully completed and the home comply with (RPS). Royal Pharmaceutical Society Guidance for residential homes. Staff that administer medication have completed and passed an appropriate medication course. In addition the manager and deputy carries out checks on staff who administer medication to make they are competent in safe handling of medication. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. People are encouraged and supported to express their views and concerns. Staff knowledge of safeguarding adults protects people. Evidence: We saw that the home has a complaint procedure in words and pictures, which will help people with staff support, to make their complaint. During discussion with staff it was evident from their comments that peoples wellbeing is paramount and had no concern about whistle blowing on a colleagues or friend to make sure people get the care and attention they need and they are in a safe environment supported by staff who put people first. We were told that peoples friends and relatives are encouraged to advocate on their behalf, one example is that one persons mother is encouraged to be involved in their care and advocate on their behalf by attending meetings concerning her relative and highlight any concerns she has about the care of her relative. Since the last key inspection two safeguarding adults referrals have been made to the safeguarding adult unit at Leeds Social Services. Action plans have been put in place to resolve the safeguarding issues. We were told that there are regular meetings with relatives or others who have an interest in their relatives or friends care. Most people in the home have no speech and staff rely on body language to get information on how people are feeling and what they prefer. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: Records are kept of all incidents, complaints and safeguarding outlining what the issue was and what action had been taken to resolve it. For example there had been a medication error and the organisation has put a policy procedure in place for dealing with medication errors . All staff are reminded at their regular meetings of the need to make sure that peoples medication is delivered safely. Care Homes for Adults (18-65 years) Page 19 of 28 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment. Evidence: The home is located in the Middleton area of Leeds accessible to shops and the White Rose shopping centre. The home has four bedrooms and is joined to another registered care home which is also managed by the manager. There is an on going programme of redecoration and refurbishment with general maintenance when needed. Although we found that the home was satisfactorily maintained the communal sitting rooms carpet had large areas which are stained. The home shares a large garden to the rear of the building with the other home. People can sit out in private in the good weather. We were told by the home that they provide an accessible, homely, clean, safe and well maintained, comfortable environment to meet individual peoples needs. Risk assessment are carried out for the building to make sure it is a safe place for people to live. All risks are reviewed annually some more often depending on the potential risk. Care Homes for Adults (18-65 years) Page 20 of 28 Care Homes for Adults (18-65 years) Page 21 of 28 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. People have access to staff that are trained and flexible to make sure people have the care and support they need to live the life they want. The organisation has a robust recruitment process that is protecting the people that live there. Evidence: Staff told us that the home provides people with a good standard of care, and things have improved since the new manager came. For example, people now get more person centred care. At the time of the inspection there were three care staff on duty. One was the senior care worker who had responsibility for the shift. The manager was also on duty but her role was mainly management. We were told that during the day there are two care staff including the senior worker. The manager said that that she was having peoples care and support needs reassessed because peoples individual need have changed over the years and they now need more one to one from staff to support and enable them to live a normal life. This she hopes will increase staffing during the day, and would give people the opportunity to go out more. We were also told if peoples needs changed, then the organisation would look at the staffing levels. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: It was clear that staff knew people living at the home very well, they could tell us about the individual needs of people and how they were met. They were aware of equality and diversity issues including peoples specialist communication needs. Staff and the people living in the home appeared to relate well to each other and there was a relaxed and friendly atmosphere in the home. From the information seen and from discussion with the manager and staff it would appear that staff training is a high priority. All new staff have induction training with further training relevant to their role including Health and Safety and training related to Dementia. Looking at a sample of staff recruitment files and the organisation recruitment procedure, it was confirmed that all necessary pre employment checks are carried out. We looked at three files which showed that (CRB) Criminal Record Bureau and (POVA) first Protection of Vulnerable Adult checks had been carried out . References taken up and all staff were interviewed. The home told us that all staff are familiar with the General Social Care Council code of practice standards which is provided at the recruitment stage and reinforced during the induction training. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 has effective management systems in place to make sure that the home is led and is run in the best interest of the people who live there. Evidence: The manager has been in post for three months, she has the relevant experience to manage the home. She has enrolled on a management course to improve her skills and has regular meetings with line management for support. She has daily contact with people that live at the home and staff. Staff told us that the manager is supportive and will listen to them. From discussions with staff and from observation, it was apparent that staff are given the opportunity to take a lead part in caring for people with the manager support. For example, one persons key worker negotiated with the housing association for a raised garden area. We noted at the inspection that the manager was having problem with the homes ITT system when she tried to retrieve a document and to print it off to give us a copy. The administration of the home would be more effective with the help of effective Information technology ITT equipment. Staff commented at the inspection and in surveys that they would benefit Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: from the availability of ITT equipment to access information about peoples illness, which they think could help them access information quickly. It was evident throughout the inspection that the home is led by the interest of the people who live there. Staff training, recruitment and development are all undertaken in the interest of providing an effective and safe place for people. The organisation carries out annual Quality Audits by sending out questionnaires to get the views of people who use their service staff and professionals who have an input in the home. To get their views on the service provided by the home and the organisation. Time is given to people to express their views thus promoting their choice and rights. Staff are able to identify peoples reaction from their body language, to get make sure their views are sought. In the AQAA we were told that the organisation provide people with a well run home with manager and staff who respects the individual rights and ensures that their best interest are safeguarded through good role modeling and addressing poor practices. Care Homes for Adults (18-65 years) Page 25 of 28 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 Adults (18-65 years) Page 26 of 28 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 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 37 The manager should make application to be registered with the (CQC) Care Quality Commission, so that people can be sure that the home is managed by a person who has been registered as trained and competent. Care Homes for Adults (18-65 years) Page 27 of 28 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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