Care Home: The Bartlett at Henry Cox

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What the care home does well Kyffin Taylor has a well-trained staff group and an established management team and residents appeared to be benefiting from the service they receive. Comments received were, "It is good here." "I am very comfortable and I have all I need." Residents/visitors were of the opinion that there is an open management style and they said that if they had any concerns, they know that staff would take them seriously. Staff have the skills needed to support people who have dementia and a resident said, "I have trust in them." Care files give evidence that prospective residents have had their needs assessed, and the outcomes form the basis of their care plans. In addition to being a permanent home for thirteen residents, Kyffin Taylor provides a valuable service to residents and their families through the dementia respite service. The move to new temporary accommodation has been in consultation with residents and their representatives and has been carried out as a well planned and phased operation. Residents said their temporary home is comfortable, clean and to their satisfaction and staff also appear to have adapted to their new environment and have organised files in the storage areas currently available to them ensuring that information is easily accessible and safe. What has improved since the last inspection? To improve the facilities for residents in the long-term, building work at Kyffin Taylor is progressing and residents have settled into their temporary accommodation. To ensure that staff have the skills and qualifications to meet residents` needs the training programme for staff of Kyffin Taylor has continued and further NVQ qualifications have been gained since the last visit. What the care home could do better: To ensure that residents receive the necessary support in continence management, it is recommended that planned interventions are more detailed and are provided more frequently. Some residents said that although they are satisfied with in-house leisure activities, they would like to go out more often. A recommendation is made that residents be consulted about leisure activities and outings be arranged accordingly. To ensure that the fire roll call list is a true representation of the numbers in residence in case of fire, a recommendation is given that the list be updated each time a resident goes into hospital or on holiday. To ensure that residents will be protected from falls and accidents through identifying risks and hazards, it is recommended that the accident book be monitored and risk assessments updated for those who are prone to falls. CARE HOMES FOR OLDER PEOPLE Kyffin Taylor House at Henry Cox Parkhaven Trust Liverpool Road South Maghull Liverpool Merseyside L31 8BR Lead Inspector Mrs Trish Thomas Key Unannounced Inspection 30th October 2007 10:00 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 Kyffin Taylor House at Henry Cox DS0000070078.V348049.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 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. Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kyffin Taylor House at Henry Cox Address Parkhaven Trust Liverpool Road South Maghull Liverpool Merseyside L31 8BR 0151 527 3926 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) Parkhaven Trust Mrs Joan Quinn Care Home 20 Category(ies) of Dementia (7), Dementia - over 65 years of age registration, with number (7), Old age, not falling within any other of places category (20) Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP. Dementia over 65 years of age - Code DE (E) (maximum number of places: 7) Dementia - Code DE (maximum number of places 7) The maximum number of people who can be accommodated is: 20 Date of last inspection 15/12/2006 Brief Description of the Service: Kyffin Taylor House is a care home, which is registered for twenty older people. The building is currently being extended and refurbished and while work is in progress, residents are being accommodated in Henry Cox (which is for their sole use). Parkhaven Trust are the owners of both homes and the manager of Kyffin Taylor is Mrs. Joan Quinn. Kyffin Taylor provides a respite service for seven people who have dementia and is a permanent care home for a further thirteen residents. Staff of Kyffin Taylor continue to support the residents in their temporary home which is situated on the Parkhaven state, close to bus routes and local amenities. The weekly charge for the service is £405.55p. Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this unannounced visit, discussion took place with the senior person in charge Fiona Nicholson, as the manager Mrs. Joan Quinn, was not on duty. Records regarding care, staffing and health and safety were read and a tour of the premises was carried out. Discussion took place with residents and staff on duty and time was spent with residents in the lounge during a craft session. Discussion took place with two visitors, who were on the premises and reference made to quality questionnaires, which have been completed by residents and their representatives. What the service does well: What has improved since the last inspection? To improve the facilities for residents in the long-term, building work at Kyffin Taylor is progressing and residents have settled into their temporary accommodation. To ensure that staff have the skills and qualifications to meet residents’ needs the training programme for staff of Kyffin Taylor has continued and further NVQ qualifications have been gained since the last visit. Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.S.doc Version 5.2 Page 6 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. Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.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 Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.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): Quality in this outcome area is good. Prospective service users have had their needs assessed and they, and their representatives, have the information they need before the person moves in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 2,3 and 4. Prospective residents who are referred to the respite service have had their needs assessed and staff confirmed that copies of their assessments are faxed to Kyffin Taylor before each person moves in. In this way staff will know the level of support which each person needs before they move in and will ensure that their needs can be met by the facilities available in the home. Prospective residents and their relatives/representatives are given a copy of the service user guide, which gives them information about Kyffin Taylor, including the complaints procedure and the most recent inspection report. Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.S.doc Version 5.2 Page 9 Residents’ diversity is respected through identifying their needs during the assessment process and arranging for these to be met through action planning, procedures and training. To ensure that staff are aware of the ways in which residents’ diversity will be supported, the training programme in Kyffin Taylor provides Equal Opportunities Training for staff. Residents’ religious affiliations are supported through arranging for ministers to visit, and for services to be carried out on the premises. For residents who are physically frail, there is a range of disability equipment in the home (such as assisted baths and hoists) and staff have received training in moving and handling. In support of those who are mentally frail, staff have received training in dementia care and are skilled in supporting people who may be confused or agitated. Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.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): Quality in this outcome area is good. Residents’ health and personal care needs are addressed in their care plans and they have access to health and paramedical services when living in Kyffin Taylor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 7,8,9 and 10. Reference was made to residents’ care files and three care plans were tracked in detail. Care plans follow a standard format and there are systems for reviewing residents’ needs and managing risks. Care plans, which were case tracked during the visit, had been satisfactorily maintained other than where a recommendation is given regarding continence support, as interventions need to be carried out with more frequency and recorded in more detail. There was evidence in residents’ individual care files that all those who live permanently in Kyffin Taylor, have been registered with a G.P. For people who use the respite service they have access to a G.P. during their stay. All residents have access to paramedical services such as chiropody and are able to attend medical appointments and receive services from district nurses as needed. Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.S.doc Version 5.2 Page 11 There is a system for managing medication and staff who administer residents’ prescribed medication have received relevant training. There are procedures in place for the return of un-used medication to the pharmacy, to ensure that all medication admitted into the home is accounted for. Medication is secured in a locked trolley and the medication administration records had been well maintained at the time of visit. A resident who lives permanently in Kyffin Taylor said, “The staff bring the medication round at the same times every day. I have no cause to complain and I have every confidence in them.” A visitor said “(Name) is being well cared for so far, the support here is good.” For staff guidance, there are policies and procedures in Kyffin Taylor for privacy and dignity. Staff who were spoken with were aware of the need to ensure that residents’ personal records are stored safely and written in a way which respects the dignity of each person. There are procedures for confidentiality and access to personal files and care records were well maintained at the time of visit. Staff were observed on separate occasions, speaking with two residents who were agitated and restless, and they demonstrated excellent skills in supporting people who have dementia, whilst respecting the person’s dignity and confidentiality. Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.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): Quality in this outcome area is good. The lifestyle in Kyffin Taylor was meeting residents’ needs and they receive a wholesome appealing balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 12,13,14,15. Kyffin Taylor employs a part-time activities co-ordinator and residents were enjoying a craft session with her during the visit. There are regular in-house leisure events, which provide a valuable purpose in supporting residents who have dementia. For residents who live permanently in Kyffin Taylor they expressed satisfaction with in-house activities while stating they would like to go out more often. To ensure their needs are met, a recommendation is made that residents be consulted about leisure activities and outings be arranged accordingly. Two visitors said that they are left in private when visiting their relatives and staff and residents make them welcome. There was a very relaxed atmosphere in the home, and both visitors said this is always the way they find things to be. Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.S.doc Version 5.2 Page 13 There was evidence in care files that each person’s religion is recorded before they move in. To respect each person’s beliefs and wishes, arrangements are made for religious services to take place, which are attended through choice. There are arrangements for residents who have no family to receive the services of local advocates if needed. Residents are consulted about their care, meals and how they wish to spend their time. Residents’ social histories were in their care files and their choices and preferences of activity and diet were on record. For those who have dementia, support for their mental health is recorded in consultation with their families. Residents said that the food is very good and there are choices and alternatives available. Residents’ comments include, “The food is excellent, always nice and hot.” Another said, “The dining room is lovely and bright and it is next to the kitchen so the food is hot.” “If I don’t want what is on the menu, they give me something else.” To ensure that residents are well nourished, a record is kept of each person’s weight on admission and throughout their stay in Kyffin Taylor. Residents’ meal preferences and special diets (if appropriate) are recorded and catered for. Kyffin Taylor employs cooks and kitchen domestics. On visiting the kitchen and food stores it was evident that there were good stocks of food in store. There was a choice cereals, hot and cold drinks, fresh meat, fish, fruit and vegetables. Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.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): Quality in this outcome area is good. Residents’ complaints are listened to and they are protected through the procedures and training in Kyffin Taylor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 16 and 18. Kyffin Taylor has a complaints procedure, which sets out how to make a formal complaint and time limits for responding. This is given to prospective residents and their representatives as part of the admissions procedure. A resident said, “If I have a grumble I let the staff know and they sort it out. I have never had cause to make a formal complaint but I am sure they would deal with it.” A visitor said, “They are very open here and listen to what you want regarding care, I am sure that if I had a complaint, it would be dealt with in the same way.” Kyffin Taylor has procedures for protection of vulnerable adults and “whistleblowing” and staff have received the relevant training as in evidence in staff files. Staff who were spoken with were aware of the indicators of abuse and the actions to be taken in alerting suspected abuse of a resident to the relevant agencies. There have been no complaints or safeguarding referrals made to CSCI about Kyffin Taylor House, since the last inspection. Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.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): Quality in this outcome area is good. The building is a temporary home and is well maintained, clean and comfortable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 19,22 and 26. Kyffin Taylor House is being extended and refurbished. Residents are currently being accommodated at temporary registered premises in another care home owned by Parkhaven Trust, called Henry Cox. This arrangement is for the period of building works, and was made in consultation with residents/representatives and CSCI. The building provides a warm and comfortable temporary home for the residents. There are two large lounges and a dining room on the ground floor with access to the grounds, which are well maintained with parking spaces for Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.S.doc Version 5.2 Page 16 staff and visitors. Bedrooms are for single occupancy and there are toilets and assisted bathing facilities throughout the home for residents’ convenience. There is hoisting equipment to support residents who are physically frail, and staff have received training in patient handling. Residents said they were comfortable and that the building is nice and warm. Comments include, “This is just for a short time but is very pleasant and the staff are the same.” “(Name’s) bedroom is very comfortable with nice views. (Name) has all he needs.” Staff said that as the premises were previously in use as a care home, the facilities are suitable to residents’ support needs and the office and staff room are satisfactory. For staff guidance there are training and procedures for infection control and domestic staff are employed. The building was clean and odour free in the areas which were seen and the cleaning schedules had been well maintained. A visitor said, “It is always lovely and clean and staff appear to work hard. The bedrooms and toilets are always clean as well as the lounge and dining room. I am very pleased with standards here.” A resident who commented confirmed these comments. Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.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): Quality in this outcome area is good. Residents are protected through the recruitment and training procedures in Kyffin Taylor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 27,28,29,30. To check that staffing levels are maintained, reference was made to the staff rosters, which records the staff names and job role for each shift. In addition to care staff there are ancillary staff such as cooks, domestics, gardening, maintenance staff and an activities co-ordinator. A visitor said, “There are always plenty of staff when I call at different times of day.” Dependency levels are constantly changing as they are influenced by the needs of residents of the respite service. During the visit, staff confirmed that residents’ needs were being met by staff numbers in place, with regards to personal care and support for people who have dementia. For residents’ protection, Parkhaven Trust has a recruitment procedure, which includes advertising posts, interviewing job candidates and taking up references and police clearances before staff take up their posts. A sample of staff files provided evidence of the recruitment procedure and induction training provided to newly appointed staff. Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.S.doc Version 5.2 Page 18 Records give evidence that there is a training programme, which includes mandatory training with updates and training provided to meet the needs of residents, such as training in dementia care, patient handling, first aid and diversity (Equal Opportunities). The NVQ training programme is ongoing. Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.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): Quality in this outcome area is good. The home is managed in a way, which protects residents’ health and wellbeing and they are protected through the procedures in place, further action is needed regarding management of risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 31,33,35,38. The registered manager, Mrs. Joan Quinn, is a qualified in management and has many years experience in running care homes for people who have dementia. Staff said that they are well supported by the management team and receive regular supervision and annual appraisals to ensure their training needs are addressed. The registered providers, Parkhaven Trust, provide support at senior management level and through human resources and training sections. Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.S.doc Version 5.2 Page 20 There is a quality assurance system in place which is based on seeking the views of residents and their representatives through distribution of quality questionnaires. Staff confirmed that questionnaires had recently been distributed to residents and the outcomes would be monitored and remedial action taken if necessary. There are also staff and residents’ meetings and an open-door management style, to ensure that people feel free to consult with management on matters, which are important to them, either to give compliments or make complaints. Staff comments and the policies in place give evidence that Parkhaven Trust do not become involved in residents’ personal finance management, other than to hold small amounts of personal allowance in safekeeping for regular use. To protect residents and staff, management systems for personal allowances includes, retaining receipts for purchases and keeping signed records of all transactions, which are regularly audited. A resident said, “I have no money problems, nobody from here interferes. I have everything I want.” Health & safety certification was satisfactory. The fire records were well maintained regarding safety checks and training. To ensure that the fire roll call list is a true representation of the numbers in residence in case of fire, a recommendation is given that the list be updated each time a resident goes into hospital or on holiday. There are procedures for recording and reporting accidents and the accident book has been well maintained. To ensure that residents will be protected from falls and accidents through recognizing risks and hazards, it is recommended that the accident book be monitored and risk assessments updated for those who are prone to falls. Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.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 X 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.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. 1. Refer to Standard OP7 Good Practice Recommendations To ensure that residents receive the necessary support in continence management, it is recommended that planned interventions are more detailed and are provided more frequently. To ensure that leisure activities on and off the premises are to residents’ satisfaction, it is recommended that residents be consulted about leisure activities and outings be arranged accordingly. To ensure that the fire roll call list is a true representation of the numbers in residence in case of fire, a recommendation is given that the list be updated each time a resident goes into hospital or on holiday. To ensure that residents will be protected from falls and accidents through identifying risks and hazards, it is recommended that the accident book be monitored and risk assessments updated for those who are prone to falls. 2. OP12 3. OP38 4. OP38 Kyffin Taylor House at Henry Cox DS0000070078.V348049.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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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