Care Home: The Sycamores

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What the care home does well The Sycamores provides care in a well maintained and recently refurbished home. The work completed extended not only to the exterior of the building but included refurbishment of corridors, communal areas and private bedrooms. A stable and committed staff team is employed offering a good standard of care. Admission procedures ensure people are provided with information about the home and the person`s needs are assessed before a service is offered. Health and social care needs are identified in records and staff have the necessary training and support to meet people`s needs. What has improved since the last inspection? Programmes of refurbishment for the entire building had been carried out and greatly enhanced the building. The changes were complimented in comments by people living there and relatives visiting at the time of the inspection. This included the roof having been replaced and a new conservatory at the front of the home. Recording of information for people being supported was written in a person centred way and reflected peoples` wishes and preferences. Programmes of training and development for staff were well established and staff were further supported through supervision and staff meetings. Health, personal care and social care programmes supported peoples` needs and preferences. What the care home could do better: No requirements were made following this inspeciton. CARE HOMES FOR OLDER PEOPLE The Sycamores Victoria Street Newton Hyde Tameside SK14 4DH Lead Inspector Joe Kenny Unannounced Inspection 18 March 2008 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 The Sycamores DS0000005584.V360049.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. The Sycamores DS0000005584.V360049.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Sycamores Address Victoria Street Newton Hyde Tameside SK14 4DH 0161 368 4297 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) Meridian Healthcare Ltd Lynn Mary Davidson Care Home 60 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (60), of places Physical disability over 65 years of age (45) The Sycamores DS0000005584.V360049.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 60 service users to include: *up to 60 service users in the category of OP (Old age not falling within any other category). *up to 60 service users in the category of DE(E) (Dementia over 65 years of age). *up to 45 service users in the category of PD(E) (Physical disability over 65 years of age). 4th December 2006 Date of last inspection Brief Description of the Service: The Sycamores is a large, two storey, purpose built home registered to provide care for 60 older people, some of whom may have dementia or a physical disability. Accommodation is provided on each of the two floors. There are 60 single rooms, 13 of which have en-suite facilities. The home is divided into self-contained units, each one having its own small kitchen and laundry. There are aids and adaptations to meet the assessed needs of the service users. Paved sitting areas have been created to the front of the home and also to the rear, the latter being secured by fencing. The grounds are fully accessible to the service users, with garden furniture to be used in the better weather. The home is located in a residential area of Newton with associated community resources and transport links to Ashton and Hyde. Fees for accommodation and care at the home are £377:03 for a single room and £405:53 for singel room with en-suite. Additional charges are also made for hairdressing and chiropody services, newspapers and personal toiletries. There is also a voluntary weekly charge of £1:00 for social activities. The statement of purpose and service users guide is available in the main hallway. The Sycamores DS0000005584.V360049.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was carried out unannounced on the 18 March 2008. The inspection looked at all core standards. The site visit took place over a period of seven hours. The home had provided the commission with a completed self-assessment document, its Annual Quality Assurance Assessment, of how well it perceives it meets its objectives and the needs of people who are cared for. The main focus of the inspection was to understand how the home was meeting the needs of the people and how well the staff were themselves supported by the home to make sure that they had the skills, training and support to meet the needs of the people who used the service. During the inspection time was spent talking to residents, relatives and staff and observing the home’s routine and staff interaction with residents. Individual details of their experiences and care were examined from the point of admission. The inspector looked around the building and a selection of staff and residents’ records was examined, including records of care, medication records, employment and training records. People using the service, staff and relatives were consulted about their experiences of the home, using comment cards. Sixteen completed comment cards were returned on behalf of people living there, twelve completed comment cards were returned by relatives and twelve by staff. The information has been used to assist the finding of this inspeciton. What the service does well: The Sycamores provides care in a well maintained and recently refurbished home. The work completed extended not only to the exterior of the building but included refurbishment of corridors, communal areas and private bedrooms. A stable and committed staff team is employed offering a good standard of care. Admission procedures ensure people are provided with information about the home and the person’s needs are assessed before a service is offered. The Sycamores DS0000005584.V360049.R01.S.doc Version 5.2 Page 6 Health and social care needs are identified in records and staff have the necessary training and support to meet people’s needs. 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. The Sycamores DS0000005584.V360049.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 The Sycamores DS0000005584.V360049.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): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures are in place to provide people with information about the care they should receive. People’s needs are assessed before they are admitted to the home so that they can be confident that their needs can be met. EVIDENCE: A range of literature is available about the home and care provided at the Sycamores. This included a colour brochure, Statement of Purpose and Service User Guide, which set out the aims and objective of the care home. At the time of visiting there were 59 people residing in the home. One bed is purchased by Tameside’s Commissioning team to provide rotational respite care. The Sycamores DS0000005584.V360049.R01.S.doc Version 5.2 Page 9 The manager confirmed that they receive the required information about people being referred and this also enables the home to carry out its own assessment of needs using its own admission documentation. The records for a person recently referred, but not yet admitted were viewed. The process includes completion of an enquiry form, receipt of a care managers assessment, completed home’s assessment and “Getting to know you” form. The person had taken the opportunity to visit the home prior to their planned admission. This is a standard procedure for all new admissions and an essential part of the admission process. The “getting to know you” form gives a brief but very personal social history of the person, with a check list of information to be provided to the person before a service is offered. The Statement of Purpose was examined and the manager was advised to ensure the document retained evidence that it had been reviewed, such as date of last review or planned next review. People are provided with a contract of care or statement of the terms and condition of their placement. The fees for care are covered in contracts and any amendments notified in writing to relatives. Most relatives, it was stated, receive and retain contracts on behalf of people. A copy of the original is held on the persons file. Evidence should be retained that the person or their representative had been given the opportunity to sign the contract. Information in the comment cards received from people living in the home were that people had been provided with information about the home, or were supported by a relative to make the decision to move there. The Sycamores DS0000005584.V360049.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): 7,8,9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans set out individual health and personal care needs and effectively address social and leisure interests. EVIDENCE: A selection of care plans were examined to evaluate how people’s needs were identified and responded to by staff. Plans recorded identified needs and support to be offered. Plans of care also recorded how staff should assist and support people. People are supported by designated key workers and a named co-worker. Staff maintain a daily record of events, with up to three entries recorded on a daily basis. Care plans documented the action to be taken by the carers to ensure all aspects of health, personal and social care are met and reviewed. Referrals were made to other professionals such as the chiropodist, audiologist and dietician, when required. The Sycamores DS0000005584.V360049.R01.S.doc Version 5.2 Page 11 Each person was registered with a general practitioner and records were maintained of outcomes of visits by the general practitioner and other health professionals. At the time of the visit district nurses supported eight people. During the course of the visit the opportunity was taken to speak to a consultant from Tameside Hospital regarding peoples’ continuing care following discharge form hospital. Discussion was also held with one of the district nurses. Both confirmed that plans of support were understood and adhered to by staff supporting the people they visited and that people are supported in accordance to the advice and care plans put in place. No one was receiving support in relation to pressure care. The senior staff are responsible for the administration of medication. There was evidence to show they had received training to correctly administer medications. The medication storage arrangements and records were examined and found to be in order. The manager checks medication on a regular basis, including the quantity of medication held and records of administration.. Procedures were in place to check medication when received by the home and to record medication returned to the pharmacist for disposal. Medication procedures were observed. Staff were seen administering medication to individuals and signing the records following administration. However one person chose to carry the container of tablets to her room to take them later. It was recommended that the medication administration record confirms that the medication has been given to the person, but that they have not been observed taking it. This arrangement needs to be included in the person’s care plan. It is recommended that the procedures for charging when a person is supported to be admitted to or attend hospital are reviewed. This specifically related to comments by a relative that they had been charged. All potential charges need to be brought to the attention of all residents and their relatives at the time of admission to the home and be included in information provided about the home. Relatives resonding through the comment cards said they would speak to staff or the manager to clarify issues around their relative’s care and had established good links with staff to ensure effective lines of communication were maintained. The Sycamores DS0000005584.V360049.R01.S.doc Version 5.2 Page 12 People commented “staff very good”, “Family very pleased with care and support ……..receives” and “staff are extremely helpful, supportive and approachable”. The Sycamores DS0000005584.V360049.R01.S.doc Version 5.2 Page 13 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): 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for daily routines and activities are relaxed and enable people to choose how they spend their day. EVIDENCE: A member of the care staff team has responsibility for co-ordinating social care and activity programmes. Thoughout the week a series of activities are available for people. People living in the home pay a voluntary weekly charge of £1:00 for social activities. This arrangement is clearly written up on personal files with a copy of the letter confirming subscription, signed by the resident or person acting on their behalf. There is an activity book maintained to record events, costs and people attending. A range of activates are planned in the home and a calendar of events is published of planned trips out for the year. These are events scheduled and paid for from the £1 contribution by people to the social fund. The Sycamores DS0000005584.V360049.R01.S.doc Version 5.2 Page 14 The list included social evenings, two planned barge trips, and a trip to Southport and to Tameside theatre. On the day of the inspection several residents were attending the hairdresser to have their hair done and a clothing party was held in the afternoon. This was well attended and people said they enjoyed the event and had made purchases. People responding through the comment cards said programmes of activity were “excellent”. One commented “I have often participated in armchair aerobics” one person also stated they “did not choose to take part”. Entertainers also visit the home on a regular basis and people are also supported on religious observances as ministers attend the home. A visitor said she always felt she could visit when she wanted to and was kept informed of the needs and care required by her relative. Meal arrangements provide people with a choice of menu and alternatives on a daily basis. Records are maintained of meals served. There was ample provision in the kitchen and pantry areas, including fresh fruit and vegetables. On examination of the fridge and freezers, staff are advised to ensure all products stored are labelled and dated as a means of checking ‘use by’ dates. A number of containers were stored and it was unclear wha thet product was or when it was placed for storage. Hot plates are used to transfer food to the four different units. The main meal of the day is served at midday; breakfast is flexible, as and when the residents get up. A lighter tea is available later in the day and supper prior to going to bed. The Sycamores DS0000005584.V360049.R01.S.doc Version 5.2 Page 15 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): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures were in place to ensure the views of people are listened to and that people are protected from harm or abuse. EVIDENCE: There is a detailed complaints procedure in place. This is displayed in each room and detailed in the home’s Statement of Purpose. A register of complaints is held in the home and procedures indicated the home was open to receiving complaints. Since the previous inspection in December 2006 the home had received and dealt with 13 complaints. The records held information about the concern raised and how it had been investigated. Records indicated the complaint had been resolved and the manager was advised to add a section to the complaints form to enable the complainant to indicate that they are happy with the action taken by the home to address their concerns. No concerns or complaints had been received by the commission in the same period. The Sycamores DS0000005584.V360049.R01.S.doc Version 5.2 Page 16 The organisation has clear adult safeguarding policy and procedures. This included training provided to staff on abuse awareness and action to take in the event of an allegation of abuse being brought to staff’s attention. Training programmes for staff evidenced that Protection of Vulnerable Adults (POVA) training was provided to staff and that a confidential helpline run by Meridian was available to staff to discuss care and emergency issues. Staff confirmed in discussion and through comment cards that they had received formal training in POVA and demonstrated their understanding of their responsibilities. The manager was advised to ensure all staff had been given time to access and read Tameside Local Authority’s procedures as means of evidencing procedures have been followed in the event of having to deal with an allegation. The Sycamores DS0000005584.V360049.R01.S.doc Version 5.2 Page 17 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): 19 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides people living there with a well maintained, bright and homely environment. EVIDENCE: The standard of accommodation and décor had been greatly improved since the last visit. Programmes of refurbishment have provided people with a pleasant, bright, clean and well maintained property. A new conservatory to the front and a large selection of lounges and private bedroom spaces offer people a safe and secure place to live. The home is set out in four units each with its own lounge /dining area, satellite kitchen and designated staff team to support people. The Sycamores DS0000005584.V360049.R01.S.doc Version 5.2 Page 18 One relative spoken to commented that the home “was more warm and welcoming” since the home’s refurbishment. There is a well maintained designated smoke lounge on the ground floor and small enclosed courtyards to access, weather permitting. Although single rooms are small in area the recent refurbishment provides people with pleasantly decorated and furnished rooms. Some units have been built in and offer people a lockable facility. Each room offers access to a plasma screen television enabling people to watch a wide range of channels via a satellite system. Some work was required to windows in the lounges on the first floor. The manager confirmed in writing following the inspection that the identified risk had been addressed. The dishwasher in the satellite kitchen (first floor looking onto Victoria St) was not in use due to a fault on the waste outlet. This required attention, as there was a strong stench from the machine when the door was opened. The manager did confirm that this was being addressed. The manager was advised to monitor and address the use of door wedges which were seen to be in use on touring the home. People responding to questions in relation to the home all stated it was clean and comfortable. One person commented, “home very clean no complaints at all”. The Sycamores DS0000005584.V360049.R01.S.doc Version 5.2 Page 19 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): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment and selection procedures ensure a stable and committed staff team provide people with the support they need. EVIDENCE: There is a designated staff team on each of the four units to meet people’s assessed needs. The manager, staff and relatives said that staff turn over is low. Training had been provided to staff in specialist areas such as British Sign Language as one of the service user’s only means of communication was through BSL. The person had chosen to move to the home and appeared settled and happy. During discussion with staff, one person spoke positively about her role and responsibility. The member of staff said the organisation had a positive approach to training and encouraged staff to further develop their skills and knowledge. She confirmed supervision and staff meetings were held on a regular basis. Senior staff have responsibility for up to six carers, offering them regular one to one supervision and team meetings at least four times per year. The Sycamores DS0000005584.V360049.R01.S.doc Version 5.2 Page 20 Training programmes were well established and monitored to ensure staff received agreed programmes of development. There was a good awareness of abuse procedures and medication procedures There is a team of 45 staff employed in the home with no vacancies in the staff team. Two staff are deployed to each house, with a senior supporting all units. During the day, the manager is also available. A cook and assistant cook are on duty on a daily basis. There are two domestics on each unit seven days a week. The laundry service is managed by night staff and day staff on a daily basis as required. The training plan covers the following subjects; Moving and handling, first aid, food hygiene, NVQ, deaf awareness, health and safety, POVA, dementia, mental health, equality and diversity, infection control and safe handling of medication. NVQ training will have been provided to all staff once the two remaining carers complete their training. A small number of staff files were examined. They contained the required documentation and there was evidence of references, including satisfactory checks with the Criminal Record Bureau. The Sycamores DS0000005584.V360049.R01.S.doc Version 5.2 Page 21 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): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management and administration procedures ensure the home is run in the best interest of people living there. EVIDENCE: The manager is supported through the organisation by the operations director and in the home by senior carers. She has the skills, experience and qualifications to manage the home. A number of internal audits are carried out to ensure people are protected and staff work in a safe and will maintained environment. Regular internal health and safety audits are conducted. The Sycamores DS0000005584.V360049.R01.S.doc Version 5.2 Page 22 Additional audits are conducted by the PCT in relation to medication audits. Four company audits are held each year and these looked at records such as finances, training, personal files, care plans. There was a comprehensive manual of the organisation’s policies and procedures available to staff. The maintenance person carries out the weekly/monthly and annual checks on fire systems and regularly monitors temperatures of hot water outlets. These records were checked on the day and found to be in order. Regular maintenance and service checks are carried out on equipment and these were also found to be up to date and in order. A system of annual satisfaction questionnaires is used to enable people and their relatives to comment on their care and make suggestions for improvement. The results are made public and recommendations acted upon. The Sycamores DS0000005584.V360049.R01.S.doc Version 5.2 Page 23 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 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 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 3 The Sycamores DS0000005584.V360049.R01.S.doc Version 5.2 Page 24 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 2 3 Refer to Standard OP1 OP2 OP8 Good Practice Recommendations The Statement of Purpose should evidence the date that it is reviewed. Evidence should be retained that the person or their representative has been given the opportunity to sign their contract. Procedures for charging when residents attend hospital should be clearly stated in the information given to residents and their relatives at the time of admission to the home. The manager was advised to ensure all staff have been given time to access and read Tameside Local Authority’s adult safeguarding procedures as a means of evidencing procedures have been followed in the event of having to deal with an allegation. The manager was advised to monitor and address the use of wedges at doors. 4 OP18 5 OP19 The Sycamores DS0000005584.V360049.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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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