Care Home: Tresillian

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What the care home does well Tresillian presents as a friendly, homely and a well maintained home. There are no outward signs of it being a care home. The residents are able to experience day to day life of a household and are able to access a variety of activities within the local community. The residents are encouraged to maintain their independence and individuality as much as possible, whilst having their welfare taken care of. The residents are asked about their feelings and ideas when decisions are to be made and these are clearly taken into account by the providers. Training and support is provided regularly and is appropriate in enabling staff to meet the needs of the people who currently live in the home. What has improved since the last inspection? All of the recommendations made following the last inspection have been acted upon. For example the Statement of Purpose has been reviewed and includes up to date relevant information about the service and what it offers, the complaints procedure has been updated and the Safeguarding /Adult Protection procedure has been amended to ensure staff know the steps to take in the event of having to report an allegation of abuse. Decoration and maintenance is ongoing making the environment suitable for the current residents. An adapted mini bus has been purchased which has allowed for more freedom to get around and not so much reliance on public transport. CARE HOME ADULTS 18-65 Tresillian 41 Eastcliffe Road Par St Austell Cornwall PL24 2AJ Lead Inspector Mandy Norton Unannounced Inspection 11 August 2008 10:00 th Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tresillian Address 41 Eastcliffe Road Par St Austell Cornwall PL24 2AJ 01726 814834 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) Mr Nigel William Hart Mrs Sharon Dawn Hart Manager post vacant Care Home 6 Category(ies) of Physical disability (6) registration, with number of places Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 6 adults with a physical disability (PD) Total number of service users not to exceed a maximum of 6 Date of last inspection 15th August 2006 Brief Description of the Service: Tresillian provides care for up to six adults with physical disabilities. The house, which is privately owned, is a large, attractive dormer bungalow set in its own grounds which have been landscaped to be accessible to wheelchairs. It is close to the local amenities and public transport. The accommodation for service users comprises six single rooms, a large lounge/dining room, kitchen, bathroom /WC and a wet floor shower room/WC on the ground floor. Mr & Mrs Hart, the registered providers, live upstairs and provide much of the care for the service users. There is car parking. The registered provider, Mrs Hart, has had considerable experience in caring for younger adults who are physically disabled. Mr Hart and a team of experienced carers support her. Tresillian DS0000009231.V365371.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 unannounced inspection took place from 10.20 am until 3.30 pm on the 11th August 2008. The inspection was conducted with the Mr & Mrs Hart, the providers. A tour of the home was carried out and 3 of the people who live at the home and the three care staff(who all came into the home during the inspection) were spoken to. The report also contains information taken from the completed Annual Quality Assurance Assessment submitted to the Commission prior to the inspection. What the service does well: What has improved since the last inspection? All of the recommendations made following the last inspection have been acted upon. For example the Statement of Purpose has been reviewed and includes up to date relevant information about the service and what it offers, the complaints procedure has been updated and the Safeguarding /Adult Protection procedure has been amended to ensure staff know the steps to take in the event of having to report an allegation of abuse. Decoration and maintenance is ongoing making the environment suitable for the current residents. Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 6 An adapted mini bus has been purchased which has allowed for more freedom to get around and not so much reliance on public transport. 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. Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have information about the home in order to make an informed decision about whether the service is right for them. EVIDENCE: There is a pre admission assessment procedure in place that is completed prior to admitting anybody. This ensures that the home can meet the person’s needs and that the person will ‘fit in’ with the current residents. There are currently 5 permanent residents and the 6th room is often used for respite and short - term care. The provider said that the residents have said they like having new people in the home and if they didn’t then they would reconsider how they use the room. The current residents often know the people that come in for short - term care but they also have to have a pre admission assessment and are invited to look around the home prior to staying. The provider said that this lets them know what the home looks like and allows them to meet the current residents, if it is felt that they wont ‘fit in’ with the current residents then they cannot be offered a service. The Service Users Guide seen was up to date explaining the ethos of the service and what the service has to offer including transport provision. This Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 9 document is available to people in a format that is suitable to them and can be done on an individual basis. Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The practice regarding the planning and delivery of care and support means that people can be sure that their social, health and personal care needs will be met. EVIDENCE: The care plans examined had a lot of information about the individual and their abilities and lifestyle choices. They had been regularly evaluated and updated. The plans showed when other health care professionals are involved with care and support such as GP’s, dentists, opticians and any restrictions on choice or freedom. Information is recorded each day about a person’s welfare and how they have spent their day. The people spoken to were clearly able to express themselves and are actively involved in decisions about how they spend their time, where they go on holiday and what meals they eat on a daily basis for example. Each person has access to their own money (they all have their own accounts) and the manager said that those able to manage their finances independently Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 11 are encouraged to do so, with support from staff as required. She explained the system in place to manage people’s money, this includes recording income and expenditure and keeping receipts. The home have recently acquired a mini - bus, the manager said that the residents pay 50 of their mobility allowance to help with its upkeep. The staff spoken to described how people are involved in the day to day running of the home this includes deciding on what meals to have and what activities they would like to be involved with in side and outside of the home. They are also consulted when any changes are being bought in, such as the current decision to use one room as a respite room for short - term residents. Residents spoken to agreed that they are involved in decisions made in the home and often take new ideas to the staff for discussion. The manager explained about how risks are managed within the home and the community on an individual basis and are kept under constant review. The risks are documented in the care plans and discussed during staff handovers as required. She said they encourage residents’ independence but are mindful about their personal safety. Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of activities within the home and community meaning the people have opportunities to participate in stimulating and motivating activities that encourage personal development and independence. Meals and relaxed making them an enjoyable occasion for people. Residents are offered meals that they enjoy and meet their nutritional needs EVIDENCE: The 3 residents spoken to were able to say how they spend their time in the house, what they do outside the home and what they like to do as individuals. The residents attend local day centres and are included in the local community as they are all out and about during the week engaged in a variety of activities including work related schemes and educational activities. On the day of the inspection 3 residents had volunteered to stay at home and speak to the inspector and described what they normally did during the day Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 13 and some of the activities they have done recently including their holiday (to Florida) and a recent visit to the circus. The Annual Quality Assurance Assessment states that ‘ we do not plan holidays at ‘special’ resorts and our clients respond positively to this. They hate to be tarred as a special needs group. This does not always make it easy for staff however when booking accommodation but we respect our clients feelings’. The manager said that they go out on group trips using the mini bus that they have recently acquired. This has been a big help as the local train station has poor access for disabled people. The communal lounge had a TV, books and games and the 2 residents rooms seen had TV’s, CD players and personal collections of music. One resident said that if they don’t all agree on which programme to watch on the TV then they can go to their own room to watch what they want to. The garden is accessible to all of the current residents and has a patio area with tables and seating which is used often in the good weather. The provider has just completed a raised garden bed accessible to wheelchair uses. The residents enjoy the vegetables that they help to grow in the vegetable patch and the greenhouse. Visitors are encouraged to visit at any time and can spend time with people in the spacious garden, communal lounge or in their own room. The staff and residents said that they have some household tasks to help to keep the environment clean and tidy. These are included as part of the care plans. Breakfast and evening meals are usually taken together but the residents are often out during the day and will choose what they want to eat and where, the staff ensure they have money for this if necessary. Staff spoken to said that residents help to choose what they would like to eat but that the staff are mindful about the nutritional assessments of the residents and take care to ensure they do not put on too much weight for instance. During the inspection people were heard interacting appropriately with each other and the staff. Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The providers commitment to the delivery of care and support means that people can be sure that their health and personal care needs will be always be met. EVIDENCE: The residents spoken to said that they can go to bed when they want and go out when they want as long as they tell somebody where they are going. Mealtimes are at scheduled times but residents can eat at different times if they wish to. Care plans seen included individual records that detailed peoples preferred routines and likes and dislikes. Rooms that are used by wheelchair users have a lowered work- top are to enable them to manage some of their personal grooming independently (as able). The manager said that residents visit the GP, optician and dentist as required. One resident said that he was very pleased that the manager had spoken with the GP about a problem he had experienced following swimming, a nose spray has been prescribed and he is so pleased he really likes swimming again now. Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 15 The Annual Quality Assurance Assessment states that the local Community Nursing service visit the home regularly at the moment and they have a good working relationship with them. The nurses are flexible and try to visit to fit in around the lifestyle of the person they are visiting. A record is maintained of the current medication for each person. The staff spoken to said that they have to make sure that people take any medicines they need out with them if they have to be taken during the day, they all said that they have received medicines training and felt confident in administration of medicines however the manager/provider is always available to ask, even if she is not on duty, if something new has been prescribed or a prescription changed. The receipt and storage of medicines is in accordance with laid down legislation.(Medicine management was not looked at in detail during this inspection). Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Formal complaints and reporting of abuse policies and procedures are in place. They are available to anybody working with the residents and people visiting the home at all times. People feel their concerns are listened to and acted upon making them feel supported and safe. EVIDENCE: There is a formal, up to date complaints procedure in place which is in the Statement of Purpose and displayed within the home. There has been one complaint since the last inspection (done on 15th August 2006) following investigation none of the aspects of the complaint were upheld. During discussion it was clear that the staff giver was aware of adult protection/safeguarding procedures and would know who to contact if necessary. Staff spoken to said that they had had training in Safeguarding from Cornwall County Council. The Annual Quality Assurance Assessment states that all of the residents and the staff have had a copy of the ‘Say No To Abuse’ booklet and this has been discussed freely between the residents and the staff. A poster that also has the ‘Say No To Abuse’ logo is displayed on the residents notice board. The manager said that the policies and procedures had been updated to reflect good practice and these are available to staff at all times. Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 17 The residents visit day centres and have contact with outside agencies to whom they are able to talk if they have any concerns that cannot be shared with staff at the home. Residents spoken to said that if they were worried about anything they would speak to any of the staff. Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 28 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have a homely, comfortable, suitably adapted and safe environment in which to live. EVIDENCE: Tresillian is a detached chalet bungalow with the providers (Mr & Mrs Hart) living on the first floor and the residents rooms and all other facilities provided on the ground floor. It is situated in the village of Par, near St Austell. On the day of the inspection the home was clean, tidy and homely. The individual rooms seen were decorated appropriately and had personal possessions and ornamentation chosen by the residents themselves. Rooms that are used by wheelchair uses have an area of work surface that is at a lower height to enable them to manage a number of activities independently. There is a communal bathroom/toilet and a shower room (accessible to wheelchair users). The Annual Quality Assurance Assessment states that specialised equipment is in place, following occupational therapy and physiotherapy assessments to assist individuals with posture and mobility. Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 19 There is a communal lounge diner that is used by all the residents. Washing is done in a domestic machine and the cleaning and household chores are done by the staff with some help from the residents. Ongoing repairs and maintenance are done by Mr Hart. When decorating residents rooms the staff discuss it with them and they are able to choosing their own colour scheme with in put about how they would like the room laid out.. A number of documents were seen that confirmed ongoing servicing and maintenance of equipment. They included the fire risk assessment, gas safety check, annual portable appliance testing (PAT) records and an electrical wiring certificate. People spoken to said that they liked their rooms, the lounge and using the outside space when the weather is good. Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provider and care staff show a responsible attitude and implement changes and improvements in order to keep improving quality and outcomes for people living in the home. Tresillian access training designed to give staff the skills they need to ensure people are being looked after and supported appropriately. EVIDENCE: Mr & Mrs Hart look after the residents with the support of three care staff. All of the care staff were spoken to on the day of the inspection. They all said that Mr & Mrs Hart are very supportive, there are good training opportunities (including safeguarding, medication management and equality and diversity) and there are regular staff meetings, one commented that it is ‘like a family’. One person acts as deputy if Mr & Mrs Hart are away, she has worked at the home for a number of years and moves into the house whilst they are away. The Annual Quality Assurance Assessment states that all staff have National Vocational Qualification level two, 2 have level three and 1 is working towards a level four, with I also being an National Vocational Qualification assessor. It Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 21 goes on to say that all staff have supervision sessions and appraisals and regular attend staff meetings. Hours worked are flexible around the needs of the residents, there are less staff available when the residents are out during the day and more staff when they are in the house. The usual levels are 2 care staff during the day when people are in and Mr & Mrs Hart overnight. The care staff said they work alternate weekends. It was clear during discussion that the staff know the residents very well and feel able to cater for their ongoing needs. Staff interaction with the residents during the inspection was appropriate and ongoing. Mr & Mrs Hart have a recruitment procedure that includes getting a CRB check, 2 written references and previous employment history. People have an interview and the residents are asked for their opinions, there is then an opportunity for an induction period to ensure the person has the skills required to support and care for the residents, know how to deal with untoward incidences and are aware of information they need to document and policies and procedures that are in place. Staff turnover is very low with all the current staff having been there for a number of years. They all spoke knowledgeably about up to date issues such as safeguarding and equality and as one commented they like to ‘help the residents to have a good quality lifestyle’. Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provider and care staff work to meet the needs of the service and to continually improve what the home offers to meet the needs and welfare of the people that live there. EVIDENCE: Since the last inspection (August 2006) the home has notified the Commission of any incidences that they are required to report and have submitted their annual quality assurance assessment (AQAA) to the Commission. Mr & Mrs Hart own and manage the home, with Mrs Hart dealing mainly with care and support issues and Mr Hart dealing with ongoing maintenance and upgrading and the financial running of the home. They have run the home well for a Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 23 number of years and the care staff and residents spoken to said that they are supportive and responsive to change. There is a formal quality assurance system in place which is based on seeking the views of those that live in the home it was suggested that they also ask other people who visit the home in a professional capacity for their views. The quality assurance questions are designed so that the current residents can understand them and are able give their opinions. Risk assessments are completed for individuals and generally for the house. These are updated as required and are available to staff at all times. The day to day documents that are in use by Mr & Mrs Hart and the care staff such as the diary, accident book, daily evaluation sheets, medication recording sheets and care plans are kept in the kitchen area where a lot of daily activity takes place and they are accessible to all. The induction procedure and ongoing training in place covers aspects of health and safety relevant to the current residents (when they are in and out of the house), the staff group and the building including security of the premises, safe storage of hazardous substances and risk assessments. Statutory training includes food hygiene and lifting and handling. Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 4 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 4 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Tresillian DS0000009231.V365371.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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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