Care Home: West View

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What the care home does well There is a relaxed and homely atmosphere. People say that the nurses, care workers and health care assistants (care workers who have had extra training in basic medical things) are kind and attentive. They also say that they receive the support and assistance they need. People are helped to stay in good health. This includes keeping an eye on how everyone is and then calling doctors and other medical-type people as soon as they are needed. People`s medicines are handled safely so that they take them in the right way at the right time. Good quality meals are provided. Sensible things are done to help prevent people having accidents. What has improved since the last inspection? A new activity coordinator post has been created. This person will have all of their time devoted to developing the range of social opportunities offered to people who live in the Service. Members of staff have been helped to get to grips with the various computer systems that are used to plan and record the support provided in the Service. Some of the care workers and health care assistants have done special training in how to safely and reliably give medication. Nurses, care workers and health care assistants have completed workbooks. These are designed to assess that they know what they`re doing in relation to key bits of the personal support provided in the Service. What the care home could do better: Quite a lot of the paperwork is complicated and longwinded. Also, most of it is on the computer. All of this might make it difficult for people who live in the Service to get to grips with it. This then might take away from how able they are to fully take part in deciding things that are about themselves. The activities calendar is not that well developed. Some people would like to have the chance to do more social things. Parts of the quality assurance system don`t fully involve all of the people who live in the Service. This is important because they are the real experts on what it is like to live in West View. They need to have a direct and definite say in how things are going. Also, they need to be told what is going to be done to respond to any improvementsthey may come up with. Inspecting for better lives Key inspection report Care homes for older people Name: Address: West View Plummers Lane Tenterden Kent TN30 6TX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mark Hemmings     Date: 0 5 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 39 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 39 Information about the care home Name of care home: Address: West View Plummers Lane Tenterden Kent TN30 6TX 01580261500 Telephone number: Fax number: Email address: Provider web address: mandy.brown@kent.gov.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Mandy Kathleen Brown Type of registration: Number of places registered: Kent County Council care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 60. The registered person may provide the following category/ies of service only: Care home with nursing only - (N) to service users 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 (OP) Dementia (DE). Date of last inspection Brief description of the care home Up to 60 older people can live in West View (the Service). The property is purpose built. Its a detached building on two floors. The living space is divided into wings or units. Each unit has a similar layout. There is a lounge/dining room. Attached to the dining area is a small kitchenette. There are a number of bedrooms in the area. People normally use the lounge nearest to their bedroom but they dont have to. The units also have a shared use bathroom and shared use toilets. On the ground floor, the units Care Homes for Older People Page 4 of 39 Over 65 0 60 60 0 Brief description of the care home are called Wittersham and The Lindens. Wittersham is reserved for 15 people who have difficulty understanding some everyday things and who can find it hard to say what they want. Four of the places in this unit are set aside for people staying for short term care. These people normally stay for a week or two so that their carers at home can have some time to themselves. The Lindens is occupied by 15 older people, ten of whom can make their longer term home there. Five of the places are for short term care. On the first floor, the units are called Benenden East and Benenden West. Each can accommodate 15 people. These units are reserved for people who are taking part in something called the Intermediate Care scheme. We say more about this scheme later on. In the Benenden units, 20 of the places can be used for people who need nursing care in addition to personal care support. All of the bedrooms are for single occupancy. Each has a private bathroom with a shower, toilet and wash hand basin. There are two passenger lifts that give step-free access around the accommodation. There is a call bell system with call points in each of the bedrooms including the private bathrooms. This means that people can ring for assistance should they need it. The Service stands in its own grounds. Its down a quiet lane just outside the main bit of Tenterden. There are no shops within easy walking distance. Care Homes for Older People Page 5 of 39 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this Service is 2 Star. This means that the people who use this Service experience good quality outcomes. Since 1 April 2006, we have developed the way we do our inspection of care services. This inspection of the Service was a Key Inspection. We arrived at the Service at about 9 oclock and were there for about eight and a half hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in its self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, we considered any information that we have received about the Service since the last inspection. During the inspection, we spoke with the six of the people who live in the Service and with three of their visitors. We Care Homes for Older People Page 6 of 39 also spoke with the Manager, Deputy Manager, senior administrative officer, one of the team leaders (care workers who are in charge of each shift), two nurses, four care workers, the cook and the kitchen domestic. We walked around parts of the accommodation and we looked at a selection of key records and documents. The place was built as part of the Governments private finance initiative or PFI. This means that a private company owns and runs the building. The Registered Provider is like a tenant there. The company that owns the building has employed another company to run it on a daily basis. They have a senior person based there. He is called the Facility Services Manager. He organises all of the catering, housekeeping, laundry and maintenance services. We spoke with him and we looked at various records and documents he keeps. Before we called to the Service, we asked some of the people who live there and some members of staff to fill out a questionnaire for us. We wanted them to tell us what they think of West View. We sent out 10 questionnaires for people living in the Service and we got eight of them back. We sent the same number for members of staff and we got three of them back. What the care home does well: What has improved since the last inspection? What they could do better: Quite a lot of the paperwork is complicated and longwinded. Also, most of it is on the computer. All of this might make it difficult for people who live in the Service to get to grips with it. This then might take away from how able they are to fully take part in deciding things that are about themselves. The activities calendar is not that well developed. Some people would like to have the chance to do more social things. Parts of the quality assurance system dont fully involve all of the people who live in the Service. This is important because they are the real experts on what it is like to live in West View. They need to have a direct and definite say in how things are going. Also, they need to be told what is going to be done to respond to any improvements Care Homes for Older People Page 8 of 39 they may come up with. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 39 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 39 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 3 and 6. People who are thinking of moving in are asked about what support they need and how they want this to be done. People who want to stay for shorter periods are helped to go back home. Evidence: The way the Service is set up means that more than half of the people will only be staying for a few weeks or so. The Manager says that for people who stay for short term care, there is a definite plan from the start about them going home on a set date. For the people who are part of the Intermediate Care scheme the date is not fixed. This is because of the nature of this arrangement. The people who use it have often been in hospital and they need time to recover their strength. Also, they may need to re-gain some of the skills that we all need in order to manage at home. To do all of Care Homes for Older People Page 11 of 39 Evidence: this, arrangements are made for them to work in a focused way with a whole number of people who can assist them. These include people like occupational therapists, physiotherapists, nurses and care managers (social workers). These people all have their offices in the Service and so they are readily to hand. A persons length of stay depends on how they do, but usually it is hoped that it wont need to be longer than about six weeks. When someone moves into a residential care setting theres always the risk that their stay might become longer than is necessary. We looked at what is done in the Intermediate Care service to prevent this. There are frequent and regular meetings between all of the Intermediate Care members of staff. At these meetings, all sorts of relevant things are talked about. For example, what needs to be done to help the person become more independent in the kitchen and in the bathroom. Or, it might be that enquiries need to be made early on to make sure that home care support is ready for when the person goes back to their own home. We looked at the records of some of these meetings. They show that all of these things are being actively thought about. The Assessment says that the Intermediate Care scheme has a good success rate. By this it means that most of the people who use the service end up being able to go home. The Manager or the Deputy Manager ask people who are thinking of moving in, about what support they need and want. This is done so that everyone can be confident that moving into West View is the right thing for them. They also talk with family members and with people like care managers. For people who move into the Service under the Intermediate Care scheme, the Manager and the Deputy Manager will also often speak with people such as occupational therapists, physiotherapists and nurses. All of this is done so that they can build up a really good picture of how the person can best be supported. After they have got all of this information, they can then decide if West View can meet the persons needs for help. We looked at the information that has been collected for one person who has recently moved into the Service. We wanted to see what sorts of things were considered. There is lots of useful information. For example, there is information about how the person likes to be helped to promote their continence. There is also information about their health care needs and the special arrangements that need to be followed to make sure that they get the right medical treatment. The Manager says that when she gets the information she and the Deputy Manager share it with the nurses, care workers and health care assistants. This is done so that they know in advance about what support they will need to provide. We asked a team leader, two nurses and two care workers about how all of this works out in practice. Care Homes for Older People Page 12 of 39 Evidence: They say that they are indeed told about people who are about to move in. They say that as a team they discuss how best to help the person in the first few days while they get to know them better. The Manager recognises that moving into a residential care setting is a big step for anyone to take. She says that she wants to do everything possible to put the persons mind at rest. We agree that this is really important. She says that as part of the assessment process, people are invited whenever possible to visit West View. This is so that they can see what the place is like first hand. She says that during these visits people can ask any questions they want. There are also some written documents that say about the Service in quite a lot of detail. These are called the Service Users Guide and the Statement of Purpose. People can ask to see these if they want. The Manager is quite happy for them to take away a copy if they want to have a look at them at their leisure. We asked one person about their experience of moving in. They say that the nurses, care workers and health care assistants did know about the support they need from the start. They also say that they were made welcome and that this made a big difference for them. In summary they say, it (the moving in experience) wasnt rushed at all, I just got to know staff. They knew the main things about me from when I first moved in and then got to know little extra things. It was all relaxed and not pressurised at all. Care Homes for Older People Page 13 of 39 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 7, 8, 9 and 10. People are provided with the personal and health care they need. Some of the paperwork is complicated and not at all user-friendly. Medicines are handled safely. People are treated with kindness and respect. Evidence: The people who live in the Service say that the nurses, care workers and health care assistants offer them all the assistance they need. There is a written individual plan of support for each person. These are kept on a computer. There is a terminal in each of the units so members of staff can get into whats on the electronic system. These support plans are important. This is because they are one of the ways that people can say what assistance they want to have and how they want it to be done. Also, the plans give information to members of staff so that they know what to do. We looked at four of these plans. They give a clear account of who needs to do what and why. For example, there is useful information about things such as helping people in the Care Homes for Older People Page 14 of 39 Evidence: bathroom, about health care and about keeping people safe. In more detail, one person needs special help because they have to take nutrition in a special way. Another person has problems organising their thoughts and needs to be helped to say what they want. Someone else needs to be supported to make sure that they drink enough and so dont get too thirsty. We asked a nurse, a team leader and two care workers about some of these things. We wanted to know what all of this written information means in practice. Whether its used or not. They know all about it and we saw them using it in practice. For example, they are patient with the person who finds it hard to make sentences. They wait for them to finish what theyve got to say. Then they check out that they have understood them right. Or, they know about the special things that need to be done to support the person who finds it difficult to eat in the normal way. The plans are kept up to date so that they are accurate. This involves nurses, care workers and health care assistants making daily notes about how things are going. There are then regular reviews. This is when the nurses and the team leaders check out with other members of staff and with the people concerned, how things are going and what might need to be changed. All in all, theres a lot of information on the computer system. If you print out one of the support plans you end up with a whole pile of paper. Members of staff are spending large amounts of time writing things down and fiddling about on computers. This then results in there being lots of complicated looking forms and general paperwork to wade through. Were used to this sort of thing, but it looked a bit daunting even to us. It took us a long time to understand where different bits of information are and how they relate to each other. Its very unlikely that the people who its written about will find it easy to use. Or, that they will think it interesting enough to spend time on. Each person is given a summary sheet. But this doesnt say much really and some of its written in a form of computer-speak. Were not surprised to hear that people dont really bother about whats in their individual support plans. We asked one person about all of this. They say, Oh its all on computer these days, I dont know what staff are typing about all the time, Im sure it must be important or they wouldnt do it. Staff do talk to me about things and I suppose they type up things that I say. This sort of account is a pity because the support plans are all about the people who live in the Service. Theyre much more likely to be right and to be helpful if people have a direct say in whats in them. The Assessment doesnt really mention this as being an issue, but we think that its really important. We have asked the Manager to look into what can be done to make the whole process more straight-forward and more user-friendly. Care Homes for Older People Page 15 of 39 Evidence: Sensible steps are taken to ensure that people do not have any avoidable accidents. For example, some people are a bit unsteady on their feet. They are accompanied by a nurse, care worker or health care assistant so that they dont lose their balance. People are helped to keep healthy. Nurses, care workers and health care assistants keep a tactful eye open so that a doctor can be called if someone is becoming unwell. Since our last inspection, a number of people have seen their doctors, some on more than one occasion. There have also been visits by other professionals such as district nurses and dieticians. We looked at some of the records about how quickly doctors are being called after the need for medical attention is first noted. Its being done straightaway. The Manager and the Deputy Manager are active about this. They make sure that people get the medical attention they need. Some people manage their own medication. Most of these people are part of the Intermediate Care scheme. When people first come to West View, they are asked about this so that members of staff know what help might be needed. For example, they are asked about what medicines might need to be re-ordered so they dont run out. Another thing they are asked is whether or not they want a hand in being reminded about taking medicines on time. Now and then members of staff check out how things. This is done to make sure that everyone is managing their medicines okay. For the other people, members of staff handle their medicines for them. There is a system to check that the correct medicines are received from the chemist. Once in the Service, they are stored securely. There is a procedure for administering medicines. This is designed to double-check that the right medicines are given to the right people at the right time. There is a record that is completed on each occasion that a medicine is given. We examined three sets of these records. They are correctly completed. We looked at two medicines in more detail. This was done to see if the remaining stock matches what should be there. Again, we found things to be in order. There are special arrangements in place for particular medicines. This involves extra security measures. These are in place because the medicines in question might be misused if they were to get into the outside community. Some medicines can be given as and when they are needed rather than on a routine basis. At the moment, these are mainly things like mild pain killers. Since we were last in West View, more detailed written guidance has been prepared for nurses and team leaders to use when giving this type of medicine. This has been done so that there is a clearer account of what circumstances should lead staff to consider dispensing them. We asked one of the nurses about these arrangements. They are confident that these Care Homes for Older People Page 16 of 39 Evidence: when needed medicines are being used in the right way. More generally, they say the medication is well organised, reliable and properly recorded. It meets what I understand to be good national nursing practice. We asked a number of people what they think of the nurses, care workers and health care assistants. They praise them saying that they are courteous and attentive. Last year, the Registered Provider sent a questionnaire to each person living in the Service. They were asked all sorts of things. These add up to what they think about West View. We looked at the results of this exercise. Not many people responded. This low response rate is a shame and we talk about it later on. However, those who did respond give a generally positive account of their day to day lives in the Service. For example, when they are asked if their views and choices are respected and if members of staff listen to them, the three people who replied answered always. Another question asks about if people are treated with respect. Two of the three people who answered say that they always are and one says usually. We also asked about this sort of thing in the questionnaires that we sent. One of the things we ask is, do you receive the care and support you need. Everyone says that they always do. Only one person chose to add some detail for us in their response. They say the level of care is excellent. Another question we ask is, do staff listen and act on what you say? All but one person says always and the one who doesnt says that they usually do. Two people summarise the general comments that were made to us when we were talking with people in the Service. One person who lives in the Service says, I like the staff, because theyre excellent and theyre always around to help me whenever I need them. Nothing is too much trouble really. No you cant fault them at all. Another person who visits the Service says, the carers are really good. Nothing at all is too much trouble for them to help my grandmother. Theyre polite, friendly and welcoming. I really like coming here because its how care should be We did a special thing when we were in Wittersham unit. We made a point of sitting in the lounge for about one and a half hours. We carefully watched what three of the people who live there were doing. We wanted to see in detail what they do, how they get on with care workers and how they are in themselves. We wrote down what we saw. We did this so that we could look at it afterwards in order to tell you about our conclusions. We saw lots of examples of care workers chatting with people about everyday things such as the weather. There were also conversations about practical things such as the support needed when people wanted to use the bathroom. People were given the time they need to express themselves. They werent rushed. The two care workers in question have a really good knowledge of how people prefer to say Care Homes for Older People Page 17 of 39 Evidence: what they want. For example, it wasnt at all clear to us what one person was saying at one point. They only used a few words and we couldnt quite understand even those. However, one of the care workers was able to understand what the person was saying without any real problem. This was about wanting to go from the lounge into the dining room where a sing-a-long was just starting. When she was helped to walk into the dining room the person smiled showing that the care worker had got it right. People are helped to wear neat and clean clothes so that they can present themselves how they want. They are given their post promptly. Also, they are helped to deal with it if something is difficult for them. People can use the phone if they want. Care Homes for Older People Page 18 of 39 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 14 and 15. There are some interesting things for people to do, but some of them might want to do more. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: The intention is that each weekday the care workers and health care assistants on each of the units offer people the chance to do a social activity. There is also an arrangement whereby entertainers come into the Service now and then. Also, there are some trips out. We looked in some detail about how all of this works in practice. The activities that are arranged by the care workers and health care assistants have to be done once they have finished all of their other work. This means that if there is something it will usually take place in the afternoon. There is no set plan as such. Members of staff and the people who live in the Service, decide what to do on the day. In Wittersham care workers say that they do things such as sing-a-longs, floor skittles, board games and quizzes. When we were there doing our observation exercise, we saw one of these sing-a-longs. Seven people joined in and they seemed to be enjoying Care Homes for Older People Page 19 of 39 Evidence: singing old time favourites while having a cup of tea. In addition to this, one person was looking at a jigsaw and two people were looking at a picture book on the royal family. There was a lively and interesting atmosphere in the place. However, when we went to the other units there wasnt much going on at all. In The Lindens, there were four people sitting in the lounge, but they didnt seem to be doing anything in particular. In the Benenden units, everyone was resting in their bedrooms. We said hello to a couple of people there and we found them sitting on their own without any real occupation. There is a record that shows roughly what each person has chosen to do. We looked at two of these. We wanted to see what people are choosing to do in practice over a period of time. So we looked at the whole December 2008. One person did two activities organised by members of staff and the other did three things. We ask about social activities in our questionnaires. We say are there activities arranged in the Service that you can take part in? Three people say that there always are, four people say usually, three people say sometimes and no one says never. When in West View, we asked people about the social things they can do and we got different answers. One person says, We do things but sometimes things can be boring. I think we could do a bit more like its at home. While the other says, Im quite happy doing my own thing like jigsaws and dont want to be doing things like sing songs and other stuff. There is a balance to be struck between people being able to do interesting things and not being pushed into doing what they dont really want to do. Were not sure that the balance in West View is quite right at the moment. The Manager says that she has just appointed a new activities coordinator. This person is about to start work. She will organise both small group activities that everyone can attend and more one to one things for people who like to do things by themselves. The Assessment says that she will be supported in her work by various pieces of recreational equipment that have recently been bought. For example, games and things that help people reflect upon the lives they have lived so far. We think that this new person is a very good idea. This is because it should mean that more frequent and more varied activities can be offered. The Manager says that the first thing the new coordinator will do is to talk with all of the people in the Service. This is so that she can get a good idea of what they want to do. The Manager says that this will be completed by 1 April 2009. People are helped to keep in touch with members of their families, if this is necessary and if this is what they want. Family members and friends are welcome to call to the Service at any reasonable time. The Manager and the Deputy Manager keep in touch with family members so that they know how things are going. For example, if someone is not well or if they are admitted to hospital. We asked a relative about this whole Care Homes for Older People Page 20 of 39 Evidence: subject. They say, Im always told about what is going on and theres usually quite lot with mother. Ive no complaints at all, I feel fully involved in things. The Manager says that the Registered Provider doesnt get involved in handling peoples financial affairs. For example, running bank accounts or signing for things in someones name. Its a good idea not to get involved in this way. This is because it avoids conflicts of interests. These can sometimes lead to complicated misunderstandings about who has the right to do what. Instead, most people get help from members of their family or from their solicitors. People say that they receive good quality meals and that they have enough to eat. They consider meal times to be a relaxed and pleasant affair. One person summarises the general view when they say, the food here is too good and theres too much of it. I have put on weight and I need to lose some of it now. There is a choice of dish at each meal time. We looked at the records of the meals provided over a two day period for two people. We wanted to see if different people are actually having different things. They are. For example for lunch one the first day one of the people had steak pie while the second person had smoked haddock. On the second day, the dishes chosen were chicken in white sauce and sausage and onions. Care workers say that people can have drinks and snacks throughout the night. This is because they have access to kitchenettes on each of the units. This is a good idea. Otherwise, it can be a long time for some people between the late evening milky drink and breakfast the next day. In our questionnaires we ask do you like the meals at the Service? Six people say that they always do and one person says usually. The person who says usually then refers to a particular problem. This is to do with the fact that sandwiches are sometimes chilled in the kitchen and then they have not always got to room temperature by the time they are served. In their comments to us they say that, I believe that every effort is now made to solve this problem. Care Homes for Older People Page 21 of 39 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 16 and 18. There is a complaints procedure, but its not that user-friendly. Complaints are dealt with properly. People are safeguarded from being bullied or taken advantage of. Evidence: We asked people about making complaints. They say and show us by their relaxed manner that they will feel quite okay about speaking up should they need to do so. There is a written complaints procedure. This explains how to go about making a complaint or raising a less formal concern about something. Its best for things to be sorted out informally in the Service. This is because it means that problems can get put right quickly with the minimum of fuss. However, people do have the right to complain to us direct, if they dont want to go to a member of staff. The current procedure doesnt make this clear enough. The Manager is going to sort this out by 1 March 2009. The current procedure is written in a straightforward manner and so most of the people who live in the Service should be able to use it with no trouble. However, most of the people who have difficulty understanding things might find it to be heavy going. The Manager is aware of this. She hopes to develop a more user-friendly version in the near future. We think that this is a good idea. Care Homes for Older People Page 22 of 39 Evidence: Since we were last in West View, the Registered Provider has received one expression of concern and three more complicated formal complaints. The concern was about a misunderstanding that had occurred between the person making the complaint and some of the members of staff in the Intermediate Care team. The records show that the Manager passed the matter over to the Intermediate Care people. The misunderstanding was then cleared up to the persons satisfaction. With reference to the formal complaints, the most recent one of these is still being looked into. The other ones have been sorted out. We had a look at how this was done for one of them. The complaint was from a relative and it was about various things to do with the support provided for their mother. In the main, it concerned a claim that the person who lives in the Service was not helped in time to use the commode when they got up in the morning. It was also said that the commode was then left unemptied in the persons bedroom for the rest of the day. The records show that a senior manager who isnt based in West View, dealt with the complaint. They did this by arranging for all of the members of staff concerned to be spoken with and for the necessary records to be examined. They did this so that they could find out exactly what had happened. They then wrote quite a long letter to the person who made the complaint. They explained what had happened and why. In the letter they are quite open about things. They point out that the person in question was in fact assisted to use the commode. However, they also acknowledge that the commode wasnt emptied in a timely manner. They then apologise for this. They also outline what has been done to help prevent the same thing happening again. The Registered Provider has a procedure for how complaints have to be handled. This includes clear timescales for doing things such as responding to people who make complaints. This complaint was dealt with within the required timescale. Overall, we think that this complaint was dealt with in an appropriate and helpful way. Its very important that people are confident that they are safe from being taken advantage of. For example, they need to know that theyre not going to be bullied or pushed around. The Assessment commits the Registered Provider to guarding against this. We asked a nurse and some of the care workers about this matter. They know what to look out for. The things that might show that somethings not right. None of them have any concerns about how things are going. The people who live in the Service say and show us by how relaxed they are, that they feel safe living in West View. Care Homes for Older People Page 23 of 39 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 19, 22, 25 and 26. The accommodation is well decorated and furnished. Its spacious and things have been well thought out to help people be as independent as possible. Evidence: As we have said earlier, West View is quite a new building. Its made from modern materials and its fitted out with all sorts of up to date things. For example, it has automatic opening front doors and various energy saving devices. It looks new. However, on the outside the gardens have got going and so the place doesnt look too stark. At the back there, is a walled garden that can be safely used by people who have problems with their understanding. On the inside, its plain that careful thought has gone into designing things. The corridors are nice and wide. The bedrooms are spacious and even the private bathrooms are a very good size. Doorways are wide so its easier for things like wheelchairs to be used. Theres also plenty of storage space for wheelchairs and other bits of equipment. In the units, the lounges are well sized. Somehow this doesnt end up making these areas feel empty or hospital-like. Instead, they feel quite lived in. This is especially so for Wittersham where care workers have done various paintings Care Homes for Older People Page 24 of 39 Evidence: on the windows to make the place interesting and colourful. Having said all of this, some of the shared use bathrooms are a bit bare. More could be done to make them into welcoming spaces. Most areas of the building are fitted with an automatic sprinkler system. This provides a very high level of fire safety protection. Sprinkler systems are now recognised to be the best system possible. This is because theyre so safe. We understand that the system is being serviced regularly. Also, we understand that the Kent Fire and Rescue Service say that everything is okay with the sprinklers and with other fire safety things. The Registered Provider has a system of doing regular fire safety risk assessments. This is where the Facility Services Manager goes around the place to check out that everything is still working in the right way. We had a look at the report of the most recent one of his assessments. It shows that important things are being checked. Such as are escape routes well signed and are they kept clear? The Facility Services Manager isnt sure if the assessment has been sent to the fire brigade people. Its a good idea to do this. This is so that they can check that everything that needs to be looked at has been included. The Manager says that she will sort this out by 1 March 2009. The local Department of Environmental Health people called in mid 2007 to look at the kitchen. They say that its equipped and operated to a very high standard. They gave it five stars out of a possible five. We looked at the kitchen too. Its well equipped, clean and well organised. The cook does sensible things to ensure good food hygiene. For example, once food is opened it is covered. Then a date is written on it. This is done to make sure that things are not allowed to hang around too long. She regularly checks the fridges and the freezers to make sure that they are cold enough. She also checks the temperatures of certain cooked foods. This is done to make sure that they are properly cooked through. She knows about good food hygiene. For example, she knows about the need to use different chopping boards for different foods. Also, she is aware of the importance of washing your hands before touching food. People who need it are helped to get about. Weve already mentioned the wide corridors and such like. This extends to the shared use bathrooms that are on each unit. These are a good size and they are well laid out so that things are easy to get to. Each has a special bath. These have a whirlpool function that some people find to be relaxing. There is a hoist attached to each bath. This means that you can sit in a chair outside the bath that then rises up and goes over the side. It then goes down into the bath and lifts back out when youve finished. There are also mobile hoists that can be used in the bedrooms. This might be needed if someone cant manage at all to get out of bed. In two bedrooms, there are things called tracker hoists. These are hoists that run on a track that is securely fixed to the ceiling. These tracks run from above the bed right into the private bathroom. They mean that someone who cant easily stand up, can be Care Homes for Older People Page 25 of 39 Evidence: helped out of bed. Then they can move straight into the bathroom. At key places there are assistance poles. These are fitted to the wall and they are there for people to hold onto for extra support. There are frames near to the toilets. People find these very helpful when they are getting down and getting back up again. The toilets themselves are high level ones. This also helps with getting down and getting up. The passenger lifts give step-free access around all parts of the accommodation. There are other less obvious things to help people get about. For example, there are special belts that can be used to give people that extra bit of help they might need when getting up from a chair. Also, there are special sheets that can be used to help people change position in bed. We asked people how warm the accommodation is kept. They say that they are always comfortable even during the coldest weather. It was warm inside when we were there and it was a very cold day outside. The radiators are a special design so that their outside surface doesnt become hot enough to burn someone. The hot water taps that are used by the people who live in the Service are temperature controlled. This means that they wont get hot enough to scald someone. We tested one of the taps and the temperature seems alright to us. The laundry has two commercial grade washing machines. These have an extra cycle for items that need an especially hot wash. There are also two large dryers. We looked in the laundry. Its quite a large room. Its neat and well organised. The Facility Services Manager says that the Service gets through quite a lot of laundry. There was no build up of things waiting to be washed when we were there. Everything seems to be running smoothly in the laundry. The Manager says that everyones clothes are marked so that theres less chance of them getting lost or mixed up with other peoples things. This is very important because its a really basic thing to wear only your own clothes. We asked people about this. One person sums up the general opinion when they say, I like to be neat and clean and theres no problem here. Ive never really get the wrong things back or very rarely. Im not worried about it, my clothes always come back neat and clean. The Manager says that she plans to introduce a new system for people who arent staying for long in the Service. This will mean that they will have a tag attached to the inside of their garments that can be removed once they go home again. In this way, they wont have to have a permanent mark made in their clothes. New rules have been brought out to make sure that used water from the washing machines and from the dishwasher doesnt leak back into the main pipe-work. It looks like the Registered Provider already complies with the rules. However, to double check Care Homes for Older People Page 26 of 39 Evidence: this the Facility Services Manager is going to contact the local water supply company. Hes going to do this by 1 February 2009. Care Homes for Older People Page 27 of 39 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 27, 28, 29 and 30. There are enough staff around. They know what theyre doing. Security checks are completed on new members of staff. Evidence: The staffing arrangement is that during the day there is one team leader who is in charge of the care workers in Wittersham and The Lindens. There is a minimum of three care workers on duty in each of the two units. Upstairs, there is a nurse in charge of each of the Benenden units and there is a minimum of seven care workers and health care assistants on duty there. At night, there are two nurses on duty and seven care workers for the whole building. There are also special security arrangements at night. We asked three care workers if they think that the Service is staffed okay and they say that it is. In our questionnaires for people who live in the Service we ask, are staff available when you need them? All of the people who respond say that they always are. The questionnaires for staff ask, are there enough staff to meet the individual needs of all the people who live in the Service? Two people answered this question. One says always and one says sometimes. We looked at a number of common sense Care Homes for Older People Page 28 of 39 Evidence: things to show us if there are enough staff on duty. For example, we noted the time it takes for call bells to be answered. We didnt see any delays. We also looked to see if people who sometimes spill things are helped after lunch to put on fresh clothes. They are. We think that in general there are enough members of staff around. The Assessment says that since we were last in the Service, quite a lot of new appointments have been made. This is particularly the case for care workers. However, the Manager says that there are still some vacant posts in the Service at the moment. This is because people have left. Then it has been difficult to recruit because of the local employment market. The vacant posts mean that other members of staff are having to fill in by working overtime. In addition to this, some shifts are being filled by agency members of staff. These are people who are employed by an outside company and who can be sent to work in one of a number of services. Most people agree that its a good idea to keep the use of agency members of staff to a minimum. This is because it can be difficult for them to know the sort of detail that established care workers have to build up over time about the people who live in the Service. We looked in some detail at the records of the actual shifts worked in each of the units over the course of a recent week. We wanted to see how many shifts are being filled by agency members of staff. Also, we wanted to see if any shifts are not being filled for whatever reason. Nearly all of the planned shifts were filled. However, for quite a few of them this was done by using agency members of staff. The Manager says that she has just appointed some more permanent care workers. Also, she intends to recruit more as a matter of priority. She says that in the meantime she will carry on trying to help agency staff to make a full contribution in the Service. She does this by using the same agency staff whenever this is possible. Also, she tries to make sure that agency members of staff are introduced to how things are done in West View before they start work. During the day there are other members of staff around. For example, there is the cook, the kitchen domestic and four or five housekeepers. There is also someone who works in the laundry. Its very important that only honest and trustworthy people are employed as nurses, care workers and health care assistants. With this in mind, the Registered Provider completes a number of security checks on new members of staff. These include things such as confirming their identity, taking up references and doing a police check. We looked at the records for two care workers who have been appointed since our last inspection. All of the checks that we need to see have been done. New nurses, care workers and health care assistants receive introductory training before they work on their own. We asked one recently appointed care worker about their introductory training. They say that it was very useful. They say that they were Care Homes for Older People Page 29 of 39 Evidence: introduced to the people who live in the Service and that they were told about each persons needs for support. Also, they were told about important things. For example, the individual plans of support and how to go about things such as helping people get about safely. One care worker summarises their experience of joining West View by saying, the introduction was very good and I got all sorts of training.This place is really good and you get lots of training. This initial training is just to get people started. Theres a lot to learn after that. They begin this by completing a workbook. This takes them about 12 weeks to finish. It involves them having training on the job from the Deputy Manager and from existing members of staff. It also involves them reading things like guidance notes and the Registered Providers own policies and procedures. We looked at one of these workbooks. Its based upon a national model that we think is very well done. We looked to see how well the care worker concerned has completed their workbook. Its quite detailed. It shows that the person filling it out has been thinking about important things. For example, they have written things about how best to help people who have difficulty saying what they want. The Manager says that after their introduction, nurses, care workers and health care assistants are provided with ongoing training. This is designed to develop further their ability to provide a high quality residential care experience. The Registered Provider intends that particular members of staff will do certain courses on a rolling basis. This is so that they have regular refreshers. We looked at some of the records of this extended training for two care workers. We wanted to see how well this system is working in practice. They have done quite a lot of useful training. For example, they have attended a training course in how to safely help people who have difficulty getting about. Also, they have done training in how to support people who have problems with their understanding. When we were in Wittersham doing our observation, we saw lots of examples of this knowledge being used to good effect. For example, during the sing-a-long, tea was served and there were lots of cups on the table that people were sitting around. One person wasnt sure which cup was theirs. A care worker carefully explained this to them and then helped them by gently guiding the persons hand to the cup they had already drunk from. The Manager isnt completely sure that all nurses, care workers and health care assistants are fully up to date with all of the training required by the Registered Provider. She and the Deputy Manager are going to review the records in question. This is so that if there are any gaps they can be seen. Then additional training can be arranged. They are going to complete this review by 1 March 2009. We are pleased to note that all of the existing nurses, care workers and health care Care Homes for Older People Page 30 of 39 Evidence: assistants and not just the new ones, have now completed the workbooks that we spoke about earlier. This has been done as a one-off exercise to make sure that everyone has the knowledge and skills they need to support the people living in West View. The Assessment says that more than two thirds of the care workers and health care assistants have completed a National Vocational Qualification (NVQ) at Level 2 or 3 in health and personal care. This qualification is a very good idea. This is because it helps care workers and health care assistants to deliver high quality residential care services. We spoke with two nurses and with four care workers to find out what they know about particular bits of the support they give to people. They know a lot about how each of the people who use the Service like to be supported. More generally, they know about important subjects such as helping older people to take care of their skin. They also know about how to respectfully help people who need assistance to manage their continence. Care Homes for Older People Page 31 of 39 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 31, 33, 35 and 38. Things are well managed. People are asked what they think, but this needs to be a bit more organised. People are helped to buy what they want. There are sensible health and safety things. Evidence: The Manager is a qualified nurse and she also has a social work qualification. The Deputy Manager is a qualified nurse. The Manager and the Deputy Manager run things on a day to day basis. They have a detailed knowledge of how things are going. When we ask them questions about points of detail, they pretty much know the answers. They dont have to fiddle about looking for things and they dont have to ask other people. This is a good sign because someone senior needs to be in charge and on top of things. Care Homes for Older People Page 32 of 39 Evidence: The nature of the Service means that there are quite a few comings and goings. The Manager and the Deputy Manager cant be there all of the time to oversee every aspect of this. They have to rely upon people like the team leaders and nurses to take decisions on their behalf. They have set up some good systems to help staff be clear about what they should be doing. Also, they keep an eye on how these are working out in practice. We think that all of these things are really important. The nurses and the care workers say that there is good team work between them. One care worker sums up the general mood when they say, we all work as one team and if we need to talk with one of the nurses we just do it. There are no hard and fast divisions between the care staff and the nurses. There are handover meetings at the beginning and end of each shift. These are held so that everyone can be kept up to date with developments. In each unit there are team meetings every month or so. We looked at the record of the sorts of things that were discussed at the most recent meeting in Wittersham. Theyre practical and relevant. For example, staff talked about how to make the best use of the new activities coordinator. Also, they discussed how to make sure that the individual plans of support are kept up to date. Its really important that the people who live in the Service have their say on how things are going. After all, theyre the experts because they live there. There also needs to be a system for getting what members of staff think. This is because they know in detail how things work in practice rather than in theory. We have already spoken a bit about the questionnaires that the Registered Provider has asked people who live in the Service to fill out. Its rather disappointing to note that only a very small number of people wanted to responded. The Registered Provider will need to find out why this happened. What we do know is that none of the people who live on Wittersham were able to really understand the written questions that were asked. Much more will now need to be done so that they can have a meaningful voice in future versions of the questionnaire. For example, thought should be given to using things like pictures and drawings to illustrate the questions being asked. Also, more can be done to set up different and imaginative ways for people to show what they think when giving their answers. Members of staff and peoples relatives have also filled out their own version of the Registered Providers questionnaires. The answers they have given havent been added up yet by the Registered Provider. Therefore, we cant tell you yet what these groups of people have said. There are regular house meetings in Wittersham and The Lindens. Everyone can go along to them and they can talk about anything they want to do with their home. We Care Homes for Older People Page 33 of 39 Evidence: looked at the records of the last such meeting. These show that people in general are quite happy with their home. Things such as activities and whats on the menu were discussed. We asked a care worker about these meetings. They say that it can be difficult to engage some of the people in Wittersham in this sort of group activity. So we looked at the records of who went to the last three of these meetings. Four people attended two of them and only three wanted to go along to the most recent one. This is rather disappointing. The care workers think that a different system is needed that gives each person one to one time with a member of staff. This is so that they can say things in their own way and at their own pace. The Manager says that she is looking at what might be the best way to organise this in the future. We think that its really important for her to do this. We want to be sure that everyone is indeed having their say in Wittersham. She says that she hopes to have the new system in place by 1 June 2009. At the moment, there is no organised system to find out what people using the Intermediate Care scheme think of West View. The Manager is going to look into how this can best be done. She is going to do this in time for us to be told about what has been decided when the Registered Provider sends us its next Assessment. A senior person from the Registered Provider calls to the Service about once a month. They have a look around, talk to people and check out that things are going okay. We looked at the records of the most recent of these visits. They are checking important things, such as how the Intermediate Care service is working out. Also, they doublecheck to make sure that there are no complaints waiting to be dealt with. This senior person has a further system where they check that the developments we have asked for have been done. They also check that planned improvements that we have been told about in the Assessment, have in fact been introduced. We think that this is a very good idea indeed. This is because it helps to make sure that things dont get forgotten or overlooked. There is a system to help some of the people who have made their home in the Service to manage their personal spending monies. This is done so that money doesnt get lost and so that each person has enough to buy the things that they want. The system involves the Service holding small amounts of money for people and then using it to buy things for them. For example, paying for toiletries or paying for someone to see the visiting hairstylist. The system needs to be clear and well recorded to show that everything is above board. We spoke with the senior administrative officer. She oversees all of this and she keeps a track of all the money as its received and spent. She has an organised system to do this. We looked at the records in detail for one person. The amounts spent add up in a logical way and the things bought are reasonable. For example, in recent weeks it has been used to pay for the person to see Care Homes for Older People Page 34 of 39 Evidence: the hairstylist and the chiropodist. We checked three recent transactions to see if they are supported by a receipt and they are. The paper balance matches the cash balance. The Assessment says that there are robust financial procedures. We agree, everything seems okay to us. The Manager says that people who move into the Service only for short stays are asked to manage their own personal spending monies. Regular checks are completed to ensure that the Services fire safety equipment remains in good working order. This includes a weekly test of the fire alarm bells. More detailed checks are completed every now and then by an engineer. There are regular fire drills. In addition to this, the Registered Provider arranges for all members of staff to do fire safety training at least once a year. This is so that they know things such as how to use fire restraining doors in the right way. Also, its done so that they know how to prevent the occurrence of a fire safety emergency in the first place. This means doing sensible things such as unplugging electrical appliances when they are not being used and in particular at night. Together, the drills and the training should add up to all members of staff doing a fire safety thing about once every six months. We checked the records for three members of staff and they are about right. However, the Manager isnt sure that everyone is up to date with the six monthly timescale and the Facility Services Manager says that some of his members of staff are overdue. Between them, they are going to set up a new system to make sure that all members of staff have a period of fire safety training at least once in every six months. They say that this will be done by 1 March 2009 at the latest. There are up to date reports from engineers about things such as the electrical wiring, the gas appliances and the hoists. They say that everything is in good working order. We looked at the record of accidents that have occurred in the Service during the last month or so. There have been quite a lot. But most have been minor bumps and bruises. The Manager keeps an eye on who has had an accident and what happened. This is done so that she can do something if there is a particular problem that is causing the accidents. We dont think that theres anything obvious that needs to be sorted out at the moment. Each month the Facility Services Manager does a review of the building to see if there are any hazards that might cause someone to have an accident. We looked at the records of the most recent of these reviews. This was done in late November last year. He is looking at sensible things. For example, are all of the fire checks up to date and is there no obvious damage to things such as hoists? He says that he has not found any obvious hazards around the place. We kept our eyes open when we were walking around. We didnt notice any particular Care Homes for Older People Page 35 of 39 Evidence: hazards. Theres nothing obvious that might cause someone to trip up. Things such as bleach are stored safely when they are not being used. This is done because some people might mistake this for something you can drink. Care Homes for Older People Page 36 of 39 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 37 of 39 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 38 of 39 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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