Care Home: Wirral Christian Centre

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What the care home does well The home offers an excellent range of activities, 7 days a week. This includes group activities, one to one activities and weekly trips out. There is a designated activity co-ordinator who plans activities along side people who live there, to ensure they are fully involved. Comments were made such as "there is so much to chose from, it`s a pleasure to be here". Staff training is ongoing, feedback from staff is positive and the manager is now evaluating all training sessions to ensure that they are appropriate. People like the staff that care for them. One person commented, " this is the best place I have ever been". Care plans are clear and kept up to date. People are made aware of these plans and can contribute towards them. This allows people to have a say in the care they are given. People are supported by a range of external health professionals. The records of these visits are of a high standard and show why a visit occurred and theoutcome of this visit. This ensures a high standard of care is given to individuals. What has improved since the last inspection? Staff at the home have gained a nationally recognised quality assurance award called Investors in People. This ensures the manager continually monitors the care that they give and ensure people living at the home and staff are happy. The manager has ensured that staff receive regular fire drills and that a risk assessment has been completed with regard to fire prevention. This helps ensure the safety of residents. The environment of the home has been improved by the addition of a new staff room, a 50 inch plasma TV in the upstairs lounge, an new washer and dryer in the laundry, new dining room table and chairs and a new garden design. Residents commented that these improvements were " welcome and much enjoyed". What the care home could do better: Contracts given to people who use the service must have accurate information in them to ensure people are kept up to date. Staff need to be reminded of the need to double sign handwritten medication records to ensure residents safety. People should be encouraged to sign their care plans to formally agree to them. Staff needing infection control training should have this arranged in order for them provide the correct care in this area. CARE HOMES FOR OLDER PEOPLE Wirral Christian Centre Woodchurch Road Birkenhead Wirral CH41 2UE Lead Inspector Natalie Charnley Key Unannounced Inspection 26th November 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wirral Christian Centre Address Woodchurch Road Birkenhead Wirral CH41 2UE 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) 0151 653 8307 0151 653 4600 wcc@wccuk.org Wirral Christian Centre Trust Limited Mrs Evelyn Jane Epton Carol Frances Eichenauer Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Two named adults with physical disablement and one named adult with a learning disability may be accommodated Thirty-six elderly persons (not falling within any other category) To accommodate one named person under 65 years old Date of last inspection 21st June 2006 Brief Description of the Service: The Wirral Christian Centre is a residential home located in Birkenhead, Wirral and was formally the local children’s hospital. It is located on a busy main road and is close to local shops, bus stops and transport links. The home is located in a large building that also houses a day nursery, which is inspected by Ofsted. The home uses two floors of the building, bedrooms and lounge areas are located on both. The total maximum number of residents living at the home at one time is 39. The home has a small car park to the front and access is via the main reception. This area is accessible for wheelchairs. It costs £405.79 per week to live at the home. Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit to the home was unannounced and was carried out over a period of one day. We spoke with 4 staff and 8 residents about what it was like living and working at the home. No visitors were available at the time of the visit. The manager was asked to provide a selection of information in the form of an annual quality assurance document (AQAA), which was used as part of the inspection process. Comment cards were sent to the home for people who live at the home and staff to complete. This gave them the opportunity to contribute to the inspection process. We completed the inspection by looking at the homes records, a tour of the building, formal and informal interviews and information from previous inspection reports and AQAA document. Feedback was given to the person in charge during and at the end of the inspection. A meeting has been arranged with the responsible individual to discuss the long-term plan for the home, including plans to change the layout of the building. Details of this will be available in the next inspection report. What the service does well: The home offers an excellent range of activities, 7 days a week. This includes group activities, one to one activities and weekly trips out. There is a designated activity co-ordinator who plans activities along side people who live there, to ensure they are fully involved. Comments were made such as “there is so much to chose from, it’s a pleasure to be here”. Staff training is ongoing, feedback from staff is positive and the manager is now evaluating all training sessions to ensure that they are appropriate. People like the staff that care for them. One person commented, “ this is the best place I have ever been”. Care plans are clear and kept up to date. People are made aware of these plans and can contribute towards them. This allows people to have a say in the care they are given. People are supported by a range of external health professionals. The records of these visits are of a high standard and show why a visit occurred and the Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 6 outcome of this visit. This ensures a high standard of care is given to individuals. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3. Standard 6 is not offered at the home and could not be assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information that the service gives to people about the services they provide, allows people to make informed choices. EVIDENCE: All people who move to the home are asked to come for a visit before making the decision to move to the home. Records of these visits are kept in care plans. The visits allow the person to see if they like the home and for staff to see if they can meet all their needs. The manager was able to produce evidence that a person had been on an introductory visit on 8th September 2007, and that a full assessment had been carried out at the local hospital. The home had taken details of physical and mental health and how the person would need to be supported on a daily basis. These were well recorded and addressed any equality and diversity Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 9 issues that the home needed to address. All other care plans sampled during the site visit showed that similar standards of pre admission assessments had been carried out. People spoken with confirmed and records showed that all residents are given a contract when they move into the home. These were simple and clear. It is recommended that an audit of these documents be carried out as a large proportion state that the home is regulated under the 1984 Registered Homes Act. This information is incorrect and could be misleading to residents. One person commented “ When I moved in, I was given all the information I needed by staff”. Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Healthcare practices and procedures ensure people are kept involved, safe and treated with respect. EVIDENCE: Care records were comprehensive and were kept under review on a monthly basis. They detailed what help or assistance a person may require form staff. Any changes in a persons physical or mental health were well recorded. Records showed that people have access to a range of health professionals such as dentists, opticians and district nurses. Records of when these visits took place were very well recorded, with clear information as to why they visited and what action was needed. This ensures the health care needs of people are maintained to a high standard. Risk assessments are completed on a variety of areas such as falls, nutrition and manual handling. These records are also updated monthly by staff to Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 11 ensure they are accurate. The majority of people spoken with knew they had a care plan and what this was. One person stated, “ I like to know what is going on, staff always let me know what needs to be done”. It is recommended that people should be encouraged to sign their individual plans to confirm they agree to them. One person with a poor appetite, had records kept of what they ate and drank. The person was encouraged by staff, who spent time with them at meal times. This information was then shared with the GP (General Practitioner) and dietician, who offered additional support to the person. This person is now showing signs of improvement in their general health. Care plans also contain information to support the social needs of people. The activity co-ordinator has completed social history information and information about what activities people like to join in with. This information allows staff to ensure good quality all round care is given. Medication records and storage areas were checked during the visit. Staff confirmed that they had all recently undertaken additional training on medication administration. This involved a course, completing a workbook and a test of their competence to give medication by the home manager. This is an example of good practice. Medication records were well recorded with only a small number of errors when medications that had been handwritten had not been double signed. Storage areas were satisfactory and kept clean and tidy. Staff encourage those people who are able to take their own medication, to do so. People have a risk assessment completed by a senior member of staff to ensure they are safe to take their own tablets and that they understand when to take them. People are also offered lockable storage to store any medications to ensure they are kept safe. People spoken with during the inspection stated that they are treated with dignity and respect. Staff were observed talking to people in a clear and kind manner and knocking on bedroom and bathroom doors before entering. People commented “ we are kept safe and well at the home” and “ staff are so nice and kind, I can’t fault it here”. Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People using the service are able to fulfil an active and varied lifestyle and are involved in making choices. This enables them to be proactive and maintain their independence. EVIDENCE: Evidence of activities are located everywhere around the home. Photographs show trips out and parties, involving staff, people from the home and family members. People follow a weekly activity plan, which is arranged by the designated activity co-ordinator. The co-ordinator has undertaken specialist training in providing and arranging activities and has applied to undertake a further NVQ (National Vocational Qualification) in this subject. People have access to weekly trips out to places such as Blackpool, Port Sunlight and local theatres. People spoken with stated they really enjoyed this. One lady commented “ The trip to Port Sunlight was nice, I used to live near there and I have a lot of memories from there”. Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 13 The activity co-ordinator completes a risk assessment before all trips and activities to ensure people are kept safe. Records are also kept when people join in with activities to ensure that everyone is accessing activities if they wish to. Those people who like to stay in their own room are provided with one to one activity care, even if this is just to read the paper or chat. The activity coordinator was able to show that by helping one person join in with playing a regular board game, that this persons appetite had increased and they had become more settled at the home. The manager has a team of volunteers that assist with activities. They assist with the many varied activities that are on offer such as Tai Chi, cross-stitch, reminiscence therapy, art and a reading circle. The weekly activity plan is displayed around the home and each individual person is given a personal copy. Four people were supported to go an annual holiday in the summer to Llandudno as a way of promoting their independence and skills. The activity co-ordinator has a busy activity plan available for the Christmas and New Year period. This includes a party, entertainment and a panto. People spoken with were looking forward to the activities that they had helped plan during their residents meetings. Comments were made such as “ Christmas is a nice time here. We get involved with everything that is going on”. There is a 4-week menu that rotates around available to people. Menus samples looked at and peoples comments confirmed that there is always a choice of meal. The chef is able to offer a vegetarian alternative menu and currently cater for a small number of diabetic residents, who may need slight variations of meals. People were observed finishing their lunch, which was a social and unhurried occasion. People also confirmed that they could have meals either in their bedrooms or in the pleasantly decorated dining area on the ground floor. The dining room has benefited from recent redecoration and has new tables and chairs. Each table has a full menu in order for people to make their meal choices. People commented, “ the food here is very nice” and “ there is always enough to fill me up, its delicious”. People are encouraged to maintain links with the wider community and with visitors. There is an open visiting policy and people spoke about how they are supported to go shopping, visit family and friends and attend local churches. Whilst the home is situated within a church setting, people are welcome from any religion. Those who do not follow the Christian faith are supported by staff to maintain their beliefs in any way they chose to do so. Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are protected from harm by staff that have a good working knowledge of safeguarding procedures. EVIDENCE: There is an up to date complaint procedure in place, details of which are displayed around the home for people to read. Complaints records checked, showed that there have been no recorded complaints since the last inspection in 2006. Policies are also in place to protect staff including a policy on equal opportunities, bullying and harassment, whistle blowing and sexual harassment. A resident commented “ I know how to make a complaint, if I want to, but would speak to the Manager first”. Staff have undertaken adult protection training. This ensures that they are familiar with what to do in the event of an allegation of abuse. They have access to a copy of the local authority guidelines to assist them if they need advice. Staff have all undergone Police checks to ensure they are safe to work with vulnerable people. Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service live in a well maintained, warm and clean environment. This helps to ensure people are happy and safe where they live. EVIDENCE: A tour of the home was carried out and a sample number of bedroom and bathroom areas were looked at. All areas of the home were clean, tidy and warm. People spoken with were all satisfied with their accommodation. They commented “ I like my room here” and “ I enjoy the busy lounges but it’s also nice to have a quiet space”. People were observed using the lift and also have access to a number of stair lifts to take them to different floors. This ensures they can access all areas of the home. Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 16 Bedroom areas were found to be homely and have personal belongings in them to brighten them up. Many had examples of arts and craft work that people had been making in the run up to Christmas. Communal areas were bright and light. People were observed sitting and talking with each other, enjoying each others company. Lounge areas are located around the home on each floor. There is also one designated smoking lounge. During the visit, work was being carried out to the garden areas. The deputy manager stated that new seating and shrubs were being put in to make the areas more pleasant to people. Staff have access to a policy on infection control and have good knowledge in this area, which ensures that people are kept safe. There are plenty of domestic staff employed and people felt the home was always kept clean and tidy. One member of staff commented “ there are plenty of supplies of cleaning products to allow us to keep the place clean”. Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People are supported and cared for by competent staff that they like. This makes them feel safe in their environment. EVIDENCE: All staff working at the home are trained to NVQ level 2 or above. This ensures that they have specialist knowledge in caring for the people living at the home. The training matrix showed that there is ongoing training for staff. Recent courses include fire awareness, dementia, medication and safeguarding adults. Each member of staff has a training plan, which ensures that they are kept up to date with training. It also allows staff to ask for specific training if they feel it is suitable to their work. There were a number of staff that were not up to date with infection control training, however the deputy manager stated that this was being addressed. Staff files showed that they receive appropriate checks including references and a Police check. This ensures that they are suitable to work with vulnerable people. Staff spoken with confirmed that they have regular appraisals, a job description, a contract of employment and underwent an induction when they started work. All of this helps to keep staff when looking after people living at the home. Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 18 People commented that “ there are lots of staff on hand” and “ there is always someone there if I need them” when asked if there were enough staff working at the home. Observation also confirmed this during the site visit. People also spoke about how much they liked staff commenting that they were “ considerate” and “ really nice people”. Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good management and record keeping systems in place. This means that the best interests of people using the service is always promoted. EVIDENCE: The home has two managers who are registered with the Commission for Social Care Inspection. One of these managers works in the capacity of ‘general manager’ and the other works on the floor along side the other staff. Both managers work closely with each other to ensure staff have the same information given to them. The manager in daily charge of the home has worked there since 1988 and has recently achieved a specialist managers qualification. Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 20 People commented that the mangers have an open door policy and can always be found around the home. They commented, “ the manager is friendly and approachable” and “ very friendly and helpful”. Staff at the home have gained a nationally recognised quality assurance award called Investors in People. This ensures the manager continually monitors the care that they give and ensure people living at the home and staff are happy. People who live at the home are involved in the running and development of the home by participating in regular residents meetings. Minutes of these meeting showed that people had been involved in decision making in relation to food, activities and Christmas planning. Surveys are also sent to people using the service as another way of monitoring standards. Financial records were sampled, which were well recorded. Records showed all monies that are held on a persons behalf and all monies given to individual people to spend. Large amounts of money are returned to families or put in peoples bank accounts in order to ensure money is kept safely. Lockable draws are available if people want to secure small amounts of money or valuables in their own rooms. Accidents are well recorded by the home and are monitored by the manager for signs that patterns in accidents are occurring. All necessary certificates are in place to show that the home is safe. Staff have undertaken regular fire practices to ensure they know what to do in the event of an emergency. Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 4 Refer to Standard OP2 OP7 OP9 OP30 Good Practice Recommendations It is recommended that contracts be changed in order for inaccurate information to be removed. This will ensure people are provided with the correct information It is recommended that all people be encouraged to sign their care plans to formally agree to them. It is recommended that staff are reminded of the need to double sign handwritten medication records to ensure residents safety It is recommended that the manager of the home carry out infection control training for those staff that require it. This ensures that staff are able to provide appropriate care. Wirral Christian Centre DS0000018956.V352894.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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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