Setting

South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 1 ADOPTION SERVICE

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Lead Inspector Sean White Announced Inspection 12th December 2006 10:00 South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 2 The Commission for Social Care Inspection aims to:

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• 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

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Reader Information Document Purpose Inspection Report Author CSCI Audience General Public Further copies from 0870 240 7535 (telephone order line) Copyright 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 Internet address www.csci.org.uk South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 3 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 Adoption. 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

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Every Child Matters, outlined the government’s vision for children’s services and formed the basis of the Children Act 2004. It provides a framework for inspection so that children’s services should be judged on their contribution to the outcomes considered essential to wellbeing in childhood and later life. Those outcomes are: • Being healthy • Staying safe • Enjoying and achieving • Making a contribution; and • Achieving economic wellbeing.

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In response, the Commission for Social Care Inspection has re-ordered the national minimum standards for children’s services under the five outcomes, for reporting purposes. A further section has been created under ‘Management’ to cover those issues that will potentially impact on all the outcomes above.

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Copies of Every Child Matters and The Children Act 2004 are available from The Stationery Office as above. This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 4

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Name of service

Address 16 Barrington Street South Shields Tyne and Wear NE33 1AN

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manager (if applicable)

Type of registration Local Auth Adoption Service South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 5

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Brief Description of the Service:

South Tyneside Adoption Agency is a relatively small service that operates the full range of adoption related provision; some areas are worked in partnership with other voluntary or independent agencies, for instance support services to birth families. It is a member of the North East Consortium. The range of services provided are: • Recruitment, preparation and assessment of prospective adopters. • Family finding, matching, introduction and placement of children in appropriate homes – in partnership with children’s social workers. • Placement support. • Post adoption support – in partnership with other agencies; this includes the full range of services as defined in regulations.

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Brief Description of the Service:

The agency is located close to the town centre of South Shields, which is easily accessible by both car and public transport. South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 6

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SUMMARY

This is an overview of what the inspector found during the inspection.

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SUMMARY

Despite several changes that were made in the arrangements for this inspection – at the request of the Commission – the manager prepared well for the visit and ensured that everything was in place to enable the inspection to be conducted as efficiently as possible. Everyone involved in the agency offered every assistance and courtesy throughout, some of which was beyond that which is expected. This demonstrated a service that is responsive and inclusive – and one that is able to manage complex and detailed arrangements.

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SUMMARY

The inspection was conducted over three days by two inspectors, plus an extra day to accommodate an adoption panel – there was no panel arranged for the period in which the fieldwork took place. The visit was organised to be concurrent with an inspection of the authority’s fostering service.

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SUMMARY

During the course of the visit the following was undertaken: • Interviews with key managers and staff, including the agency decision- maker. • Interview with an elected member (lead member for children) of the council. • Interviews with partner agency staff. • Observation of the adoption panel – and interview with the chairperson. • Visits to four service users. • Meeting with birth parent. • Inspection of policies, procedures and protocols. • Reading of case files (adopters and children). • Examination of personnel records and HR practice (undertaken by CSCI fostering inspectors on behalf of adoption inspectors). • Inspection of administrative procedures and practice. • Analysis of survey questionnaires returned: Adopters/prospective adopters – 12. Placing social workers – 6. Placing Authorities – 1. Birth families – 9. Specialist advisors – 1.

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What the service does well:

This is a service that does most things well. It is clearly an agency that places children’s safety and welfare at the forefront of its operations – a commitment that was evident at all levels of management and practice. South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 7 It has a welcoming and inclusive approach to recruiting adopters that supports diversity and aims to meet the needs of children requiring adoptive placements. There is a thorough and rigorous approach to preparing and assessing adopters that is very efficiently managed within required timescales. In one instance the timescale from application to the placement of a child being only ten months – and this was not unique or unusual. The skills and knowledge of workers was very evident in the quality of the work they produced and adopters were effusive about their efforts and abilities. Comments made included, “Our social worker was brilliant”, “Our social worker

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What the service does well:

was first class”, “Exceptional preparation groups” and “The prep groups exceeded our expectations”.

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What the service does well:

There is a well-managed approach to collaborative working between adoption and children’s social workers that enabled appropriate matches to be made in light of full and detailed information being shared – underpinned by effective ‘early warning’ systems that ensured everyone involved was aware of children requiring adoptive placements and reducing delays. A well managed and administered adoption panel demonstrated a rigorous and careful approach to its deliberations with recommendations being supported by clear and informative minutes, enabling the decision maker to be fully informed to make well considered decisions. A very high proportion of looked after children being successfully adopted, and low disruption rates demonstrate realistic outcomes for children. Children’s social workers commented: “Excellent communication”, “…work well in partnership”, “very supportive and professional”.

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What the service does well:

Support services are exceptionally good. The evidence found shows a committed and demonstrably effective approach to supporting families using innovative and imaginative approaches. Assessments are thorough and practical and outcomes beneficial and optimistic. It was very evident that support packages are tailor-made and that the input is very relevant to the needs of the families. Adopters were very appreciative of the support they received, saying, for instance, “…support was first class” and “our social worker was always there for us”.

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What the service does well:

Birth parents/families receive support services that are of a very high standard. In an area of adoption that is all too often neglected or under- resourced this agency provides non-judgemental, inclusive support that has resulted in a high level of satisfaction. Again, using innovative approaches – and partnership working with other agencies - to support birth families, developing life-story work and promoting contact, the agency has been able to achieve outcomes that are beneficial to all – children, adopters and birth parents/families. Birth parents commented, “I have been very well informed and well respected” and “I would like to thank the staff for all the support they gave me”.

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What the service does well:

The management of the agency, both strategically and operationally, are of a very good standard at all levels of the authority - and supported by a committed, and rigorous, executive. South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 8 A sound, informative statement of purpose is in place supported by operational policies and procedures. A children’s guide – to be completed in the near future – is of an exceptional standard, both in presentation and content and written in a way (as a children’s book) that is relevant and understandable.

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What the service does well:

The staff are well managed and supported and demonstrate a high level of skill and knowledge; training is well resourced and workers demonstrated a commitment to personal development and improvement in professional practice, together with impressive attitudes towards commitment and conscientiousness.

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What has improved since the last inspection?

This agency has come a long way in the three years since the last inspection. It has improved considerably in all areas and has addressed all of the issues raised in the last report.

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What they could do better:

The main shortfalls in the agency surround inefficient and poorly resourced administrative systems. More attention needs to be paid to prioritising the administrative processes to enable the service to be better supported. The managers, however, were responsive to the findings during the visit and took immediate steps to correct shortfalls.

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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. South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 9

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CONTENTS

Being Healthy - There are no NMS that map to this outcome

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CONTENTS

Achieving Economic Wellbeing - There are no NMS that map to this outcome

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CONTENTS

Statutory Requirements identified during the inspection South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 10

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The intended outcomes for these standards are:

• The agency matches children with adopters (NMS 2) • The agency assesses and prepares adopters (NMS 4) • Adoptors are given information about matching (NMS 5) • The functions of the adoption panel are as specified (NMS 10) • The constitution and membership of adoption panels are as specified (NMS 11) • Adoption panels are timely (NMS 12) • Adoption agency decision is made without delay and appropriately (NMS 13) • The manager is suitable to carry on or manage an adoption agency (NMS 15) • Staff are suitable to work with children (NMS 19) • The agency has a robust complaints procedure (NMS 24 Voluntary Adoption Agency only) • The agency safeguards and promotes the welfare of its service users (NMS 32)

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The Commission considers Standards 2, 4, 5, 10, 11, 12, 13, 15, 19, 24

and 32 the key standards to be inspected.

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JUDGEMENT – we looked at outcomes for the following standard(s):

2, 5, 10, 11, 12, 13, 15, 19, 24, 32. Quality in this outcome area is excellent.

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JUDGEMENT – we looked at outcomes for the following standard(s):

This judgement has been made using available evidence including a visit to this service.

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JUDGEMENT – we looked at outcomes for the following standard(s):

The agency has a thorough and rigorous approach to the recruitment, preparation and assessment of adopters that has ensured realistic and safe placements for children.

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EVIDENCE:

South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 11 It was very clear that this agency places children at the centre of its operations - and that its policies and practices reflect the commitment to keeping children safe.

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EVIDENCE:

The agency has a recruitment strategy that is incorporated into its business plan that outlines the processes of attracting appropriate people to become adoptive parents. It was evident that by developing a Sth. Tyneside ‘brand’ successful outcomes have been achieved. Information provided by the agency ensures that all members of the community are encouraged to apply to be adopters and that they are welcomed without prejudice. The agency consistently places a much higher than average number of looked after children for adoption and there is little delay created within the service’s systems. The standard of cooperative working between the adoption service and children’s social workers is very good and ‘early warning’ systems are in place – which includes the cooperation of Independent Reviewing Officers - to keep everyone informed of children who may require adoptive placements. This strong commitment to working in partnership with children’s social

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EVIDENCE:

workers enables the most appropriate matches to be made and there has been a low incidence of disruptions in recent years.

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EVIDENCE:

The approach to preparation and assessment of prospective adopters is very thorough and demonstrated a committed approach to ‘getting it right’. Information is provided for prospective applicants in a well-balanced way; this enables applications to be made from an informed position. Preparation thereafter is thorough and focused – the materials and approach used being of a very good standard. In order to ensure that people from black and minority ethnic backgrounds have their needs met throughout the process the support of a local voluntary agency is used to enhance the processes in place within the agency. Assessment reports showed a rigorous approach to determining the parenting capacity of applicants, which enables the panel and decision- maker to be fully informed when reaching their conclusions.

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EVIDENCE:

An appropriately constituted panel is well managed and ensures that the adoption processes are rigorously scrutinised and that its recommendations are made in full knowledge of all relevant and necessary details. It was very clear that the panel chair understands her role and exercises her responsibilities thoroughly yet sensitively and fairly.

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EVIDENCE:

The timescales for assessing adopters was very impressive; most are processed well within the required limits – many being completed within four months.

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EVIDENCE:

The depth and quality of the agency’s approach to recruitment, preparation and assessment was commented on very favourably by service users with comments such as, “…tough but fair and caring” and “The preparation course was invaluable” being typical. Placing social workers also reported that they were very satisfied with the quality and depth of the assessment reports – South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 12 which enabled them to approach matching children with all relevant information available. Comments made about assessment reports included, “Thorough, informative information – excellent” and “Well focused, comprehensive and accurate”.

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EVIDENCE:

It was felt, however, that by striving for full and complete information in assessment reports, workers tended to include too much extraneous detail – often written at length by the applicants themselves – which did nothing to enhance the core and necessary information. The manager should consider tighter editing of reports to ensure information is relevant.

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EVIDENCE:

The authority has a sound approach to the recruitment and selection of workers; personnel practices demonstrated that only those people who are fit to work with, or on behalf of, children are employed. Both the manager and the staff demonstrated high levels of competence, knowledge and understanding of adoption matters and all were clear that the focus of adoption was on achieving best outcomes for children.

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EVIDENCE:

The agency’s child protection procedures are comprehensive and have a discrete section on children in adoptive placements. The soon to be completed children’s guide (see later in this report) also demonstrates the agency’s positive approach to keeping children safe and the promotion of their welfare. South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 13

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The intended outcomes for these standards are:

• The adoption agency provides support for adoptive parents (NMS 6) • The agency has access to specialist advisers as appropriate (NMS 18 • Services are tailored to meet the needs of people affected by adoption (NMS 33)

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JUDGEMENT – we looked at outcomes for the following standard(s):

Quality in this outcome area is excellent.

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JUDGEMENT – we looked at outcomes for the following standard(s):

This judgement has been made using available evidence including a visit to this service.

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JUDGEMENT – we looked at outcomes for the following standard(s):

Through having a thorough, focused and inventive approach to support the agency provides for very optimistic outcomes in adoption placements.

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EVIDENCE:

The agency’s approach to supporting adopters and adoption placements was of a very high standard indeed.

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EVIDENCE:

In one instance the file was a model example, with clear assessments and up to date recording, all typed and signed by the manager. The assessment was excellent - working methodically through the dimensions of adoption support and identifying clear actions and timescales where required. This is particularly impressive. The adopters’ views were actively taken into account and again clearly recorded.

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EVIDENCE:

There was evidence of imaginative thinking with adoption support funds being used, for instance, to pay for a support teacher in school. Files reflected, and adopters confirmed, that the service demonstrated a model of inter-agency South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 14 working with workers engaging health, education and social services in active cooperation.

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EVIDENCE:

The issues that were very evident when examining the agency’s approach to adoption support were: • Clear and thorough assessments. • A timely, helpful and practical approach from workers. • Positive, helpful outcomes. • Excellent partnership working, with service users and across agencies. • Good, realistic advocacy by workers. • The achieving of practical outcomes.

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EVIDENCE:

One family said that the work the agency had done had, “…helped them stay together as a family”; others said, “The support they have given us was brilliant” and “The benefits [of support] have been immense”.

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EVIDENCE:

It was abundantly clear that the agency takes very seriously its responsibilities in this area and ensures that its approach is one that aims to provide a service that is discrete and tailor-made for the people who request, and are assessed for, support.

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EVIDENCE:

There is a range of specialist services available to the agency and, as already outlined above, they are accessed as required and ‘dovetailed’ into the package of support being constructed. South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 15

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The intended outcomes for these standards are:

• Birth parents and birth families are involved in adoption plans (NMS 7) • Birth parents and birth families are involved in maintaining the child’s heritage (NMS 8) • The Adoption agency supports birth parents and families (NMS 9) • Service users receive good quality services based on their needs (NMS 34)

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JUDGEMENT – we looked at outcomes for the following standard(s):

Quality in this outcome area is excellent.

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JUDGEMENT – we looked at outcomes for the following standard(s):

This judgement has been made using available evidence including a visit to this service.

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JUDGEMENT – we looked at outcomes for the following standard(s):

The agency has an active commitment to working with birth parents that manifests itself in innovative yet practical ways that enables everyone involved to be included positively in the process of adoption.

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EVIDENCE:

The findings in respect of including birth parents in plans for children and supporting them during and after the adoption process are very impressive.

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EVIDENCE:

There was an unusually high response by birth relatives surveyed prior to, or interviewed during, the inspection (9), most of whom were very satisfied with the services provided; two were generally satisfied and only one was dissatisfied. The comments made included, “I feel I received the right kind of support throughout” and “I have, and always will have, so much respect for [social worker]” and “The service was very good and extremely helpful”. These survey results alone demonstrate an inclusive, non-judgemental, service that achieves good outcomes. South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 16 It was very evident that the agency makes great efforts to include birth families in its work within the ‘adoption triangle’ and takes seriously the need to engage with them. Some of the support is provided by the adoption workers but there is also a service level agreement with a local Adoption Support

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EVIDENCE:

Agency to provide independent support to birth parents; this arrangement, although a contractual one, was clearly worked on a partnership basis.

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EVIDENCE:

Another innovative aspect of the agency’s approach is in respect of an arrangement with a voluntary agency to be part of a pilot project being run in the region. The project ‘Connected for Life’ has set-up ‘Life Foundation’ days where adopters, their support worker, birth relatives and birth relative’s independent worker meet - facilitated by a project worker. The main focus of this being the sharing of information about the child with longer term benefits in respect of openness and contact. The material that this had generated was invaluable and provided a depth of information and background that was very impressive indeed.

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EVIDENCE:

There were some excellent examples of life-story work seen during the visit and it was clear that the agency continues to improve its performance in this area. Life story work remains the responsibility of children’s social workers and although the authority suffers from the typical competing priorities when identifying workloads, the arrangements developed with a children’s centre to assist in this work are reaping rewards. South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 17

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The intended outcomes for these standards are:

• There is a clear written statement of the aims and objectives of the adoption agency and the adoption agency ensures that it meets those aims and objectives (NMS 1) • The agency provides clear written information for prospective adopters (NMS 3) • The manager has skills to carry on or manage the adoption agency (NMS 14) • The adoption agency is managed effectively and efficiently (NMS 16) • The agency is monitored and controlled as specified (NMS 17) • The staff are organised and managed effectively (NMS 20) • The agency has sufficient staff with the right skills / experience (NMS 21) • The agency is a fair and competent employer (NMS 22) • The agency provides training for staff (NMS 23) • Case records for children and prospective / approved adopters are comprehensive and accurate (NMS 25) • The agency provides access to records as appropriate (NMS 26) • The agency’s administrative records processes are appropriate (NMS 27)

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The intended outcomes for these standards are:

• The agency maintains personnel files for members of staff and members of adoption panels (NMS 28) • The premises used by the adoption agency are suitable for purpose (NMS 29) • The adoption agency is financially viable (NMS 30, Voluntary Adoption Agency only) • The adoption agency has robust financial processes (NMS 31)

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JUDGEMENT – we looked at outcomes for the following standard(s):

1, 3, 14, 16, 17, 20, 21, 22, 23, 25, 26, 27, 28, 29. Quality in this outcome area is excellent.

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JUDGEMENT – we looked at outcomes for the following standard(s):

This judgement has been made using available evidence including a visit to this service.

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JUDGEMENT – we looked at outcomes for the following standard(s):

The service is very well managed, at all levels, by skilled and committed people; this provides for a coherent and well-organised service within which workers can flourish and develop. South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 18

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EVIDENCE:

This is a very well managed service at all levels within the authority. The adoption manager, supported by a strong infrastructure and senior managers, operates an innovative service that serves all users very well indeed. In addition there is strong commitment and rigorous scrutiny supplied by the executive that underpins the work of the agency in a positive manner.

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EVIDENCE:

The work of the agency is informed by a sound statement of purpose that outlines clearly its aims and objectives – this is underpinned by well presented policies and procedures that provide a firm and practical base for both operational and strategic direction. The agency has also developed a children’s guide to adoption that is formidably good both in terms of presentation and content: it is in the form of a children’s book that could grace the shelves of any bookshop – its graphic design and storyline being of a very professional standard. Although not yet ‘published’, this again demonstrates the agency’s committed approach to placing children at the centre of all its activities.

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EVIDENCE:

The manager and staff all demonstrated abilities, skills and knowledge in adoption matters and the quality of their work was evident in case files, recording and through interview. The constant moving forward and improvement of the service was clearly shown to be a central tenet of the agency and everyone involved. The service has benefited from a significant increase in staff resources in recent times adding value and depth to its operational responsibilities and strategic direction.

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EVIDENCE:

Workload and case management is well organised and staff felt appropriately supported in their roles. Training opportunities are well resourced and there was a clear commitment to staff development. Case recording demonstrated a depth of understanding and knowledge within the workforce that provided evidence of skilled casework, and workers were clear about their roles and responsibilities. It was also clear that workers were very committed and conscientious - in some instances way beyond the call of duty. Adopters were very complementary about the worker’s efforts and effusive about their approach, skills and professionalism. Comments made, amongst many, included, “The level of commitment…has been excellent”, “We have nothing but praise for the team – 100%” and “I enjoy my contact with Sth. Tyneside and can always rely on their professionalism”.

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EVIDENCE:

File management – both adopters and children - is well organised and files contained all required information in an accessible format; they would benefit, nevertheless, from a detailed checklist of processes. Administrative systems and arrangements, however, are not the strongest point of the agency. It was South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 19 found that there are several ‘informal’ systems in place that are not supported by a sound, efficient administrative infrastructure. For instance, administrators deliver adoption panel papers by hand and there is no checklist for tracking checks on applicants. The manager was aware of these issues and was actively addressing how matters could be improved. File storage, archives and security were, however, well managed. Personnel records for workers were very good and included all required information and records in respect of panel members

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EVIDENCE:

The premises – located close to the town centre and, thereby very accessible – are fit for purpose and provide for a comfortable and appropriately resourced working environment - and they are very secure. South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 20

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SCORING OF OUTCOMES

This page summarises the assessment of the extent to which the National Minimum Standards for Adoption have been met and uses the following scale.

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SCORING OF OUTCOMES

4 Standard Exceeded (Commendable) 3 Standard Met (No Shortfalls) 2 Standard Almost Met (Minor Shortfalls) 1 Standard Not Met (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

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SCORING OF OUTCOMES

BEING HEALTHY MAKING A POSITIVE Standard No Score CONTRIBUTION No NMS are mapped to this outcome Standard No Score 7 4 8 3 9 4 34 4

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SCORING OF OUTCOMES

STAYING SAFE ACHIEVING ECONOMIC WELLBEING Standard No Score Standard No Score 2 4 No NMS are mapped to this outcome 4 4 5 3 MANAGEMENT 10 3 Standard No Score 11 3 1 4 12 3 3 4 13 3 14 4 15 3 16 4 19 4 17 3 24 N/A 20 4 32 3 21 3 22 3 ENJOYING AND ACHIEVING Standard No Score 25 3 6 4 26 3 18 4 27 3 33 4 28 3 29 3 30 N/A 31 N/A South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection?

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STATUTORY REQUIREMENTS

This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Voluntary Adoption and the Adoption Agencies Regulations 2003 or Local Authority Adoption Service Regulations 2003 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales.

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STATUTORY REQUIREMENTS

No. Standard Regulation Requirement Timescale for action

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RECOMMENDATIONS

These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out.

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RECOMMENDATIONS

No. Refer to Standard Good Practice Recommendations South Tyneside MBC Adoption Service DS0000050051.V323616.R01.S.doc Version 5.2 Page 22

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Commission for Social Care Inspection

North West Regional Office 11th Floor West Point 501 Chester Road Old Trafford M16 9HU

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Commission for Social Care Inspection

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. Extracts may not be used or reproduced without the express permission of CSCI

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