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Summary

No overall grade in this framework

Peter Allcock

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  • Inspectors verified

    Peter Allcock

  • Postcode verified

    RM1 3NH

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FindingsAbout the inspectionWhat needs to improveLeadership positive critical
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  • Leadership136w+27
  • What needs to improve328w−50

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Flesch 40, typical 45
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21 words
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typical 5
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Findings 86%Leadership 3%What needs to improve 7%About the inspection 4%

Full report text

X10029.doc Version 1.40 Page 1 FOSTERING SERVICE

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RM1 3NH

Lead Inspector Peter Allcock Key Announced Inspection 20th November 2006 10:00 am The Commission for Social Care Inspection aims to:

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RM1 3NH

• 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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RM1 3NH

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

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RM1 3NH

London Borough of Havering Fostering Service SC_SC042373_20061120.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 Fostering Services. 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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RM1 3NH

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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RM1 3NH

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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RM1 3NH

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.

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RM1 3NH

London Borough of Havering Fostering Service SC_SC042373_20061120.doc Version 5.2 Page 3

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Name of service

London Borough of Havering Fostering Service

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Name of service

Address Scimitar House Eastern Road Romford Essex RM1 3NH

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Fax number

Email address Linda.mcgrath@havering.gov.uk

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(if applicable)

London Borough of Havering Children’s Services

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manager (if applicable)

Type of registration Local Authority Fostering Service

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manager (if applicable)

London Borough of Havering Fostering Service SC_SC042373_20061120.doc Version 5.2 Page 4

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Conditions of registration:

Date of last inspection 9th January 2006

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Brief Description of the Service:

This is a Fostering Service provided by the London Borough of Havering. It is a part of the Family Placement Service, which is managed within the Children’s Services Section of the Children’s Service. Short and long term fostering, shared care (Family Link), and kinship fostering are provided. Staff recruit, assess, train, review, and support foster carers. The service is divided into two teams; the Family Link Scheme provides respite breaks for children with disabilities, and the Fostering Team, which acts as the boroughs main Fostering Service provider. Where the needs of young people cannot be met from within the in-house service, a separate Commissioning Unit purchases placements from independent providers.

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Brief Description of the Service:

The service provides a range of support groups for foster carers, a men’s support group, endings group, coffee mornings, carers forum, and a group for foster carer’s own children. A newsletter is sent out five times a year.

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Brief Description of the Service:

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SUMMARY

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

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SUMMARY

This announced key inspection was undertaken at short notice immediately following the local authorities Joint Area Review, and the inspector has adopted a proportionate and targeted approach given the recent extensive inspection of the local authorities children’s services. As a result not all national minimum standards have been examined where these standards were judged as part of the Joint Area Review.

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SUMMARY

The inspector would like to thank the management and staff of the service for the professional and hospitable support given to the inspector during this inspection. The inspector would also like to thank the foster carers, children and young people who took the time to meet with him during the inspection.

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SUMMARY

The overall impression is of a well managed service with a committed and enthusiastic staff team who provide a service which in general keeps children safe, supports them in their education and encourages them to live a healthy lifestyle. There is support for contact arrangements and support for young people to develop independence skills.

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What the service does well:

The overall impression is of a well managed service with a committed and enthusiastic staff team who provide a service which in general keeps children safe, supports them in their education and encourages them to live a healthy lifestyle. There is support for contact arrangements and support for young people to develop independence skills. Foster carers are well supported and have numerous training opportunities, and the inspector was struck by their commitment to do their best for the children and young people they care for.

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What has improved since the last inspection?

Five of the six requirements made at the last inspection have been met, leading to improvements to staff checks, the procedures for managing allegations against carers and the quality of assessment reports.

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What they could do better:

The fostering service is well aware of the areas required for improvement, and Has made progress in both the timely conduct of reviews and the time taken to bring completed foster carers to panel. The improvements to the service offered to Kinship carers has revealed a number of anomalies with regard to

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What they could do better:

London Borough of Havering Fostering Service SC_SC042373_20061120.doc Version 5.2 Page 6 Criminal Records Bureau checks for carers and adult members of their families which are currently being addressed.

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What they could do better:

The inspector is confident that the fostering service will meet these requirements within the timescales notified in this report.

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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.

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What they could do better:

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CONTENTS

Statutory Requirements Identified During the Inspection

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CONTENTS

London Borough of Havering Fostering Service SC_SC042373_20061120.doc Version 5.2 Page 8

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The intended outcome for this Standard is:

• The fostering service promotes the health and development of children.(NMS 12)

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12

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

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12

Children and young people benefit from placements with foster carers who are supported by the fostering service to ensure that their health care needs are met.

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NMS 12 – Health and Development

Foster carers spoken to during this inspection clearly understood their responsibilities to ensure that children and young people were registered with a GP and attended regular dental appointments. Records maintained by the fostering service demonstrated that nearly 98% of looked after children had up to date immunisations and that 95% had received an annual dental examination.

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NMS 12 – Health and Development

The local authority has a fast track system for children and young people to access the child and adult mental health service, however two foster carers reported that they had encountered delays in accessing this service for young people placed with them.

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NMS 12 – Health and Development

Foster carers are provided with training in first aid, and for those caring for very young children and babies a more specialised course in paediatric first aid has been provided.

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NMS 12 – Health and Development

London Borough of Havering Fostering Service SC_SC042373_20061120.doc Version 5.2 Page 9 The fostering service has systems in place to monitor the health of looked after children, however the Primary Care Trust (PCT) has still to provide a designated doctor and nurse to monitor from a health service perspective the health of looked after children, and it is recommended that the fostering service resolve this matter with the PCT as a matter of urgency.

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NMS 12 – Health and Development

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The intended outcomes for these Standards are:

• Any persons carrying on or managing the service are suitable. (NMS 3) • The fostering service provides suitable foster carers.(NMS 6) • The service matches children to carers appropriately.(NMS 8) • The fostering service protects each child or young person from abuse and neglect.(NMS 9) • The people who work in or for the fostering service are suitable to work with children and young people.(NMS 15) • Fostering panels are organised efficiently and effectively.(NMS 30)

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3, 6, 8, 9, 15, 30

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

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3, 6, 8, 9, 15, 30

Children and young people’s welfare is safeguarded by the fostering services policies for the recruitment and selection of staff and carers, though may be compromised in a small number of cases by incomplete checks on kinship carers and their families. Children and young people are further safeguarded by the service’s child protection procedures.

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NMS 3 – Suitability of Responsible Persons

The fostering service has just appointed a new manager, and is currently managed on a temporary basis by the head of family link scheme. Discussion with the responsible person and temporary manager demonstrated that they are experienced and well qualified professionals and are suitable persons to run a service concerned with safeguarding and promoting the welfare of vulnerable children and young people.

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NMS 6 – Suitability of Foster Carers

London Borough of Havering Fostering Service SC_SC042373_20061120.doc Version 5.2 Page 11 The foster homes visited during this inspection were providing a safe, healthy and nurturing environment for the young children and young people who are placed there. There are systems in place to ensure that all foster homes meet the relevant health and safety standards for the age of the children and young people placed there. The health and safety of foster carers homes is reviewed annually.

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NMS 6 – Suitability of Foster Carers

Foster carers preparation and ongoing training includes health and safety issues and carers are provided with written guidance on their health and safety responsibilities.

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NMS 6 – Suitability of Foster Carers

All the foster carers visited during this inspection were aware that they could be visited as part of the commission’s inspection process.

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NMS 8 – Matching

The inspector discussed matching issues with managers and staff of the fostering and commissioning services. It is clear that the fostering service places considerable importance on matching foster carers and young people, and that their currently assessed needs, ethnic, religious and cultural needs are taken into consideration when attempting to achieve the best possible match. The foster placement agreements seen during this inspection included specific information on the criteria used in making the placement.

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NMS 9 – Child Protection

There is a high level of commitment within the fostering service to safeguarding children and young people, and there are clear policies and procedures in place to protect children and young people form abuse, and to safeguard children and young people who go missing from their placement.

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NMS 9 – Child Protection

The fostering service provides training for its staff and carers in child protection procedures, and safe caring guidelines were in place on all the foster carers files seen during this inspection. There are procedures in place which allows the service to monitor all child protection concerns for the children and young people that it places.

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NMS 9 – Child Protection

The fostering service provides clear written guidance to foster carers describing how any form of corporal punishment is not acceptable, and none of the children and young people visited during this inspection indicated that they were being bullied in their placement.

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NMS 9 – Child Protection

Since the last inspection, the fostering service has responded to the concerns of some carers that allegations made against them can take a very long time

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NMS 9 – Child Protection

London Borough of Havering Fostering Service SC_SC042373_20061120.doc Version 5.2 Page 12 to resolve. Newly drafted policies and procedures should ensure a more timely resolution of these issues.

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NMS 15 – Suitability of Staff

The recruitment and selection of staff is administered centrally by the local authorities Human Resources department. Following a requirement made at the last inspection the fostering service has conducted an audit of all staff files and the managers of the service stated that all appropriate checks are fully documented and in place.

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NMS 15 – Suitability of Staff

At the fostering panel the inspector noted that in respect of one Kinship carers family not all the checks were in place for adult members of the family. Whilst the inspector acknowledges that this family have an uneasy relationship with the department, it is essential that these essential checks be carried out. This is a requirement of this report.

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NMS 15 – Suitability of Staff

The inspector met with a large group of staff during this inspection and was impressed by the loyalty, enthusiasm and commitment to the children and young people placed by the service. Staff were appropriately qualified and experienced, and knowledgeable as to their roles and responsibilities.

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NMS 30 – Fostering Panel

The inspector attended a meeting of the foster panel, which is known as the carer’s panel. The panel has members with expertise in health, education and providing foster care. Further panel members include someone with experience of being looked after and an elected member of the local authority.

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NMS 30 – Fostering Panel

There are extensive and detailed operational guidelines for the operation of the panel which include annual performance reviews for all panel members including the independent chair, and the review of all placements which result in a disruption meeting.

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NMS 30 – Fostering Panel

Observation of the panel meeting, and records of previous panel meetings demonstrated careful and rigorous consideration of all the documentation placed before it, and a determined and forthright approach to the exercise of its quality assurance responsibilities. Matters presented to the panel were deferred when insufficient information was available to make a safe decision.

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NMS 30 – Fostering Panel

The panel will shortly be undertaking joint training with members from two other local authorities, which will provide a useful opportunity to compare current practice within the three fostering panels. The inspector considers that the operation of the carer’s panel exceeds this national minimum standard.

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NMS 30 – Fostering Panel

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The intended outcomes for these Standards are:

• The fostering service values diversity.(NMS 7) • The fostering service promotes educational achievement.(NMS 13) • When foster care is provided as a short-term break for a child, the arrangements recognise that the parents remain the main carers for the child.(NMS 31)

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7, 13, 31

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

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7, 13, 31

Children and young people benefit from placements which value diversity and support them to make the most of educational opportunities that are available to them.

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NMS 7 – Diversity

The profile of the borough has been predominantly white UK though this is changing. The fostering service has recruited a diverse staff team and this now needs to be extended into the recruitment of more black and ethnic minority foster carers. The service is aware of this and has plans to target their recruitment of carers to achieve this. The assessment of foster carers and their ongoing training provide a level of challenge to carers to examine their attitudes to diversity issues.

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NMS 7 – Diversity

Staff and foster carers have received equalities training and the borough’s celebration of Black History Month provided carers with opportunities to learn more about the different history, dress and food of the communities who live in the borough.

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NMS 7 – Diversity

London Borough of Havering Fostering Service SC_SC042373_20061120.doc Version 5.2 Page 15 Discussion with a group of carers at a support group meeting demonstrated the importance they attach to issues of diversity and their willingness to use their network of foster carers to further increase their knowledge and understanding.

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NMS 13 – Education

There is strong support for young people’s educational achievement and discussion with foster carers demonstrated their commitment to ensuring that the children and young people placed with them were able to take advantage of the educational opportunities available to them. Foster carers described how they assist with homework; attend parent’s evenings and liase with school staff where appropriate.

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NMS 13 – Education

The fostering service has provided financial assistance to foster carers to support young people’s participation in school trips and a variety of extra curricula activities.

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NMS 31 – Short term Breaks

The fostering service includes a Family Link team who work specifically with children with disabilities and their families to provide short-term respite care. This can either be in the family or the carer’s home, or in the local community. The service is strongly committed to the principles of shared care, as a means to provide continuity for children and young people. Whilst it is clear that families who use the service greatly value the support that it provides for them, and the opportunities for activities and making new friends created for children and young people with disabilities, the demand on the service is such that families can wait for some time before being able to access the service.

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NMS 31 – Short term Breaks

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The intended outcomes for these Standards are:

• The fostering service promotes contact arrangements for the child or young person. (NMS 10) • The fostering service promotes consultation.(NMS 11)

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10, 11

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

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10, 11

Children and young people benefit from contact arrangements, which ensure that they can maintain appropriate relationships with their family. Whilst there are opportunities for consultation on issues that affect their day-to-day lives and futures, there are more limited opportunities for them to comment on the services that are available to them.

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NMS 10 – Contact

Discussion with foster carers and records seen during this inspection demonstrate a clear commitment by the service and foster carers to supporting contact arrangements. Contact arrangements are clearly set out in placement plans and their effective implementation monitored by the service’s social workers during their regular supervision visits to foster carers. One young person told the inspector that their carer always picks them up from the station when they have been to see their family.

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NMS 11 – Consultation

The fostering service provides a number of opportunities for foster carers to make their views known to senior managers of the service. There are regular meetings with fostering services managers, and young people have formal

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NMS 11 – Consultation

London Borough of Havering Fostering Service SC_SC042373_20061120.doc Version 5.2 Page 17 opportunities to make their views known during the review process. The borough is aware that ongoing consultation work with children and young people is underdeveloped, and are in the process of implementing a newly drafted participation strategy. It is recommended that the fostering service consider the development of a website for looked after children and young people.

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NMS 11 – Consultation

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The intended outcomes for these Standards are:

• The fostering service prepares young people for adulthood.(NMS 14) • The fostering service pays carers an allowance and agreed expenses as specified.(NMS 29)

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14, 29

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

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14, 29

Young people benefit from a range of support services to assist them to develop the skills and provide ongoing support for independent living, and from the financial security provided to foster carers by the regular payment of allowances and appropriate expenses.

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NMS 14 – Preparation for Adulthood

The fostering service works closely with colleagues in the leaving care team to assist young people in developing the skills they need for independent living. Foster. Young people can receive additional tuition for the GCSE subjects they are studying. The files of young people aged over fifteen seen during this inspection all contained appropriate pathway plans.

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NMS 29 – Allowances and Expenses

There is a written statement of the allowances payable to foster carers, and information on the expenses that foster carers may claim. Allowances and allowable expenses are reviewed annually. Discussion with a number of foster carers suggested that allowances are paid correctly and on time.

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NMS 29 – Allowances and Expenses

London Borough of Havering Fostering Service SC_SC042373_20061120.doc Version 5.2 Page 19

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The intended outcomes for these Standards are:

• There is a clear statement of the aims and objectives of the fostering service and the fostering service ensures that they meet those aims and objectives.(NMS 1) • The fostering service is managed by those with the appropriate skills and experience. (NMS 2) • The fostering service is monitored and controlled as specified. (NMS 4) • The fostering service is managed effectively and efficiently.(NMS 5) • Staff are organised and managed effectively.(NMS 16) • The fostering service has an adequate number of sufficiently experienced and qualified staff.(NMS 17) • The fostering service is a fair and competent employer.(NMS 18) • There is a good quality training programme. (NMS 19) • All staff are properly accountable and supported.(NMS 20) • The fostering service has a clear strategy for working with and supporting carers.(NMS 21) • Foster carers are provided with supervision and support.(NMS 22) • Foster carers are appropriately trained.(NMS 23)

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The intended outcomes for these Standards are:

• Case records for children are comprehensive.(NMS 24) • The administrative records are maintained as required.(NMS 25) • The premises used as offices by the fostering service are suitable for the purpose.(NMS 26) • The fostering service is financially viable. (NMS 27) • The fostering service has robust financial processes. (NMS 28) • Local Authority fostering services recognise the contribution made by family and friends as carers.(NMS 32)

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

London Borough of Havering Fostering Service SC_SC042373_20061120.doc Version 5.2 Page 20

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1, 16 17, 21, 24, 25, 32

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

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1, 16 17, 21, 24, 25, 32

Positive outcomes for children and young people are pursued by a well- managed fostering service employing a loyal, committed and enthusiastic team of staff. The service has robust systems in place to monitor its performance, and there are clearly identified strategies to meet the shortfalls described in this report in respect of the length of assessment and the timely reviewing of foster carers.

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NMS 1 – Statement of Purpose

Both the fostering service and Family Link schemes have clearly drafted statements of purpose and colourful and informative children’s guides which include all the matters set out under regulation 3 of the Fostering Services Regulations 2002.

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NMS 16 – Organisation and Management of Staff

The fostering and family link teams are staffed with professionally qualified social workers, who receive regular supervision and annual appraisals. Training is provided and staff value the opportunity presented for their professional development. There is a clear management structure in place, but the resignation of the fostering team manager has clearly resulted in a significant workload increase for the services remaining managers.

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NMS 16 – Organisation and Management of Staff

It is acknowledged by managers within the service that the restructuring of responsibilities has resulted in a delay in holding annual reviews for foster carers. Annual reviews are up to date for carers in the family link scheme. Whilst there are clear plans to reduce this backlog and the inspector is confident that these plans will ensure reviews are held in time, the timely holding of reviews must be a requirement of this report.

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NMS 17 - Experience and Qualifications of Staff and Carers

The fostering service has, unlike many other London Local Authority fostering services managed to recruit and retain social workers with fostering

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NMS 17 - Experience and Qualifications of Staff and Carers

London Borough of Havering Fostering Service SC_SC042373_20061120.doc Version 5.2 Page 21 experience. As noted at the last inspection, the assessment process for new carers can take between nine and twelve months. Current government targets for this work are that prospective carers are assessed and approved within six months. There is clearly a dilemma for practitioners who wish to undertake a protracted and complicated piece of work to a high professional standard, and the need for the service to recruit new carers in a timely manner. The requirement that the fostering service manager must ensure that staff who carry out assessments of potential foster carers are equipped to do so in a timely manner is restated, as there are clearly systems in place to further improve the performance in this area that has been achieved over the past year.

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NMS 17 - Experience and Qualifications of Staff and Carers

There is a clearly set out process for the assessment of foster carers based on The British Association of Adoption and Fostering form F, and includes consideration of all the matters set out in national minimum standards 17.6 and 17.7 in considering the suitability of applicants to become foster carers. The fostering service has entered into an agreement with an independent fostering agency who provide the local authority with foster carers who are trained and supported to provide a home for young people with more complex or challenging needs.

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NMS 21 – Supporting Carers

The fostering service has a clear strategy for working with and supporting foster carers. Foster carers have written information on how to access support including out of hours support, which commendably is available on a 24 hour basis. There is also written information provided to foster carers detailing the arrangements for supervision and the formation of support groups is actively encouraged.

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NMS 24 – Case Records

The fostering service has clear policies and procedures governing case recording, and case audit. Case records seen during this inspection were well presented, told the story of the work done with children and young people and relevant information could be found with ease. There was evidence of regular management oversight of the quality of recording, and an audit trail that ensured that the required information is properly recorded.

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NMS 25 – Administrative Records

Confidential records are securely kept. The fostering service maintains all the records required under this national minimum standard and its associated regulations to a good standard.

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NMS 25 – Administrative Records

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NMS 32 – Family and Friends as Carers

The fostering service has separate policies and procedures, which recognise the particular relationship and position of family and friend carers. Following a consultation with kinship carers, the fostering service is currently in the process of reviewing all kinship carers. The service has appointed a specialist worker to recruit and support kinship carers.

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NMS 32 – Family and Friends as Carers

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SCORING OF OUTCOMES

This page summarises the assessment of the extent to which the National Minimum Standards for Fostering Services 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 ACHIEVING ECONOMIC Standard No Score WELLBEING 12 3 Standard No Score 14 3 STAYING SAFE 29 3 Standard No Score 3 3 MANAGEMENT 6 3 Standard No Score 8 3 1 3 9 3 2 X 15 2 4 X 30 4 5 X 16 2 ENJOYING AND ACHIEVING 17 2 Standard No Score 18 X 7 3 19 X 13 3 20 X 31 3 21 3 22 X MAKING A POSITIVE 23 X CONTRIBUTION 24 3 Standard No Score 25 3 10 3 26 X 11 3 27 X 28 X 32 3

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SCORING OF OUTCOMES

London Borough of Havering Fostering Service SC_SC042373_20061120.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES

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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, Fostering Services Regulations 2002 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 1 FS15 20(3) schedule Advanced Criminal Records Bureau disclosures must be obtained for all Kinship carers and adult members of their households. 31/07/07

p.25

STATUTORY REQUIREMENTS

2 FS16 29(1) The responsible persons must ensure that foster carers reviews are held on time. 31/07/07

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STATUTORY REQUIREMENTS

3 FS17 27 The fostering service manager must ensure that staff who carry out assessments of potential foster carers are equipped to do so in a timely manner.

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as the original deadline of

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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

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RECOMMENDATIONS

1 FS12 It is recommended that the fostering service pursue the allocation of a doctor and nurse to monitor the health of looked after children and young people with the Primary Care Trust.

p.26

RECOMMENDATIONS

2 FS11 It is recommended that the fostering service consider the development of a website for looked after children and young people.

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RECOMMENDATIONS

London Borough of Havering Fostering Service SC_SC042373_20061120.doc Version 5.2 Page 26 London Borough of Havering Fostering Service SC_SC042373_20061120.doc Version 5.2 Page 27

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Commission for Social Care Inspection

Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU

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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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