Inspection on 06/09/05 for Ashgrove Nursing Home

This inspection was carried out on 6th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashgrove Nursing Home 09/08/06

Ashgrove Nursing Home 18/01/06

Ashgrove Nursing Home 12/01/05

Ashgrove Nursing Home 21/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Ashgrove Nursing Home Dudley Wood Road Netherton Dudley DY2 ODA Lead Inspector Amanda Hennessy Announced 6 September 2005 th 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 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. Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ashgrove Nursing Home Address Dudley Wood Road, Netherton, Dudley, West Midlands, DY2 ODA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01384 413913 01384 413665 Highfield Care Centre Ltd Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) Physical disability (12) Physical disability of places over 65 years of age (2) Terminally ill (12) Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 12/1/05 Brief Description of the Service: Ashgrove was previously a residential home for the elderly. Ashgrove can accommodate up to 39 residents requiring either nursing or personal care within 28 single and 5 double bedrooms on two floors. The first floor can be accessed via a passenger lift. There is a lounge and dining room on the ground floor and a small lounge on the first floor. A small smoking room and hairdressing salon are on the ground floor. laundry and catering facilites are available within the home. The home has parking facilities both at the front and rear of the property. There is a large well-maintained garden and sensory garden with garden furniture and garden lighting available enabling service users to sit out and enjoy the beautiful garden. Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection undertaken by one Inspector. The inspection was undertaken between 09.45 and 18.30. The inspection included talking to service users and staff, a review of records and information (pre-inspection questionnaire) forwarded prior to the inspection. Care records were reviewed as part of the “case tracking” of four residents. Eight comments cards were received from service users, visitors and relatives prior to the inspection. The home’s ownership changed in April 2005 and is now privately owned by Southern Cross Healthcare. The home has a new manager is Mrs Jayne Gripharis. Fourteen of the previous twenty-nine requirements were found to have been addressed, seven new requirements were made as a result of this inspection. What the service does well: The home has good systems for the assessing service users needs and care planning to meet those needs. Service users spoken to during the inspection said that daily routines are flexible, they can choice where they spend their day, have their meals, get up and go to bed. Service users say that they enjoy the meals that are served and that the food at Ashgrove is very good, is varies and that a choice of meal is always available. The homes policies demonstrate an open ethos and a positive stance to complaints and the protection of vulnerable people. The home has sufficient staff with staffing levels having been increased since the previous inspection. The home has a new manager Mrs Jayne Gripharris, who is an experienced manager and highly regarded of by her colleagues, peers and other health professionals. Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 Page 6 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. Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Prospective service users needs are assessed prior to their admission to the home, this gives assurance their needs will be met. EVIDENCE: Services users all have a detailed assessment of their needs before coming to live at Ashgrove Nursing Home. Staff do involve the service user or their representative in the assessment of their needs whenever possible but this is not always recorded. The Home Manager writes to the prospective service users confirming that the home is able to meet their needs should they wish to come and live at Ashgrove Nursing Home. The pre-admission assessment of service users needs is undertaken by either the Home Manager or a senior nurse. Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 The healthcare needs of service user’s are identified and generally met but communicating changes and involving to relatives in care planning is not satisfactory. Procedures in relation to medicines are generally satisfactory but require further improvement to fully safeguard service users. Service users are treated with respect and their right of privacy is upheld. EVIDENCE: All service users’ care records seen contained care plans and care risk assessments. Risk assessments available include the risk of pressure sores, moving and lifting of residents, continence, nutrition and falls. One service user who has bedrails had no risk assessment for use of bedrails as required. Care plans and risk assessments are reviewed at least monthly. Care plans require development with service users requiring a social needs care plans. One service users needed regular toileting had no care plan to identify this. The same service user has had recurrent urinary infections and although has received treatment from her GP, staff need to seek the advice of the Continence Nurse Specialist for their ongoing care management. Feedback from relatives highlighted that they do not feel that they are involved in care planning with concern specifically highlighted about reasons for restrictions in Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 Page 10 toileting. Records seen show that service users are able to access specialist medical and nursing services alongside dental, optical and chiropody services. Several relatives who returned comment cards or contacted the Commission for Social Care Inspection said that they were not always informed that their relative had seen a Doctor or when there were changes to their health needs or treatment. One relative also said that her relatives GP had been changed without her permission or knowledge. The home has appropriate policies for the safe handling and administration of medicines. Requirements made at previous inspection are being addressed but there is a need for staff to ensure consistency of practice (see requirements list). Qualified nurses administer medicines to service users. The Staff now have appropriate records prescriptions that have been ordered, when the prescription has been checked and medicines that have been received. The drugs fridge temperature is checked daily but they also need to record the maximum and minimum temperatures to ensure that medicines are safely stored. Medicines with a limited life after opening had no opening date recorded as required. The storage and administration of controlled drugs was checked and all was found to be appropriate. The medication administration records were checked and were generally found to be completed appropriately although staff do not consistently sign for creams and lotions as required. Service users said that staff treat them with respect and preserve their privacy. Staff were seen to knock on toilet and bedroom doors before going in. Service users may either receive their visitors in their own room or in one of the lounges if they wish but one relative said that they felt that they had little privacy in the lounge and although they could go into their relatives bedroom this restricted the number of visitors who could visit at any one time. Staff call service users by their preferred name, with a record of their preferred name made in care records. Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,15 Activities are available but as service users social needs and recreational needs are not fully explored there is no assurance that social and recreational needs are met. Meals are nutritious offering a healthy and well balanced diet for the residents. EVIDENCE: Service users spoken to during the inspection said that daily routines are flexible; they can choice where they spend their day, have their meals, get up and go to bed. Information about resident’s life history and preferred leisure interests has been sought from relatives and was available in two of the three care records seen. There is a need to combine the life history and the leisure interests into a social plan of care. Families spoken to say that they are encouraged and enjoy, taking part in the various social events that the home holds. Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home has appropriate and comprehensive policies and procedures to highlight concerns and complaints, to safeguard residents from abuse. EVIDENCE: The home has a detailed complaints procedure. The complaints procedure is displayed in the main reception area of the home and is also included in the service user guide. The home has received no complaints in the previous twelve months. Residents and relatives spoken to said if they had any concerns they would discuss them with the Home Manager. The home also has appropriate policies for staff to highlight concerns whilst feeling safe to do so. Comprehensive adult protection procedures are in place and identify appropriate contact with the Police, Social Services and the Commission for Social Care Inspection. The majority of staff have received training in adult protection and awareness of what is abuse. Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 The home is pleasant, homely and well maintained with no offensive odours and has a beautiful garden for service users to enjoy. EVIDENCE: Areas of the home seen during this inspection were found to be clean, homely, welcoming with no offensive odour. The home has an ongoing refurbishment plan in operation with the main lounge recently redecorated and has new lounge chairs; a major refurbishment of the dining room is also planned shortly. There is large lounge and a separate large dining room downstairs and a small quiet lounge upstairs. The home has a full nurse call system and a variety of aids and adaptations such as grab rails assisted baths and a wheel in shower available for dependent service users. The home has an extensive garden, which is well maintained. The garden area outside the dining room is particularly noteworthy with its garden furniture, patio planters, decking, water features and garden lighting, this garden area has been developed as a partnership between volunteers of primarily visitors and staff and the homes Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 Page 14 proprietors. The remainder of the garden is mainly lawns with mature trees and shrubs and trees. Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The home has sufficient skilled staff to meet service users needs. EVIDENCE: Staffing numbers and the skills and expertise of staff meet the needs of residents. The home is staffed with the following staff: 08.00-14.00 1 trained nurse and 6 care staff 14.00-20.00 1 trained nurse and 4 care staff 20.00-08.00 1 trained nurse and 3 care staff The home also has domestic, laundry and catering staff employed daily. Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33 Service users benefit from an experienced and competent manager. The home is generally run in the best interest of service users. EVIDENCE: The home has a new manager Mrs Jayne Gripharris who has relevant skills and knowledge to manage a nursing home. Mrs Gripharris is an experienced and competent Registered Nurse, and has successfully managed another home within the company for a number of years. To ensure that her knowledge and skills are kept updated the manager attends regular training courses. Southern Cross homes have an identified Quality plan. Quality audits are undertaken six monthly with corrective actions identified, with a copy of the audit sent to both the Regional Manager and Regional Director. The home undertake audits of pressure sores, service users weights, accident statistics, vacancies and recruitment, the kitchen and a review of all regulation 37 notifications that have been sent to the Commission for Social Care Inspection (CSCI). Service user surveys are undertaken are undertaken by the company Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 Page 17 but details of the findings are not consistently communicated with the Home Manager. The number of comment cards returned to the Commission for Social Care Inspection was disappointing although those that were returned highlighted a number of concerns, in relation to staff failures in notifying them of visits by a Doctor and the outcome of the visits and the attitude of some staff. The Manager was advised to actively solicit service users, relatives and visitors views of the home. The required documented visits by an identified responsible person within the organisation has not been undertaken regularly as a result of changes in personnel. The number of ongoing requirements of the home by the Commission for Social Care Inspection remain a cause of concern. Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x 2 x x x x x Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 Page 19 No Are there any outstanding requirements from the last inspection? 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. 1. Standard 1 Regulation 4 Requirement Timescale for action 31/10/05 2. 2 4,17 The statement of purpose needs to be developed to reflect the home and its individual characteristics for example a detailed description of facilities that are available and how the home is able to meet the needs of the client groups for which it is registered.The most recent inspection report, feedback from service users, the size of all bedrooms and communal rooms must also be included within the statement of purpose. Partially met -New Manager details need to be included. Terms and conditions of 31/12/05 residency should be available for all service users and should be individualised identifying the room(s) that the service user will occupy and also identify what is covered by the fee, who the fees will be paid by, the rights and obligations of the service user and the registered person and who is liable if there is a breach of contract. The contract should also detail a trial period to enable the service user and/or their representatives time to E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 Ashgrove Nursing Home Page 20 3. 4 15 4. 7 14 5. 9 13(2) make their decision to live in the home permanently. Partially met- New Southern Cross contracts are now available but need to include the room to be occupies and ammend the trial period to twelve weeks. No new service users are Ongoing admitted to the home requiring terminal illness care until the home has a member of the home’s staff with a must have a relevant and up to date qualification in terminal illness care. This requirement was met and is ongoing. 31/10/05 Care plans:· reflect the needs of the service user.· are drawn up with the involvement of the service user or their representative whenever possible· are evaluated at least monthly or as clinically indicated. Partially met care plans did not reflect all needs. Staff must also identify the involvement of the service user in planning their care. The drugs fridge temperature:· 31/10/05 is maintained between 2 and 8oC. · is recorded daily. The date that the drugs fridge is defrosted is recorded. Staff record service user’s pulses prior to the administration of digoxin. The amount of medication given is recorded for those service users prescribed a variable dose of medication. A record is made of the amount of each individual service user’s medication received into the Version 1.40 Page 21 Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc home Partially met- the drugs fridge temperature is recorded daily but thermometer is not accurate and requires replacement. Staff still need to record when fridge is defrosted and consistently record service users pulse when they are in receipt of digoxin and the amount of variable dose medication given. 6. 7. 12 24 16(2)(n) 16,23 The home to perform an updated audit of residents’ interests. Partially met The home undertakes an audit of each room recording where all elements of standard 24 are met and identifying the reasons why they are not met. Partially met- audit has been undertaken but need to reflect it to individuals care needs. All residents requiring nursing care have height adjustable beds.The home must address the provision of height adjustable beds on the basis of needs assessment Partially met - six profiling beds now available and an additional six beds have been ordered- this requirement should have been met by 31/3/05 All staff receive first aid training. Partially met thirteen staff have received first aid training- this requirement should have been met by 31/3/05. The cook attends an intermediate food hygiene certificate. Partially met 1 cook has completed training with one cook still to attend the training. This requirement should have been met by the 31/3/05l 31/10/05 31/10/05 8. 24 16,23 31/10/05 9. 30 13,18 31/12/05 10. 30 13,18 31/12/05 Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 Page 22 11. 30 18 All staff attend induction and foundation training to National Training Organisation specifications. 12. 36 13. 37 14. 38 15. 38 16. 33 17. 15 18. 19. 7 8 Care staff receive formal supervision at least 6 times each year, with an appropriate level of clinical and supportive supervision for all other staff. Partially met- supervision has commenced but not undertaken regularly. 17 All records are stored and constructed as required by the Data Protection Act and to safeguard service users. Partially met 18(1)(a)(c All staff to receive infection ) control training. Partially met- fifteen staff have received trainingthisrequirement should have been met by 31/3/05 18 All staff receive health and safety awareness training. Not met this requirement should have been met by the 31/3/05. 26 Recorded unannounced visits are undertaken at last monthly with reports forwarded to the Commission for Social Care Inspection. Partially met- recorded visits not underatken as frequently as required. 38 Service users who require bed rails must have a risk assessment for the use of bed rails. 15 Service users must have a social care plan. 12(1) The registered person must make proper provision for the health and welfare of the service user- when appropriate relatives must also be kept informed of any changes to their relatives E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc 18(2), 21 Not assessed no new staff appointed. Ongoing 31/10/05 31/12/05 31/12/05 31/10/05 With immediate effect. 31/10/05 With immediate effect. Ashgrove Nursing Home Version 1.40 Page 23 health. 20. 9 13(2) A date of opening must be recorded on medicines which have a short life following opening. There are no gaps on the medication administration record. The administration of creams is recorded. An application for the Home Manager to be the registered manager is made to the Commission for Social Care Inspection. A survey of service users views is undertaken with a report of the findings forwarded to CSCI and made available for service users. With immediate effect With immediate effect. 30/9/05 21. 9 13(2) 22. 31 9 23. 33 24 31/12/05 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. Refer to Standard 26 9 Good Practice Recommendations Colour coded laundry bags are used to cease the need for laundry staff to “sort” dirty laundry. THe fridge thermometer is replaced Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Mucklow Office Park West Point, Mucklow Hill Halesowen B62 8DA National Enquiry Line: 0845 015 0120 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 Ashgrove Nursing Home E55 S4895 Announced Ashgrove V238832 060905 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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