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Inspection on 21/11/05 for Cale Green Private Nursing Home

Also see our care home review for Cale Green Private Nursing Home for more information

This inspection was carried out on 21st November 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

All residents spoken too said they liked living in the home and were complimentary about the staff. Care staff were described as `very good`. One visitor said he was very happy with the care his relative received. Residents were encouraged to personalise and decorate their bedrooms to reflect their lifestyle. Most staff were motivated and wanted to provide a good service. Training had been provided in health and safety. Cale Green offers a intermediate care service for six residents and employs a dedicated nurse to work with these residents.

What has improved since the last inspection?

Care planning documentation has improved and this helps staff provide a consistent service, however this does need further development Parts of the home have been redecorated and all bedroom doors now have privacy locks. Bathrooms and toilets have had new flooring laid. It was reported that the redecoration and refurbishment of the home was on going

What the care home could do better:

Staffing levels in the home especially in the afternoon and evening need increasing and the service currently being provided is task orientated and not personalised. At this visit, staff working on the top floor had to walk down to the kitchen on the ground floor to collect meals for residents and then carry the food back upstairs for all thirty residents living on that floor, this is time consuming for staff and does not promote a pleasant dining experience for residents. Some medication practices are unsafe in that records are poorly maintained and systems for the safe disposal of unused medication have not been arranged. Residents spoken too said they had limited choices with regards going to bed. Residents said they go when staff come for them or are free. Residents accepted this practice as normal, `because staff are so busy`. Staff were pleasant and polite to residents, although one staff member spoke dismissively to a resident when she asked for assistance. Care staff had not received any training in specific health and medical illnesses; this may help with providing care to residents who require an intermediate care service. Quality assurance monitoring had not been implemented fully and one visitor to the home said he missed the resident and relative meetings that had been held when the manager was still in post. Systems need to be implemented, to ensure resident`s monies held by the management are safe. Areas of the home still need refurbishing and it was noted that a number bedroom curtains were not wide enough to cover the bedroom window, potentially leading to a loss of privacy and dignity.

CARE HOMES FOR OLDER PEOPLE Cale Green Private Nursing Home Adswood Lane West Stockport Cheshire SK3 8HZ Lead Inspector Tracey Rasmussen Unannounced Inspection 21st November 2005 2:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cale Green Private Nursing Home Address Adswood Lane West Stockport Cheshire SK3 8HZ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0161 4771980 0161 4804928 Smallwood Homes Ltd Debra Pengelley Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50), Physical disability (10), Physical disability of places over 65 years of age (50), Terminally ill (2) Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. No service user may be received in the establihment who is less than 30 years old, male/female. 18th May 2005 Date of last inspection Brief Description of the Service: Cale Green nursing home is a care home that provides 24 hour nursing care and accommodation to 50 adult service users. Many of the service users accommodated at the home have high physical dependency needs. The home is privately owned by Smallwood Homes Ltd. Cale Green nursing home is situated in Cale Green on Adswood Lane West, about one and a half miles from the centre of Stockport. Local bus services are available. A small drive way leads to a car park and the main entrance to the home. The home is a two storey purpose built building which has been extended to provide 43 single bedrooms and three shared rooms. Eleven rooms have ensuite toilet facilities. Assisted bathing facilities are available on both floors. There are lounges on both floors. The ground floor also as a separate dining area. Adaptations and aids are provided and this includes a passenger lift and hoists. Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over almost six hours by one inspector on the afternoon and evening of the 21st November 2005. Since the last inspection in May 2005 there has been improvement in some of the areas of service. The registered manager of the home had left several weeks previous to this visit. The general manager for the company had been providing a caretaking service and he was in the process of attempting to recruit a new manager for the home. A tour of the home took place and care records were seen. Five residents, one relative and five staff were spoken to. Ten resident and ten visitor questionnaires were left at the home. None had been returned at the time of writing this report. Verbal feedback of the findings from the inspection was given to the general manager the day after the inspection. What the service does well: What has improved since the last inspection? Care planning documentation has improved and this helps staff provide a consistent service, however this does need further development Parts of the home have been redecorated and all bedroom doors now have privacy locks. Bathrooms and toilets have had new flooring laid. It was reported that the redecoration and refurbishment of the home was on going Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 6 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. Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 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 the following standard(s): 3, 5 and 6 Residents are encouraged to visit before admission and the home can confirm it meets resident’s needs on admission. Residents admitted for intermediate care are supported to achieve the agreed outcomes of their stay. EVIDENCE: A selection of care records were seen on both floors of the home. Preadmission information had been obtained in the form of community care or nursing assessments. The home also undertook its own assessment. The majority of care needs identified in the pre-admission assessments did have a corresponding care plan, however this could be further improved. Visitors and residents did confirm that the home was visited before a decision to enter the home was made but the relative, due to health restrictions of the proposed resident, usually did this. The home offers an intermediate care service (step up and step down), which has been operational for just over six months. The continuation of this service will be reviewed in March 2006. The home ensures it receives clear information Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 9 about each new resident admitted into one of these short term support beds and weekly reviews are held with a dedicated care manager to monitor the progress of each resident. Care planning documentation for residents accommodated in the intermediate care beds was detailed with clear interventions to promote the resident’s independence to achieve the desired outcomes of the stay. Although a dedicated nurse has been employed for the intermediate care unit Monday to Friday between 8am and 4pm and at weekends between 8am and 2pm the provision of dedicated care staff was inadequate and this impacted at times on the whole service in the home, particularly in the afternoon and evening. Further reference to this is made in Standard 27. Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Care planning documentation and implementation needs further improvement and care practices do not promote the dignity and privacy of the residents consistently. Medication practices are not safe. EVIDENCE: Almost all the resident’s spoken to were complimentary about living in Cale Green and said they felt at home there. Residents said the staff were usually pleasant and polite, although one resident said there was one or two staff members who were not particularly pleasant. One staff member was observed to speak to resident in a curt manner when assistance was requested. The resident requested the same assistance from other members of the staff team, a few minutes later and assistance was provided in a pleasant and appropriate manner. One relative spoken to said he ‘had peace of mind’ that his wife was being cared for properly. The relative said his wife was always presentable, with attention to hair, nails, clothing and bedding Care records seen had been improved since the last inspection so that all health risk assessments were followed by the corresponding care plan. This is Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 11 considered good practice because actions to address needs are accessible to the nurse and carer. Nurses spoken to said they felt the new records format was an improvement. Resident care files still need further improvement. One bedrail assessment had not been up dated since September 2004, care plans for pressure area care should include the type and setting of specialist mattresses, assessment information detailing MRSA positive should have a corresponding care plan and actions stated in a care plan must be undertaken for example on plan required blood sugar monitoring four times daily evidence that this had been undertaken in November was not available. Although the home has addressed some of the areas identified at the last inspection in relation to medication, practices remain unsafe. Records for receipt and administration of medication were maintained fairly consistently, for tablets but receipt and administration records for topical lotions, dressings or aids were not recorded. Handwritten additions to medication sheets had not been signed or dated and one resident’s medication administration sheet did not identify the dosage of the medication to be administered. Two lots of eye drops had been opened and not dated and in one medication trolley dispensed tablets were left in a pot in the drug trolley door. The general manager stated that the home was negotiating a contract with a waste disposal firm to remove waste medication. As a result stocks of old medication were kept in the manager’s office. The CD cupboard was full of old controlled drug medications. These were checked twice daily at the beginning of every shift. Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 and 15 Resident’s social needs are not met and choices for some aspects of daily life are restricted. EVIDENCE: The activity co-ordinator employed at the home at the last inspection had left the company. A new activity co-ordinator had just started in the home. Residents spoken to said ‘there wasn’t much going on’ in the home and another resident said ‘it is boring sometimes’. Other residents said they were happy with a good book and the privacy of their own room and another resident said she had video delivered from the library every month. Care plans for social aspects of care were recorded in three out of four plans seen and these also had information about the resident’s social background. Residents did say they were offered choices at meal times but evening bedtimes were dependent on staff coming for the resident. A consistent picture provided by residents was that they did not ask to go to bed but they had to wait until a staff member came for them. Discussion with staff and the general manager for the company indicated that the dependency levels of residents receiving an intermediate care service impacted on the availability of staff to meet resident’s need accommodated in all of the home. Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 13 At this visit one resident, had requested a yogurt in the evening and staff could not provide one because these were locked up in the food storage area. The nurse on duty said that the cook had the key to the storeroom and that they no longer had access to the store room. The following day’ during feed back the operational manager assured the inspector that this had been addressed and the nurse in charge now held a key to the food storeroom. The evening meal up stairs was served on small tables where residents were sat. Staff had to go up and down the stairs to the ground floor to collect three meals at a time. It was identified that the bain-marie was broken and had been for sometime which resulted in staff having to carry up stairs plates of hot food. Staff had been informed that the bain-marie would not be repaired or replaced. The carrying of plates of food up stairs is unsafe to staff, residents and visitors due to the risk of trips, slips and falls. Residents cannot be guaranteed the food they receive will be hot and choices regarding daily preferences in relation to food portions and choices cannot be given. The registered person has a duty to provide adequate equipment to meet the needs of residents and to ensure a safe environment. Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards not assessed at this inspection. EVIDENCE: Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, and 26 Residents live in a home, which is being re-decorated, but further refurbishment is required and some equipment does need renewing. EVIDENCE: There was evidence that some refurbishment had been undertaken in the home. Corridors on the ground floor had redecorated and all the bathrooms and toilets had had new flooring. The general manager stated that new carpets would be fitted after the redecoration had been done. Privacy locks had been fitted to all bedroom doors and some bedrooms had been redecorated. Decoration in some rooms appeared to be patched up, a number of bedroom curtains were not wide enough to cover the width of the window and so did not promote privacy and dignity for residents and some curtain valances were hanging down. The operational manager stated that the curtains were being renewed next year. Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 16 Staff reported that equipment such as the bain-marie and hot water geyser in the kitchen were in need of repair Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30 Staffing levels were insufficient to meet resident care needs in the afternoon and evenings. Staff are training does not include specialist care needs of residents accommodated. EVIDENCE: Staffing levels in the home in the afternoons and evening are an area of concern. Staff explained that after 2 pm a care worker from the ground floor must go up to the first floor to assist the intermediate care unit. This leaves two care staff and one nurse on the ground floor. Staff stated that they take it turns to work between both floors and to provide personal assistance to residents with for example bathing. This has resulted in a task orientated service, whereby residents are bathed by staff who they may not have had contact with for some time. Discussion with the general manager identified an awareness of the problem. The general manager has been asked to write to the Commission for Social Care Inspection (CSCI) detailing the staffing levels of the home and the service specification for the intermediate care service. The home has been without a manager for a number of weeks now and the general manager did state that training in specialist areas had not been Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 18 provided. Newer staff to the home did detail the induction training they had received and this included health and safety and care practices. Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 and 38 Residents do not currently have a say in the way the home is run and some health and safety practices do not promote the welfare of residents. Residents personal monies are not totally safe. EVIDENCE: The home has been without a manager for a number of weeks and the general manager for the company has been providing on the job supervision. The general manager acknowledged that some areas of the service have not had his attention due to the pressures of his job. At the time of this visit the general manager was interviewing for a manager to run the home. Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 20 Quality monitoring had not been undertaken although some auditing of aspects of the service had been undertaken. One resident said that he had missed the resident and relatives meetings that used to be provided. The general manager stated that he anticipated that these would resume as soon as a manager was recruited to the home. Samples of resident’s financial records were briefly examined. A new financial recording format had been introduced. One out of the three records seen, identified a discrepancy between the recorded financial balance and the actual monetary balance. The discrepancy was in the resident’s favour. The general manager stated he had not had opportunity to review the resident’s monies. The last financial audit undertaken was in April 2005. The home’s laundry and kitchen areas were clean and tidy. Two staff members were observed to move and transfer one resident by an under arm lift without using appropriate moving and transferring aids. This resident was then placed in a wheel chair without footplates and wheeled out of the lounge. Both practices are unsafe and breach health and safety regulations. Staff carrying plates of food upstairs to feed residents at mealtimes is also unsafe practice. Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 2 x x x x 2 x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x 2 x x 1 Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES 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 OP3 Regulation 15 Requirement The registered person must ensure that all care plans reflect identified needs detailed in the pre-admission assessment The registered person must ensure that care plans are comprehensively recorded to reflect all the needs of the service user. (Timescale of the 28/02/05 was not met). The registered person must ensure that care plan interventions are undertaken to maintain the health and welfare of residents. The registered person must ensure that the management of medication promotes the safety of residents and complies with the Royal Pharmaceutical and The NMCs guidance. (Timescale of the 30/06/05 was not met). The registered person must ensure a service contract for the disposal of waste medication is arranged and implemented. The registered person must ensure that all residents are treated in a manner that DS0000017291.V266123.R01.S.doc Timescale for action 28/02/06 2 OP7 12 14 15 28/02/06 3 OP8 12,13,14 28/02/06 4 OP9 13 15/12/05 5 OP9 13 15/12/05 6. OP10 12 15/12/05 Cale Green Private Nursing Home Version 5.0 Page 23 7 OP14 12 8 OP15 16 9 OP19 13,16,23 10 OP24 16 11 OP27 18 12. OP30 18 13 OP33 24 14 OP35 17,20 15 OP35 17,20 respects them and promotes their dignity. (Timescale of the 28/02/05 was not met). The registered person must review the service provided and implement strategies for residents to have more choice in their daily routine. The registered person must ensure that appropriate equipment is available to allow residents to receive a hot meal of their choice in a congenial environment. The registered person must ensure that the home environment including equipment is maintained in safe working order. The registered person must ensure that bedroom curtains fit properly to ensure resident’s privacy and dignity. The registered person must ensure that there are enough care staff employed to ensure continuity of care to residents living in the home The registered person must ensure that staff receive training and information about the specialist care service provided in the home. The registered person must ensure quality assurance and monitoring is undertaken regularly in the home. (Timescale of the 01/06/05 not met). The registered person must ensure that resident’s personal monies are maintained safely and records of all transactions are accurate. The registered person must ensure that resident personal monies held by the home are audited on a regular basis. DS0000017291.V266123.R01.S.doc 15/12/05 15/12/05 15/12/05 15/12/05 15/12/05 28/02/06 28/02/06 15/12/05 15/12/05 Cale Green Private Nursing Home Version 5.0 Page 24 16 OP38 12,13 17 OP38 13,23 The registered person must ensure that residents are not put at risk from unsafe working practices. The registered person must undertake a risk assessment and implement control measure to protect the staff whilst carrying food upstairs at each meal time. 30/11/05 30/11/05 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 Refer to Standard OP12 Good Practice Recommendations The registered person should ensure that activities are undertaken regularly and that all residents have a social care plan. Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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 Cale Green Private Nursing Home DS0000017291.V266123.R01.S.doc Version 5.0 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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