Inspection on 20/11/07 for Cartmel Old Grammar

This inspection was carried out on 20th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Cartmel Old Grammar 08/11/06

Cartmel Old Grammar 24/07/06

Cartmel Old Grammar 11/01/06

Cartmel Old Grammar 15/07/05

Cartmel Old Grammar 25/01/05

Cartmel Old Grammar 20/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Cartmel Old Grammar Cartmel Grange-over-Sands Cumbria LA11 7SG Lead Inspector Ray Mowat Unannounced Inspection 08:30 20 November 2007 th 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 Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cartmel Old Grammar Address Cartmel Grange-over-Sands Cumbria LA11 7SG 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) 015395 36868 Beverley Anne Clarke Ms Beverley Anne Clarke Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 19 service users to include: up to 19 service users in the category of OP (Older People) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 8th November 2006 Date of last inspection Brief Description of the Service: Cartmel Old Grammar offers accommodation for up to 19 older people needing social and personal care. The home is owned and managed on a day-to-day basis by Ms Beverley Clarke. Cartmel Old Grammar is situated just outside the village of Cartmel, overlooking the racecourse and within walking distance of the Priory and the centre of the village. It is a large two-storey building that has been refurbished and extended for its present use as a care home. There are large well-kept gardens providing outside sitting areas, with car parking facilities at the front of the building. Accommodation is on two floors, with the upper being accessed by a passenger lift. There is a bright airy entrance hall, a lounge and a wellappointed dining room, all of which provide plenty of communal space for the residents to enjoy. Information about the home is made available to new and existing residents. The range of fees charged is from £405 to £505 with additional charges for personal sundry expenses. Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit took place over one day and included a tour of the building and grounds. We (Commission for Social Care Inspection, CSCI) also met with many of the people living in the home, either on their own or in small groups, which included joining a group of people for lunch. We also met with the care staff on duty and the management staff. We received surveys from and met with relatives, friends and other professionals who had contact with people in the home. In addition we received surveys from people living in the home and spent time looking at records relating to their care. The information gathered as part of this inspection informed the judgements made in each section and the overall quality rating. What the service does well: Before people choose to move into the home their needs are assessed and they are given the opportunity to visit or stay in the home to try it out. The manager works closely with other agencies to make sure specialist needs are assessed. All the people in the home have agreed a contract of terms and conditions and are made aware of their rights and how to raise concerns. Staff have developed good relationships with people, which is evident through the ‘healthy banter’ between them. People confirmed that there is a “relaxed atmosphere” and it “feels like home”. The home is decorated and maintained to a high standard throughout and is clean and hygienic. There is safe and comfortable communal space both inside and outside the home where people can relax or pursue their interests. There is a pleasant well-furnished dining room where people enjoy freshly prepared and nutritious meals of their choosing. Mealtimes are a real social occasion with convivial chat, with some people enjoying a glass of wine or sherry with their meal. Christmas and people’s birthdays are celebrated, if they so choose, with the home providing a present and a cake, which is a nice personal touch that contributes to the homely atmosphere. Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 6 All maintenance is completed to a high standard and records are up to date. People feel safe in the home and any hazards are eliminated or minimised to promote an independent lifestyle both in the home and in the local community. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good assessment procedure in place that ensures the home can meet people’s needs and they are able to make an informed choice about moving into the home and their rights and choices are respected. EVIDENCE: The manager or senior staff completes an initial needs assessment in addition to a Social Work assessment. These take account of any specialist needs and assessments by other professionals. The files I examined contained detailed assessments that identified individual needs and preferences enabling staff to support people to lead an independent lifestyle. Contracts of terms and conditions are agreed at the end of an agreed probationary period, which is normally one month. The contracts contain relevant information regarding the fees including additional charges and the services provided. They are agreed and signed by the person living in the home or their representative and the manager. The contracts are very Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 9 detailed and in line with the requirements of the Care Home Regulations and National Minimum Standards. The home actively encourages people to have a trial visit or stay before making a decision about moving in. Some people have had a short term respite stay, which has given them the opportunity to “test drive” the home. Senior staff undertaking the initial assessment will visit the person in their own home to gain a greater understanding of their individual or specialist needs, ensuring they can be met by the staff and that the environment is suitable. Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans have continued to improve with more detailed information being recorded and kept under review. Some medication procedures do not follow recommended good practice. EVIDENCE: The home has reviewed the format of their care plans and has completed reviews with the person and their representatives. Additional sections have been added including a personal profile, family history and career history. They also include a more detailed record of personal and healthcare needs including risk assessments, religious beliefs, social interests and psychological needs. The plans now contain valuable information enabling staff to understand people and respond appropriately to individual needs. Personal care assessments and strategies have also been completed, which are very informative and help staff to ‘enable’ people to help themselves and promote their independence. All healthcare needs and involvement with other professionals are also recorded. Diet and nutrition including weight are Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 11 monitored on a weekly basis, with weight gain or loss and changes in dietary needs recorded and reported to the senior staff. There was evidence of care plans, including risk assessments being regularly reviewed at least on a monthly basis and any changes recorded. There were records of appropriate referrals to other agencies being made when needs are identified. I spoke to a visiting District nurse who confirmed this. We examined the medical records (MAR charts) against the medication held. The ones examined were up to date and included a picture of the person. If a person chooses to self-administer their medication this is verified by their GP and the person signs an agreement. It is recommended that more detailed information is recorded for PRN medication to ensure staff understand why, how ands when it should be given. There was an appropriate supply of medication as listed on the MAR chart, which was securely stored. The MAR charts were signed and up to date. A stock book is maintained to record medication coming into and leaving the home. This needs to take into account existing stock so there is an accurate record of all medication held in the home, which can be audited. The majority of medication supplied to the home is in a monitored dosage system cassette, with additional medication held in the prescribing pharmacists containers. If the manager or supervisor is not going to be around for the medication round, they have developed a practice of putting up medication for each individual in a named pot, for trained care staff to administer. Strictly speaking on the occasions when medication is administered in this way it is secondary dispensing. The manager should now review this practice to ensure medication is administered at all times from the dispensing pharmacist’s container by trained staff. Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are enjoying a lifestyle of their choice and taking part in suitable activities. Good quality meals are provided with the mealtimes being a pleasant social occasion. EVIDENCE: People’s hobbies and interests and preferred social activities are now recorded in the care plan. A range of weekly activities is organised by care staff including a quiz, exercise class, creative craft activities and a weekly games afternoon. The day before the inspection people had been making Christmas cards, which had proved to be a popular activity. In addition to organised group activities people pursue their own interests in the home such as music, reading and other sedentary activities. Periodically musical entertainers are organised to provide a concert, which always prove a popular event. Some people still enjoy an active lifestyle accessing the amenities of the local village independently. One person has maintained contact with the local photographic society another enjoys a weekly bridge club, whilst other people go out for walks or to visit friends and family. Some people said how much they enjoy the gardens and when the weather allows “sitting out on the patio” Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 13 I met with several visitors to the home during the inspection who all confirmed, “They are made welcome” and talked about it being a “nice home that has a friendly atmosphere and is always clean”. Mealtimes are a social occasion with people being able to eat in the main dining room or alternatively in their own rooms. Some people enjoyed a glass of sherry and a “social chat” before lunch, other people enjoyed a glass of wine with their meal, which typifies the relaxed and homely atmosphere of the home. Meals and mealtimes are very flexible with alternative meals provided and special diets catered for. I joined a group of people for lunch, which was freshly prepared, nutritious and well presented. Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are aware of their role and responsibilities in safeguarding people and responding to their concerns and complaints. EVIDENCE: When people move into the home they agree a contract of terms and conditions, which explains their rights and includes the policy and procedure for dealing with concerns and complaints. Based on feedback from people living in the home they are aware of their rights and how to complain. They said they “can discuss anything with the manager and they are always helpful”. There have been no formal complaints requiring investigation recorded since the last inspection. In house training is provided to staff in relation to identifying and responding to abuse and how it should be recorded and reported. Staff complete a workbook to check out their understanding. More formal training for senior staff in relation to the Local Authority Adult Protection procedures would be beneficial. No adult protection referrals have been made by the home. Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is decorated and maintained to an excellent standard and provides a safe and comfortable living environment that has a very homely feel. EVIDENCE: The home is well maintained and decorated to a high standard. All areas of the home were clean and hygienic and there were no malodours. The layout of the home provides suitable living space for people to relax and enjoy the company of others. The grounds and gardens are also well maintained with accessible patio areas to the back and side of the home. Some people I spoke to during the inspection said how much pleasure they get from the “views from the home and spending time in the garden”. Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 16 All the bedrooms were well equipped and decorated to a high standard. People have made them “their own” by bringing in their own furniture and belongings, which makes them more homely. There is a call bell system throughout the home enabling people to get assistance when required. Aids and adaptations are in place to assist people in maintaining their independence around the home and with personal care tasks. These include handrails and grab rails, toilet raisers and manual handling hoists. These were all regularly serviced and maintained as required. The heating and lighting in the home are suitable and enable people to control their own environment. One of the visitors to the home who I spoke to commented, “it’s always so warm, clean and bright there are never any bad smells”. Water temperatures are checked on a weekly basis and recorded in line with good practice guidelines. The manager completes a building and rooms risk assessment, which includes communal areas of the home. These are regularly reviewed with any defects and action taken recorded, signed and dated. It is recommended a review of infection control procedures in the home is completed to ensure good practice guidelines are adhered to. Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a stable staff team who have developed good relationships with the people living in the home and work well as a team. They provide a consistent and very personalised service. EVIDENCE: There is sufficient staff on duty to meet the assessed needs of the people living in the home. Staff turnover is very low and there is an experienced staff team in place. Regular staff or a senior to maintain a continuity of service, with someone who is familiar with the routines of the home and the people living there, covers staff absences. All Criminal Record Bureau (CRB) checks have been completed for all the current staff team including POVA (Protection of Vulnerable Adults) first checks for the most recently employed staff. The home is maintaining a database of the necessary information in line with data protection guidelines. There has been one new member of staff employed since the last visit who had all checks completed and references in place prior to commencing in the post. They then ‘shadowed’ an experienced member of staff to enable them to be inducted to the routines of the home and to get to know the people living there. Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 18 Currently only one member of staff has completed their NVQ qualification, however a further eight staff have now expressed an interest and will be registering for the award in the near future. This will enable the home to meet the target of 50 of staff trained to NVQ 2 or above by April 2008. The manager maintains an individual staff training record for all training activity undertaken. The home is using a mix of independent training providers and in-house training to provide staff with a range of training in both core subjects and in specialist areas of care. These include first aid, manual handling, pressure care, and Dementia awareness. The level of training staff have completed is variable and some of the in-house training content could be strengthened particularly in specialist areas. It is recommended a full audit of training needs is completed and a suitable training programme developed to meet the needs identified. Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to be run in the best interests of the people living there. They are able to contribute to all aspects of home life and feel their choices and opinions are respected. EVIDENCE: Since the last inspection visit the home has continued to develop new systems and procedures in line with the National Minimum Standards. These include the formal supervision of staff, annual appraisals, quality assurance questionnaire and improvements to the care plans and records maintained by the home. People who live in the home, their relatives and staff all commented on the “relaxed and homely atmosphere” in the home and the “good relationships with the manager”. People feel safe and secure and able Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 20 to raise any issues or concerns in confidence they will be listened to and acted upon. People living there have a lot of autonomy to lead an independent lifestyle, which they value very highly. An annual quality assurance questionnaire has been developed, which is issued to everyone living in the home or their representative. This includes questions about all aspects of home life including, food and nutrition, communication, privacy and dignity, the home environment, personal care and general comments or feedback. The manager had collated the results and actions identified with individuals to improve their experience in the home. The overall feedback though was very positive with the following quotes capturing people’s views. “I could not wish to be in a better home. All the staff without exception are kind and considerate”, “I am satisfied in every way” and “We are well looked after”. The policies and servicing and maintenance records identified in the Annual Quality Assurance Assessment, completed by the manager prior to the inspection, confirmed that records had been reviewed and were up to date. The safety and welfare of people living and working in the home are safeguarded by the health and safety policies and procedures being followed by staff. This includes the completion of suitable risk assessments when hazards are identified. Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 3 3 Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended the home develop a more comprehensive care plan based on an assessment of needs that includes a pen picture/social history, hobbies and social interests and personal relationships. It is recommended the home review their medication administration procedures in line with good practice guidelines. It is recommended for people on a soft diet that food be pureed individually to enable the person to experience the different flavours and make the meal look more appetising. It is recommended the home review their current recording systems with a view to formalising their monitoring of service quality on a regular basis. It is recommended that all staff receive regular supervision DS0000022582.V351349.R01.S.doc Version 5.2 Page 23 2. OP9 3. OP15 4. OP33 5. OP36 Cartmel Old Grammar at least six times a year and an annual appraisal, with a record maintained and actions agreed. 6. OP9 It is recommended that more detailed information is recorded for PRN medication to ensure staff understand why, how ands when it should be given. The medication stock book should account for existing stock, as well as stock coming into or leaving the home, so there is an accurate record of all medication held, which can be audited. The manager should now review the practice of “potting up” medication, to ensure medication is administered at all times from the dispensing pharmacist’s container by trained staff. It is recommended a review of infection control procedures in the home be completed to ensure good practice guidelines are adhered to. It is recommended a full audit of training needs is completed and a suitable training programme developed to meet the needs identified. A review of the management structure should take place, so it is clear who the person in charge is, particularly when the registered manager is not in the home. 7. OP9 8. OP9 9. OP38 10. OP30 11. OP31 Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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 Cartmel Old Grammar DS0000022582.V351349.R01.S.doc Version 5.2 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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