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Inspection on 04/01/06 for Castletroy Residential Home

Also see our care home review for Castletroy Residential Home for more information

This inspection was carried out on 4th January 2006.

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

What has improved since the last inspection?

The home had taken action on requirements from the previous report to remove the trip hazard from the entrance to the laundry, add contact details of the CSCI to complaints procedures for personnel, carry out fire drills on a three monthly basis and improved individual staff training records.

What the care home could do better:

Whilst written care planning arrangements were mostly satisfactory, there were still shortfalls in a few aspects of care needs. It was worrying that one file contained a resuscitation notice from a hospital in relation to actions in the event of the service user`s death, which were not compatible with the home`s policy on such matters. The total care planning arrangements were not maintained in one file for each service user to enable day-to-day documentation used by the care team to be more readily accessible. However it was evident there were issues about reassembling the case file for archiving once a service user had left the home. The total case file must be available and maintained for a statutory length of time. One service user who died in the home recently had not been seen by her GP since 2003. Service users must be seen by their General Practitioner (GP) at least once in a 12-month period. A record must be maintained where a GP has declined to carry out a minimum of an annual health check. Similarly, records must be maintained to show that GP`s have been requested to carry out an annual review of medications. The manager was advised to ensure that the home`s personnel only describe symptoms of illness to GP surgeries when requesting GP visits and to avoid any attempts to diagnosis illnesses. Care notes must only record symptoms of illness until a doctor has diagnosed an illness. Records for the administration of medicines must show where service users have declined to take medication. Medications dispensed into monitored dosage systems must be administered in day and date sequence for audit purposes. Initials of personnel who sign medication records must conform to the sample signatures recorded on the procedures documents.Records indicated that a few personnel had not undertaken sufficient induction and statutory safety training. However records also indicated that the manager had been taking steps with personnel who had failed to attend training sessions. She stated that she was considering suspension of members of staff who had continuously failed to attend for statutory training. The previous inspection had raised concerns about the eligibility of staff to work in the UK. Action was underway on the requirement to verify permits to work but had not been completed as yet.

CARE HOMES FOR OLDER PEOPLE Castletroy Residential Home 130 Cromer Way Luton LU2 7GP Lead Inspector Leonorah Milton Unannounced Inspection 4th January 2006 12:30 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 Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 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. Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Castletroy Residential Home Address 130 Cromer Way Luton LU2 7GP 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) 01582 417995 01582 723615 Castletroy Home Mrs Jacqueline England Care Home 70 Category(ies) of Old age, not falling within any other category registration, with number (70), Physical disability over 65 years of age (8) of places Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service user must not exceed 70. No one falling within the category of OP may be admitted to the home where there are 70 persons of category OP already accommodated within the home. No one falling within the category of PD(E) may be admitted to the home where there are 8 persons of category PD(E) already accommodated within the home. 3rd October 2005 Date of last inspection Brief Description of the Service: Castletroy is a purpose built two-storey home situated on the outskirts of Luton in a residential area. The home is registered to care for up to seventy service users over the age of sixty-five years, eight of whom may also have physical disabilities. Single room accommodation with ensuite toilet and washbasin facilities is provided for each service user. There are communal areas on both floors such as a lounge and dining room. Shared bathing and toilet facilities are conveniently located throughout the home. A hairdressing salon and activity room are located on the ground floor. A lift ensures all areas of the home are easily accessible to all service users. There is a spacious and well-maintained garden both at the front and rear of the home. Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second of the statutory two inspections that the Commission for Social Care Inspection (CSCI) is required to carry out each year. This inspection was carried out in accordance with the CSCI’s procedures to assess core care standards within the two inspections as detailed on this and the previous report. This inspection therefore focused the progress to meet requirements from the previous inspection and core standards not assessed at that visit. During this inspection the arrangements for the care of three service users was assessed. Sundry records relevant to individual care and the operation of the home were inspected. Conversations took place with three service users, a member of staff and the manager. A partial tour of the building took place. It is recommended that this report be read in conjunction with the report of the inspection carried out in October 2005 for a complete overview of the standard of the operation between these dates. What the service does well: The home provided a well-maintained and comfortable environment that was suitable for the care of frail older people. At this inspection many service users were observed relaxing in their rooms after lunch and appeared to be comfortable in their bedrooms, which despite the uniformity of layout and décor had achieved a unique appearance through the service users’ personal belongings. The home was well managed. The manager was competent and qualified. She was helpful and co-operative with the inspection process. The manager had been assisted by an able administrator and a senior team. It was reported that the proprietor been supportive of the manager and her team and that he had visited the home on a weekly basis. Staffing arrangements were satisfactory. There were sufficient ancillary as well as care personnel to ensure that all aspects of the operation of the home functioned well. In conversation with a senior member of the team it was evident that she was well versed with service users’ care needs and the systems to run the home. The arrangements for the care of one service user who had an infections condition were satisfactory and had taken account of good practice guidelines to prevent the spread of infection. Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 Page 6 Service users spoken to at the inspection were satisfied with the arrangements for their care. One person recently admitted to the home stated that she wished to remain in the home on a permanent basis, described members of staff as “kind, attentive and lovely”. Another stated that she would like to go out of the home more often. The manager later explained that the service user frequently made such statements but usually declined opportunities to go out. What has improved since the last inspection? What they could do better: Whilst written care planning arrangements were mostly satisfactory, there were still shortfalls in a few aspects of care needs. It was worrying that one file contained a resuscitation notice from a hospital in relation to actions in the event of the service user’s death, which were not compatible with the home’s policy on such matters. The total care planning arrangements were not maintained in one file for each service user to enable day-to-day documentation used by the care team to be more readily accessible. However it was evident there were issues about reassembling the case file for archiving once a service user had left the home. The total case file must be available and maintained for a statutory length of time. One service user who died in the home recently had not been seen by her GP since 2003. Service users must be seen by their General Practitioner (GP) at least once in a 12-month period. A record must be maintained where a GP has declined to carry out a minimum of an annual health check. Similarly, records must be maintained to show that GP’s have been requested to carry out an annual review of medications. The manager was advised to ensure that the home’s personnel only describe symptoms of illness to GP surgeries when requesting GP visits and to avoid any attempts to diagnosis illnesses. Care notes must only record symptoms of illness until a doctor has diagnosed an illness. Records for the administration of medicines must show where service users have declined to take medication. Medications dispensed into monitored dosage systems must be administered in day and date sequence for audit purposes. Initials of personnel who sign medication records must conform to the sample signatures recorded on the procedures documents. Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 Page 7 Records indicated that a few personnel had not undertaken sufficient induction and statutory safety training. However records also indicated that the manager had been taking steps with personnel who had failed to attend training sessions. She stated that she was considering suspension of members of staff who had continuously failed to attend for statutory training. The previous inspection had raised concerns about the eligibility of staff to work in the UK. Action was underway on the requirement to verify permits to work but had not been completed as yet. 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. Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 Page 8 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 Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 Page 9 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 Sufficient information in relation to service users’ care needs had been obtained prior to admission to ensure that the home could properly meet assessed needs. EVIDENCE: The pre-admission assessment of need for two service users were assessed and showed that a through assessment of need that had taken account of the details specified in standard 3 had been carried out. There was evidence that an assessment carried out under the care management processes had included the consultation with the service user, her representatives and several healthcare specialists. The home did not provide an intermediate and rehabilitation service. Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 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): Care planning documentation was not fully consistent with an assessment of need, which could result in serious consequences in relation to service users’ care. Service users’ health care needs may have been compromised because not all had been seen by their GP or had their medication reviewed on at least an annual basis. EVIDENCE: Care plans were of a good standard but predominantly centred on service users’ physical needs. However their had been some improvement in relation to recording service users’ interests, the files assessed containing a tick list of social and recreational interests. The case file for one service user made to no reference to her mental health needs, food preferences or wishes at death. The care plan for one service user showed that she should be offered a warm bath prior to going to bed. However her assessment of need showed that her physical condition, which required daily dressings by the District Nursing Services, prevented her from taking baths. The case file also displayed in a prominent position a “Resuscitation Order” from the Luton and Dunstable Hospital, which could have be misleading to personnel in the home. The Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 Page 11 manager explained that the home had no such policy and that the document should not have been included in the care records. One service user who died in the home recently had not seen her GP since July 2003. It was explained and confirmed by the home’s records that until her last illness, the service user had been in reasonable health. It was also explained that her GP had declined requests to visit her for at least an annual check up and a review of medications, repeat prescriptions having been organised by telephone contact. This had included a prescription for antibiotics during the service user’s final illness, which had been issued without the GP having visited the home to examine his patient. There were no records to indicate that the home had raised objections with the GP about such practice although a central log showed that the GP had been requested to attend the home at her last illness, had failed to do so and had issued a prescription without having seen his patient. The manager stated that the cause of the service user’s death was currently being reviewed by the Coroner as is usual when a GP had not attended someone shortly before his or her death. Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 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): 14 Service users had been supported to exercise control of their lives within the limitations of their physical frailties. EVIDENCE: Conversations with service users established that they could make decisions about their every day routines. Bedrooms and records showed that service users had been able to bring personal possessions into the home. The manager stated that two visitors from a local church provided an informal advocacy service. Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 Page 13 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): 16, 18 Satisfactory arrangements were in place to enable service users and personnel to raise concerns. Recruitment procures needed some improvement to ensure the protection of service users. EVIDENCE: The previous inspection had identified, “The home’s complaints record was examined. There have been seven complaints since the last inspection. Six were made directly to the home and one complaint was made through the CSCI. All complaints were responded to or resolved within the relevant timescales”. The complaints procedure had been examined at that inspection and this was found to be satisfactory but the contact details of the CSCI for referral of complaints had not been included in the employee handbook. This had been addressed. The home’s written protection procedures had been based on the Department of Health’s “No Secrets” guidance, which was also available in the procedural manual. Records indicated the care personnel had been provided with training on adult protection procedures. The manager explained that it was planned to provide ancillary personnel with such training this year. Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 Page 14 Recruitment procedures had not included in all instances referral for a POVA first check. The manager showed the inspector a memo from an advisory company about this requirement, which could be misconstrued and identified that the manager had made a genuine mistake in this matter. Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 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): 26 Satisfactory arrangements were in place to ensure that service users were provided with a clean, hygienic environment. EVIDENCE: Areas of the building seen at this inspection were clean and orderly. Satisfactory written procedures were in place to prevent the spread of infection. Notices were posted in relation to a service user with MRSA and protective clothing had been supplied. Members of staff (other than the few who had not completed induction) had received instruction infection control procedures. Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 Page 16 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): 27,28,30. The team on the whole had the skills to care for service users, however the overall performance of the team and the welfare of service users had been compromised by those few personnel who were reluctant to undertake statutory training. EVIDENCE: Rotas indicated that sufficient care and ancillary personnel had been rostered to meet service user’s needs. There was evidence to show that the manager had written to member of staff who had failed to attend organised training events to complete core training within acceptable timescales. Other memos indicated that the whole team had been advised about the consequences of failing to attend for such training. The manager supplied information on request after the inspection that showed that there had been progress to ensure that at least fifty percent the care team held a minimum qualification in care practice to an NVQ standard. Six of the forty members of the care team had achieved NVQ awards at level 2 and one held an award at level 3. Seventeen others had almost completed the work towards the award at level 2 and five more were due to commence work towards the award in March of this year. The home had a qualified NVQ assessor. External verification of candidates’ portfolios was via Milton Keynes College. Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 Page 17 Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 Page 18 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): 31,33,37 The home was managed by a qualified person who had strategies in place to consult with service users and their representatives. EVIDENCE: The manager was a qualified nurse. She had achieved the Registered Manager’s award this year and had received her certificate since the last inspection. A copy of this certificate was given to the inspector. She evidently worked closely with her team and had maintained contact with service users and was aware of their care needs. Service users expressed confidence in her abilities. Minutes of meetings showed her involvement with issues involving service users’ care and personnel management. The minutes of meetings and discussions with one service user identified that service user meetings had taken place on a quarterly basis. The minutes Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 Page 19 showed that issues raised by service users’ via customer satisfaction questionnaires had been raised at the meeting with the view to achieving service users’ wishes where possible. The home had invited service users’ representatives to a meeting in December 2005. The manager reported this however had been poorly attended. The most recent quality assurance exercise had not been completed. Questionnaires had been circulated to service users and their representatives in January of this year and a date to complete a review of the exercise and draw up a resulting action was planned for the end of the month. Records had been maintained to a professional standard. The manager expressed frustration at the omissions to archived care records and the inclusion of the resuscitation notice on a current care file. She stated that she would be reviewing this situation with senior personnel with the delegated responsibility for these records. Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 Page 20 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 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x x x 2 x Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 Page 21 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 OP7 Regulation 15 Sch 3 Requirement The registered persons must ensure that service user care plans clearly identify the needs of service users and goals relevant to those needs. Files must contain a photograph of the service user. (Previous timescale of 03.01.06 had not been met) Service users’ care records must not include Resuscitation Orders issued by another care provider. The registered persons must ensure that service user care plans clearly identify the needs of service users and goals relevant to those needs. Files must contain a photograph of the service user. (Previous timescale of 03.01.06 had not been met) The home must maintain records that they have requested that service users’ GPs carry out at least one annual health check where they have not been examined during the preceding year. The home must maintain records DS0000015033.V275912.R01.S.doc Timescale for action 31/03/06 2 3 OP7 OP7 12(1)(a) 15(1) 15 31/01/06 31/03/06 4 OP8 12(1)(a) 13(1)(b) 31/03/06 5 OP9 12(1)(a) 31/03/06 Page 22 Castletroy Residential Home Version 5.1 13(2) 6 OP9 12(1)(a) 13(2) 7 OP9 12(1)(a) 3(2) 8 OP18 12(1)(a) 13((6) 19(1)(a) (b)(c) Sch 2 9 OP29 10 OP7 19(1)(a) 11 OP30 18(1)(a) (c)(i) 12 OP33 24 of requests to service users’ GP for at least an annual review of medication. Records for the administration on medicines must be signed in accordance with sample signatures and identify where service users have declined to take medications. Medicines dispensed in monitored dosages systems must be administered in date and day sequence for audit purposes. Recruitment procedures must include reference to the POVA first register for the protection of vulnerable adults. The registered persons must ensure that references are verifiable. Where staff previously worked in a position involving work with vulnerable adults and children, written confirmation must be sought for their reason for leaving. (Not assessed in full at this inspection) The registered persons must ensure that evidence of current eligibility to work is available for all members of staff. (Progressing) The registered persons must ensure that all staff receive basic training covering the core areas of moving and handling, food hygiene, basic first aid, infection control, fire safety and adult protection. (Previous timescale of 31/01/06 had not been met) The registered persons must ensure that a quality assurance exercise is carried out to seek the views of service users, relatives and other stakeholders. A report of the findings of this DS0000015033.V275912.R01.S.doc 31/01/06 31/01/06 31/01/06 31/01/06 31/01/06 31/03/06 31/03/06 Castletroy Residential Home Version 5.1 Page 23 exercise must be available for inspection by the CSCI. (Previous timescale of 31/01/06 had not been met) 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 37 Good Practice Recommendations It is recommended that a central record of all personnel be introduced to show when each individual had attended a fire drill so that any gaps in attendance can be readily identified. Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Castletroy Residential Home DS0000015033.V275912.R01.S.doc Version 5.1 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. 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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