Inspection on 26/07/05 for Dunkirk Memorial House

This inspection was carried out on 26th July 2005.

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

Dunkirk Memorial House 27/02/07

Dunkirk Memorial House 09/11/05

Dunkirk Memorial House 06/01/05

Dunkirk Memorial House 10/08/04

Dunkirk Memorial House 23/03/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Dunkirk Memorial House Minehead Road Bishops Lydeard Taunton TA4 3BT Lead Inspector Barbara Ludlow Announced 26 & 27 July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Dunkirk Memorial House Address Minehead Road Bishops Lydeard Taunton TA4 3BT 01823 432407 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Royal British Legion Mrs Pauline Shields Care Home with Nursing 60 Category(ies) of Old Age - (60) registration, with number of places Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 30 places for Nursing care within the overall number of 60 registered places. 2. A Registered Nurse must be on duty at all times. 3. To accodate three named individuals under age 65 fo General Nursing Care. Date of last inspection 6 January 2005 Brief Description of the Service: Dunkirk Memorial House is a Royal British Legion Home. The home opened in 1995 for the care of ex-service men and women who meet the eligibility criteria of the Royal British Legion. Previously exempt from inspection by Royal Charter, the home was registered with the NCSC and is now regulated by the CSCI. The home is situated eight miles from Taunton on the Minehead road near the village of Bishops Lydeard. The purpose built area of the home is the main accommodation. The home sits in attractive landscaped grounds. The older original building accommodates the administration offices, lounge / bar and chapel. The home is registered to provide nursing and residential care for up to a maximum of 60 older persons, nursing places are for a maximum of 30 persons within that total number. There has been a variation to registration approved by CSCI for three named younger adults to be accommodated. The building is on three floors with the basement being the service area. There is disabled access throughout the home. There are 48 single rooms and 6 double rooms all have en suite facilities, there are also assisted bathing facilities. There is a nurse call link throughout the home; designated staff carry pagers and mobile phones. There are two lifts to access the first floor. There is a Registered Nurse on duty at all times. There are comfortable communal and recreational areas. Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over two days and was conducted by B Ludlow on behalf of CSCI. There had been two recommendations made at the last inspection, which had been acted upon. The home had 53 service users in residence at the inspection. This was a very positive inspection with Service Users confirming their satisfaction with every level of service provision at the home. Requirements and recommendations for improving practice were made at this inspection. The inspection was well received. The homes Registered Manager, Mrs Pauline Shields, had submitted a completed pre-inspection questionnaire and provided supporting documents prior to the inspection. The inspector met with Mrs Shields (Registered manager), the appointed Senior Nurse and the person appointed to the new post of Support Services Manager. Other information was supplied during the inspection such as a copy of the most recent Statement of Purpose and the current weeks duty rota. A tour of the premises was made and service user accommodation was sampled. Activities and lunch on both days were observed. Service users and families or carers had returned six written responses to CSCI questionnaires. Service users were seen during the inspection and were spoken with both in communal areas of the home and in the privacy of their own rooms. Visitors to the home were seen, both family and professional. Care plans and medication administration records were sampled. Staff and volunteers were met and asked for their comments about their work at the home. Staff files and maintenance records were examined. Feedback was given during the inspection period and at the conclusion of the inspection. The inspector would like to that all staff and service users for their courteous assistance with the inspection process. What the service does well: Dunkirk Memorial House is purpose built and offers an excellent standard of individual and communal accommodation. The home is well equipped and is well maintained. The grounds offer level access and the gardens are well managed. Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 Page 6 The home offers a good range of activities and social support. Personal choices and independence are encouraged and respected in relation to all daily living activities. The home is well managed and there is good administrative support. The nursing team and care staff are encouraged to train and develop their skills, offering a good level of general nursing care and personal care to service users at the home. The meals are served well and in a pleasant dining room. A good choice of menu is offered. Social catered functions are open to families and friends and were reported to be well attended. There is a significant team of volunteer support who were seen to assist with activities, drive the minibuses, attend to summer floral displays and support community outings. Care staff also offer support to the home in their own time to assist with outings. Service users reported that there is an excellent laundry service. The home has achieved Quality Rating with Somerset Social Services. The home offers respite periods, often at short notice to people on its waiting list, when there are vacant rooms. This service is valued and enables people to sample the service offered at Dunkirk Memorial House before they need to commit to long-term care placement. What has improved since the last inspection? What they could do better: The care planning system was changed and is now fully implemented. Staff are continuing to develop their skills with the new system. Care should be taken when completing reviews of the care plans to ensure they are Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 Page 7 meaningful and reflect all aspects of care and all changes in health and condition. Medications management, although subject to regular audit which has improved practice, should continue to be reviewed and any ambiguities should be identified and eliminated from recording practice. Management reported that a defined care staff handover was to be reinstated with new budgets taking effect in October. It was noted at the inspection that staff do not always receive a defined handover. Unsafe practice was not evident, however, there should be a clear handover for staff between shifts. It was not evident that all incidents/ events had been reported to CSCI under Regulation 37 notices. These notifications must be made if a significant event occurs at the home, in line with the regulatory requirement. 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. Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 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 standard(s) 1,2,3,4,5, NMS6 does not apply. The home has clear admission policy and procedures for ex service men and women to follow when applying for residence or respite care at Dunkirk House, needs are assessed to ensure they can be met prior to admission. Visits are welcomed and the trial period is eight weeks, this meets the standard for Older Persons care homes. All charges are clear and are clearly invoiced. EVIDENCE: The home has a new Statement of Purpose; a draft copy was presented at the inspection. Care plans and 4 financial records were sampled. The home has an administrative team to deal with all accounts and invoices. Pre-admission assessments and pre-admission costing for continuing care packages and assessment for free nursing care funding and subsequent reviews were seen. Family/carers are invited to attend care plan reviews where appropriate by letter. Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 Page 10 Invoices were seen to have been raised for extras such as bar drinks, telephone costs, newspapers, hairdressing, chiropody, guest accommodation and guest meals. The home does not offer intermediate care but when there are vacancies respite care is offered to those on a waiting list. Respite care cannot be booked on a regular basis although can be offered to regular respite service users as seen at this inspection. Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 Health and welfare are promoted and care records support the homes good practice. Privacy and dignity are respected and promoted through staff training and good care practices. EVIDENCE: Four care plans were sampled for a range of service users. Multi disciplinary involvement of community health care specialists was evident with the continuing health care and nursing clients pre admission assessment and ongoing reviews. The input of supplementary health care services such as chiropody care was evident. The home has the service of a Chartered Physiotherapist for four hours each week. It was noted that the outcomes of health care investigations and interventions were not always clearly reported on the care plans, some changes in monitoring requirements were not recorded and two oral assessments were incomplete, these care issues were discussed with the clinical nurse lead at the inspection. Hoists are not always identified in the individuals care plans, references made included ‘full’ hoist, these entries should identify the equipment required. Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 Page 12 Wound care management was observed in the care plans for two service users who have pressure sores. The care and equipment in use was appropriate and the records were up to date. Medications management was discussed with reference to the guidelines on drug returns. MAR charts were examined and overall the practice was of a good standard. Two signatures were recorded for drugs checked coming into the home. The management of anticoagulant therapy was very clear. Gaps on the MAR charts for topical medication were noted, a change to practice was recommended to alleviate the omissions. On one prescription where medication dose changes had been ordered by the G.P the effective dates were unclear. These instructions needed to be made more clearly to reduce the risk of error. The homes nursing staff medication administration practice is regularly audited and staff are alerted to any deficits, this system may need to be reviewed to ensure practice continues to improve. The home has a Chapel, funeral and remembrance services are held there. The home has guest accommodation that can be used, if relatives wish to stay overnight. Family support was evident, with relatives seen visiting and staying for lunch. There is a charge made for visitor accommodation and meals. Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Service users are encouraged to participate in the variety of activities on offer, but it remains their choice. Families were seen to be welcomed to the home and social events are well supported. Appetising meals are served. EVIDENCE: Dunkirk House has a good range of activities available for all service users. There is an extensive network of volunteer support, staff also support service users on trips out, in their own time; this collective input is of valuable benefit to the social lives of service users. Trips out are available and the home has two new minibuses. Long trips are charged at 50 cost. Service users shared their experiences of recent trips, which included Buckingham Palace, to the ‘Not forgotten Association’ garden party. The luncheon club is popular and service users commented on their enjoyment of this activity. Service users praised staff and volunteers for their care and support. One service user commented on how independent they were able to be at Dunkirk House. The home has a House Committee which was due to meet the following Friday. Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 Page 14 A recent barbeque open to family and friends catered for 98 (50 service users attended). Celebrations were in hand for celebrating VJ day and the tenth anniversary of the home with the opening of the new sensory garden. Lunch was observed on both days and meals were served to over 40 service users in the dining room each day, and three guests. Mealtimes were unhurried social occasions and three courses are offered. Staff supported those requiring assistance in a sensitive manner. The meals times were busy. Service users asked all made positive comments about the food, which included “good food “by three persons and “very good food” by another. The home has a bar and service users were seen enjoying this facility in its pleasant and comfortable surroundings. The Manager confirmed that the home had acquired the appropriate new bar license. Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,18 There are policies and procedures in place to protect service users from harm. The recruitment practice is good. Legal and civil rights are respected and promoted. EVIDENCE: Service users asked confirmed that they would be able to raise concerns at the home if they wanted to. Service users confirmed that they were able to vote at the last election. There had been one verbal complaint since the last inspection and this had been dealt with. The home has a whistle blowing policy. There are other policies and procedures in use to protect service users such as the recruitment policy. There is a staff disciplinary policy and procedure. Financial management of service user accounts and monies held was examined and was of a good standard. There is a mechanism for CRB checking all staff when employed. Staff files were sampled and recruitment practice was satisfactory. Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19.20.21.22.23.24.25.26 This home is clean, comfortable and is maintained to a good standard. The home is purpose built and meets the needs of the main category of registration, older people requiring nursing and residential care. EVIDENCE: The home was found to be clean and well maintained. Building work on the first floor had been started to convert a communal room into two bedrooms this room had been sealed off from the corridor preventing access. The carpets were in need of a little attention, the inspector was informed that there was a shortage of cleaning staff at that time, however, this was the only housekeeping deficit noted during the inspection. There are good staff facilities. There are adequate hand washing facilities and protective clothing such as gloves and aprons are readily available for staff to use. Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 Page 17 Service user accommodation is comfortable and can be personalised by the Service users. All bedrooms have en suite shower facilities. The home has some double rooms that are used a single accommodation to allow the service users to have adequate space for their personal items and equipment. The home has three younger clients, less than age 65 years. They have bedrooms that meet the Younger Persons National Minimum Standards spatial requirement. There is no overhead tracking available in bedrooms or bathrooms at the home. There is a range of communal space and all is well used. There are assisted bathing and toilet facilities. The home has extensive well-maintained grounds and gardens; the sensory garden has been completed and has level access. Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 The home has a large staff team divided into departmental teams. Agency staff are used to provide care and trained staff cover required. There are adequate numbers of staff employed at the home. Recruitment practices were satisfactory. Staff receive induction and ongoing training and development. EVIDENCE: There was an adequate numbers of staff on duty on the day of the inspection. Copies of staff rotas were provided to confirm adequate staffing numbers on duty and a Registered Nurse on duty at all times. The home has increased the daytime Registered Nurse (RN) hours to have two RN’s on duty throughout the day. Staff work in teams allocated to specific service users. Staff were asked about their induction and training. Those who were asked confirmed that they have received manual handling and fire training. The staff-training matrix was provided for analysis, this confirmed care staff with National Vocational Qualifications (NVQ) and NVQ training in progress. Staff expressed concerns about the handover they receive when coming on duty; the quality of handover was variable; sometimes very good at other times poor. The handover process and time allowance is due to be altered officially in October with time scheduled into the staff working hours. In the interim period it was recommended and agreed at this inspection that the manager and nursing staff will review the handover and rectify any weaknesses. Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32.33.34.35.37.38 The home is well run. Service users are safeguarded through policies, procedures and good practice. Service users confirmed that their welfare is paramount and comments included, “we come first” and the home is “conducted well and we are given a great deal of care”. EVIDENCE: The home has an experienced Registered Manager. There is a good level of administrative support at a local level and good management support from the wider organisation of the Royal British Legion. Regulation 26 management visits are made to the home. The organisation has appointed a new Responsible Individual. Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 Page 20 Within management structure a new member of staff has joined as Head of Support Services to assist Mrs Shields. The home has since this appointment, submitted an application and achieved ‘Quality Rating’ with Somerset Social Services. A senior nurse has been appointed to lead on care issues at the home. Service users confirmed that they are involved in the management of the home; there is a Residents Committee and representation to the House Committee. Service users are involved and informed about activities and celebrations held at the home. A weekly programme of events is issued to each service user. Four individual service users financial records were examined and these demonstrated clear accounts and invoices raised for service users. The homes current Registration Certificate and Employers Liability Insurance certificate were on display with the last inspection report and CSCI service user feedback forms. Following discussions about events at the home it is recommended that submission to CSCI of Regulation 37 notice is reviewed, to ensure that staff are aware of the events which are reportable. Servicing records for equipment were examined and were found to be up to date. A new fire policy has been written and the home has a new fire alarm system. This allows close determination of the fire source on the fire panel. All tests were up to date. Nursing equipment such as the syringe driver and weigh scales are calibrated at the local hospital medical physics department. (Musgrove Park Hospital) Hoists and lifts were seen to be serviced under contract. One widely opening first floor stairwell window was brought to the attention of the management, it was confirmed that action was taken during the inspection to reduce the opening to a safe limit. Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 4 4 3 4 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 x 3 3 Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 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. 1. 2. Standard OP7 OP9 Regulation 15(1)(2) (b) 13(4) Requirement Care plans must be completed and reviews/intervention outcomes recorded. Medication administration records must be completed with doses given or omitted recorded. Timescale for action 19/09/05 19/09/05 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 OP 27 Good Practice Recommendations Handover practice should be reviewed as agreed and any deficits should be addressed. Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 Page 23 Commission for Social Care Inspection Riverside Chambers Castle Street Taunton TA1 4AL 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 Dunkirk Memorial House D53_D02 S40169 Dunkirk Memorial House V225354 260705 Stage4.doc Version 1.40 Page 24 - 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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