Inspection on 17/05/05 for Hygrove House Nursing Home

This inspection was carried out on 17th May 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hygrove House Nursing Home 20/02/07

Hygrove House Nursing Home 16/05/06

Hygrove House Nursing Home 04/01/06

Hygrove House Nursing Home 19/11/04

Hygrove House Nursing Home 09/06/04

Hygrove House Nursing Home 12/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hygrove House Nursing Home Minsterworth Gloucestershire GL2 8JG Lead Inspector Sharon Hayward-Wright Unannounced 17 May 2005 06.40 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. Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Hygrove House Nursing Home Address Minsterworth Gloucestershire GL2 8JG 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) 01452 750716 01452 750331 Highfield Care Homes No 2 Limited Mrs Rita Harris Care Home with Nursing 48 Category(ies) of Dementia over 65 (48) registration, with number of places Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 19/11/04 Brief Description of the Service: Following a recent merger between Highfield Care and Southern Cross, Hygrove House is now part of the Southern Cross Group. Hygrove House sits back off the main A48 Gloucester to Chepstow road in Minsterworth. The house itself is a large extended period building surrounded by extensive gardens, with views over the surrounding countryside and Gloucester City. At the time of inspection the majority of the redecoration work had been completed and further refurbishment work was still awaiting completion. The Home cares for elderly people who suffer from a dementing illness. The building is on three levels and has a passenger lift including stair lifts where required. Many of the Service Users are prone to wander and can do so freely within safe areas, which are secured with keypads on the doors. Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 7 hours. Twelve service users and 3 relatives were spoken with to gain their views on the home and the care provided. Four staff members, the Deputy Manager and Registered Manager were also spoken with. Staff were observed going about their duties and interacting with each other and service users. A part tour of the premises took place and breakfast and lunchtime were observed. Care and food records, duty rotas and personnel files of new staff were inspected. A number of requirements issued at previous inspections remains outstanding and must now be addressed. The home has undergone a period of instability due to staff changes. Relatives and staff spoken with felt the home is improving and all felt confident in the abilities of the Registered Manager and the new Deputy Manager. What the service does well: What has improved since the last inspection? Since the last inspection the standard of vetting and recruitment practices has improved with the home obtaining the required information and carrying out checks prior to the staff member starting work. However there was one outstanding request for a written reference that was missing from one newly appointed staff member file. The standard and presentation of the meals provide by the home has improved, with them offering both choice, variety and catering for special dietary needs. Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 Page 6 From the areas inspected the overall cleanliness of the home has improved. The home has improved the training programme for all staff to assist in providing them with the skills required to care for the service users. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Service users are admitted to the home following an assessment of their care needs. EVIDENCE: Two requirements issued at the last inspection were not checked, as the timescale for completion is 1 July 2005. Pre admission assessments for 2 recently admitted service users were examined. The Registered Manager had undertaken these assessments, both contained information regarding their care needs. Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 & 10 The care planning system in place does not take into account service users individualised care needs and lacks detail, therefore they do not provide staff with the information they need to satisfactorily meet service users needs. Outside health professionals’ are accessed for service users with an assessed need. EVIDENCE: Three service users were case tracked. Each service user had a plan of care that showed evidence of reviews. However, none had a care plan for their specific mental health need. The first service user case tracked had been admitted to the home in February this year, their main problems had been identified, but the care plans lacked specific detail. The care plan for personal care recorded the need for assistance of 1 carer, but does not say what assistance is needed or if this service user has a bath. The review of this care plan stated that 2 carers are needed but this was not added to the care plan. Another example is the risk assessment for falls stated, “ensure the service user has proper footwear”, but Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 Page 10 this is not explained in detail. There was no care plan that relates to their mental health needs. The second service user has also recently been admitted to the home, again the care plans lacked specific individualised care and the care plan was not updated to reflect the changes in this service users care. The third service user case tracked had been living at the home for a while. Again the care plans did not detail specific individualised care for this service user. This service user has a wound but no care plan was available detailing the care needed to address this need. Evidence was seen of health professionals’ involvement in service users care. Two-service user case tracked had wounds, one had healed but there was no evidence to suggest in the care plan that this was the case. The other service user’s care plan had limited detail about the wound care; it is recommended that wound mapping or photographs (with the permission of the service user or their family) be used to monitor progress. All service users had a Waterlow assessment score but when checked the first service user had been scored to high, this could be due to lack of understanding of the assessment tool. It is a requirement that staff have training suitable for the tasks they are to perform. RNCC assessments were seen in service users care plans. The Registered Manager is aware of the issues with care plans and has plans to address these now the Deputy Manager is in post. It is recommended that the home identify any service users who are subject to Care Programme arrangements and obtain a copy of the plan. One service user case tracked requires a ‘prn’ or when needed medication. A care plan must be devised to assist staff in when this should be used. Medication was not inspected, as the home is due to change medication systems in the next few weeks. Staff were seen observing service users privacy by knocking on door prior to entering service users rooms. Two relatives confirmed that staff treat their relatives in a respectful way. One service user said she likes to have the door to her private room locked to prevent other service users wandering into her room. However on the top floor a number of other service users rooms were locked thus preventing them from entering their own rooms. This must be reviewed as the home is limiting the choices of service users, 1 relative said a gate had been placed in the Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 Page 11 doorway of their relatives room at their request to prevent other service users from entering. Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 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 standard(s) 12, 13 & 15 Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. The activities coordinator provides activities to suit service users needs when on duty, however service users do not always receive stimulation from the staff due to there other duties. EVIDENCE: The home has an activities coordinator who works 25 hours a week and when she is not at the home the staff provide activities. The activities coordinator is able to provide group activities as well as 1:1. On the day of the inspection no activities were taking place. The home is also experiencing difficulties with staffing (this is discussed further in standard 27) this may be one of the reasons why activities were not taking place. The ‘music and movement’ entertainer and the local vicar visit the home. Visitors to the home confirmed that they are able to visit when it is convenient for them. Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 Page 13 The cook was able to provide evidence that the appropriate health and safety checks take place. Detailed records of food provided to service users are maintained to include special diets, however the home needs to maintain records of types of sandwich filing used. Choices are offered and service users that require liquidised or soft meals have these done individually. On the day of the inspection service users on the ground floor were enjoying their meal sat at their tables, staff offered assistance discreetly and service users were allowed to take their time. Service users, staff and 1 relative commented on how much they enjoyed the food provided. Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home is aware that improvement is needed to address issues identified in the complaints received by the Commission for Social Care Inspection. However relatives now feel confident to discuss any concerns they have directly with the home. EVIDENCE: The Commission for Social Care Inspection has received 2 complaints that were referred to the company for investigation. The Commission also received a small number of concerns from Social Services and they were advised to speak directly with the home, which they did. An action plan has been devised for the home to address the issues raised. Relatives spoken with said they would feel confident to speak to the Registered Manager or Deputy Manager with any concerns they might have. The Registered Manager and Deputy Manager are due to undertake some prevention of abuse training at the local college and this will be disseminated to the staff in the home. Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 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 standard(s) 19 & 26 Once the home has finished the refurbishment work, the environment will be greatly improved for both service users and staff. EVIDENCE: A tour of parts of the premises was undertaken and where the home has been re decorated it has improved the environment, however service users have damaged the wallpaper off in places. The Registered Manager said this would be addressed. A number of requirements relating to the environment remain outstanding since previous inspections, however the timescale for 3 of these lapses on the 1 July 2005. The Commission will follow these up. The floor in the downstairs treatment room by the main office is uneven and heavily stained in places. This must be changed to prevent injury to staff using this room. Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 Page 16 The outsides of the windows are very dirty in places and this spoils the view for service users. This must be addressed. From the parts of the home inspected the cleanliness has improved since the last inspection. Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 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 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, 29 & 30 Although staff morale is improving, the recent high turn over together with poor attendance and sickness is disrupting the consistency of care to service users and placing other staff under greater pressure. EVIDENCE: The Registered Manager said the home has 300-care hour’s vacancies and 40 hours qualified nurse. The homes exsiting staff covers some of these hours. The home now has a core group of staff that enjoy working at the home and looking after the service users. In the last two weeks there has been a number of incidents on nights that has meant the home has been operating on 3 night staff and not 4. This is in breach of Regulation 18 (1a) of the Care Homes Regulations and potentially puts service users at risk. On the morning of the inspection only 3 night staff were on duty. As the lay out of the home is over 3 floors and due to the medical condition of service users a number of these are likely to wander at night. With only 3 night staff on duty if more that 1 member of staff were required to assist service users this would leave one floor with out staff supervision. And staff are not able to leave the floor to have a break. This must be addressed. The Registered Manager said that the home has just placed an advert in the local press for more staff. Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 Page 18 Relatives and service users all said the staff are friendly, helpful and work very hard. Personnel files for 3 recently appointed staff were examined and all contained the correct information except one needed another reference (it had been requested). This must be rectified. One of these staff members had an unsatisfactory reference, but no records were kept to explain why. The Registered Manager corrected this during the inspection. The home has now devised a training matrix for easy recognition of training that has been provided and which training is required for staff. Staff spoken with confirmed training is provided. The Registered Manager said she is looking to arrange NVQ 2 training through a local college. The Registered Manager is aware of the requirement for all new staff to have a supervisor, however no records are maintained to provide evidence that this is happening. Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 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, 36 The Registered Manager and the new Deputy Manager have a clear understanding of where improvements are need in the home. The home must ensure that all staff receive supervision to ensure consistency in practice and that the staff are meeting the needs of the service users. EVIDENCE: The Manager has recently been registered with the Commission for Social Care Inspection. The home has also recently appointed a Deputy Manager who is a Registered Mental Health Nurse. The Registered Manager is currently undertaking the NVQ 4 Registered Manager award. The Deputy Manager now supports the Registered Manager and they are both aware of what areas in the home need addressing. Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 Page 20 Relatives and staff confirmed they could approach the Registered Manager with any concerns they might have. Handover meetings have started to take place to ensure there is continuity of care. Staff confirmed that things are starting to improve in the home with more training being offered and now the Registered Manager has a Deputy Manager to assist in the running of the home. The home has yet to complete a requirement to find out how many service users are subject to the Power of Attorney processes, however the home has requested this information from service users relatives. The home has yet to start formal staff supervision sessions as required at previous inspections. A warning letter has been sent to the company requiring them to start this process or the Commission for Social Care Inspection will consider further action. During a tour of the home it was noticed that the door to room 47 was propped open even though a door guard is fitted, this practice must stop as it potentially put service users at risk. Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 1 x x x x x x 1 STAFFING Standard No Score 27 1 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 2 x x 1 x x Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 5(1b & c) Requirement Service users, irrespective of how their care is paid for, must receive a copy of the homes terms and conditions. Timescale of the 1/8/04 was not met, however due to the merger with Southern Cross this has been put on hold. This will be completed once the company has reviewed their documentation. The Registered Person must send evidence to the inspector that they are meeting Regulation 5 in respect of the RNCC payments and the informaiton given to the service user or their relative/representative. Timescale of 30/9/04 was not met. As Regulation 1. The home must be adapted to meet the specific needs of its service users, those being with dementia. Timescale of the 30/9/04 was not met, however work has started to meet this requirement. The Registered Person must enusure that all service users have care plans that are reflect Timescale for action 1/7/05 2. 2 5 1/7/05 3. 4 23(2a) 1/7/05 4. 7 15 1/9/05 Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 Page 23 their individualised needs. 5. 7 15 The Registered Person must ensure that any changes in the service users care are documented in their care plans. The Registered Person must ensure that if the Waterlow assessment tool is to be used that all staff receive training in its use, to ensure that service users receive the correct scoring for their needs. The Registered Person must devise care plans for service users that require as and when necessary medication. The Registered Person must not lock service users rooms unless they or their family request it. A safe area in the garden, which can be accessed from the main building, must be established for service users. Timescales of the 1/8/04 and 1/3/05 were not met. The old middle bathroom must be refurbished to provide further bathing facilities. Timescale of the 1/8/04 was not met. The Registered Person must replace the flooring in the downstairs treatment room as it a health and safety risk. The Registered Person must clean the outside of the windows as they are dirty. The laundry must be fitted with a continuous floor covering which can be adequately washed. Timescales of the 1/8/04 and the 1/2/05 was not met. The Registered Person must ensure that at all times suitably qualified, competent and experienced persons are working in the home in such numbers as 1/8/05 6. 8 18(1ci) 1/9/05 7. 7 15 1/8/05 8. 9. 10 19 12 23(2o) 1/6/05 1/9/05 10. 19 23(2j) 1/7/05 11. 19 23(2b) 1/8/05 12. 13. 19 26 23(2d) 13(3) 1/8/05 1/7/05 14. 27 18(1a) 17/5/05 Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 Page 24 15. 29 19 & Schedule 2 18(2bi) 16. 30 17. 33 24 18. 35 17 & Schedule 3 (3b) 19. 36 18(2) 20. 38 13(4a & c) are appropraite for the health and welfare of service users. The Registered Person must obtain a second written reference for the newly appointed maintenance man. The Registered Person must provide evidence that all new workers are having an appropriately qualified and experienced supervisor. The home must demonstrate that the quality of care being delivered is being reviewed and that service users or their representative are being consulted about this and other issues. Timescale of the 1/8/04 and 1/2/05 was not met, however the home has started this process. The details of the person acting with Power of Attorney must be requested and documented in the service users file. Timescales of the 1/8/04, 1/2/05 and 1/5/05 were not met. All staff must receive adequate supervision. Timescale of the 1/8/04, 1/2/05 and 1/5/05 were not met. A warning letter has been sent company for this to be addressed as a matter of urgency. Fire doors must not be propped open as this can potientially put service users at risk. 20/6/05 1/7/05 1/6/05 1/9/05 1/7/05 17/5/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 Page 25 No. 1. 2. 3. Refer to Standard 8 7 12 Good Practice Recommendations The home should consider using wound mapping or photographs for wound care plans to assist in monitoring the progress of the wound. The home should find out if any service users are subject to the Care Programme Arrangments and if they are, obtain a copy of the plan. The home should ensure that when the activities coordinator is not on duty service users receive stimulation from staff. Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 Page 26 Commission for Social Care Inspection Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL3 4AB 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 Hygrove House Nursing Home D51_D03_S38272_Hygrove_V221380_170505_Stage 4.doc Version 1.20 Page 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!