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Inspection on 30/06/05 for Kelstone Court Nursing Home

Also see our care home review for Kelstone Court Nursing Home for more information

This inspection was carried out on 30th June 2005.

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

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

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

What the care home does well

Residents spoken to during the course of this visit gave very positive comments on the staff group and their approach. Staff were described as "very patient", "kind", "always smiling" and "caring". Residents stated that they felt that "nothing is too much trouble" for the staff in the home. One resident stated that they could not think of one staff member who was not helpful. The manager of the home was viewed as approachable and "very caring". The home provides a good and varied activity programme which is led by residents preferences. Staff were found to be committed to improving the opportunities for residents. Residents clearly gained pleasure and a sense of achievement in taking part in the activities available to them. One resident pointed out flowers which they had assisted in planting. Residents were pleased with the reading of poems and were looking forward to the reading of a book. The home owners are clearly committed to improving the environment for residents. Residents were looking forward to the completion of the extension to the lounge area.

What has improved since the last inspection?

Staff are taking steps to improve the care planning systems to produce a more person centred system which will provide residents with more opportunity to include their wishes and needs in relation to social and emotional care. Improvements in the environment have continued. Further new beds have been provided, which residents reported were very comfortable.

What the care home could do better:

To ensure that residents are cared for and supported by a well informed staff group a review of the training programme should be carried out with particular reference to the needs of the residents in the home. Staff need to be provided with regular planned supervision from a more senior member of staff to ensure consistency and a well supported staff group. Staff need to ensure that records relating to the administration and management of medication are up to date and accurate.

CARE HOMES FOR OLDER PEOPLE Kelstone Court Cambourne Road Morden Surrey SM4 4JN Lead Inspector Liz OReilly Unannounced 30th June 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. Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Kelstone Court Address Cambourne Road Morden Surrey SM4 4JN 0208 660 6719 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) Yourcare Ltd Sarah Elizabeth Jackson CRH Care Home with Nursing 30 Category(ies) of OP Old age (30) registration, with number of places Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th January 2005 Brief Description of the Service: Kelstone Court is a registered care home with nursing providing accommodation and care for up to thirty residents. Twenty places are for older people who require nursing care. Ten places are for older people who require residential care. Accommodation is set over three floors with a passenger lift available for access. The home is a large purpose built property situated in a residential area of Morden in Surrey. The home is close to a group of local shops and a pub with Morden Park and Cannon Hill recreation grounds nearby. Public transport is easily accessed from the home and unrestricted parking is available in the local area. The home is owned by Yourcare Limited. Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on 30th June, 15th and 18th July 2005, by one regulation inspector and one pharmacy inspector. The inspectors had the opportunity to speak with ten residents, three staff, two visitors, the deputy manager and the registered manager. The inspectors also examined records and parts of the environment. What the service does well: What has improved since the last inspection? Staff are taking steps to improve the care planning systems to produce a more person centred system which will provide residents with more opportunity to include their wishes and needs in relation to social and emotional care. Improvements in the environment have continued. Further new beds have been provided, which residents reported were very comfortable. Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 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 Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 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, 5 & 6 Residents can be confident that staff in the home are aware of their individual needs prior to admission as staff carry out a pre admission assessment of need and are in receipt of a care management assessment if applicable. EVIDENCE: Prior to any admission to the home staff visit prospective residents and carry out an assessment of individual needs to ensure that on admission staff are aware and are prepared for the resident. Where a resident is placed via the local authority a copy of the care management assessment is made available to the home. Prior to making any decision on moving into the home residents, their family and or friends are welcome to visit the home and meet with staff and other residents. This home does not provide intermediate care therefore Standard 6 is not applicable. Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 Page 9 Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 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 standard(s) 7, 8, 9 & 10 Residents can be assured that their needs are known to staff by the provision of individual care plans. Arrangements for the ordering, storage, recording and administration of medication ensure service users’ health is protected. Staff have access to a pharmacist for advice. Omissions in recording and labelling were found that might affect the health and welfare of service uses. The health care needs of residents are met. EVIDENCE: To ensure the needs of each resident are met a care plan is produced for each person. At the time of this inspection staff were in the process of introducing a new care planning system. This system will allow for a more person centred care plan which will include the wishes as well as the needs of residents along with the social and emotional needs of residents as well as their physical needs. The new care planning system must provide evidence of consultation with residents on their own care plan and must be signed and dated. To ensure the safety of residents care planning documentation must include the type of hoist and the size of sling to be used for all residents who require this type of support. Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 Page 11 The written policies and procedures were found to be adequate on the last inspection and were not reviewed on this visit. All medications administered by staff along with the records relating to receipt, storage, administration and disposal of medication were examined. The manager and deputy manager were interviewed, communications records relating seen for three service users and eight service users medications not supplied in the monitored dosage system counted and compared to the amount that should be in stock from records of receipt and administration. From these discussion and observations all medication was stored securely under correct conditions and administered appropriately as directed by the doctor unless otherwise recorded. The receipt of one service user’s medication had not been recorded. One service user had missing entries on the administration records indicating administration/non-administration of one medication. The medication had been removed from the appropriate sections in the monitored dosage system. Two items were labelled “use as directed”. Directions for administration were seen on the administration record. The directions on the label did not agree with the administration record for one item. From previous records the correct dose was being administered. Sufficient information to be able to identify individual tablets was not available for nine service users’ medication in the monitored dosage system. Staff were not able to identify the individual tablets for two of these service users. The controlled drug cupboard does not comply with the Misuse of Drugs Regulations 1973. All action described in the communication notes had been completed at the time of the visit. Residents are supported to access health care services. All residents are registered with local GP practices. Arrangements are in place for residents to get regular optical, dental and chiropody check ups. Staff consult with other health care professionals such as the tissue viability nurse and continence advisor to ensure that residents receive appropriate treatment and aids. Residents gave very positive comments on the staff approach. Residents felt that staff took care to respect their privacy. Staff were observed to offer assistance and advice in a discreet manner. Staff were also observed to knock on bathroom and toilet doors before entering. Residents confirmed that staff always addressed them using their preferred manner. Residents also confirmed that they met with health care professionals in the privacy of their own room. Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 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 Residents are provided with a varied and interesting activities programme which is adapted in line with residents interests and wishes. Residents gave positive comments on the quality and quantity of food on offer. The manager should continue to monitor the menu to ensure it does not become too repetitive. EVIDENCE: Residents are provided with daily choices on activities. One resident stated they enjoyed the quizzes held in the home which are carried out in teams. Several residents stated they very much enjoyed a recent evening out at a local pub and were looking forward to the next pub evening at a country pub. One resident said they had a good time visiting Wisley Gardens. Plans are in place for a monthly cinema evening. A number of residents stated they enjoyed the poetry reading sessions and were looking forward to the reading out loud of Rebecca. Staff were found to be very committed to providing residents with stimulating group and one to one activities. A part time activities organiser is employed in the home and residents spoken to were very complimentary on the range of activities provided by the staff. Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 Page 13 Families were seen to be invited to join residents and staff on outings and to become involved in the activities in the home should they so wish. The activities organiser spends time with each resident and records with the resident what activities they like and what they might like to try. Staff are aiming at increasing the opportunities for residents to go out in the evenings. Other activities include art, crafts, exercises crosswords, current affairs debates, gardening and parties, the latest of which was to celebrate the anniversary of VE day. An aromatherapist visits the home on a regular basis. Two residents stated they looked forward to the hand massage provided. Visitors spoken to at this inspection confirmed they were free to visit at any time and “always feel welcomed” by the staff. Residents confirmed they could meet with visitors in the main lounge or in the privacy of their own room. At the time of this visit one resident was attending church on a regular basis. Residents gave positive comments on the food provided. One resident stated they “looked forward” to fish and chips on a Friday. One resident said that staff were “very good cooks”. Staff were observed to assist residents with eating in a considerate manner, going at the residents pace and talking to the person throughout the meal. Alternatives are available at each meal time. To ensure all residents receive a varied nutritional diet a record of food is maintained. A four week menu is produced. It was noted that sausages and chicken casserole were provided each week for three weeks. The manager should ensure that the menu is monitored to ensure the meals provided do not become too repetitive. Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 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 & 18 To ensure that residents feel confident that any concern or complaint will be taken seriously the home has in place a clear complaints procedure. Policies and procedures are in place to protect residents from abuse. EVIDENCE: Residents spoken to during this visit expressed confidence in the manager to deal with any concern or complaint they might have. None of the residents spoken to had any concerns at that time. The homes policy and procedure on complaints provides information on the in house complaints process and gives details of the Commission. The home keeps a record of any complaint along with actions taken and outcomes. No complaints had been recorded since the last inspection of the home. In order to ensure the protection of residents from abuse all staff have been provided with training on recognising and dealing with any suspected abuse. The homes procedure was seen to be in line with the local authority procedure which ensures an appropriate response to any concerns. Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 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, 20, 22 & 26 The home owners have and continue to make significant investment in improving the environment for residents in the home. EVIDENCE: At the time of this inspection work was taking place to erect an extension to the home to provide additional shared space on the ground floor. This extension will provide space for a dining area, additional office space and further space for activities and relaxing. A passenger lift is available in the home. Plans were being made for a new lift to be installed within the next few months. Arrangements will be made for additional staff to be made available during this work. Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 Page 16 New carpets, curtains have been provided. All but two beds in the home have been replaced and new pressure relieving mattresses, a hoist and scales have been purchased. Plans are in place for the lounge area to be decorated, a new power shower and Parker bath to be installed and for the laundry room to be refurbished. Individual bedrooms are redecorated whenever a room becomes vacant. Staff maintain a clean and tidy environment for residents. The home owners are clearly committed to providing a well maintained and comfortable environment for residents in the home. Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 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 Residents were seen to be supported by sufficient staff to meet their needs at the time of this inspection. Residents are protected by recruitment procedures. Further work should be carried out in relation to staff training. EVIDENCE: Two registered nurses are available on duty on each shift during the day. Five care staff are available in the mornings with four carers in the evening. At night one registered nurse and three carers are available awake in the home. The registered manager and or the deputy manager are available in the home each day. Catering and domestic staff are available in the home. An administrator, maintenance person and activities organiser are also employed. These staffing levels were seen to meet the needs of the residents in the home at the time of this inspection. The home owners have increased the staffing levels in the home over the last year. Systems are in place to protect residents by checks, including Criminal Records Bureau checks, being carried out on all staff prior to working in the home. It was noted that all care staff are not provided with a copy of the General Social Care code of conduct. In order to ensure that all care staff are fully Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 Page 18 aware of their responsibilities all staff should be provided with a copy of this document. In order to ensure that residents are cared for by a well informed staff group opportunities are available for staff to take part in a number of training sessions. Staff have taken part in training on health and safety, moving and handling, risk assessments, the protection of vulnerable adults. Qualified staff have taken part in training on the management of medication and the deputy manager has trained to be a manual handling assessor. The manager informed the inspector that four members of staff have completed NVQ level two and one member of staff has achieved NVQ level three. The activities organiser has taken part in training on person centred care, chair bound exercises and courses run by the National Association of Providers of Activities for Older People. When reviewing the training programme for staff the management should consider the inclusion of courses relating to the specific needs of residents in the home. In order to ensure that all staff receive appropriate training an individual training and development plan must be retained in the home for each member of staff which provides evidence of at least three days paid training for each member of staff. Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.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) 36 & 38 In order to ensure that residents are cared for by a well supported staff group all care staff must be provided with regular supervision. Staff take steps to protect the health and safety of residents and visitors to the home. However further monitoring needs to be carried out on the fire detection system and the hot water supplied to residents. EVIDENCE: At the time of this inspection staff were not in receipt of regular one to one supervision. All staff must be provided with supervision at least six times a year. Supervision should focus on practice issues, the philosophy of care in the home and the career development of each staff member. This will assist in ensuring residents receive consistent, up to date care. Staff carry out regular checks on the building, furnishings and equipment to ensure the health and safety of residents and visitors to the home. Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 Page 20 The records of checks carried out on the fire detection system, hot water temperatures, lift maintenance, electrical equipment testing, hoist maintenance and fire drills were examined during the course of this inspection. The majority of records were found to be well maintained and up to date. It was noted that the record of hot water temperatures indicated that hot water was supplied at 50 degrees centigrade on a regular basis. The registered persons must ensure that where records indicate the temperature of hot water is in excess of 43 degrees centigrade action is taken and recorded to reduce the temperature. Staff must test and record the temperature of the water prior to any resident taking a bath or shower. It was noted that the record of testing of the fire alarm system was not carried out every week. The registered persons must ensure that weekly tests are carried out and recorded on the fire detection system. Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.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 x x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 x 3 x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x 1 x 2 Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 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 7 Regulation 15 Requirement The registered persons must ensure that care planning documentation includes: Evidence of consultation with the resident, their family and or advocate. The type of hoist and the size of sling to be used for each individual who requires such support. All care planning documentation must be signed and dated by staff. 2. 9 13(2) The registered person must ensure that sufficient information is available for staff to identify individual medications in the monitored dosage system. The registered person must ensure that the receipt of all medication is recorded. The registered person must ensure that staff record the administration/nonadministration of medication accurately. 22nd July 2005 Timescale for action 1st October 2005 3. 4. 9 9 13(2) 13(2) 1st September 2005 1st September 2005 Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 Page 23 5. 9 13(2) 6. 30 18(1) (c ) The registered person must ensure that the directions for administration on the dispensed label and the administration agree for all medications. The registered persons must ensure that a training and development plan is produced for each member of staff. Evidence of the number of paid days training for each member of staff must be available. 1st September 2005 1st January 2006 7. 36 18(2) 8. 38 13(4) The registered persons must ensure that all staff providing care are provided with regular one to one supervision from a more senior member of staff at least six times a year. The registered persons must ensure that tests are carried out and recorded on the fire detection system. The registered persons must ensrue that action is taken and recorded where hot water is supplied above the recommended temperature levels. 1st October 2005 1st September 2005 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 9 Good Practice Recommendations It is recommended that a cupboard complying to the Misuse of Drugs Regulations 1973 be available for the storage of controlled drugs. The registered persons should ensure that all care staff are G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 Page 24 2. 29 Kelstone Court 3. 30 issued with a copy of the General Social Care Council code of conduct. The registered persons should carry out a review of the training programme to ensure that staff have the opportunity to receive training on conditions relating to the residents in the home. Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Ground Floor - CSCI 41-47 Hartfield Road Wimbledon SW19 3RG 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 Kelstone Court G54-G04 S60496 Kelstone Ct S242829 300605 stage 4.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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