Inspection on 07/09/06 for Laurel Bank Nursing Home

This inspection was carried out on 7th September 2006.

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

Laurel Bank Nursing Home 23/08/07

Laurel Bank Nursing Home 10/11/05

Laurel Bank Nursing Home 02/06/05

Laurel Bank Nursing Home 07/12/04

Laurel Bank Nursing Home 20/07/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Laurel Bank Nursing Home Main Street Wilsden Bradford West Yorkshire BD15 0JH Lead Inspector Pamela Cunningham Key Unannounced Inspection 11:25 7 September 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laurel Bank Nursing Home Address Main Street Wilsden Bradford West Yorkshire BD15 0JH 01535 274774 01535 274035 laurelbamksnurs@aol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Victorguard Care plc Mrs Carolyn Julie Bartle Care Home 40 Category(ies) of Physical disability over 65 years of age (40) registration, with number of places Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th November 2005 Brief Description of the Service: The home is situated in a rural location and has ties with all aspects of the local community. It is close to the Post Office, Garden Centre, Pharmacy, village hall and churches. There are Dentist, opticians and pubs within easy reach. It is on a bus route and there is parking for visitors cars. Entry to the home is ramped for easy access. There are three lounge areas with one being used for people who choose to smoke. The dining areas offer comfortable and congenial settings for the residents. There are gardens to the front of the home, which the residents have been involved in developing. They are well maintained and complement the overall appearance of the home. There are twenty-six single rooms, ten with en-suite facilities and seven double rooms, two with ensuite facilities. The rooms are over three floors but are easily accessed by the passenger lift and internal ramp. Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) inspects homes at a frequency determined by the assessed quality rating of the home. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a visit to the home. All regulated services will have at least one key inspection before 1st July 2007. This is a major evaluation of the quality of a service and any risk it might present. It focuses on the outcomes for people living at the home. All core National Minimum Standards are assessed and this provides the evidence for the outcomes experienced by residents. At times it may be necessary to carry out additional visits, which might focus on specific areas like health care or nutrition and are known as random inspections. This visit was unannounced and was carried out by one inspector over one day. It started at 11:25am and 5:40pm on the same day, with feedback given to the manager and the provider at the end of the visit The purpose of the visit was to make sure the home was being managed for the benefit and well being of the residents and to see what progress had been made meeting requirements and recommendations made at the last key inspection. Information to support the findings in this report was obtained by looking at the pre inspection questionnaire (PIQ). Examples of information gained from this document include details of policies and procedures in place and when they were last reviewed, when maintenance and safety checks were carried out and by who, menus used, staff details and training provided. CSCI comment cards with post-paid envelopes were sent to the home to be given to residents and their relatives in order to give people the opportunity to comment on the services provided by the home. At the time of the visit four comments cards had been returned. Comments made about the home were very positive, one person’s comments were, “Laurel Bank is excellent. I can’t praise them enough “. However another resident indicated she did not like living a Laurel Bank, and does not feel well cared for. She does not like the food, and indicated she did not wish to speak to the inspector about her concerns, and her life in the home. Other comments from residents spoken to as I toured the home were: “I think it’s quite a good home, the staff are very good. The only setback is that it gets very warm, and I can’t turn down the heating in my room as the person I share with likes it very warm”. “I don’t think there’s always enough staff on in the mornings, we don’t seem to see anybody on the top floor.” Another resident who has lived at the home for a long time said, “the staff are still smashing. I have a nice going on, and am happy here, but I can’t do my Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 6 rug making anymore. I struggled and struggled and was so disappointed to give it up, now I can only make pom pom’s” He said the food was still good, but that recently he had experienced a bit of difficulty in understanding the Polish staff. Records in the home were looked at such as care plans, staff files, and complaints and accidents records. Time was also spent speaking to residents’ to as well as members of staff and the management team. The home charges between £363.75 and £536.56 for care provided. What the service does well: What has improved since the last inspection? The home now enjoys the services of an outside accredited training agency that visit the home regularly. Qualified staff levels have been increased. Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 7 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. Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5 and 6 Quality in these outcomes is good. This judgement has been made by using available evidence, and a site visit to the home. The home provides prospective service users with sufficient up to date information so that they can make an informed choice whether or not to live at the home. All new service users have their care needs fully assessed prior to admission to the home. Where this is not possible, a copy of either the social worker assessment or information obtained through the care programme approach is obtained prior to admission. Prospective service users and their next of kin are involved in the pre admission assessment and planning of care. That way they are assured the home will be able to meet their assessed needs. Trial visits are encouraged. Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 10 EVIDENCE: The Statement of Purpose and Function are up to date and provide residents who are considering coming to live in the home with enough information to make a choice. If a senior member of staff from the home cannot visit and do a pre admission assessment of needs, a copy of the nursing needs assessment is obtained from the social worker prior to admission. If a visit can be made to the prospective residents home, the relatives, and if possible the multidisciplinary team are asked to contribute. Trial visits are encouraged and are made without any charges. Where there is a change of GP, a medical assessment is done by the GP who visits the home regularly. Intermediate managed care is not provided. Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 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 the following standard(s): 7, 8 and 9 Quality in these outcomes is good. This judgement has been made through using available evidence, and a site visit to the home. On the whole, the standard and quality of planned care is person centred and good, and ensures all residents’ can be sure that their health, and personal care needs will be fully met. However more work needs to be done to ensure residents’ leisure time is planned and identified leisure pursuits are provided. The health care needs of the residents are met and care plans provide clear and detailed instructions for the staff to follow. The home has effective systems in place to ensure the care plans are reviewed and updated monthly, and arrange additional reviews when necessary. On the whole the medication system is safe, however occasional inconsistencies were seen in recording. Residents said they are treated with respect by the care staff. Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 12 EVIDENCE: The health care needs of the residents are met and care plans provide clear and detailed instructions for the staff to follow. In one set of care documentation chosen for review and case tracking, it was noted that the care plans, and certain risk assessments were not written until between 38 and 44 days following admission. This could have resulted in essential care not being provided. In certain documentation, there was no reference seen regarding the service users religious preference. Other care plan documentation seen was of a good standard, and daily care records professionally written. All care plans seen, were linked to risk assessments where a risk to the resident had been identified, however, activity plans were not completed in all plans assessed, which gives the impression that there had been no activities provided for them. The care plans seem to be used as a working tool for all grades of staff. One member of care staff spoken to during the inspection told the inspectors she didn’t routinely see care plans, but had looked at some of them and found they were very informative. She said, “most of the time, you have to ask a nurse if you want to look at them”. She said that most information is handed over verbally, and said, “You get to know more about people at handover”. When asked how she let nursing staff know what had been going on so that the nurse could complete the daily records, she said, “You just tell them before the end of their shift, for instance if you’ve bathed someone.” She also said she gets to know about people from their families, and from spending time talking to them. This is good practice. All care plans inspected had evidence of key worker (chosen carer responsible for performing all aspects of personal care, and reporting back to the named nurse.) and named nurse. (Chosen nurse responsible for providing all nursing care, and completing care documentation.) All care documentation seen contained an up to date photograph of the service user. Care documentation reviewed also contained enough information to highlight the residents’ individuality by describing needs like “prefers to eat at dining table”. “Likes tea without sugar”. “Make sure hearing aid is on”. “Likes to be in lounge with others”. “Likes clothing to be coordinated”…….. and so on. There was ample evidence that the health care needs of the residents was being met On the whole the medication system is safe, however occasional inconsistencies were seen in recording. Residents said they are treated with respect by the care staff. Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 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 the following standard(s): 12 and 15 Quality in these outcomes is good. This judgement has been made through using available evidence, and a site visit to the home. Residents are consulted about any new developments, and are encouraged to maintain links with family and friends. 24 hour visiting is implemented. A good nutritious diet is provided. The home has an excellent recreational programme. EVIDENCE: Menus at the home are four weekly and rotational. They appear to be nutritious in value and take into account the residents’ preferences. Residents are given the opportunity to take part in activities both within the home and in the community, but judging from the comments received from service users and staff, these are not consistent, as many of the residents are very elderly and frail, and have chosen not to take part in any activities that are planned for them. Residents also said they enjoyed the food at the home and could have a choice of where they wanted to eat and what they preferred. One lady resident said Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 14 that the food was very good; infact there is too much of it. She said,” If I don’t eat too much at lunchtime, I am ready for my tea.” Residents’ religious needs are met. Religious ministers visit the home and are made welcome. A multi faith service is held on a monthly basis and is usually well attended. Some people go out with family and friends where this has been agreed in their care plan. Choirs both local and from the city visit to entertain the residents. Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 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 the following standard(s): 16 and 18 Quality in these outcomes is good. This judgement has been made through using available evidence, and a site visit to the home. The home has an appropriate complaints and adult protection policy and procedure. Complaints are well managed and dealt with appropriately. EVIDENCE: One situation, that had been effectively and sensitively handled, was discussed with the manager. The incident was recorded in the resident’s care plan documentation, and plans had been put in place to ensure the situation would not happen again. The home has an adequate complaint procedure that contains the timescales for the completion of the process. All complaints are responded to in writing. Minor concerns are dealt with during discussions with the person/s concerned.. The company has a rigorous recruitment process. Residents’ are protected from abuse and all staff have had adequate training provided by an accredited training company. Appropriate policies and procedures were seen to be in place. Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 16 Staff spoken to were aware of POVA (Protection of Vulnerable Adults,) and knew what to do if abuse was suspected. During the lunchtime meal I sat in the lounge/dining area and chatted to the residents. The dining area near the lounge area seemed to be very crowded, In fact there did not seem to be enough room for all the residents to sit and have a meal up to the dining table. Two of the lady residents had to eat their meal from an overbed table. Whilst sitting it appeared that there was a great many of the residents who were sitting up to the table in wheelchairs instead of on dining chairs. The staff in the dining room said it was their choice. There was also one lady who looked as if she had been pushed out of the way, near the fire exit. This was discussed with the manager and one of the nurses, who said the lady had been unwell for quite a while, and had just started to “rally round a bit”, and needed some help, but wasn’t yet confident enough to sit with the other residents to dine. I spoke to the lady in question, and she said she was perfectly happy to sit out of the way and be quiet, and that she didn’t want to stay in her room. The mealtime was unhurried, and staff gave help to those residents who needed it. One member of the care staff seemed particularly good at coaxing residents to “just try a bit more”. Residents meetings are held, and suggestions put forward by them are taken notice of and action taken if thought appropriate. Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26 Quality in these outcomes is good. This judgement has been made through using available evidence, and a site visit to the home. The home offers a safe, well-maintained environment for the residents and provides appropriate bathing and toilet facilities. The home is clean, pleasant and hygienic. EVIDENCE: Not all the bedrooms were inspected during this visit, but the ones that were inspected were seen to be clean, free from any unpleasant smells, and with items of personal memorabilia belonging to the residents’. One lady resident said she liked her room and that she also enjoys the activities provided. All areas of the home clean, and fresh smelling. The laundry area was seen to be clean, uncluttered and well ordered, and the garden area was tidy. Paths to and around the home were free from any moss. Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 18 The WC opposite Room 14 on the 1st Floor level has a waste bin, however, as this is not foot operated, infection control in this area could be compromised. The storeroom opposite room 19 on this floor needs the plastic covering over the wiring securing. Hot water tested in various rooms was within acceptable limits. Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All standards were assessed. Quality in these outcomes is good. This judgement has been made through using available evidence, and a site visit to the home. Staff are trained and competent to do their jobs. Staffing numbers and skills ensure that residents’ needs can be met. EVIDENCE: During the time I spent at the home staff appeared to be present in such numbers to meet the needs of the residents. On speaking to the residents’ however to get their view on what they think, comments were made, such as “they seem a bit rushed at times, and there’s a lot of Polish staff. They don’t know enough English, it’s better now they have been here a while.” “ I know what’s going on, and can communicate better, some of the other residents’ can’t.” I also spoke to the trainer who was attending the home. He said, “I attend the home regularly, there always seems to be enough staff to allow some to attend for training”. He said “the home has a big commitment to training”. Manual handling training was taking place in the home on the day of the visit. Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 20 At the last visit there were some concerns raised regarding recruitment. However, staff files inspected at this visit were complete, with all necessary pre employment checks having been done prior to employment. All staff employed, and who have regular contact with residents now have an enhanced CRB disclosure. Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 36, 37 and 38 The home has recently had a change of registered manager who has yet to put her own stamp on it. The management of the home is reasonably well organised and staff and residents’ are able to contribute to the decision making process. The interests of the residents are seen as very important to the manager and staff and are safeguarded at all times. EVIDENCE: The manager is relatively new in post having been appointed since March 06.She has relevant previous experience as a deputy manager and then manager at a 43 bedded home. She is responsible for all aspects of running the home within current guidelines and policy. Has 6 years experience within care home setting and was responsible for clinical management in the home she previously ran. Also has experience of managing an acute assessment Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 22 service in the NHS. She is not in possession of a relevant management qualification, but told me she is to commence NVQ at level 4 on 21st September 06. Residents’ meetings are held, but these are “closed shop”, and staff only attend when invited. A recent residents meeting’ identified certain residents would like to go way on an annual holiday. This is to be arranged at the residents’ discretion. Also identified was unavailability of staff in the TV lounge during the evenings, and that the only nurse call point available, is wall mounted and available to those residents’ who are mobile. Since the meeting an extra nurse call is to be fitted, and a carer allocated to that area. Quality assurance appears to be well addressed within the service, with monthly quality monitoring of pressure ulcers, staff sickness and absence, annual resident/relative survey sand Regulation 26 visits. Reports of the annual financial reviews are made available on request Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 X X X 3 X 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 3 3 3 X 3 X 3 3 Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 24 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. Standard OP7 Regulation 15 Requirement The registered provider must ensure care is planned within 48 hours following admission, that religious preferences are clearly documented and that activity care plans are developed. The registered provider must ensure that reasons are given on medication administration record cards when medications are omitted. The registered provider must ensure that a foot operated clinical waste bin is provided in the WC near room 14 on the first floor. Timescale for action 06/11/06 2. OP9 13 (2) 06/11/06 3 OP26 13 (3) 06/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Laurel Bank Nursing Home DS0000019861.V297610.R02.S.doc Version 5.2 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. 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!