Inspection on 28/11/05 for Lymehurst

This inspection was carried out on 28th November 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

Lymehurst 30/10/07

Lymehurst 21/11/06

Lymehurst 11/07/06

Lymehurst 24/08/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Lymehurst 112 Ellesmere Road Shrewsbury Shropshire SY1 2QT Lead Inspector Terry Woods Announced Inspection 28th November 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 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. Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Lymehurst Address 112 Ellesmere Road Shrewsbury Shropshire SY1 2QT 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) 01743 351615 01743 351416 lymehurst@aol.com Mrs Goulsen Ibrahim Mr Tay Sivri, Mr Seref Ibrahim, Ms Narin Ibrahim Care Home 32 Category(ies) of Dementia (8), Old age, not falling within any registration, with number other category (24) of places Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate 32 Elderly Persons of which a maximum of 8 persons may be suffering from Dementia. 24th August 2005 Date of last inspection Brief Description of the Service: Lymehurst is a private care home registered with the Commission for Social Care Inspection to provide a full residential service for up to thirty-two older people. The home is situated on Ellesmere Road close to the centre of Shrewsbury. The homes owners Mrs Ibrahim and her family operate the business with Mrs Ibrahim having day-to-day management responsibilities. The property has been converted from a large double fronted Victorian family style residence and extended at ground floor level to provide comprehensive and spacious accommodation. The Home stands in its own grounds entered from the road onto a large forecourt. There is an established staff group providing residents with consistency in a warm homely atmosphere. Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on the 28th November 2005 over five hours and was carried out as a routine announced visit. A full tour of the premises took place and a sample of two staff files and two residents’ care records were inspected. Four of the staff on duty, nine residents and two visitors were spoken during the day. What the service does well: What has improved since the last inspection? What they could do better: Records could be collated with dates of each staff member’s achievements to assist the manager to identify requirements and more effectively plan future training. Implement a system of formally reporting issues of maintenance involving both staff and management to ensure that action is taken particularly to eliminate risk to individual’s health and safety as soon as this is identified. The current area of concern is with regard to maintaining an acceptable level of heating Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 Page 6 throughout the home and specifically within resident’s bedrooms. There is also a staff training issue to consider with regard to monitoring the heating levels particularly where individual residents struggle to manage their radiator controls effectively. 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. Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 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 the following standard(s): 2, 3 & 6 The home has a satisfactory and functional admissions procedure providing an effective needs assessment and evaluation of suitability for both privately funded residents and those placed by the local authority. Not all the people admitted are provided with a formal agreement setting out the terms and conditions of residence EVIDENCE: Prospective residents at Lymehurst are admitted via either the local social work team, directly from hospital or through a private arrangement with no social worker involvement. In all cases, and confirmed in the residents’ files inspected the home’s pre admission assessment is completed to identify the person’s individual needs and to ensure that an appropriate service can be provided. This is a good example of the required document and includes the formulation of the residents’ care plan. The assessment is also further complemented, in some cases, by a community care assessment / single assessment process or a hospital discharge document. All residents placed at the home under a private arrangement have a written contract between themselves and the home, signed by both parties, setting Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 Page 9 out the terms and conditions of residence. This agreement however has not been formally extended to residents placed by the Local Authority or other agencies. The home does not provide a discrete intermediate care facility. Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 & 10 There is a clear and consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet residents’ personal and health care needs. A safe and effective system for the administration of medication is employed with correct records being kept. EVIDENCE: Within the care plans inspected there is good evidence of maintained health care for residents with clear and detailed notes being kept. These also demonstrated the use of professional input throughout times of need. The proprietors reported confidently and knowledgeably about the health care needs of all residents. Residents were observed from a distance being treated with kindness and respect throughout the day and despite its size Lymehurst is providing a comfortable and homely environment for those in residence. One resident who is having some difficulty with his mobility reported how he preferred to stay in his room to watch television as he could then watch whatever he wanted. He also reflected on his son who has recently become ill and of the deteriorating condition of his wife with whom he shares the room, Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 Page 11 both of which were clearly affecting his normally cheerful self. Staff were observed being very kind and thoughtful towards him, to which he was responding well. A member of staff competently demonstrated the administration of medication procedure. A safe and effective system is employed with correct records kept There are currently no controlled drugs prescribed for residents however a separate purpose made metal cabinet is available for storage and a controlled drugs register is kept as a matter of good practice. It was reported that all staff involved with the administration of medication have received comprehensive training from the local pharmacist confirmed by the presentation of completed workbooks by staff. A new stair lift has been fitted to provide the less ambulant residents with a comfortable journey to the first floor. Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Lymehurst provides a balanced lifestyle based on individual needs and capabilities for the people in residence. Rotational cleaning within the kitchen is inadequate There is good evidence of residents having opportunities to maintain control over their lives EVIDENCE: A new stair lift has recently been fitted to provide the less ambulant residents with a comfortable journey to the first floor. One lady was observed, with her permission, using the stair lift without support. Although a wheelchair user, she said that she was confident to do this as it gave her complete independence around the home. She also reported that she had received ‘training’ from staff to enable her to competently and safely use the lift and her routine confirmed this. The inspector was informed that a risk assessment had also been completed. The resident’s care plan however did not contain a risk assessment or evidence of safety training in the use of the lift. Further investigation revealed that the use of the stair lift in general had not been formally risk assessed for either independent or supported use. Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 Page 13 Residents said that they are in touch regularly with friends and family members and spoke about receiving their visitors throughout their daily routine. One resident spoke of being taken out to Elsemere for the day at the weekend and having a really pleasant time in the sunshine with her close family. Another spoke of a shopping trip and of buying daffodil bulbs for the spring. She added that staff planted them in the garden for her in a position where she could see them from her window. Two visitors were spoken with during the day. Both reported that they were pleased with the service being provided for their relative. They added that they are always made welcome at the home and were observed being offered refreshments during this time. Residents reported taking part in activities that match their individual preferences, which could include reading, walking or watching television. A large number of residents take a daily newspaper to keep up with current affairs. Residents reported on group activities organised throughout the week, which included quizzes, bingo, exercise games and visits from a ‘craft lady’. The inspector was not invited to join the residents for the midday meal on this occasion. Observations and feedback from residents however confirmed that they are happy with the meals at Lymehurst and the menu showed that these were wholesome and balanced. Residents said that choices were offered as an alternative to the main theme however the menu provided did not reflect this. The kitchen is a part of the most recent developments at the home, completed at the time of the new wing. The Environmental Health Officer visited earlier in the year and the routine cleaning of the kitchen including appliances was seen to be an issue. The extractor fan was specifically mentioned and during this inspection found to require cleaning. The cook on duty was unable to produce a cleaning rota for the kitchen and could not verbally report her cleaning duties other than in general terms. Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 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 the following standard(s): 16 & 18 The home has a satisfactory and user-friendly complaints system however not all families are fully aware of this. The arrangements for the protection of residents from abuse are satisfactory but with recognition that formal training is needed for both management and staff. EVIDENCE: One resident complained to the inspector of a cold bedroom the previous night and said that her radiator had ‘gone off’. When asked if she used the call bell to alert a member of staff to the situation she replied that she did not like to complain. A senior staff member checked the radiator together with the inspector and confirmed that the radiator was not working correctly. A plumber was consulted immediately and an air lock was discovered and rectified. Two formal complaints have been received in recent months. One lead to a POVA investigation, which was appropriately managed by the home as a result of this process. Another was concerned with the heating in a resident’s room, which was not managed to the complainant’s satisfaction and passed onto the Commission for Social Care Inspection for further action. This was found to be partly upheld. It is clear from the above that there are issues with the heating system and that a clear routine process of monitoring the heating in residents’ rooms by staff particularly in the evening is required. (See Standard 25) Formal written feedback from relatives as a part of the inspection process revealed that seven families were not aware of the home’s complaints Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 Page 15 procedure. Two visitors on the day however reported that they were aware of the complaints procedure and would inform the proprietor were they not satisfied with anything. Complaints booklets are available on display in the reception area however it was agreed that a system to regularly make families aware of the procedure is needed. The home has a policy and procedure with regard to Adult Protection and the prevention of abuse, which includes whistle blowing. The home has the current edition of the county’s adult protection procedure document. Management advised that three staff have attended ‘Protection of Vulnerable Adults’ training provided by ‘Care assessment in Shropshire’ and a further three are ‘booked in’ for December. In discussion it was noted that this is an identified training need for both the proprietors and the remaining staff in future. Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21, 24, 25 & 26 The home is constantly improving the environment to benefit those in residence. EVIDENCE: The home has recently been extended by adding a new wing to provide ten more bedrooms all on one level. This is now being occupied by residents. A further development being planned for the spring of 2006 is the demolition of the older wing and rebuilding it to a higher standard. The bedrooms were all seen to be equipped with appropriate furnishing, sinks and window restrictors. It was seen that most of the bedroom doors had been fitted with appropriate locks and those that are not are unlikely to remain in use for much longer. The building generally was seen to be warm, bright and well ventilated. However as previously mentioned there are issues with the heating system and a clear routine / process of monitoring the heating in residents’ rooms by staff particularly in the evening is required. The communal space within the home currently consists of a large lounge area, two dining rooms and two further sitting rooms. Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 Page 17 Furnishings in communal rooms are in an acceptable condition. A paved terrace area to the rear of the building was installed as part of the upgrade programme. The appropriate number of toilets and baths are available in the home. One bathroom will be demolished and replaced as part of the second phase rebuild. The home was seen to be clean and reasonably odour free. Issues of incontinence are being addressed and new floor coverings have been laid to three rooms to make them more readily cleanable. A decommissioned bathroom in the main house is in the process of being refurbished and converted into a walk in shower facility with WC and wash hand basin. The two rooms 9 & 10, which are the subject of the heating complaint have been vacated and are to remain so. It is intended that these rooms will be converted into a staff room facility in the spring. The laundry facility is well set out and serviceable. It is however situated in the cellar and has a quarry-tiled floor, which is very cold under foot for staff. The room is also used as a store facility and it was agreed that this is an area that would benefit redesign and improvement to make it discrete for purpose with the storage facility sectioned off. Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 29 There is a stable staff group working positively and enthusiastically to provide the residents with a quality of life that meets their individual requirements and aspirations Improvements have been made to the recruitment process to ensure that it is robust and protects those in residence EVIDENCE: A fully detailed staff duty rota was seen. Appropriate staffing levels were seen to be in place with extra staff being on duty in the mornings, when doctors and district nurses are most likely to visit and may require the attention of staff. The care staff are supported by two cooks and domestic support staff. The home’s recruitment procedure includes an application form, interview process and two references. Application forms have been reviewed to now include a section requesting a cautions declaration as well as convictions following issues raised at a recent POVA investigation. Records showed that on occasions staff have commenced employment prior to Criminal Records Bureau checks being returned. It was reported that this was at times of staff shortage and only after receiving a satisfactory POVA check and two written references. A protocol is now in place concerning the employment of applicants with a ‘CRB’ disclosure. This sets out the process by which individual cases are assessed and an example was presented with regard to one staff member. This was well set out and included evidence of an interview with the staff member, Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 Page 19 their statement concerning the disclosure and the home’s justification for the decision made. Staff files are kept to the standard required and current photographs have also been inserted. Records confirmed that the home has adopted the TOPSS induction and foundation training schemes. One staff member was able to show the inspector her workbook and reflected on the welcomed support that she had received from the management team. Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 Page 20 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): The systems for monitoring the quality of the home including resident consultation are good with evidence suggesting that their views sought and acted upon however there are still areas for improvement. The home does not provide staff with satisfactory formal supervision. EVIDENCE: The current manager, Mrs Ibrahim, has many years of experience in the care profession and of managing the home. However she has no desire to pursue further qualifications and her son Mr Tay Fun Siuri who is nearing the completion of the Registered Managers Award / NVQ level 4 will be submitting an application to register as manager in the near future. Those residents at Lymehurst that are articulate and able to voice their views and opinions reported that staff listen to them and issues are acted upon to their satisfaction. The home also carries out a resident / family satisfaction Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 Page 21 survey regularly every six months. These are taken to the management meetings for action as required. There are currently no residents’ meetings organised however assurances were given that these were to be started and carried out monthly in future. There is now evidence of staff appraisals being completed and the supervision of staff has commenced however the format of these is not appropriate. The outcome from discussions between the inspector and senior management revealed the need to review the process and the recording format. Staff appraisals are good, however it was decided to change the frequency from six monthly to twelve monthly and integrate the outcomes of the supervision sessions. The recording of incidents is carried out in a Data Protection act compliant format and filed appropriately. The required policies and procedures were seen to be in place with examples given where these have been reviewed. Records showed and staff confirmed that they had received appropriate manual handling, first aid and infection control training. Health and safety issues have been addressed throughout the report and requirements made as necessary in the relevant standards. The home has no involvement with service users’ financial affairs and residents either manage their own affairs or rely on family members for support. The manager does however keep small amounts of cash for fourteen residents on behalf of their families to pay for such items as newspapers or hairdressing. A sample was inspected including a spreadsheet, receipts and the balance of cash, all of which were in order. Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 X X 3 X X 3 2 3 STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5.b Requirement The home is required to ensure that all residents have a formal agreement setting out the terms and conditions of residence The home is required to ensure that a written risk assessment is completed concerning the use of the stair lift The home is required to ensure that a written individual risk assessment is completed concerning the safety of the resident using the stair lift independently The home is required to ensure that written individual risk assessments are completed concerning the safety of the residents using the stair lift with support The home is required to ensure that the process of providing safety training in the use of the stair lift to the resident that independently uses the lift is recorded in the individual’s care plan The home is required to ensure that the menu or record of food DS0000061052.V257585.R01.S.doc Timescale for action 02/01/06 2. OP14 13.4.b 05/12/05 3 OP14 13.4.b 05/12/05 4 OP14 13.4.b 05/12/05 5 OP14 15.2.b 05/12/05 6 OP15 17.2 schedule 05/12/05 Lymehurst Version 5.0 Page 24 4.13 7 OP15 16.2.j 8 OP16 22.5 9 OP18 19.5.b 10 OP25 23.2.p 11 OP25 23.2.p 4. OP36 18.1.c.i reflects residents’ choice options with regard to meals The home is required to provide a cleaning rota for the kitchen and ensure that all relevant staff comply with the instructions The home is required to ensure that all residents and their families or representatives have a copy of the homes complaints procedure The home is required to ensure that all staff and managers receive appropriate Protection of Vulnerable Adults training. The home is required to introduce a process of monitoring the heating in residents’ rooms and provide staff training to facilitate the effective use of individual temperature controls on residents’ radiators The manager must ensure that all residents have adequate functional and consistent heating in their rooms The home is required to provide formal and recorded staff supervision at least six times a year and in an appropriate format. 05/12/05 05/12/05 06/02/06 05/12/05 05/12/05 02/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP33 Good Practice Recommendations It is recommended that the home holds regular residents’ meetings to enhance the quality monitoring process and provide opportunities for resident participation DS0000061052.V257585.R01.S.doc Version 5.0 Page 25 Lymehurst Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Lymehurst DS0000061052.V257585.R01.S.doc Version 5.0 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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