CARE HOMES FOR OLDER PEOPLE
Margaret Clitherow House Priory Road Torquay Devon TQ1 4NY Lead Inspector
Stella Lindsay Announced 19 July 2005
th 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. Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Margaret Clitherow House Address Priory Road, Torquay, Devon, TQ1 4NY 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) 01803 326056 01803 315066 Margaret Clitherow Housing Association Mrs Margaret Parsons Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17th November 2004 Brief Description of the Service: The Margaret Clitherow House provides residential care for up to 41 older people. There are 38 bedrooms, of which three could be double if required. All but one room has en suite facilities, and that one has an adjacent wc. Most of the Home is accessible via the shaft lifts, with a short flight of steps to some rooms. There is a dining room large enough to seat all the residents while providing quiet corners. There are two shared sitting rooms, a gazebo and a conservatory. There is a kitchenette where residents may make hot drinks or snacks, if assessment shows this to be safe. The Home has extensive gardens, which are accessible to residents. There is suitable garden furniture and shade provided. Vegetables are grown for the kitchen. The Home is adjoining the Catholic Church, and is close to the St. Marychurch precinct with all its amenities and services. Transport is provided for medical appointments and social activities. There is a Residents’ Social Fund, which pays for entertainments. Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place on a Tuesday in July 2005, between 9.30am and 6.30pm. It involved a tour of the premises, and examination of care records, staff files, health and safety records and the medication system. As well as discussion with Mrs Margaret Parsons, the Registered Manager and Mrs Pat Gough, the Chairman of the Committee, the inspector met with 12 residents and six staff, and thanks all for their time. Written comments were received from six residents and three relatives. These will be included in the text of the report. What the service does well:
Residents and relatives have testified to the good care they receive at the Margaret Clitherow House. ‘We are well looked after and well fed’; ‘my mother has been here for several years, and her care is excellent’; ‘the house is excellent in every way, it is a joy to live here’. It is a large and busy home, so good organisation is needed to achieve this. The management team is highly competent, and caring. Staff spoken to all said that ideas or concerns they raised would be dealt with. The staff were seen to be very caring and hard-working. All health care needs are dealt with promptly and sensitively. The work of the Home is supported by the Committee of the Margaret Clitherow Housing Association, who work hard to maintain the building and provide the facilities needed by the residents. The ‘Friends of MCH’ give support by raising funds for the on-going building work. Continual efforts are made to share information and communicate between staff groups and residents. Daily care records are kept, so that in-coming staff are up to date with care needs. Staff meetings, care assistants’ meetings, and residents’ meetings are held. Questionnaires are used to give residents and their families an opportunity to give feedback. Residents have said they enjoy their meals and the social life of the home. Those who go on the trips out which are offered when the weather is good have greatly enjoyed them. The garden is important to many of the residents, for a sense of freedom and a variety of interesting places to sit and stroll, for the supply of flowers to the house and vegetables to the kitchen. One resident showed the inspector the garden they tend themself. Another said how much they like to sit in the gazebo, as it is bright and peaceful. Several chose to come here because of the Home’s connection with the adjoining Catholic Church, and others attend another local Church. Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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.
Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 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 Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 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) 1,2,3 Good information about the service is given to prospective residents and members of the public. Care is taken to assess a person’s needs before offering accommodation. EVIDENCE: The Home’s statement of Purpose has been up-dated to maintain accuracy. All information for prospective residents required by Standard 1 is provided, except for a representation of residents’ views. It is recommended that a summary and analysis of the questionnaires that have been completed be made available. A video has been produced, showing daily life at the Margaret Clitherow house. It has been useful for prospective residents who live too far away to visit. It has also been used to promote the service and gain supporters. The Home has produced a ‘Client Agreement’ to clarify terms and conditions, and these were seen on residents’ files, signed by themselves. The Manager has produced a standard form for gathering information about the care needs of prospective residents who wish to move into the home. This covers all the aspects of care as required by Standard 3. It also includes a
Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 Stage 4.doc Version 1.40 Page 9 space for a summary. This should be used to include the judgement made as to whether the home can meet the care needs. It would also be useful to record the reason why the person wishes or needs residential care. A letter is sent to confirm the offer of accommodation, which is good practice. It should include the Manager’s judgement of the home’s suitability for that individual. Intermediate care is not offered at the Margaret Clitherow House. Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 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 Good care is given, and records kept. However, personal records must be kept in personal files, with health care provision clearly presented. The system for the administration of medication is good, to ensure that residents safely get the medication they need. EVIDENCE: The Standex system of care recording is used. This is helpful in providing structure for the staff to record the care plan summary and risk assessments. However, because it is not quick to read, a daily report book is used to ensure that staff coming on duty are informed about any issues, health problems or appointments for the day. This results in personal details of various residents being recorded on the same page, which is not in line with the Data Protection Act 1999. The Manager must ensure that this book is used to alert staff to issues and tasks, and that personal records are kept in the resident’s own file. The home operates a colour coding system with the files, so that staff know which residents must have a record made three times a day, because close monitoring of health or emotional problems is necessary, and which residents need more occasional recording of significant events.
Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 Stage 4.doc Version 1.40 Page 11 A care plan to cover diabetes care was drawn up by an Assistant Manager on the day of the inspection, to ensure that staff understand the overall care needs. The results of the blood sugar tests had been consistently recorded, but not the action taken to deal with any difficulties. Residents said that any health concern is dealt with promptly, appointments will be made for them, and they will be accompanied by staff if necessary. Residents are enabled to self-medicate if risk assessment shows them to be safe to do this. A good assessment form was seen on file, completed and signed by the resident. The procedure for administering and recording medication is adhered to carefully. Staff who have been trained to administer medication are listed at the front of the record book, with sample signatures. The supplying pharmacist checked the system on 05/07/05. Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 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) 12,15 Residents are well suited by the daily routines, the opportunities for social activity, and the Church connections. Meals are very good, offering both choice and variety, and plenty of fresh food. EVIDENCE: Residents told the inspector they were happy with their care and their bathing arrangements. The only part of daily life that caused worries was the delivery of clean laundry. Little books are used to record the items sent to the laundry, and staff had sometimes marked them as complete on return when they were not. The washing and ironing are done well, but the system of delivery needs revision. There is a weekly Music and Movement session, and some residents continue to enjoy bingo. Outings are offered regularly and enjoyed by those who go. One resident works in their own part of the garden on most days. Many residents have links with the adjoining Catholic Church, or another Church nearby. Food eaten is recorded, as a record of residents’ nutrition, and in order to be able to trace the cause if any food related illness should occur. Vegetarian alternatives are available, and vegetables from the garden are used regularly. Salads are being served twice a week throughout the summer, which several residents said they were very pleased about. There are always two puddings, including a milk pudding. One relative returning a comment card to the
Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 Stage 4.doc Version 1.40 Page 13 inspector said that they sometimes heard complaints about the food, but all other opinions given were favourable – ‘food is plentiful, beautifully cooked, and lots of different dishes’. The serving of meals and pots of tea has been discussed by staff and residents, and residents felt it had improved, with those who are able having small teapots brought to the table so they can serve themselves. At tea-time, residents can take sandwiches to their own room, and eat them when they like, or come to the dining room for a hot meal. Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 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 There is a satisfactory complaints procedure, but the procedure for adult protection needs to be brought in line with local multi-disciplinary arrangements so that any allegation of abuse could be properly dealt with. EVIDENCE: The complaints policy is displayed in the home, and give to prospective residents. There is also a suggestions box, and well as residents’ meetings, and questionnaires. A file is kept to record any complaints or suggestions made, and action taken. There have been no official complaints. Several residents told the inspector they felt able to speak to any of the staff if they have concerns. The Home has a policy and procedure for the Protection of Vulnerable Adults, but the procedure for reporting any allegations of abuse needs to be brought into line with local arrangements, and staff made aware. Ten staff have been booked onto Vulnerable Adults training over the autumn. Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 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) 19,20,21,23,24,25,26 The Committee is constantly planning and carrying out work to the building, to improve facilities and maintain a safe and comfortable house. Work to achieve this is still needed. EVIDENCE: The Margaret Clitherow House was purpose built for communal living, having previously been a convent. There 38 bedrooms, three of which are large enough to be used as double rooms if required. The corridors are wide, and there are two shaft lifts. One of these has just been rebuilt, which was a major investment and building project. A start has been made on the next major project – the replacement of some windows, which is badly needed. Some upstairs bedrooms have been draughty. The Home must also provide a set of locks for bedroom doors, for privacy and security, which are suitable for the residents, and can be opened by staff in an emergency, with a master key. Planning permission has been gained for the replacement of the conservatory, and work was expected to start in August 2005.
Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 Stage 4.doc Version 1.40 Page 16 Visitors to the home often struggle to find a safe place to park. The Home has extensive grounds, but residents are fiercely resistant to any of the garden being turned into car park spaces. The Committee should consider how to make the best use of the space available. The garden is important to many of the residents, for a sense of freedom and a variety of interesting places to sit and stroll, for the supply of flowers to the house and vegetables to the garden. One resident showed the inspector the garden they tend themselves. Another said how much they like to sit in the gazebo, as it is bright and peaceful, and nobody knows they are there. Several said they appreciate being so close to their Church. There is a large lounge, called the Iverson Room, and a smaller lounge where the most dependent residents are generally gathered. The dining room is divided by an archway, so that some tables are in quiet corners. There are two utility rooms where residents can make hot drinks, and snacks. The bedrooms have widely differing outlooks and characteristics. Residents were seen to have their own furniture, and equipment for their chosen activities. One had particularly low cupboards, so that she could reach her clothes. All have an en-suite toilet except one, who has a toilet for their own use directly across the corridor. Some have their own shower or bath, but not all are able to use these. There is a room with an adjustable sink for hairdressing, which is also used by the chiropodist. All radiators have been fitted with attractive covers, to protect residents from risk of harm, except the two new radiators beside the new lift, which are awaiting their covers. Some upstairs rooms will need extra heaters in cold weather until their new windows are fitted. This work has been prioritised by the Committee, and work has started. Work had been done to make the laundry floor more hygienic, but cracks were still evident, which are not readily cleanable, and there was a crack in the floor of the corridor between the kitchen and the servery. Also, in the first floor bathroom there were small cracks in the flooring and in the skirting board behind the door, which could be a potential hazard to residents. The house was clean and sweet smelling throughout. Stainless steel surfaces had been fitted in the servery. A disinfecting system had been installed to assure the disinfection of all laundry and bed linen. Stocks of disposable gloves and aprons are kept in the bedrooms of residents who have on-going personal care needs. There is a system in place for ensuring that soiled laundry does not contaminate other items, and a suitable place for sterilising commode pots. Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 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) 27,28,29,30 Staffing levels are sufficient to provide the care and services needed. A sound system of recruitment is in place, and training is provided, with the result that staff are caring and competent. EVIDENCE: There are four care staff on duty every morning and most afternoons, as well as one or two Assistant Managers and separate dining room staff, cooks and domestics. At night there are two awake care staff, and a manager sleeping in. There is a dedicated laundry assistant, a handy man and a gardener. Juniors are not employed as care staff. System were seen to be working well, and staffing levels are sufficient to meet current care needs, though would need to be reviewed if overall care needs increase any further. There are no cleaning staff at the weekend. Night staff clean toilets, and there have been no complaints with regard to standards of cleanliness at weekends. Care is taken with the appointment of new staff, to ensure protection of the residents. Two written references and CRB clearances are obtained, and proof of identity was seen on staff files. Fourteen of the 22 care staff had NVQ2 or equivalent. An in-house induction check-list was seen to be completed for a recently appointed staff member, and they were booked to attend foundation training, starting September 2005. Health and safety training has been provided – see Standard 38. Other training recorded also under different sections includes Adult Protection, and supervision and appraisal. The Head Carer has received training in dealing with
Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 Stage 4.doc Version 1.40 Page 18 incontinence and care of people with dementia. Further training directed at the care needs of people with sensory loss or specific conditions would be a benefit. Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 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) 31,32,34,36,38 There is a clear management structure in this large and busy home, and staff are given support and guidance to provide the care and services to the residents in a safe and consistent way. EVIDENCE: The Registered Manager has achieved NVQ4 and the Registered Managers’ Award, and is experienced and competent in the management of residential care. She is supported by the Committee, who are looking to appoint a new Chairperson. The current Chairperson has given several months notice of her intention to retire after many years service. Two new Committee members were appointed during 2004. A support group called the Friends of Margaret Clitherow House raise funds towards the on-going building works. The Assistant Managers and the Accounts Clerk are directly responsible to the Manager. The more recently appointed Assistant Manager is engaged in NVQ4 in Care, and a new Head Carer has been appointed.
Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 Stage 4.doc Version 1.40 Page 20 The Home has achieved the Investors in People Award, and a review is due in September 2005. The Committee has supplied the Commission for Social Care Inspection with Financial Statements for the year to 31/12/05, showing the proper running of the establishment. Staff meetings, Care Assistants’ meetings, and residents’ meetings are held. In spite of this, some residents said that they felt they were not informed about what was going on in the house, in particular about the progress and planning of building works, and what happens to suggestions that are made. It may be that residents do not like to ask questions when they can see that senior staff are busy. Constant efforts are needed to open all possible channels of communication, including keyworkers spending time listening to their residents, newsletters etc. Staff said that if they have any ideas for improvement, or concerns, they take them to the Head Carer, who passes them to management as appropriate. They said they felt able to raise issues at meetings. Staff receive individual supervision and appraisal. Assistant Managers and the Head Carer have received training in assessment and appraisal. Safe systems of work are in place. Kitchen staff have been trained in Food Hygiene. A Cook is available until 6.30pm, and residents have some supplies in their rooms, so care staff do not normally need to handle food. Moving and Handling training is provided annually, which is good practice. Many staff are qualified First Aiders, including Senior staff, with the result that there is always one on duty. Fire training has been provided, and the Manager has kept a chart which shows that most staff have benefited – but there are gaps. She will ensure that the people involved take advantage of this training, to assure the safety of residents at any time. The Fire Safety Officer last visited on 29/05/05, and the fire precaution system was serviced professionally on 14/06/05. Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 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 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 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 3 4 4 x 4 2 2 2 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 x 3 x 3 x 3 Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 Stage 4.doc Version 1.40 Page 22 Are there any outstanding requirements from the last inspection? yes;- still within timescale given. 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 OP18 Regulation 13.6 Requirement Timescale for action 30/09/05 2. OP24 12 3. 4. OP26 OP38 13.4 23 The Registered Manager must re-write the homes policy and procedure on Adult Protection to include the local reporting arrangements, make staff aware, and send a copy of the new policy to the Commission for Social Care Inspection. Locks must be fitted to bedroom 31/08/05 doors which are suited to the needs of Service Users and can be accessed by staff in an emergency. The laundry and all toilets and 31/10/05 bathrooms must have floors which are readily cleanable. All staff must receive fire safety 31/10/05 training. 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 OP3 Good Practice Recommendations The summary of the pre-admission assessment should include the judgement as to whether the home can meet the assessed needs.
D54-D07 S18395 Margaret Clitherow V224338 190705 Stage 4.doc Version 1.40 Page 23 Margaret Clitherow House 2. 3. 4. OP7 OP12 OP19 All care records should be kept individually, so that residents may see them on request. Senior staff should revise the system of delivering clean laundry The Committee should consider how to make the best use of the space available for car parking. Margaret Clitherow House D54-D07 S18395 Margaret Clitherow V224338 190705 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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