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Inspection on 27/06/05 for Marina Rest Home

Also see our care home review for Marina Rest Home for more information

This inspection was carried out on 27th June 2005.

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

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

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

What the care home does well

Without doubt the staff are highly thought of by the resident`s and visitors to the home. One resident`s partner stays all day at the Home and has meals with their partner and other resident`s and is welcomed by the staff. Meals are commented on as being `very good` and the catering staff are valued as they come out of the kitchen to speak to resident`s, therefore are part of the team. There is a welcoming, friendly, relaxed atmosphere at the Home. The staff speak openly to the inspector and are seen to spend time talking to the resident`s. There is a willingness on the part of the staff to try to improve what they do and the management team continue to listen and act on advice when given.

What has improved since the last inspection?

There has been a good effort made to try and improve the care plan records so that the needs of the resident`s are identified to help staff know more about the people they are caring for and how to care for them. A quality assurance system has been started, which with further development should help the management team look at what the Home does well and what needs to improve. This should make life better for the resident`s living at the Home as areas for improvement are identified and plans made to make sure those things are acted on.

What the care home could do better:

There has been a longstanding issue with the number of hours available for the maintenance man to work in the Home. This is still not satisfactory and many issues raised in previous inspection reports are still not dealt with. This means that the staff and resident`s have to wait along time to benefit from improvements to the Home and for repair work to be completed. The design of the dining room and lounge areas could be improved to allow resident`s to choose from different rooms and whom they sit with. Currently, there is a lot of mixed noise with two televisions and a radio playing, which can be heard in the whole area. Further training for staff in dementia care could be improved to enable staff to understand the needs of people with dementia and adaptation of the environment in the dementia care unit to help the resident`s get around the Home without the help of staff if and keep their independence.

CARE HOMES FOR OLDER PEOPLE Marina Rest Home St Cuthbert Street Hebburn Tyne & Wear NE31 1DJ Lead Inspector Sharon McDowell Announced Monday, 27 June 2005 : 10:00am 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. Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Marina House Address St Cuthbert Street, Hebburn, Tyne & Wear NE31 1DJ 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) 0191 483 5588 Dr I Vinayak Mrs Heather Pirie PC Care home only 44 Category(ies) of 28 x OP; 17 x DE(E); 1 x MD(E) registration, with number of places Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 17th February 2005 Brief Description of the Service: Marina Rest Home is a converted property to its present use as a care home. It comprises of two units, one caring for up to twenty-seven older persons and a separate seventeen-bed unit for people with dementia. The home does not provide nursing care. The older persons unit is two-storey, the first floor being accessed by a passenger lift or stairs.The home is staffed throughout the 24hour period by senior care staff and care staff. Therefore support is available to service users at all times.The Home is situated in a residential area close to the town centre. It is within walking distance of local amenities and accessible by local transport services. There is ample car parking space to the front of the building. Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 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 over six hours. During the inspection time was spent discussing care and services at the Home with the Registered Manager, Deputy Manager and care staff. Two visitors were spoken with and seven residents. The Commission for Social Care Inspection received five comment cards from resident’s at the Home and ten relatives/visitors comment cards. A number of records were reviewed during the inspection including three residents care records, menu plan, complaints, staff training records, fire safety rand maintenance records and quality assurance audits. What the service does well: What has improved since the last inspection? There has been a good effort made to try and improve the care plan records so that the needs of the resident’s are identified to help staff know more about the people they are caring for and how to care for them. A quality assurance system has been started, which with further development should help the management team look at what the Home does well and what needs to improve. This should make life better for the resident’s living at the Home as areas for improvement are identified and plans made to make sure those things are acted on. Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 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 Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 4 The admission process is reasonably robust enough to ensure resident’s needs are assessed prior to being admitted to the Home for care. However, this is not confirmed in writing to the prospective resident therefore they cannot be assured their needs will be met. EVIDENCE: All three care records had care manager assessments available giving information to the Home to enable them to make a decision as to whether the Home could meet the resident’s identified needs. The Registered Manager advised that the Home also visits the prospective resident before they come to live at the home to complete a preadmission assessment. These were not always completed in full for the care plans reviewed. However in one a good pen picture was available, which included information about the resident’s interests, mobility and sleeping pattern. The Registered Manager does not currently confirm to the prospective resident in writing that the Home can meet their assessed needs, which would help them decide if the want to live at the Home. Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 8 Whilst there has been some improvement in care records the health and personal care needs recorded in the care plans do not fully reflect the resident’s current level of need. As such the resident’s welfare is not fully promoted and safeguarded. However the management team are keen to continue with development of care plans therefore residents and relatives can be assured the Home will endeavour to meet resident’s needs. EVIDENCE: Care records contain information about the assessed needs of the resident. Pen pictures are available in some of the records but are not yet completed in all care plans. Some risk assessments had not been completed, for example, moving and handling. One resident was identified as being at low risk in relation to falls. However their care record demonstrated they had a history of falls and was at high risk. Another resident was identified as having several episodes of verbal and physical aggression towards staff and had tried to leave the building however there was no risk assessment or details of how any restrictions were being placed on their freedom of movement. Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 Stage 4.doc Version 1.40 Page 10 Records of visits by Doctors, District Nurses and other health professionals are written in the resident’s care record demonstrating the residents have access to appropriate health care. Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 Arrangements to provide activities and occupation are seriously underdeveloped within the home. Therefore residents are not assisted to have a stimulating and fulfilling lifestyle. Visitors are welcomed to the Home therefore residents can be assured they can maintain contact with their friends and family. Service users are offered and receive a varied, wholesome, nutritious and wellpresented menu, which contribute s to their general health and wellbeing EVIDENCE: Discussion took place about the value of life history documents, which includes information about the residents past employment, family, interests and hobbies, food likes and dislikes and many more relevant pieces of information, which can help staff appreciate the life of the people they are caring for and to enable them plan to meet their social needs. This is particularly relevant to people with dementia that might find they talk about a part of their life from many years ago. This work has started in the home and suggestions of alternative documentation to help the process were given. The Home does not employ an activity person. This matter has been raised in several past inspection reports and is a concern to resident’s and relatives. Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 Stage 4.doc Version 1.40 Page 12 Resident’s made comment that there was little to do and they found the two televisions in the sitting area annoying as they were not synchronised therefore the same programme could be on but the speech was delayed on one of them. One resident said ‘there is nothing to do, we used to have games of bingo but we were told there are no funds for prizes’. The Registered Manager explained there is no money in the social activity fund as there is no one to organise fund raising events. Resident’s were asked to pay a small fee to play bingo but they did not want to pay. There has been a Thornton’s chocolate and clothes party at the Home but no outside entertainers or trips out of the Home have been arranged. Throughput the inspection resident’s were sat in the lounge, a small few sat outside as it was a warm day and residents in the dementia care unit were all sat in the living room with music on. A visitor expressed concern at the lack of activity and three out of five resident comment cards stated there were not enough suitable activities. Arrangements for increases in care staff and nomination of a care staff to organise activities each day have been discussed previously but have not been acted on. Visitors are welcome to the home and a couple were seen in the Home during the inspection. Comment cards from relatives stated satisfaction with the care and services at the Home and made comments, such as, ‘an excellently manned home, with all staff very caring to their people’, ‘I think the staff are underpaid for all the good work they do here’ and ‘there is much kindness and thoughtfulness’. Resident’s are offered a choice of at least two hot meals at lunchtime, which is displayed on the large notice board in the dining area. One relative joined their partner for lunch and said they always enjoyed the food. One resident praised the catering staff, explaining how they come out to speak to them to ask what they want and if they enjoyed the meal. On the day of inspection there was a choice of homemade corned beef pie or pork casserole with potatoes and vegetables. For dessert there was jam sponge and custard or fruit and ice cream. The food is served from a hot trolley therefore is at a reasonable temperature when it is given to the resident’s. The tables are set with appropriate condiments, cutlery and tea and coffee pots for hot drinks. All but one of the five comment cards received from resident’s said they were satisfied with the meals provided and one said they were sometimes satisfied and one relative made a comment that the ‘food is best quality’. Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 Stage 4.doc Version 1.40 Page 13 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 A clear complaints procedure is available therefore residents and visitors can make their concerns known and will know how their complaint will be dealt with. Whilst local Protection of Vulnerable Adults procedures are available in the Home not all staff have attended training therefore residents cannot be assured the correct action will be taken if they should be subject to harmful activities. EVIDENCE: The Home has an appropriate complaints procedure, which is available to residents and visitors. There have been no complaints made since the last inspection. Not all staff have attended training in Protection of Vulnerable Adult although it is covered during the induction process and within NVQ in Care training. There is currently a problem for care homes in that the training agency that the home used for training in Protection of Vulnerable Adults has stopped this training. The Registered Manager advised South Tyneside Council are offering courses, which she hopes to send staff on. The Home has a copy of the local policies and procedures for Protection of Vulnerable Adults therefore are able to read information about how to recognise abuse and what action to take. Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 Stage 4.doc Version 1.40 Page 14 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 Whilst the Home is clean and reasonably comfortable, arrangements for maintenance are not satisfactory. Resident’s cannot be assured that repairs or planned work is carried out in an acceptable timescale therefore some areas of the building are not well maintained. The unit for resident’s with dementia care needs is not adapted to enable the resident’s maintain independent living skills therefore resident’s are highly dependant on staff to meet their needs. EVIDENCE: The Home overall offers a reasonably comfortable environment for the resident’s however there are still concerns about general maintenance and the time available for the maintenance staff member to carry out their work. Some discussion took place regarding this matter and staff confirmed that an average of ten hours a week are made available to attend to repairs and work in the Home. During the inspection the maintenance man had to leave to attend to a problem in one of the Registered Provider’s other premises. This same problem had occurred every day for about two weeks. Due to work Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 Stage 4.doc Version 1.40 Page 15 being interrupted there has been little progress with issues raised at the last inspection. The Registered Manager and staff praised the maintenance man, stating how he endeavours to make sure he attends to matters of health and safety. Indeed maintenance records for fire equipment and other services and installations were up to date. Outstanding work includes: • The lift servicing company have advised the current passenger lift will not meet new disability legislation requirements therefore improvements should to be reflected in the annual development plan. • Several bedroom windows were noted to be ill fitting, paintwork was cracked and peeling, catches were loose and a draught was evident. (The Registered Manager advised the Registered Provider plans to have the Home fitted with double-glazing this year). Radiator guards have been fitted which are of a pleasant design. Many are not currently painted or varnished therefore are at risk of staining and look unfinished. There is evidence of water damage to first floor ceiling at top of stairwell. (The roof has been repaired and ceiling prepared for painting). Lighting in new quiet lounge on first floor should be improved and be of a domestic style. Several items of bedroom furniture are chipped and chipboard exposed • • • • Comments were also made about the lounge and dining area with two televisions and a radio playing at the same time, which was distracting to residents and served no useful purpose, as the resident’s were not able to enjoy any of them. There are no environmental adaptations in the unit for people with dementia too help them maintain independent living skills, for example, bathroom doors being painted a different colour to other doors to help the resident’s know which doors lead to toilets. Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 Stage 4.doc Version 1.40 Page 16 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) 30 Staff are experienced in the care of older person’s and demonstrate they are able to generally look after the resident’s and have a good level of knowledge about the individual people they care for. However, some aspects of training in relation to health and safety issues are not up to date therefore resident’s are not fully protected. EVIDENCE: Information about staff training is held in individual staff files. Certificates are available for some courses. A training matrix was discussed, as an easier way to retrieve information about training needs of staff. Nineteen out of the twenty one care staff employed have NVQ Level two in care, which exceeds the required National Minimum Standard of 50 of the workforce to be trained to this level. The pre-inspection questionnaire completed by the Registered Manager states that staff have attended training in fire safety, dementia care, The Mental Health Act, nutrition, infection control and falls prevention. Moving and handling training is organised for the week following the inspection and whilst staff have had previous training, two staff were seen to use improper techniques to assist a resident to their chair from a dining chair. They dragged a dining chair over to a lounge chair, which could lead to injury of the staff and then used an under arm lift to help the resident in to a lounge chair, which could cause injury to the resident. Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 Stage 4.doc Version 1.40 Page 17 Fire training records show that staff have only attended one fire training session when day staff should have two sessions and night staff four sessions annually. This does not follow recommendations by the fire authorities and might place resident’s at risk in the event of a fire. Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 Stage 4.doc Version 1.40 Page 18 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) 33 The quality assurance system is not sufficiently developed to assist in the formation of information to help ensure the Home provides a quality service. EVIDENCE: Since the last inspection the Registered Manager and Deputy Manager have implemented a quality assurance tool to measure the quality of care and services in the Home. The tool currently reviews issues related to resident’s and does not review the full service, for example, there is no environmental audit, which might help provide information to demonstrate the issues related to maintenance of the Home. Discussion was held about the quality tool reflecting the National Minimum Standards. The Registered Provider does not submit Regulation 26 notifications to the Commission for Social Care Inspection as required in The Care Home Regulations 2001. Visits are to be conducted monthly and notifications are required as evidence of the Registered Provider or a representative visiting the Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 Stage 4.doc Version 1.40 Page 19 Home to speak to residents, ensure standards are maintained in the Home, inspect the premises and review complaints. A copy of the report from the visit is to be left in the Home. The staff confirmed the Registered Provider visits the Home at least twice a week. Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 2 x x x x x Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 Stage 4.doc Version 1.40 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1)(d) Requirement The Registered Person must confirm in writing to the resident that the Home can meet their assessed needs. A record of any restrictions on the residents freedom of choice, liberty and power to make decisions must be maintained. Risk assessments must be completed in resdients care plans. Care plans must reflect the assessed needs of the resident and be kept up to date. The Registered Provider must ensure a social and recreational programme is available to meet the needs of the service users accommodated. (The previous timescale of 31/5/05 was not met) All staff must attend training in Protection of Vulnerable Adults. The provision of maintenance services must meet the needs of the Home to ensure the required work as detailed in the body of this report is attended to. All staff must attend statutory training in moving and handling and updates as required by Timescale for action 31/8/05 2. OP7 17(1)(a) 31/8/05 3. 4. 5. OP7 OP7 OP12 13(4) (c) 15 16(2)(m) 30/9/05 30/9/05 30/9/05 6. 7. OP18 OP27 13(6) 16, 18 & 23 31/10/05 31/10/05 8. OP30 & OP38 18 & 13(4) 31/10/05 Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 Stage 4.doc Version 1.40 Page 22 legislation. 9. OP30 & OP38 OP33 18 & 13(4) 26 All staff must attend statutory training in fire safety and updates as required by legislation. The Registered Provider must submit a report of monthly visits to the Home to the as detailed in the body of this report. A copy must also be left in the Home. The dementia care unit must be designed to meet the needs of people with dementia. 31/10/05 10. 31/8/05 11. OP19 23 27/06/05 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 Further development of the quality assurance system should continue to enable a comprehensive quality audit of the care services to be completed. Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Baltic House South Shields Tyne & Wear NE34 9PT 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 Marina Rest Home B52-B02 S236 Marina House V219501 27 Jun 05 Stage 4.doc Version 1.40 Page 24 - 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!