Inspection on 24/07/06 for Marlstones Care Home

This inspection was carried out on 24th July 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Marlstones Care Home 16/07/07

Marlstones Care Home 22/02/06

Marlstones Care Home 15/10/05

Marlstones Care Home 18/03/05

Marlstones Care Home 01/06/04

Marlstones Care Home 17/02/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Marlstones Care Home Adgate Close off Rock Street Bulwell Nottingham NG6 8QU Lead Inspector Rob Cooper Key Unannounced Inspection 24th July 2006 10:00 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 Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Marlstones Care Home Address Adgate Close off Rock Street Bulwell Nottingham NG6 8QU 0115 9270629 0115 9760452 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) Nottingham City Council Mrs Cecilia Broughton Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 8 service users may be under the age of 65 years, but over 55 years 22nd February 2006 Date of last inspection Brief Description of the Service: Marlstones is residential care home for older people, owned and managed by Nottingham City Council. It is located to the north west of the city centre in the Bulwell area, and is close to local shops, pubs and churches. The building covers two floors, with the upper floor being accessed either via a staircase or a passenger lift; as a result people with restricted mobility can be accommodated, and can access all parts of the building. Marlstones is currently registered for forty-eight places of which four might be emergency/ short term care beds. Fees: £297.31 per week Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place through the middle of the day with one Inspector present, and lasted approximately four hours. The method of inspection used was to visually inspect parts of the premises, talk with five residents, and case track three residents. Case tracking involves looking at a range of care records, and making a judgement about the quality of care that residents are receiving. Two members of staff were also spoken with about care practices, and how resident’s specific care needs are met. In addition two visitors who were seeing a relative were spoken with. On the day of the inspection there were forty-five residents in residence. What the service does well: 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. Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 Page 6 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 Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 Page 7 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): 1235&6 The quality outcome in this area is good. This judgement has been made using the available evidence including a visit to Marlstones. Prospective residents at Marlstones have the information they need to make an informed choice about where to live. Each resident has a written contract/statement of the terms and conditions of residence. No resident moves into Marlstones without having had his or her needs assessed and been assured that these will be met. Prospective residents and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of Marlstones. Residents assessed and referred solely for intermediate care at Marlstones are helped to maximise their independence and return home. EVIDENCE: At the last inspection a requirement was set regarding the Service User Guide having information about the Commission for Social Care Inspection within it. This requirement has now been met. A requirement was also set regarding the insertion of terms and conditions of residence and the fees chargeable into the Service User Guide. This too has Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 Page 8 now been achieved, and the Service User Guide, which was seen, now meets all of the requirements of Care Homes Regulations. Two residents were asked about the Service User Guide and both said that they had a copy, with one resident indicating that her copy was in her bedroom. Three resident’s files were seen, as part of the case tracking process. One file for a resident staying at Marlstones on a short-term basis contained a Shared Nottinghamshire Assessment Process (A SNAP) assessment form – This is Nottinghamshire’s current assessment tool for older people. Another file contained an Extended Community Care Assessment, while the third had a Standard Community Care Assessment within it. All three assessments were completed prior to the residents moving into Marlstones. Two residents when asked said that they had visited Marlstones before they moved in, with one resident saying: “I came with my daughter to look around, and see if I liked it.” Marlstones does offer short-term care, and in some cases Intermediate care. Documentation in the office identified that some beds would be for emergency care and some for short-term care. Two members of staff were also asked about short-term care, and they identified how short-term residents were accommodated alongside long-term residents. Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 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 the following standard(s): 7 8 9 10 & 11 The quality outcome in this area is good. This judgement has been made using the available evidence including a visit to Marlstones. Resident’s health, personal and social care needs are set out in an individual plan of care at Marlstones. Residents at Marlstones have their health care needs fully met. Residents, where appropriate, are responsible for their own medication, and are protected by Marlstone’s policies and procedures for dealing with medication. Residents feel they are treated with respect and their right to privacy is upheld at Marlstones. Residents are assured that at the time of their death, staff at Marlstones will treat them and their family with care, sensitivity and respect. EVIDENCE: The three resident’s files seen as part of the case tracking process each contained a plan of care, which identified the individual resident’s needs and how they are met. Resident’s healthcare needs are identified within resident’s files, and records of healthcare professionals involvement are also kept. A recent review of some of Marlstone’s healthcare practices has seen new guidance produced for the management of residents who have diabetes, which Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 Page 10 has resulted in all diabetic residents having their care reviewed and updated. Marlstones use the Boots (the Chemist) monitored dosage system for their medication. This system sees boots dispense residents’ medication into a weekly pack, with the correct dose of tablets identified for each specific time. Medication was seen to be stored securely, and the Medication Administration Record (MAR sheets) were seen and found to be complete and correct. Residents who self medicate are risk assessed, and have a care plan to follow, examples of both were seen. Two residents were asked about medication, neither self-medicated, but said they were happy for the staff to “look after the tablets.” At the last inspection it was recommended that window blinds be fitted to all bathroom windows (even those that are not overlooked) to improve the privacy of residents using the bathroom. This recommendation has now been met, and all bathrooms at Marlstones are fitted with blinds for the resident’s use. Three residents were asked about respect, and privacy issues. All three said staff knocked on their bedroom doors before entering, and said that they thought the staff treated them well, and with respect. Resident’s files identify resident’s wishes at the time of their death. Information seen covered next of kin, and funeral directors, as well as identifying an individual’s wishes in respect of cremation or burial. Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 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 the following standard(s): 12 13 14 & 15 The quality outcome in this area is good. This judgement has been made using the available evidence including a visit to Marlstones. Residents find that the lifestyle experienced at Marlstones matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Residents at Marlstones maintain contact with family/ friends and representatives and the local community as they wish. Residents are helped to exercise choice and control over their lives. Residents receive a wholesome appealing balanced diet in pleasing surroundings at times that are convenient to them, although the kitchen area could be improved. EVIDENCE: Three residents were asked about activities at Marlstones, and two said it was ‘alright’, while the third said, “there could be a bit more going on.” Discussions with the manager and the line manager for Marlstones, outlined plans to turn the unused flat at one end of Marlstones (formerly a staff flat) into a day centre for the use of some Marlstones residents and some from the community. This would improve the amount and quality of activities and occupation on offer for residents at Marlstones. The resident who expressed some dissatisfaction, did say that some structured in-house activity would be good. Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 Page 12 During the inspection Marlstones was found to be a ‘busy’ place with many visitors and a lot going on. Two visitors were spoken with during the inspection, they said that they could visit when they liked, and were always made to feel welcome. Both visitors said they thought their relative was well cared for, and the staff would always answer any questions. Two residents were asked about choice within Marlstones, both said that they thought there was “quite a bit of choice”, with one resident saying how they always had a “choice at mealtimes.” And the other saying they felt that “the staff usually asked before any activity, or anything really.” The kitchen was visited during the inspection, and it was noticed that the voil (the fine mesh that covers the windows to keep out flies), only covers half of the window, which effectively renders it useless. The manager and chef said that they had already raised this as an issue with the City Council, and they were waiting for a new voil to be fitted. It is strongly recommended that the manager contacts the City Council to chase the progress, especially as we are experiencing exceptionally fine weather at the moment, and there are a great deal of flying insects about. The menus were seen, and these showed a good variety and level of choice for residents while offering a nutritionally balanced diet. Five residents were asked about the food on offer at Marlstones, and among the comments received were: “It’s very good”, “I like the food”, “yes, there’s always a choice”, “It’s very nice”, and “Oh no, no complaints about the food.” The dining room is spacious and comfortable, and makes for a very pleasant dining area. Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 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 the following standard(s): 16 & 18 The quality outcome in this area is good. This judgement has been made using the available evidence including a visit to Marlstones. Residents and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon at Marlstones. Residents at Marlstones are protected from abuse. EVIDENCE: Marlstones complaints procedure is prominently displayed around the building, and forms part of the Service User Guide, of which every resident has a copy. Since the last Inspection there have been two anonymous complaints, both of which were investigated by the City Council’s management and found to be not proven. Two residents were asked about complaints; neither had ever made a complaint, but said they would talk to Cecelia (the manager) if they ever needed to. The two relatives who were spoken with were aware of the complaints procedure, but had never had cause to complain. One of the relatives was aware of the relatives and visitors comment book, although they said, “they had never written anything in there.” However two recent entries in the relatives and visitors comment book said: “A wonderful place – I visit at different times and have always witnessed tenderness and patience to all who live here.” “You have greatly improved my life too as I no longer need to worry about mother. It’s a pleasure to visit her and see her happiness.” Marlstones has a whistle blowing policy among its policies and procedures, and staff do receive training in Adult Protection. Two members of staff were spoken with, and both said that they had been on adult protection training. Staff training records were not initially clear regarding training in Adult protection, but it was possible to evidence that staff had received the necessary training. Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 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 the following standard(s): 19 20 24 25 & 26 The quality outcome in this area is good. This judgement has been made using the available evidence including a visit to Marlstones. Residents at Marlstones live in a safe, well-maintained environment. Residents have access to safe and comfortable indoor and outdoor communal facilities. Residents at Marlstones live in safe, comfortable bedrooms with their own possessions around them. Residents live in safe, comfortable surroundings. Marlstones is clean, pleasant and hygienic. EVIDENCE: A partial tour and inspection of all communal areas and some of the bedrooms, showed that Marlstones is well maintained and there are no obvious hazards. The area at the top of the stairs was discussed with the manager – it had been suggested that a gate should be placed there to prevent residents falling down the stairs, however the manager said, that no resident had ever fallen down the stairs, and there had not been any ‘near misses.’ Looking at the residents who currently live at Marlstones this is not seen as a problem, and the manager said that recently environmental risk assessments Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 Page 15 of individuals moving into Marlstones had been introduced, and the issue of the stairs would be assessed as part of that risk assessment. On the day of the inspection a new nurse call system (a Tunstall system) was being installed, which will improve resident safety, as staff will be able to respond quicker when ‘paged.’ The building is large, but there were obvious attempts by the staff to make it homely and to introduce smaller sitting areas, rather than having one large area. The manager said that there were plans to move the smoking room away from the front of the building, as some visitors had complained that they could smell the smoke when they entered the building. Marlstones stands in it’s own grounds which are enclosed by a fence, making it secure. The plans for the new day centre would include enlarging the car park at the front of the building, which is quite small, and on the day of the inspection was full, which currently makes it difficult for visitors to park their cars. Much of the grounds are laid to grass, with a number of trees offering shaded areas, and the patio has pleasant sitting areas with hanging baskets and pots. Security is an issue, with some of the garden furniture having been stolen recently, this has meant that the tables and chairs are chained and screwed to the floor, which does not make it the most comfortable area. Inside there are a variety of communal rooms from small lounges and a dining area upstairs to the larger central lounge and dining room. The layout of the building does give residents options on where they sit, and the company that they keep. Two residents were asked about the communal facilities and both said they thought they were fine. Several resident’s bedrooms were seen, and while these are on the small side, they do meet the minimum requirements. All of the bedrooms were well personalised, and comfortable. Two residents were asked about their bedrooms, and both said that they thought they were: “Very comfortable, although a little bit warm in this hot weather”, and “Very nice, my bed’s lovely – really comfy.” At the last inspection it was set as a requirement that all radiators within the building should have radiator covers fitted to ensure resident safety, this has now been done, and radiator covers were seen in all of the communal areas, and in individual’s bedrooms. Throughout the inspection domestic staff were seen to be cleaning and tidying in many areas, with floors being mopped, and hoovered. The toilets were found to be clean, and there was a fresh atmosphere throughout. Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 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 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 28 29 & 30 The quality outcome in this area is good. This judgement has been made using the available evidence including a visit to Marlstones. The numbers and skill mix of staff at Marlstones meets the residents’ needs. Residents are in safe hands at all times. It was not possible to be sure that residents are supported and protected by Marlstones’ recruitment policy and practices. Staff at Marlstones are trained and competent to do their job, although record keeping of such could be better. EVIDENCE: The staffing rota was seen, and this showed that there were sufficient numbers of staff on duty, and that there was a hierarchy within the staff team, providing a skill mix and experience. During the inspection there were plenty of staff on duty to meet the resident’s needs, and twice residents were observed calling for assistance, and a member staff quickly responded. Staff training records showed that five staff members had their National Vocational Qualification (NVQ) level II qualification, and four more were currently training to achieve this. Care Homes Regulations say that 50 of the staff team should have achieved an NVQ qualification or equivalent by 2005. The Marlstones team is slightly below this figure, however there is clear evidence of a training plan to move towards achievement. Marlstones is owned and managed by the City Council, recruitment is managed centrally, an appointment will be made to inspect recruitment records at the City Council in the near future. Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 Page 17 Staff training records were seen, and these showed that there is a formal training programme in place for staff at Marlstones. However the records were found to be out of date, with key information on courses missing from individual’s profiles. Two staff members were spoken with, and said that they had been on a number of relevant training courses, the records however did not reflect this. Staff training records need to be brought up-to-date, with all relevant training information recorded. Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 36 & 38 The quality outcome in this area is good. This judgement has been made using the available evidence including a visit to Marlstones. Residents at Marlstones 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 her responsibilities fully. Marlstones is run in the best interests of its residents, although it’s quality assurance system does not adequately reflect this. Resident’s financial interests are safeguarded. Staff at Marlstones are appropriately supervised. The health, safety and welfare of residents and staff at Marlstones are promoted and protected. EVIDENCE: The manager’s personal file was seen, and showed her to be suitably qualified and experienced. Marlstones does have a quality assurance system in place, however questionnaires were not dated, and the system appeared to be informal, and no analysis of the information was seen, to demonstrate that the Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 Page 19 quality assurance system was being used to improve the quality of care at Marlstones. The system for residents small cash needs was seen, and a random check of three resident’s finances showed that there was a clear audit trail, and that receipts were kept, and a check on balances of monies held also tallied. Records of formal supervision in staff files show that the staff are being supervised appropriately. Two members of staff were asked about formal supervision, and both said they felt very well supported, and that they were having regular formal supervision with a senior member of staff approximately every eight weeks. A range of health & safety records were seen including Fire Safety records, water testing and records relating to the Control of Substances Hazardous to Health (COSHH). All of these records were found to be complete and in order. Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 4 X 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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. 2. 3. Refer to Standard OP15 OP30 OP33 Good Practice Recommendations The Registered person must ensure that the voil on the kitchen window is extended to cover the entire window. The Registered person must ensure that staff training records are complete and up to date. The Registered person must ensure that the quality assurance systems at Marlstones are formalised – so that questionnaires are dated, and are sent out to residents and their relatives on a regular basis. Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Marlstones Care Home DS0000037295.V297272.R01.S.doc Version 5.2 Page 23 - 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. 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