Inspection on 02/05/06 for Meadow Bank Nursing Home

This inspection was carried out on 2nd May 2006.

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

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

Other inspections for this house

Meadow Bank Nursing Home 13/05/09

Meadow Bank Nursing Home 07/05/08

Meadow Bank Nursing Home 15/06/07

Meadow Bank Nursing Home 04/10/06

Meadow Bank Nursing Home 15/11/05

Meadow Bank Nursing Home 28/04/05

Meadow Bank Nursing Home 02/09/04

Meadow Bank Nursing Home 01/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Meadow Bank Nursing Home Curthwaite Wigton Cumbria CA7 8BG Lead Inspector Colette Hibbert Unannounced Inspection 02 & 10 May 2006 09:00 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 Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 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. Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Meadow Bank Nursing Home Address Curthwaite Wigton Cumbria CA7 8BG 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) 01228 710279 Mr B & Mrs L Whalley Care Home 19 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (19), of places Physical disability (2) Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 19 service users to include: up to 19 service users in the category of OP (Old age, not falling within any other category) Two named service users in the category of PD (Physical Disabilities) may be accommodated within the overall number of registered places. Three named service users in the category of DE(E) (Dementia over 65 years of age) may be accommodated within the overall number of registered places. 15th November 2005 2. 3. Date of last inspection Brief Description of the Service: Meadow Bank Care Home is an adapted Victorian House set in extensive grounds in a rural area approximately eight miles from Carlisle. Mr and Mrs Whalley are the Registered Providers of the home. Nursing Care is provided for a maximum of 19 residents, but because most residents choose not to share a room there are not usually that number of living in the home. Therefore the double rooms maybe used as singles. There are bedrooms on both floors with the first floor being accessible by either the stairs or the passenger lift. There are two bathrooms; one on each floor, there is also a shower on the ground floor. The large lounge has big windows allowing residents lovely rural views. There is a dining room available for residents to use. Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection undertaken by 3 regulatory inspectors taking place over the course of 2 days. The registered manager was present throughout. Before the site visit information had been requested from the home, which has not been made available. A few residents questionnaire have been returned to CSCI, and this information has been used within the context of this report. The inspection included a tour of the premises, looking at all communal and private areas. Time was spent talking with residents, staff and the manager, and looking at relevant documentation such as care plans policies and procedure and other records required by regulation. What the service does well: What has improved since the last inspection? The home has purchased a new profile bed and has decorated 2 residents bedroom and fitted these rooms with new carpets. Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 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. Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3, Quality in this outcome area is poor. This judgement has been made using available evidence including two visits to this service. Prospective residents have a care needs assessment visit carried out before they are admitted to the home, but inadequate records are made to provide information to the staff for them to provide appropriate care. Residents are not given adequate information to make an informed choice. EVIDENCE: Residents are invited to look around the home prior to admission although some did choose not to as they had relatives working here. Residents have some assessment before admission but this is not adequate to ensure their care and nursing needs can be met by the home. There was no statement of purpose or service user guide to provide information about the services. This enables the prospective resident to make an informed choice. Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 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,and 10 Quality in this outcome is poor. This judgement has been made using available information including two visits to this service. Care plans do not reflect the needs of the residents putting them at risk from receiving inappropriate care. Poor working practices were observed and residents privacy and dignity is not maintained. EVIDENCE: Each service user has a care plan in place but they were not of a consistant standard. Some did not contain appropriate or adequate information for staff to deliver care. There was a policy in place for pressure care with reference to Norton scale, and guidence as to equipment to be used but this was not followed through in practice. There was also a written policy in place for care plans stating that each resident was to have one, covering all aspects of care and treatment, visiting medical and hospital appointments to be written up immediately. One resident had been admitted for 2 weeks respite care and had a blank care plan with limited information for the staff to base their care on. There were no risk assessments undretaken or documented. This resident had only a hand Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 Page 10 written scrap of paper with minimal medical information and another piece with likes and dislikes on. Daily progress records were very limited and did not identify the personal care tasks that the resident had received. Another care plan, for a resident who had a peg tube in place, did not indicate the regime details for the staff to follow which may lead to the resident not receiving the appropriate amount of nutrition. Another resident was in hospital and had had 6 GP visits this year but care plan records indicate no change in condition over this period of months. During the morning one resident was seen to be having personal care being given by a member of staff with the bedroom door wide open. This practice did not maintain the residents dignity or privacy. When one of the inspectors knocked on another door a member of staff flung the door open wide to expose the resident sat naked on the commode. Medications were looked at. Photographs of the residents would be of more practical use if they were stored with the appropriate residents MAR or medication chart. The home has two medications systems currantly running due to problems with one of the surgeries. Medication was found to be still in the trolley that were no longer in use and should have been disposed of. Also out of date medication had not been returned. The manager said that she would do that once the inspector had highlighted the problem. One residents teeth had been left in the sink and in several rooms residents glasses had been left on the bedside cabinet tops whilst the residents were in the lounge without them. Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 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, and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including 2 visits to this service. Residents can maintain contact with family and are able to make some choices in daily lives. Nutritional and dietary needs are not assessed putting the residents at risk from not receiving adequate nutrition. EVIDENCE: Residents spoken with stated that they maintain contact with their families and visitors are welcome at any time. Although on both visits to the home no visitors were seen. Some residents go to day services but the majority stay within the home. There were very limited activies and residents seem to only have staff attention when they were performing personal care tasks. Residents can make choices over what time they get up, go to bed or what they wear. There is no set menu, and the kitchen had very limited stock. The cook decides on a daily basis what he will make, records of what the residents eat is not kept in full only those who have alternatives, even though this was a requirement at the last inspection. Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 Page 12 Residents who required a soft diet were served a soft grey mash which was roast pork, mash and veg all mixed together in the bowl and did not look very pleasant or appetising. The cook said that the menu is put up in the lounge about 10:30 am for the residents to say what they want. One member of staff said they had concerns about the diet the residents were being served.The manager does the shopping for the home food supplies several times a week from various local shops, but on both visits to the home the inspectors found very few supplies within the kitchen especially fresh fruit and vegatables. The cook said that there is always a selection of puddings as the residents liked them. Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 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 and 18 The quality in this outcome area is adequate. This judgement has been made using available evidence including 2 visits to this service. Residents were aware of the procedure to complain and felt protected by policies in place. EVIDENCE: There is a compaints procedure and policy in place. Staff spoken with said that they would speak to the manager if they had any concerns. The residents spoken with said that if they had any complaints they would talk to the staff and felt that any issues would be dealt with in an appropriate manner. Staff spoken with were aware of the need to protect vulnerable adults however they had not had access to training and were not sure what the correct procedure would be to refer an incident as an adult protection matter. Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 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): 19,2o, 21,22,23,24,25,26, The quality in this outcome area is poor. This judgement has been made using available evidence including 2 visits to this service. The building in general is not well maintained and the bathrooms do not provide a pleasant environment for the residents.Some of the residents own rooms are full of nursing equipment which is not maintaining their privacy or dignity. EVIDENCE: The home in general was not well lit; it was dark and rather tired in appearance Externally there was old furniture in the garden waiting to be removed. The external fire escapes require some work on them so that they can be used safely. All the rooms are currently used for single occupancy, some have ensuite toilets, others have wash facilities. Several residents’ rooms had medical and incontinent equipment piled up against the walls and on top of wardrobes. This did not maintain the resident’s Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 Page 15 privacy or dignity and the home needs to look for alternative ways of storing medical equipment. The ground floor bathroom had an expel air that did not work and the room had no windows therefore the room had no ventilation and consequently felt damp and smelt. There was a light hanging from the ceiling with no shade. There were bottles of various toiletries on the shelf obviously for communal use in all the bathrooms, which does not promote the resident’s individuality or choice. One of the ensuite facilities need re decorating and the bedroom carpet has stains on it. This room was very smoky, as the staff sit and smoked in the corridor outside this room. The home should look to provide a different area for staff to have their breaks to improve the environment for the residents. The laundry is in the basement and clean linen is stored against a dirty damp wall and some of the bedding was in need of replacing as it was well worn. The toilet by the front door has damp on the walls and the plaster is falling off the wall and needed to be redecorated. Commodes in residents’ rooms throughout the home had been left in need of cleaning as staff had emptied them but not washed them, this is bad practice and is a health hazard. One of the first floor bedrooms need to have window restraints fitted to maintain the residents safety There are stairs from the first floor to the loft, which is used for storage and was full of rubbish and is a fire hazard and in need of clearing to maintain a safe environment. Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 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,and 30 The quality in this outcome area is adequate. This judgement has been made using available evidence including 2 visits to this service. There were adequate numbers of staff on duty to meet the care needs of the number of residents at present in the home. Staff need to have more planned training sessions in adult protection to secure the safety of the residents within the home. EVIDENCE: On the days of the inspection there was 1 RGN,2 care assistants,1 cleaner,1 Laundry assistant and 2 kitchen staff There appeared to adequate numbers of staff for the number of residents in the home but the staff stated that when all the beds are full they find it difficult to provide appropriate care. Staff spoken with were aware of the issues relating to Adult Protection but unsure of the policies and procedures relating to this area. They had not received training on this. One member of staff who had worked in the home for 15months had only been offered training in Infection Control and nothing else. Staff training records had not been kept and there was no evidence to support a training programme within the home. There had not been any further nurses taken on to allow the manager some management time. The manager stated that she has finished her RMA but no evidence was available to confirm this. Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 Page 17 The deputy manager is still going to palliative link nurse meetings and 2 nurses are doing wound care training. Moving and Handling training was not up to date and the fire training and safety checks were inadequate and not recorded. Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 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): 31,32,33,34,35,36,37,and 38 The quality outcome in this outcome area is poor. This judgement has been made using available evidence including two visits to this service The home has no quality audits to give the staff and residents the opportunity to express their opinions on the quality of service provided. Staff do not receive adequate training or supervision to ensure that they are competant to provide care for the residents in this home. EVIDENCE: The pre-inpsection questionaire and service users questionaire which were sent out to the home prior to the site visits have not been returned by the manager. The manager works 5 shifts a week as the qualified nurse on duty and has no designated management time during the week. This was discussed at the last inspection and the manager was going to address this but has not. Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 Page 19 The home has failed to send to CSCI notification of incidents within the home which is a legal requirement and the providers have not sent in monthly reports on the progress of the home to show that they are auditing the service they provide for the residents within the home. Social services hold most of residents money the home only hold small amounts of money and records were not available at the inspection so will be checked at the next inspection. Staff records had no documentation for supervision and when talking with the staff it was confirmed that they did not have support or supervision to enable them to develop and improve the service they deliver. Policies and procedures were not reviewed and updated on a regular basis to provide staff with up to date information and guidence Several bedrooms had commodes in them that had been emptied but not cleaned and the downstairs bathrooms had several disposable razors in a cup for use on any resident. This is poor practice and both a cross infection risk and a health and safety risk for the residents. The residents said that there are no residents meeting or questionaire to ask for opinions on the service. Staff spoken with said that they did not have staff meetings and the manager confirmed this stating that staff communicated at hand over. The filing system for the service records for the equipment in the home was not organised and it was hard to follow and the passenger lift had not been serviced for several years.This should be serviced regularly to secure the safety of the residents and staff. The accident book had been filled in but not signed off by the manager so no one was monitoring these incidents. Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 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 1 1 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 1 3 1 1 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 1 1 2 Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 Standard OP1 OP2 OP3 Regulation 4(2) 3(b) 5(1c) 14(1a) Requirement Statement of purpose and service user guide must be available within the home. Each service user must have an individual contract and statement of terms. Prior to admission each service user must have an admissions assessment and this must be documented in the care plan All service users health, personal and social care needs must be identified in the care plan All care plans must be updated to reflect changing needs and current objectives for health and personal care and actions to achieve these. Outstanding from 29/11/05 The timescale has been extended Medication audit must be carried out regularly and any out of date medications safety disposed of. Residents dignity and privacy must be maintained at all times More programmed organised social activities must be made DS0000010101.V291114.R01.S.doc Timescale for action 31/05/06 31/05/06 31/05/06 4 5 OP7 OP8 15(1) 15(2) 31/05/06 31/05/06 6 7 8 OP9 OP10 OP12 13(2) 12(4a) 16(2m) 31/05/06 31/05/06 31/05/06 Meadow Bank Nursing Home Version 5.1 Page 22 9 OP15 17(4) available for the residents during the day. A record of all meals taken by service users must be kept. Where a service user has something different to the main choice then this must be recorded. Outstanding from20/05/05. The timescale has been extended The meal prepared to residents on a soft diet must be presented in a more appealing and appetizing manner The home must provide a set weekly menu plan Staff must receive training on Vulnerable Adult Protection The home must develop a maintenance system and document repairs. The internal decoration of the home must be maintained The bathrooms on both floors must be repaired and ventilation improved Resident’s rooms must not be used for storage of medical stores. Residents bedrooms must be comfortable and well decorated The laundry store room must be Tidy and dry. Staff must have an individual training and development assessment profile. Outstanding from 20/12/05. The timescale has been extended 31/05/06 10 OP15 16(2i) 31/05/06 11 12 13 14 15 16 17 18 19 OP15 OP18 OP 19 OP20 OP21 OP23 OP24 OP26 OP29 16(2i) 18(1i) 23(2b) 23(2b) 22(2p) 23(2b) 23(2l) 23(2d) 23(2b) 18(1) 31/05/06 30/06/06 31/05/06 30/06/06 30/06/06 31/05/06 30/06/06 31/05/06 31/05/06 20 21 OP30 OP31 23(4 de) 10(i) Staff must have training in Fire 31/05/06 Safety and this must be recorded The manager must have allotted 30/06/06 documented time for management of the home DS0000010101.V291114.R01.S.doc Version 5.1 Page 23 Meadow Bank Nursing Home 22 23 OP32 OP36 16(2n) 18(2) The home must have residents and staff meetings with documented minutes Formal supervision of staff must commence Outstanding from 20/05/05 The timescale has been extended The homes policies must be reviewed and updated on a regular basis The manager must make the fire escape safe to be used by staff and residents. 31/05/06 31/05/06 24 25 OP37 OP38 24(1) 23(4b) 23(2b) 30/06/06 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP27 OP32 Good Practice Recommendations Personal care records should be clear about what care has been given. Staff meetings should commence, as should resident and relative meetings to aid in communication between all parties. (Outstanding from 28/04/05) Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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 Meadow Bank Nursing Home DS0000010101.V291114.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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