Inspection on 26/09/05 for Meadow Cottage Nursing Home

This inspection was carried out on 26th September 2005.

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

Meadow Cottage Nursing Home 05/12/06

Meadow Cottage Nursing Home 07/02/06

Meadow Cottage Nursing Home 27/01/05

Meadow Cottage Nursing Home 10/08/04

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Coopers Mill Ltd

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Paradise Lodge

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Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Meadow Cottage Nursing Home 14 High Street Overstrand Norfolk NR27 0AB Lead Inspector Lella Andrews Announced 26 September 2005 09:30 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Meadow Cottage Nursing Home Address 14 High Street Overstrand Norfolk NR27 0AB 01263 579221 01263 579315 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) Elizabeth Fitzroy Support Edwin Clements Care Home 16 Category(ies) of Learning disability (16), registration, with number Physical disability (16) of places Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. 16 people, of either sex, who have a Learning Disability or Physical Disability, may be accommodated. Date of last inspection 27 January 2005 Brief Description of the Service: Meadow Cottage is located in the village of Overstrand and provides accommodation for up to 16 service users with learning and physical disabilities. All accommodation and communal areas are on the ground floor, with administrative offices located on the first floor. The home is situated close to local amenities and has views across to the sea. The gardens are easily accessible to all service users. Limited car parking is available to the front of the building and there is ample on-road parking outside of the home. Specialised aids and adaptations have been fitted in service users bedrooms and all communal areas as necessary. Assisted bathing facilities are located throughout the building and offer choice for service users. Communal areas provide a choice of seating as appropriate. Each of the communal rooms are spacious, allowing easy access for wheelchair users. Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection was announced and took place on Monday 26th September 2005 between 9.30am and 5.45pm. Not all of the National Minimum Standards were measured on this occasion. The Operations Manager and the Manager of the Home were present throughout the Inspection. The Inspector also spoke to two of the staff on an individual basis and spent some time in the communal areas with a group of service users and staff. It is not easy to obtain information from the service users due to their communication needs and the Inspector was reliant on staff to assist with communication. The environment standards were not measured on this occasion but the Inspector was shown around the communal areas of the Home by one of the service users accompanied by a member of staff. Several records were inspected, including care plans and staff recruitment files. What the service does well: What has improved since the last inspection? The Manager feels that the staff team are working more effectively as a team together Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.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. Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, 4 and 5 The Home has an effective assessment process for prospective service users Service users are provided with an individual statement of terms and conditions EVIDENCE: The Manager described the assessment process which was undertaken last year for the service user who moved to the Home most recently. The records relating to this process were also seen. The Manager and assistant Manager undertake the initial formal assessment and gathered information from the service user, family members, school and other professionals involved in the service users life. A key worker is appointed from the staff team and they become involved in the many visits made to the service user at school and at home. The service user visited the Home on several occasions, including for an overnight stay. The assessment information forms the basis of the service users care plan which is then regularly updated once the service user moves to the Home. The care plan includes a copy of the service users statement of terms and conditions which is provided in both words and symbol format. Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 9 The Home is able to evidence that they can meet the needs of the service users. Staff receive appropriate training to carry out their roles effectively. The issue of communication is given a high priority with staff receiving additional training and assessments undertaken for each of the service users with regard to their own forms of communication. The Manager provided examples of how the needs of a service user are met if following an alternative religion/culture. Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7. 8 and 9 The care plans reflect the service users changing needs and personal goals Service users are consulted on as many aspects of life in the Home as possible Service users are supported to take risks as part of an independent lifestyle EVIDENCE: The Home uses the Essential Lifestyle Plan as the format for the care plans. The Inspector looked at two of the plans and these were very detailed with evidence of regular reviews and updating of the information. Each of the service users has a key worker and, in addition, other staff who are part of their ‘key team’ who provide a supporting role to the key worker. The service users also each have a ‘named nurse’ who oversees the care planning process. The care plans provide detailed guidance for staff about how to meet individual needs. The format of the care plans includes detailed information about how to support the service user throughout the day i.e., morning support, afternoons, evenings, during the night. The care plans contain information Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 11 about what the service user might consider to be their ‘best day’ and their ‘worst day’. There is detailed information about the communication needs of the service users including details about what the service user might be trying to say through the use of, sometimes, small movements or sounds. The service users living at the Home do not use verbal communication in the form of words and so the communication work that staff have undertaken is extremely important. The staff are aware of the importance of working towards effective communication as this forms the basis on which they can ensure that the views and wishes of the service users can be listened to. The Inspector observed the staff spending considerable time with service users assisting them with communication in order to find out what the service user would like to do or which choices they would like to make about a range of issues. Two of the staff have completed the Total Communication training provided by the Speech and Language Therapy department and are in the process of completing detailed communication assessments for all of the service users which will form the basis for updating the communication care plans as necessary. The care plans include written risk assessments which are personal to each of the service users. These include risk assessments relating to every day issues such as moving and handling and the use of equipment as well as for individual situations such as holidays and going to nightclubs. The Manager and staff recognise that the service users have a lot of limitations placed upon them because of their disabilities but work hard to overcome some of these to ensure that the service users are able to take part in enjoyable activities in a safe way. Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 and 16 Service users have opportunities for personal development Service users are supported to take part in appropriate leisure activities and to be a part of the local community Service users are supported to maintain relationships with family and friends Service users rights are respected EVIDENCE: As previously mentioned, communication is given a high priority as the basis on which the staff will be able to better understand and meet the service users needs. The Home has a Community Resource Centre based next door and staff from the centre support the service users to take part in a variety of different activities throughout the week including weekends and evenings. The amount of support that the service users receive from this team varies greatly Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 13 and is dependent on the contract agreed with individual placing authorities. Therefore, some of the service users spend a lot of their free time with the Community Resource Team whilst others spend the majority of their time supported by staff from the Home. The Manager continually reviews each individual situation with the placing authorities. The Homes staff work well with the Community Resource Team and joint care plans are agreed between the two teams and the individual service user. The staff support the service users to use the local shops and other facilities within the local community. Service users can be supported to attend church if they wish to. The care plans contain information about the activities within the Home and in the community that individual service users enjoy. Staff have a good understanding of the interests of the service users and are enthusiastic about supporting service users to access these. The staffing levels will affect the amount of activities that service users can take part in. Staff and the Manager advised that there have recently been some difficulties with staffing but that these have been addressed and the staffing levels are now increased. The difficulties were mainly relating to service user and staff holiday times. All of the service users have been on holiday this summer. The majority of service users went abroad and the rest had holidays within this country. Several of the service users have recently returned from an activity holiday in Devon. This holiday included horse riding, boating, rock climbing and other outdoor pursuits. The care plans contain information about the service users family relationships and friends. Service users are supported to maintain contact with family and friends in a variety of ways, including letters, visits and the use of email. The service users rights are respected. The staff are aware that it is the service users home and act accordingly. Staff were seen to knock on doors prior to entering and to explain what they are going to do before assisting service users. The manager and the assistant manager are responsible for planning the shifts and identifying staff to work with each service user. Although this is a formal system the staff advised that there is flexibility within it. The planning takes account of the personal care needs of the individual service users and the plan for their day. The plan also tries to enable key workers to work with service users. The staff included the service users in whatever they were doing e.g. household tasks, recording daily notes. The staff spoke to the service users respectfully and were friendly and kind. Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 14 Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 and 19 The service users receive personal support in the way that they prefer and require The service users physical and emotional health needs are met EVIDENCE: As previously mentioned, the care plans contain detailed guidance to staff about how to meet each service users needs with regard to personal care. Staff were heard to explain to the service user what they were doing and to ask before providing assistance. Staff are very aware of the need to respect the privacy and dignity of the service users and gave examples of how this is done in practice. Service users are able to spend time in their rooms alone if they wish to or to spend time in the communal areas. From observations it is clear that the service users are encouraged to develop their own sense of style. Staff assist the service users to make their own choices about clothes and hairstyles. Two of the service users showed the Inspector their bedrooms and these also reflected the individual’s interests and choices about decoration and furnishings. Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 16 Two of the service users require naso-gastric tube feeding and therefore there is always a qualified nurse on duty to meet their needs. The nurses take the responsibility for leading the shift and for overseeing the care provided to all of the service users. The care plans contain details with regard to the individual health needs of the service users. The service users have a detailed health check assessment which is updated as required and contains details about routine checks such as dental and optical as well as any, more serious health situations. The staff are aware of the health needs of the service users and of how to meet these needs. The care plans show evidence of other health professionals, such as the physiotherapist, speech and language therapist and the dietician, being involved in the service users life with regard to assessment, planning of care and of providing advice and training to the staff team. Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 The staff work hard to obtain the views of the service users Service users are protected from abuse, neglect and self-harm although there is a need to ensure that all staff have received updated training with regard to this issue EVIDENCE: The Home has a complaints procedure, which is available in words and symbols. Although the staff work hard to obtain the views of the service users about a range of subjects it would be difficult for them to make a complaint on their own behalf. The Managers and staff are aware of this and try to involve the service users representatives i.e., parents, friends, as much as possible with regard to the service provided. The Manager advised that there have been no complaints made since the last Inspection. The Home has a range of policies and procedures which all aim to protect the service users from any form of abuse. Staff receive training within their induction about the standards expected of them and they receive training with regard to the protection of vulnerable adults within the first six months of working at the Home. The Operations Manager advised that this subject will now be included in the two week induction period for new members of staff which will be an improvement as staff will have the necessary information prior to working unsupervised with service users. It is recommended that the Manager ensures that all staff have received updated training with regard to the protection of vulnerable adults as some staff have not attended this training for several years. Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 18 The arrangements for looking after service users money were not inspected on this occasion. Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were inspected EVIDENCE: Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33. 34. 35 amd 36 Service users benefit from clarity of staff roles and responsibilities Service users are supported by an effective staff team of competent staff who receive appropriate training Service users are protected by the Homes recruitment practice Service users benefit from well supported staff but there is a need to ensure that formal supervision is recorded by the managers EVIDENCE: The Inspector spoke to staff, both nurses and support workers, and they are clear about their own roles and that of others within the team. Staff also understand the role of the Community Support Team who are based next door and who provide support to the service users. Staff advised that they have been given a copy of their job description and their contract. Staff are also given a copy of the General Social Care Councils code of practice. Staff advised that they received a good induction and that they were not asked to undertake tasks with the service users until they felt confident to do so. Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 21 Staff said that they feel able to ask other members of the team if they require assistance or advice and that the team works well together. There has recently been some changes in the way that training is organised as this is now done from the regional office in Norwich. This has caused some readjustment on behalf of the staff who were used to arranging their own training previously but the Manager advised that the new system is now working effectively. The Inspector saw a selection of the training records and these show that staff receive training with regard to mandatory subjects such as moving and handling, first aid, food hygiene, fire safety. Some staff have also received training with regard to person centred planning. The Manager advised that at least 50 of the care staff have achieved NVQ Level 2 training. The usual staffing rotas are for there to be six support workers on duty during the morning and five during the afternoon. There is, in addition, a qualified nurse on duty at all times over the 24-hour period. Staff confirmed the Managers view that the recent difficulties with staffing were caused by staff holidays and the fact that staff were supporting service users on holiday and that the staffing levels have since improved. The rotas show that this is the case. Staff advised that the staffing levels enable them to support the service users appropriately. Team meetings take place every few months and the key teams for each service user meet together more regularly to discuss issues relating to the service user. The staff advised that they receive good support from the Manager and assistant manager and that they are able to discuss issues with them as they need to. The staff advised that they do receive formal supervision but that this does not always take place on a two monthly basis. It is recommended that the staff do receive formal one to one supervision on this basis and that records are kept of this. The qualified nurses meet together with the Manager on a regular basis to discuss clinical and management issues. Two of the staff files were seen and these contained the necessary checks for new members of staff, including a disclosure from the Criminal Records Bureau. The Managers attend management training provided by the organisation which includes training with regard to recruitment procedures. Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38 and 42 The service users benefit from the ethos, leadership and management of the Home The service users benefit from a well run Home which focuses on meeting their needs The health, safety and welfare of service users are promoted and protected EVIDENCE: The Manager of the Home is a qualified nurse and has worked at and managed the Home for several years. He has undertaken additional training and is currently liaising with the Commission about whether the management training he has undertaken is equivalent to NVQ Level 4 in management. The Home has an assistant manager who also has many years experience of working with the service users. Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 23 The staff speak highly of the support provided by the management team. The management approach of the Home is open and positive with staff feeling that they are included within the decision making processes. The Inspector saw a selection of the records kept in relation to health and safety issues. These included some of the service certificates for the fire safety equipment and the hoists. The Home maintains a COSHH register and risk assessments are completed by the Manager for the building. Staff receive health and safety training within their induction period. Regular health and safety checks are undertaken within the Home. A record of accidents is kept appropriately with the outcome of any action taken following the accident. Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Meadow Cottage Nursing Home Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 3 x x x 3 x I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 25 no 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 Regulation Requirement there are no requirements as a result of this Inspection 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. Refer to Standard 23 36 Good Practice Recommendations it is recommended that the Manager ensures that all staff have received updated training with regard to the Protection of Vulnerable Adults It is recommended that all staff receive formal supervision on a two monthly basis and that records are kept of this Meadow Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 26 Commission for Social Care Inspection 3rd Floor - Cavell House St Crispins Road Norwich NR3 1YF 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 Cottage Nursing Home I55 s15659 Meadow Cottage v236002 (an) 260905 Stage4.doc Version 1.40 Page 27 - 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!