CARE HOMES FOR OLDER PEOPLE
Melrose Residential Home 50 Moss Lane Leyland Preston Lancashire PR25 4SH Lead Inspector
Pauline Randles Unannounced Inspection 4th January 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 Melrose Residential Home DS0000039455.V275822.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. Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Melrose Residential Home Address 50 Moss Lane Leyland Preston Lancashire PR25 4SH 01772 434638 01772 434638 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) Mrs Amina Makda Miss Shazmeen Makda Mrs Janet Lesley Turner Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th April 2005 Brief Description of the Service: Melrose is a care home providing personal care and accommodation for up to 26 older people. Nursing care is not provided by the home and the district nursing team undertakes any nursing intervention needed. Melrose is privately owned and is situated close to the town centre of Leyland with all the local amenities. The home provides accommodation on three floors in both shared and single rooms. The majority of the shared rooms have a single occupant. One single room has an en-suite facility. The communal areas are situated on the ground floors and the home has a passenger lift and stair lift. The grounds to the house are small but adequate for the service users to enjoy. Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over a period of six hours. The focus of the inspection was to assess progress following a monitoring visit made in October and to assess standards not addressed at the previous inspection in April. There were sixteen people residing at the home at the time of inspection and one resident was in hospital. During the course of the inspection the registered manager, two staff and eight residents were spoken to and, three residents were case tracked. In addition policies, procedures and records were examined and relevant aspects of the premises viewed. What the service does well: What has improved since the last inspection? What they could do better:
There were five issues of serious concern identified during the inspection as follows: Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 6 A copy of the fire risk assessment was not available for inspection on the premises although this had been a requirement following a previous inspection and was an issue of safety concern. The 5 yearly electrical hard wiring testing had not been completed when due in October 2005 therefore no certification of current safety was available. There was no record that emergency lighting had been tested during December which contravened the monthly test requirement that had been agreed following a recent Fire and Rescue Service inspection. Three radiators in the lounge were not working at the time of inspection and were reported to the proprietors but no immediate action was taken to remedy the matter. Money saved on behalf of residents was not accurately recorded and did not reflect the amount of money held for individuals. Further requirements and recommendations arising from this inspection were as follows: The Service User Guide did not reflect services and facilities as provided by the care home and must be revised to ensure accuracy. To support the health and welfare of residents, nutritional assessments must be effectively applied and the adult protection procedure must be reviewed. An appropriate level of training in protection of vulnerable adults should be provided. All parts of the care home must be kept clean and reasonably decorated and residents must be consulted about activities and service quality. Plans for future refurbishment and an annual development plan of the home must be produced to ensure continuous service improvement. To support the dignity of residents, laundry systems, toilet door signage and hairdressing facilities should be reviewed. For fire safety and security purposes a record of all visitors to the care home should be maintained. A list of contractors should be held on the premises to enable ease of access when urgent repairs are necessary. The water temperature in Room 4b should continue to be monitored to assess whether a suitable water temperature is reached and maintained. A copy of the Health and Safety executive Report should be forwarded to the Commission For Social Care Inspection (CSCI), when available, to confirm that remedial work has been conducted to a satisfactory environmental standard. Supervision of care staff should take place at least six times a year to provide adequate levels support and guidance to staff. Policies and procedures should be kept under review to maintain relevance. A refurbishment plan and an annual development of the home must be produced to ensure continuous service improvement.
Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 7 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. Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 8 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 Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 9 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 and 3 Information provided by the care home did not adequately inform prospective residents about the facilities and services offered. Pre admission needs assessments were thorough and the outcome was clearly confirmed EVIDENCE: The Statement of Purpose and Service User Guide did not accurately reflect the present facilities and services provided by the home and included contradictory statements. For example the care home was described as a “nonsmoking environment” and yet the document went on to state, “Smoking is allowed in only designated areas.” It was also stated that the home “Can accept small amounts of money for temporary safekeeping” and yet it was emphasised elsewhere in the document that the home, in relation to personal finances “Does not accept any responsibility.” It is required that the Statement of Purpose and Service User Guide be reviewed and revised as appropriate to accurately reflect service provision. Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 10 Files examined indicated that initial needs assessments had been undertaken and a letter to confirm whether a residential place could be provided had been introduced so that the assessment outcome was clearly confirmed. The falls risk assessment had been further developed to include a risk reduction strategy. Detailed plans of care had been developed from the initial needs assessment information to guide care provision. Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 11 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): 8 and 10 Health care needs were suitably met through effective multi disciplinary working however the process for assessing nutritional needs was not being adequately implemented. Personal care services were delivered with courtesy and respect although the privacy and dignity of residents was undermined by some of the systems in place. EVIDENCE: Examination of individual files and discussion with residents confirmed that health care needs of individuals were being effectively met. Visits from health care professionals that included the general practitioner, district nurse and chiropody services had been recorded. Additional relevant services were accessed according to need for example one resident spoke about emergency services being called in as a response to a serious health concern and said,“ as soon as I had a stroke the paramedics came.” In respect of after care at the home the resident went on to say “they will do anything at all to make sure you are comfortable.” Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 12 The weight of individual residents was recorded and any fluctuation monitored as an element of the care plan review. Examination of a nutritional needs assessment for one resident had not identified significant weight fluctuations that had occurred and indicated “low risk” as an assessment outcome. It was required that the process of undertaking nutritional assessments be reviewed to ensure effective application. Residents confirmed that staff members demonstrated courtesy and respect in the provision of personal care. It was observed that staff spoke to residents in an appropriate manner and promoted self- determination. Comments made by residents included, “well looked after,” and “care very good, excellent.” Several residents and staff members commented that items of laundry were not always returned to the owner. It was therefore recommended that laundry systems be reviewed. Signage on the staff toilet door was unsuitable to the promotion of a dignified culture and it was requested that this be removed. Hairdressing presently takes place in a bedroom with the permission of the two residents who are accommodated in the room. It was recommended that a more suitable alternative should be identified to preserve the private space for the intended purpose. Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 13 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 Residents were not sufficiently involved in planning and evaluating activities. Meals were good and residents were enabled to exercise choice over menus. Residents were enabled to see visitors of their choosing in private if they so wished. EVIDENCE: Discussion with staff and residents confirmed that social activities had been provided over the Christmas period although records were not available to evidence this. Plans were being made for further activities to take place. It was required that consultation, participation and satisfaction of residents be recorded to ensure that activities are resident led and meet their preference. The policy of the home in regard to visitors was clear and residents confirmed that visitors were made welcome. Refreshments were offered and privacy enabled as required. The visitors’ book had not been completed for the last two months and it was therefore required for fire safety and security purposes that the practice of signing in be reinstated. Residents spoken to confirmed that they were enabled to exercise choice and control by, for example, choosing meal and bed times. There was an apparent
Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 14 openness between staff and residents and a sense of a relaxed environment that was not governed by house rules. Menus indicated a balanced and nutritious diet. Preferences of residents were clearly recorded and more than one resident commented that meals were, “very good.” Temperature records had been effectively completed and were up to date. Residents were enjoying a hot meal during the time of the inspection. The mealtime was relaxed and residents were being suitably assisted where necessary. Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 15 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): 18 The policies, procedures and training provided by the care home were not sufficient to protect residents from the potential of abuse. EVIDENCE: There was an adult protection policy in place that included procedures for whistle blowing and dealing with aggression. However the procedures had been acquired from a number of sources and were in need of review and adaptation to reflect the Melrose environment. The registered manager and a senior member of staff had undertaken protection of vulnerable adults training but at a level that was more advanced than necessary. It was required that policies and procedures are reviewed and suitable training in protection procedures be provided for the staff team. Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 16 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, 25 and 26 The general cleanliness and decoration of the premises was not of an acceptable standard. Monitoring and repairs systems were not adequately implemented. EVIDENCE: The conservatory and main corridors of the care home were in need of cleaning and redecoration at the time of inspection. Radiators in the hallways were extremely dusty, light fittings in the main entrance hall were dirty and lace curtains in the conservatory were soiled. The maintenance record had not been kept up to date and tasks had not been undertaken promptly. A list of contractors was not held at the home although this had been a previous requirement. The premises must be kept clean, reasonably decorated and in a good state of repair. Also a refurbishment plan must be in place to evidence an ongoing commitment to continuous improvement. As noted at the monitoring visit in October some improvements had been made to the distribution of hot water and water was no longer being carried to
Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 17 rooms. However the water temperature in room 4b had not been checked, according to records available, during the month of December. At the time of inspection the water in room 4b achieved only a temperature of around 30 degrees after approximately five minutes of running. It was recommended that the water temperature in room 4b continues to be monitored and remedial action be taken if there is not significant improvement. The home was generally warm on the day of inspection apart from the large lounge that had three radiators not working. The registered manager contacted the proprietors for advice but no immediate action was taken to rectify the problem and therefore an immediate requirement notice was issued. Extensive work had been undertaken in the laundry to ensure the flooring and ventilation conforms to health and safety requirements. Washing machines had the required programming ability and included a sluice facility. It was recommended that a copy of the Health and Safety Executive report be forwarded to the Commission For Social Care Inspection when available to confirm that the work that had been undertaken met required environmental standards. Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 18 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, 29 The numbers of staff and their training and experience provided a suitable mix of skills for the home. The procedures for the recruitment of staff were adequate and safeguarded residents. EVIDENCE: Examination of staff rotas and discussion with staff indicated a good skills mix and adequate cover in place that met the requirements of the previous regulatory authority. The manager works 35 hours over four days and a senior care staff member covers the fifth day in a management capacity. In addition the registered manager, or a senior care staff member, was on call at all times. Domestic staff attended to basic cleaning requirements. Heavier cleaning relied on arrangements made by the proprietor to provide a maintenance worker at reasonable intervals. As noted in relation to standard 19 there were some concerns about the adequacy of the arrangements made for heavier cleaning and repairs. Recruitment procedures had improved since the previous inspection through the introduction of a checklist that ensured all required steps in the process were taken. Also a system of maintaining a record of the unique Criminal Records Bureau (CRB) number had been introduced for reference purposes. Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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 and 38 The lines of accountability between the registered manager and the proprietors were unclear and quality assurance systems were inadequate. Care staff members were not provided with supervisory guidance and support at a suitable frequency. The financial interests of residents were not safeguarded by the systems used for recording money held. EVIDENCE: The registered manager had suitable qualifications and experience to run a care home and had undertaken further relevant training for example in adult protection, care of people with dementia and medicines management. When speaking with senior care staff their understanding of lines of accountability between themselves and the manager appeared clear. However the lines of accountability between the registered manager and the registered proprietors
Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 20 were less clear. Lack of access to budgets and lack of information to enable the commissioning of contractors were recurring issues that remain unresolved. It had been previously requested that monthly management meetings be recorded to clarify any areas of concern but there were no minutes available for examination at the time of this inspection, so this remains a recommendation. Staff members spoken to expressed their concerns about the lack of effective communication with the proprietors and their concerns about the limited powers delegated to management and the resulting constraints. There was no annual development plan for the home and feedback from residents had not been actively sought to assess how well the home was doing in meeting its’ objectives. Policies and procedures had not been regularly reviewed and a number of actions had not been progressed as required from previous inspection visits. These matters must be addressed as a matter of quality assurance. Small amounts of money were held on behalf of some residents who were unable to attend to their own affairs. Written records of financial transactions carried out were maintained. However in three records checked, the amount of money held was more than the amount recorded. It was an immediate requirement that the discrepancy be addressed without delay to protect the financial interests of all concerned. Some supervision had been provided to care staff since the previous visit using an improved matrix but the target of a minimum of six times a year was not being achieved so this remains a recommendation. There were plans to involve senior staff in the provision of supervision, subject to their undertaking training in the topic, but this had not yet materialised and there were no schedules available to evidence any ongoing plan. Training records indicated that mandatory training in safe working practices was provided for staff and there were policies and procedures in place relating to health and safety. Test certificates were in place apart from the five yearly test of electrical wiring and the emergency lighting test that had been a matter of a recent Fire and Rescue service requirement. As mentioned in regard to standard 25 there were three radiators out of order in the main lounge. Also the fire risk assessment was not available for examination although this had been a matter of an immediate requirement in November 05.To ensure the health and safety of all people living and working at Melrose these requirements must be acted upon as a priority. In addition it was recommended that books held on a shelf situated at the top of the cellar steps be removed to another site to reduce the possibility of an accident occurring. Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 X X X X X 2 2 STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 X 2 Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 6 (a) Timescale for action The Service User Guide must be 15/02/06 reviewed to ensure that services and facilities are accurately represented. A revised copy to be issued to residents and forwarded to the Commission For Social Care Inspection (CSCI) by the date indicated. Nutritional assessments must be 31/01/06 effectively maintained. Residents must be consulted 31/03/06 about activities with records maintained. (Previous timescales of 30/7/05 and 30/9/05 not met.) The adult protection policy and 31/03/06 procedure must be reviewed and appropriate training be offered to staff members. All parts of the care home 31/01/06 should be kept clean and reasonably decorated. Repair and maintenance tasks 31/01/06 must be attended to promptly and action taken recorded. (Previous timescales of 30/7/05 and 30/9/05 not met) A refurbishment plan must be 31/03/06 produced for the home.
DS0000039455.V275822.R01.S.doc Version 5.1 Page 23 Requirement 2. 3. OP8 OP12 14 (2) (a) (b) 16 (2) (m) 4. OP18 13 (6) 5. 6. OP19 OP19 23 (2) (d) 23 (2) (b) 7. OP19 23 (2) (b) Melrose Residential Home 8. OP33 24 (1) (a) 9. 10. OP33 OP35 24 (1) (a) (b) 16 (2) (l) 11. OP38 23 (4) 12. OP25OP38 23 (2) (p) 13. OP38 23 (2) (c) 14. OP38 23 (2) (p) Residents and other stakeholders must be consulted about the quality of care provided. An annual development plan must be produced for the home. Money held on behalf of residents must be accurately recorded and reflect the amount of money actually held for individuals. The action taken to remedy present discrepancies must be notified to CSCI by the date indicated. A copy of the completed fire risk assessment must be forwarded to the Commission for Social Care Inspection (CSCI) by the date indicated and a copy be retained at the care home. (Previous timescale of the 4/11/05 not met.) All radiators in the lounge must be working. Remedial action to be notified to CSCI by the date indicated. The five yearly test of electrical wiring must be completed and a certificate confirming safety be available for inspection. Action being taken to address this matter to be notified to CSCI by the date indicated. Emergency lighting must be tested monthly and a record maintained. Action being taken to remedy this shortfall to be notified to CSCI by the date indicated. 31/03/06 31/03/06 13/01/06 13/01/06 13/01/06 13/01/06 13/01/06 Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 24 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. 2. 3. 4. 5. Refer to Standard OP10 OP10 OP10 OP13 OP19 OP25 OP26 Good Practice Recommendations Laundry systems should be improved to ensure washed clothes are returned to their owners. Alternative hairdressing facilities should be identified. Unsuitable signage should be removed from the staff toilet door. A record of all visitors to the care home should be effectively maintained. A list of contractors and service numbers should be held on the premises. The water temperature should continue to be monitored in room 4b. A copy of the Health and Safety Executive report relating to the laundry floor should be forwarded to the CSCI when work has been completed and approved. Notes of the monthly management meeting should be available for inspection. Policies and procedures should be regularly reviewed. Care staff should receive formal supervision a minimum of six times a year. Books should be removed from the bookshelf at the top of the cellar steps. 6. 7. 8. 9. OP31 OP33 OP36 OP38 Melrose Residential Home DS0000039455.V275822.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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