Inspection on 04/06/07 for Ranelagh House Residential Care Home

This inspection was carried out on 4th June 2007.

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

Other inspections for this house

Ranelagh House Residential Care... 09/07/08

Ranelagh House Residential Care... 15/01/07

Ranelagh House Residential Care... 03/01/06

Ranelagh House Residential Care... 19/10/05

Ranelagh House Residential Care... 28/10/04

Ranelagh House Residential Care... 14/04/04

Ranelagh House Residential Care... 26/11/03

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

CARE HOMES FOR OLDER PEOPLE Ranelagh House Residential Care Home 533 Aigburth Road Liverpool Merseyside L19 9DN Lead Inspector Peter Cresswell Key Unannounced Inspection 4th June 2007 08:45 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 Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ranelagh House Residential Care Home Address 533 Aigburth Road Liverpool Merseyside L19 9DN 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) 0151 427 4486 lil@ranelaghhouse.com www.RanelaghHouse.com Prima Health Care Limited Margaret Lilian Martin Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th January 2007 Brief Description of the Service: Ranelagh House is situated in the Aigburth area of Liverpool, close to local amenities and on bus routes to the city centre, Speke retail park and John Lennon airport. The home provides care for up to 26 older people who have single rooms, with up to two rooms available for those who may want to share (for instance married couples or partners). Most of the bedrooms have en suite facilities. The rooms are on two floors and there is a passenger lift to the first floor. Three rooms on the first floor cannot be reached by the lift so people who live in that part of the home have to either use the stairs or a stair lift. There is car parking at the side of the house and on the main road, and a secure, well-tended garden to the rear. Fees for Ranelagh House are from £307.50 to £340 a week. Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit during which the inspector looked at all parts of the home, spoke to five residents, the registered manager (referred to as the manager in the body of this report) and three members of staff. He also spoke to the owner on the telephone and examined documents, including care plans, reviews, daily reports, fire safety documentation, accident reports and medication. The registered manager returned a pre inspection questionnaire before the site visit and four residents completed survey forms. What the service does well: What has improved since the last inspection? What they could do better: Fire doors must not be propped open unless an approved device is used. Care needs to be taken with the administration of medication to ensure that all medication is recorded and accounted for. Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 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 Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, 5. Quality in this outcome area is good. Ranelagh House’s pre-admission assessment procedures ensure that residents are appropriately placed and therefore receive care that meets their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Everyone who lives at Ranelagh Lodge is provided with a statement of terms and conditions, plus a contract when they move in to the home. Someone who is considering moving in can visit the home or have an overnight or trial stay before they move in permanently. One resident who had moved in recently told the inspector that he had been to the home before he made a final decision. The Registered Manager or her deputy carries out a full assessment of prospective residents before they are admitted to the home, to ensure that their care needs can be met. Other professionals who know the resident – such as social workers - are also normally involved in the assessment and Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 Page 9 copies of their assessment kept on file. The completed document forms the basis of the resident’s care plan when they move in. In a survey form one resident said ‘I was in a home where I did not feel settled and comfortable. I have been made very welcome here at my new home and I am very pleased by the way I have been treated’. Ranelagh House does not provide intermediate care, so Standard 6 does not apply. Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is adequate. Care planning is generally good and the monthly reviews ensure that staff are aware of residents’ current needs. Care needs to be taken to ensure that all care plans are in place. The system for organising medication is generally sound, protecting the welfare of the residents, though attention needs to be paid to the need for detailed and accurate recording. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents have an individual care plan, which is drawn up when they are admitted to the home. Care plans are reviewed each month by keyworkers and are checked and signed off by the Registered Manager. Other staff also take part in the review process, which is well documented. Care plans are written manually and it would be easier to update them if they were kept on a computer. Care plans were in place for three of the residents whose files were checked but a fourth was blank, though this person’s care had been reviewed. It is important that all residents have an up to date care plan as they form the basis of the care provided. Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 Page 11 Care staff complete a daily record for each resident and the manager has produced brief summaries of the care plan which are kept by the daily reports for ready reference by staff making the daily reports. Despite the guidance on daily reports issued by the manager, many of the reports are brief and uninformative. Everyone has access to community and, if relevant, specialist NHS resources. Where possible people retain their own GP when they are admitted to Ranelagh House but if necessary the manager will make arrangements for them to register with a local surgery or health centre. A resident was ill during the site visit and a doctor was called, arriving within 20 minutes. In the event of anyone requiring attention for a pressure area the manager and her staff contact a District Nurse immediately. During the inspection the inspector checked medication for three residents. Medicines were stored securely and the home uses a Monitored Dosage System in which most tablets are provided by the pharmacist in special blister packs. Medication was securely stored and on the whole well organised but it was not possible in every case to account for the amount of a medicine that had been administered. Records need to clearly and accurately record how many tablets have been received, and, how many have been administered. There was no written guidance when medication was to be administered ‘as required’ and in one case the manager said that the medication in question was now to be administered routinely. It is important that the administration of all medication is recorded fully and accurately and the manager needs to remind staff of this. The home does not currently stock any controlled drugs. All staff who administer medicine have been trained by the home’s community pharmacist. Medicine requiring refrigeration is kept in an ordinary kitchen fridge. Although it is secure there, such medicines are best stored in a dedicated fridge and the manager said that one was on order. The home needs a policy on the use of homely remedies and written advice from GPs as to which can be safely used for each resident. Under no circumstances must prescribed medication for individual residents, (e.g. Paracetamol) be used for other residents. Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. Staff arrange and facilitate a variety of activities to enhance the lives of the people who live in Ranelagh Lodge. The menu provides choices and meets the tastes and dietary needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents are asked about their lifestyle, preferred foods, and the sort of social activities that they would like to take part in. The deputy manager and other care staff organise outings and activities, including tea dances, social events in Sefton Park Palm House, games within the home, music, bingo, weekly visits to the pub/restaurant next door for lunch and special trips out. In a survey form one resident said that activities were ‘very good’ and the home arranged trips out. Some residents who talked to the inspector were going to a social event at a local church, with transport arranged by the church, and told the inspector about the various activities in which they took part. They were looking forward to a trip to Southport, though they felt the town wasn’t what it used to be. Ministers of religion visit the home every month and hold services for those residents who want to join in. Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 Page 13 Visitors are welcome in the home at any reasonable time and residents can entertain friends and relatives either in the communal lounges, or in their own bedroom. Residents told the inspector that they enjoyed the food at Ranelagh House and enjoyed lunch, which was sausage, egg and chips. The main meal is served at lunchtime and there is always a sweet. The evening meal is lighter but usually includes a cooked option. Residents have a choice of evening meal and can have something prepared individually if they do not like what is on offer. Residents can choose to have a full cooked breakfast and one who was enjoying his bacon and eggs said that he has one every morning. Others said they have breakfast choices such as Rice Krispies. Residents can choose to eat their meals in their own room rather than go to the dining room though during the site visit everyone seemed to have come down. The home buys its meat and vegetables from small local suppliers to ensure freshness and quality. Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. Procedures for complaints and adult abuse allegations are in place, providing protection for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have not been any complaints since the last inspection. The home has an adult protection policy and a copy of the Liverpool area protocols and guidance on adult abuse. The manager has made arrangements for all staff to attend training in the protection of vulnerable adults from abuse in the near future. Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. Quality in this outcome area is good. Ranelagh House provides a comfortable, clean and homely environment for its residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The owner carries out routine and planned maintenance and the building is homely, clean and well maintained. During the site visit two bedrooms were being redecorated. There were no unpleasant odours in the home. Ranelagh House is on a main road which is well served by buses to Liverpool city centre, Speke retail park and John Lennon airport. Several small shops are within walking distance and residents often visit the large pub/restaurant next door. There is a shaft lift to the first floor but because of the layout of the upstairs bedrooms, it does not provide access to three rooms at one end of the house. This part of the home has its own staircase and a stair lift. The stair lift has Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 Page 16 recently been replaced. One resident said he had problems using the new lift but the manager said that it was just as accessible as the old one and she would talk to the resident about the issue. There are two comfortable lounges and a dining room which overlooks the large and attractive garden through French windows. The television in the end lounge is rather small given the size of the room and the Registered Person may wish to consider getting a bigger one. The home has sufficient bathrooms and toilets, including a Parker assisted bath on the ground floor. The kitchen floor, which had contained some cracked tiles, has been replaced by an impermeable, readily cleaned vinyl surface. Residents have single, lockable bedrooms unless they have freely chosen to share a room. Many of the rooms are light and spacious with good views. The rooms are clean and well furnished, many containing cherished personal items reflecting the personality and tastes of the resident. Most of the rooms have fitted carpets. One relatively new resident had a vinyl floor, inherited from a previous resident, but was happy with the surface and had been offered a carpet. In some rooms incontinence equipment had been left out on open view. The manager said that there is a storage problem but some means should be found of storing such material out of view. The vanity units and bedside cabinets in two upstairs bedrooms are soiled and damaged and need to be replaced. In one of the rooms this has also led to damage to the décor, which needs to be made good. The ground floor toilet near to the large lounge needs to be repainted. Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. Staff are properly checked before starting work, protecting the safety of the residents. A stable, well qualified and competent staff group meets the residents’ needs, though some attention is needed to ongoing training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Rotas showed that the home is adequately staffed to meet the needs of the people who live there. Residents spoke very highly of the staff and told the inspector that staff were always available to help them when they needed it. Some felt that there should be more staff as they have to work so hard. One lady said ‘we have a really good laugh’ with staff, especially in the evenings. As well as the registered manager there is a deputy manager, seven senior care assistants, seven care assistants two domestic staff and a cook. The staff group is remarkably stable, some having worked at Ranelagh House for over 20 years. Two new members of staff have been recruited since the last inspection and the manager had obtained written references and POVA (Protection Of Vulnerable Adults register) clearance before they started work. 12 care staff have NVQ2 and a further two are studying for the qualification. Training is still not very clearly recorded and it would be sensible to update the training matrix with dates so that it is apparent when refresher training Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 Page 18 (e.g. on manual handling and adult abuse) is needed. There has been no refresher manual handling training for over twelve months. Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38. Quality in this outcome area is good. Staff morale is high in Ranelagh House, resulting in an enthusiastic workforce that works positively with residents to improve their quality of life. Safety checks are carried out to protect residents’ health and welfare but some action still needs to be taken to improve residents’ safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is highly experienced and has managed the home for two years. She has still not started her NVQ4 training but said that she intends to do so in the near future. She places a great emphasis on teamwork and holds regular team meetings. There was a positive and open atmosphere in the home during the site visit. Staff receive one to one supervision but this is not yet regular. Some supervision is now being carried out by senior carers Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 Page 20 which is good for staff development as well as creating a cohesive management team. The owner lives in the West Midlands but visits the home regularly. He or his administrative officer inspect the home and complete reports in accordance with Regulation 26 every month. The manager occasionally distributes questionnaires to relatives, especially of new residents, but this is not a systematic part of a quality assurance system. The home achieved Investors In People (IIP) status three years ago and this is due to be reviewed by IIP next year (2008). IIP is a nationally recognised quality assurance measure. Where possible, residents look after their own financial affairs. Families of residents are consulted as regards bank accounts of their relatives. The manager does retain some day to day spending money for some residents and keeps accurate records, including any receipts if anything is spent on residents’ behalf. Fire checks were up to date and gas and electrical safety certificates had been obtained. Some electrical work has been identified but none of it was classified as ‘urgent’. Numerous fire doors were propped open during the site visit – one of them on a main corridor. If a fire door is propped open it is ineffective as a barrier to the spread of fire. If a door needs to be kept open this should be done using an approved hold-open device, such as a ‘Dorgard’, , or by electro magnetic devices (such as are used in some parts of the home) which close automatically if a fire alarm is sounded. Some combustible material (boxes, equipment) was stored in one of the protected stairwells. Areas such as this need to be kept free of any moveable material which could catch fire. The cook checks and records fridge and freezer temperatures every day. The Registered Manager may wish to contact the Environmental Health Officer with a view to introducing the Food Standards Agency programme Safer Food, Better Business. Accidents are properly recorded and the home’s Accident Book complies with the Data Protection Act. Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 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 x 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 2 Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 Page 22 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. Standard OP9 Regulation 13(2) Requirement Timescale for action 19/06/07 2. OP7 15 3. OP19 13(4), 23(2) 4. OP38 23(4) The Registered Person must make arrangements for the recording and administration of medicine and must therefore ensure that each medication episode is accurately recorded and all medication can be fully and properly accounted for. (Original timescale 17/01/07) The registered person must 01/07/07 ensure that there is a written service user’s plan (a care plan) for each resident. The registered person must keep 01/08/07 the home in a good state of repair and must therefore: * replace the bedside cabinets and vanity units in the identified bedrooms and make good the décor; * adjust the door to room 9 to ensure that it does not stick; * redecorate the downstairs toilet near to the main lounge. The Registered Person must take 19/06/07 adequate precautions against the risk of fire and must therefore: *remove any combustible material from the stairwell; DS0000025364.V335530.R01.S.doc Version 5.2 Ranelagh House Residential Care Home Page 23 5. OP38 13(5), 18(c) * Ensure that fire doors are only propped open by an approved device which closes the door if an alarm is sounded. The registered person must ensure that there is a suitable system for moving and handling residents and that staff receive training appropriate to their work, and must therefore ensure that staff receive regular training in the moving and handling of residents. 01/08/07 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. 2. Refer to Standard OP30 OP9 OP38 Good Practice Recommendations The registered manager should keep an accurate record of staff training. The manager should draw up a policy for the use of homely remedies and should seek the advice of the pharmacist on its contents. The Registered Manager may wish to contact the Environmental Health Officer with a view to introducing the Food Standards Agency programme Safer Food, Better Business. Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Merseyside Area Office 2nd Floor, South Wing, Burlington House Crosby Road North Waterloo Liverpool L20 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Ranelagh House Residential Care Home DS0000025364.V335530.R01.S.doc Version 5.2 Page 25 - 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. 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