Inspection on 25/05/06 for Ravenstone Nursing and Residential Home

This inspection was carried out on 25th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Ravenstone Nursing and... 21/08/08

Ravenstone Nursing and... 10/12/07

Ravenstone Nursing and... 19/01/07

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Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Ravenstone Nursing and Residential Home 7 St Andrews Road Droitwich Worcestershire WR9 8DJ Lead Inspector N Richards Unannounced Inspection 25th May 2006 10:40 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 Ravenstone Nursing and Residential Home DS0000065965.V294026.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. Ravenstone Nursing and Residential Home DS0000065965.V294026.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ravenstone Nursing and Residential Home Address 7 St Andrews Road Droitwich Worcestershire WR9 8DJ 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) 01905 773265 01905 778890 Ashbourne (Eton) Limited Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46), Physical disability over 65 years of age of places (46), Terminally ill (2) Ravenstone Nursing and Residential Home DS0000065965.V294026.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection December 2005 Brief Description of the Service: Ravenstone Nursing and Residential Home is a 46-bedded care home providing 24-hour nursed care to older people with physiological difficulties. It is situated within central Droitwich, close to local amenities and resources. Accommodation within the home is provided on three floors – the ground floor, the first floor, and a mezzanine level. Access to all areas within the home is provided through the provision of a passenger lift, a platform lift and two staircases. Ravenstone Nursing and Residential Home DS0000065965.V294026.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection represented the first key inspection of the service for the year 2006/07. It was undertaken by two inspectors, who examined all key standards, and established how the service had or was addressing the requirements issued at the time of the previous inspection. During the inspection, opportunity was taken to interview residents (to elicit first-hand experience of the service by those individuals who use the service), staff (to elicit what it is like to work within the service) and the home’s manager-designate (to elicit information about how the home was being managed). Opportunity was also taken to; 1. 2. 3. 4. 5. Examine care records, To case-track individual residents, To examine operational procedures, To examine the physical environment and To observe care practice. Since the time of the previous inspection, standards within the home have improved, but there remains continued work to be undertaken for service development. What the service does well: What has improved since the last inspection? Opportunity has been taken to improve care documentation to enable greater continuity of care, medication management and recording has improved (thereby enhancing residents’ safety), decorative standards within the home are being enhanced and staffing levels appear to be more stable. Ravenstone Nursing and Residential Home DS0000065965.V294026.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ravenstone Nursing and Residential Home DS0000065965.V294026.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ravenstone Nursing and Residential Home DS0000065965.V294026.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service The home adequately provides prospective residents with the information they need to make an informed choice about the home. EVIDENCE: A comprehensive, written pre-admission assessment is undertaken for all prospective residents by a registered nurse prior to their admission to the home. Where prospective residents are to be funded by the local authority, a community care assessment is completed and provided to the home. This demonstrates the care needs of the individual, and enables the home to form a judgment about whether (or not) it can meet the person’s needs. Next-of-kin interviewed confirmed that a pre-admission assessment had been undertaken prior to their relative being admitted into the home. All care files examined contained a written contract/statement of terms and conditions that clearly specified the rights and obligations of the resident and Ravenstone Nursing and Residential Home DS0000065965.V294026.R01.S.doc Version 5.1 Page 9 the home. A copy of the home’s statement of purpose and complaints procedure was held in each bedroom. The provision of a contract and statement of purpose helps to provide clarity about the service for residents, and enables people to understand what they can expect from the service, and how to complain when the service falls short of their expectations. The home does not provide intermediate care. Ravenstone Nursing and Residential Home DS0000065965.V294026.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service The standard of care records within the home is poor. Records are not sufficiently detailed to ensure that individual residents’ needs are met in a consistent manner. However, care practice discussed and examined, along with feedback from residents and their relatives confirms that appropriate action is taken to meet the clinical needs of residents. EVIDENCE: Six residents’ care files were examined during the inspection. Each resident had a care plan in place, which had been completed by a registered nurse, but the quality and content of care plans varied considerably. While some care documents effectively specified how care is to be delivered, some care plans failed to effectively specify how care is to be delivered. This was of particular concern for individuals who are diabetic. The following deficits were noted about care documentation; 1. Care plans had not been formally agreed with and counter-signed by the resident and/or their next-of-kin. This is necessary to ensure that the Ravenstone Nursing and Residential Home DS0000065965.V294026.R01.S.doc Version 5.1 Page 11 2. 3. 4. 5. 6. home (a) works in participation with the individual (rather than working to preclude the individual from the care process), (b) engages the individual within the care process, and (c) ensures that the individual understands and consents to the care provided. Some care plans need to be more specific and directive. For example, one care plan relating to the management of diabetes failed to clearly specify the signs and symptoms of hypoglycaemia and hyperglycaemia. This is important if care staff are to understand the symptoms they are supposed to be monitoring. Care plans were not being reviewed in accordance with the frequency specified by the National Minimum Standards i.e. at least once a month. This is important to ensure that (a) any changes to a person’s condition are noted, and (b) the plan of care is amended in response to any change/s noted. Although each file contained a range of risk assessments and health care assessments, some required further development as; (a) one file contained a falls risk assessment indicating that the person had been assessed as being at high risk of falling. No suitable care programme had been developed to address the identified risk, (b) one file contained a moving and handling risk assessment which cited the individual as being at “moderate risk”. However, the risk assessment had not been regularly reviewed and no plan of care had been formulated in response to the identified risk, (c) one file relating to somebody who had been recently admitted contained a comprehensive range of risk assessments identifying high risks associated with nutrition. No plans of care had been formulated for any of the risks identified through assessment. Care plans for pressure ulcers did not effectively demonstrate the nursing care and nursing interventions necessary to address the problem/s identified. Following discussion with nursing staff, it transpired that some care plans were in place for problems that were no longer health care problems. A member of the nursing team was observed administering medication to residents. Medication was administered safely, sensitively and diligently to ensure that the right medication was administered to the right person, at the right time and in the right dose – thereby promoting the safety and well-being of residents. On examination, it was noted that medication administration record (MAR) charts had, generally, been accurately completed by nursing staff. There were exceptions to this. For example, manual alterations had been made to the pre-printed MAR charts, but had not been countersigned by two registered nurses to confirm the authenticity and accuracy of the manual amendment(s). Some residents had been prescribed medication on a variable dose basis. The MAR charts did not always illustrate the actual dose administered when a variable dose medication had been administered. One resident had actively refused some of her prescribed medication for a significant period of time. There was no evidence to indicate that the prescribing instructions had been reviewed. Ravenstone Nursing and Residential Home DS0000065965.V294026.R01.S.doc Version 5.1 Page 12 Residents spoken to were happy to confirm that staff within the home was meeting their care needs in a dignified and respectful way. Staff were seen providing care sensitively and discretely to residents, and discussions with staff confirmed that they were aware of residents’ care needs. Ravenstone Nursing and Residential Home DS0000065965.V294026.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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents have limited opportunity to participate in leisure and recreational activities that meet their needs and expectations. Contact with family and friends is supported, and opportunities for residents to exercise choice over their lives has been improved. EVIDENCE: While the level of occupational, social, recreational and leisure activity within the home is adequate for some residents, several residents interviewed expressed their opinion that the level of social care provided within and by the home is merely tolerable. Comments received and made by residents during the inspection process included; (it’s a) “Lonely life…got to put up with it”, “…just the company I get stuck on. You’ve got to like it when there’s nowhere else to go. Beggars can’t be choosers”. Ravenstone Nursing and Residential Home DS0000065965.V294026.R01.S.doc Version 5.1 Page 14 Residents were not critical of the staff within the home, but they did make comment that; “Service isn’t that good. Think (they’re) short-staffed”, (I’m) “well looked after” and “Staff are quite good”. Care practice was observed during the inspection process, and it was noted that staff were not paying due care and attention to individuals’ preferences and tastes regarding food. For example, one person was served curry and rice. This was left with the resident, who proceeded to explain how she did not like rice, and how she would prefer chips with her curry. The staff member had left the room without ascertaining the resident’s preferences – leaving the resident to eat only part of her lunch. Ravenstone Nursing and Residential Home DS0000065965.V294026.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): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A complaints procedure and adult protection procedure is available within the home, but attention needs to be given to the effective recording and actioning of all complaints and concerns received. EVIDENCE: The home has access to the local multi-agency adult protection procedure. The Commission has been involved in adult protection investigations regarding the service historically but, since the time of the previous inspection, this involvement has decreased. A suitable complaints procedure is available within the home. However, during the examination of some care records it became evident that some concerns/complaints raised had not been processed through the service’s complaints procedure. This is necessary to ensure that all concerns and complaints are taken seriously by the service and to ensure complainants know that their concern or complaint has been taken on-board, investigated within a pre-defined timescale, and outcomes identified and actioned, with appropriate explanations (where necessary). Ravenstone Nursing and Residential Home DS0000065965.V294026.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, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents, when able, had taken the opportunity to furnish their bedrooms with their own personal possessions and adornments. Residents said they liked their bedrooms. A relatively large area of the home had been redecorated, usually on a rolling programme (for example, when a bedroom becomes vacant). However, some bedrooms have not been redecorated and are now beginning to look tired. At the time of inspection, the ground floor corridor was being redecorated. Although there were mechanical sluicing facilities on both floors of the home, the location of mechanical sluices needs to be reviewed to ensure that crosscontamination risk is minimised as far as is reasonably practical – particularly Ravenstone Nursing and Residential Home DS0000065965.V294026.R01.S.doc Version 5.1 Page 17 as waste products (at present) need to be transported past the central kitchen area. At the time of inspection, all areas within the home were visually clean and free from offensive odours. Ravenstone Nursing and Residential Home DS0000065965.V294026.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, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service Staffing within the home is poor. Staffing levels are perceived by residents as unsuitable to ensure that their needs are identified and effectively met in a timely manner. Staff training is necessary to ensure that all care staff can effectively meet the care needs of people living within the home. EVIDENCE: Three staff files were examined, along with a range of duty rotas and staff training files. There were suitable nursing and care staff on duty to provide care and support for the 28 people who were resident in the home at the time of inspection. In addition to nursing and care staff, there were also ancillary staff on duty to support service provision. During the visit, call bells were activated, and staff responded speedily to them. Ho The duty rotas confirmed that the staffing levels were stable, with little evidence of staff being absent through short-term sickness. However, it was noted that staffing levels were reduced noticeably at the weekend period due to staff (reportedly) going absent at short notice. Staff confirmed that staffing levels at the weekends are (perceived as being) problematic. Ravenstone Nursing and Residential Home DS0000065965.V294026.R01.S.doc Version 5.1 Page 19 Training had been, and was being provided to staff, and planned training included moving and handling. Training was not being identified or accessed as a result of the needs of residents, to ensure that care delivered was appropriate to and in response to the needs of residents. Staff said that they had not received any training relating to the care and management of people with diabetes or nutrition (these areas were identified as a result of the clinical needs of residents within the home). When asked about the training received, one staff member said that the following had been provided within the previous 12-month period; food hygiene (2 hours’ duration), fire awareness (2 hours’ duration), moving and handling (2 hours’ duration), dementia awareness (3 hours’ duration) and abuse training (2 hours’ duration). The content of the training (due to brevity) is questionable, and opportunity must be taken to ensure that the content of training provided is suitable and comprehensively effective to enable care staff to deliver the care necessary. Opportunity was taken to examine four staff files. All files contained an application form, but not all files contained two written references. Limited supervision records were available, but were not sufficient to ensure that all staff had received suitable, formal supervision. A staff-training matrix for 2006/7 was available, and examined. The training matrix included moving and handling, infection control, food hygiene, fire safety, abuse, health and safety, first aid and drug administration. Training records failed to specify the course contents (see comment above). Ravenstone Nursing and Residential Home DS0000065965.V294026.R01.S.doc Version 5.1 Page 20 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service Management of the home is poor in relation to staff training and development. There is clear leadership, guidance and direction to staff by the home’s manager-designate to ensure residents receive consistent care, but an absence of critical training based on the assessed needs of residents serves to potentially place residents at risk. Employment procedures also need developing. EVIDENCE: There is no registered manager at present. The manager-designate was awaiting a GP appointment prior to submitting his application for registration to the Commission. Staff and residents spoke positively about the managerdesignate, and significant diligence and action has been undertaken to start to Ravenstone Nursing and Residential Home DS0000065965.V294026.R01.S.doc Version 5.1 Page 21 improve the quality of the service provided by the home since the time of the previous inspection. Four staff were interviewed during the inspection. Some staff said that they had not been given the opportunity to read through care files. Staff were not being formally supervised to ensure that they understood and delivered the philosophy of the home. When interviewed, residents and their families expressed their satisfaction with the staff. Residents and their next-of-kin interviewed expressed their opinion that the home was being conducted in the best interests of the residents. Environmental records confirmed that the home was being conducted so as to promote and safeguard the health and safety of residents, visitors and staff. Ravenstone Nursing and Residential Home DS0000065965.V294026.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 3 3 3 2 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 1 X 3 Ravenstone Nursing and Residential Home DS0000065965.V294026.R01.S.doc Version 5.1 Page 23 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 OP7 Regulation 15(1) Requirement Care plans must be developed to include the care required to meet the assessed needs of residents. Care plans must be written to ensure staff understand the care to be provided, and to ensure that care is provided in a consistent manner. Care plans must be formally agreed either with the resident, or with their representative when the resident is unable to provide informed agreement. Care plans’ effectiveness must be reviewed (at least) monthly by a registered nurse. Risk assessments must be regularly reviewed when a risk has been identified. Nursing staff must record the actual dose administered on MAR charts for all medication that has been prescribed on a variable dose basis. Manual alterations to MAR charts must be countersigned either by the prescribing officer (GP or dentist) or by two registered nurses to confirm accuracy and DS0000065965.V294026.R01.S.doc Timescale for action 30/09/06 2 OP7 15(1) 30/09/06 3 4 5 OP7 OP7 OP9 15(2) 15(2) 13(2) 30/09/06 30/09/06 30/06/06 6 OP9 13(2) 30/06/06 Ravenstone Nursing and Residential Home Version 5.1 Page 24 7 OP12 16(2)n, 18(1) 16(2)(i) 22(3)(k) 8 9 OP15 OP26 10 OP30 18(1)(c), 23(4)(d) 11 12 OP30 OP36 18(1)(c), 23(4)(d) 18(2) 13 OP16 17(2), Schedule 4 authenticity. Provide recreational, social and leisure activities in accordance with the needs and preferences of residents within the home. Ensure food provided is in accordance with the preferences and liking of individual residents. The location of mechanical sluices needs to be reviewed to ensure that cross-contamination risk is minimised as far as is reasonably practical. All persons employed by the registered person to work at the care home must have training appropriate to the work they perform. This is to include diabetes management and nutrition training. Training records must specify the actual course content. All persons working in the home must be adequately supervised. Care staff must receive formal supervision at least six times a year. Supervision must cover all aspects of practice, philosophy of care in the home, and career development needs. All concerns and complaints raised must be processed through the home’s complaints procedure. 31/07/06 30/06/06 30/08/06 30/09/06 30/09/06 30/09/06 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ravenstone Nursing and Residential Home DS0000065965.V294026.R01.S.doc Version 5.1 Page 25 Ravenstone Nursing and Residential Home DS0000065965.V294026.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Ravenstone Nursing and Residential Home DS0000065965.V294026.R01.S.doc Version 5.1 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. 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