Inspection on 23/02/06 for Rose Meadow

This inspection was carried out on 23rd February 2006.

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

Rose Meadow 03/07/07

Rose Meadow 02/08/06

Rose Meadow 25/07/05

Rose Meadow 11/03/05

Rose Meadow 05/10/04

Rose Meadow 02/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Rose Meadow Yarmouth Road North Walsham Norfolk NR28 9AU Lead Inspector Mr Christopher Handley Unannounced Inspection 23rd February 2006 09:45 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 Rose Meadow DS0000034927.V283823.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. Rose Meadow DS0000034927.V283823.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Rose Meadow Address Yarmouth Road North Walsham Norfolk NR28 9AU 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) 01692 402345 01692 500157 Norfolk County Council-Community Care Mrs Elizabeth Ann Lockwood Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Rose Meadow DS0000034927.V283823.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. From time to time the home may accommodate one service user over the age of 65 years who has dementia and is named in the Commission’s records. Total number not to exceed thirty (30). People who need wheelchairs to assist with independent mobility at the point of admission can only be accommodated in rooms numbered 34, 41, 66 and 68 25th July 2005 Date of last inspection Brief Description of the Service: Rose Meadow is a care home providing personal care and accommodation for up to 30 older people. The home has 28 permanent placements and 2 respite care placements. Two of the respite placements are GP beds. There is a day centre attached to and managed by the care home and this offers up to 12 day care places on Wednesdays, Thursdays and Fridays. The home is owned by Norfolk County Council and is located on the outskirts of North Walsham, being quite close to shops, pubs and other local amenities. The home was purpose built and accommodates service users on two floors. Norfolk County Council have completed some refurbishment and redecoration but further work remains outstanding. All service users have their own bedroom but several of these are rather small. The communal areas are plentiful and offer a variety of seating areas including a smoking area, quiet room and large dining room. There is a shaft lift that offers access to the first floor. The lift is very small and does not comfortably accommodate a wheelchair. There is a large garden that service users benefit from in the summer months. Rose Meadow DS0000034927.V283823.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, part of the annual inspection programme. A notice announcing the inspection was displayed in the entrance hall. The inspection commenced at 9.45am and was completed at 2.45pm. there were 28 residents in the home on the day of the inspection. During the process of the inspection a wide range of documentation was seen. Six residents, and six members of staff were interviewed. The Inspector undertook a tour of the home but concentrated on the bathroom and toilet facilities in the home. Information leaflets were passed to the Care Co-ordinator for distribution to residents. Ms Linda Gilson, Care Co-ordinator, was in charge of the home during the morning, and Ms Sally Hilburn, Care Co-ordinator was in charge in the afternoon, both demonstrated a sound knowledge of the home and were a great assistance to the Inspector. This was the first time the Inspector has inspected this home. What the service does well: What has improved since the last inspection? The engine for the lift has had a major overhaul. Rose Meadow DS0000034927.V283823.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. Rose Meadow DS0000034927.V283823.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 Rose Meadow DS0000034927.V283823.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): 2&5 All residents are supplied with an individual copy of the Terms of Conditions of the home. Prospective residents and their relatives are welcome to visit the home prior to admission. EVIDENCE: The Care Co-ordinator, Linda Gilson, said that all residents are given a Terms and Conditions document. A copy of the document was seen and read by the Inspector. The document contains all the information required by Standard 2. It is very well set out and in a large print size which would help people who may have poor sight to read it. The content is clear and unambiguous. The document is a Norfolk County Council Contract and is a good example of its kind. Rose Meadow DS0000034927.V283823.R01.S.doc Version 5.1 Page 9 A Care Co-ordinator or Manager reads through the document with the resident and relatives to ensure their understanding of the content of the document. A copy of the signed document is kept in the office and the resident is given a copy. The Inspector was told that frequently it is the accompanying relative who keeps the copy. Ms Gilson said that prospective residents and their relatives are welcome to visit the home prior to admission. They undertake a tour of the home, meet staff and residents, and ask any questions they wish. Refreshments are provided. It is felt that it is important that residents get a view of their possible future home. Staff are aware of the importance of these visits. Admissions on a trial basis may also take place, Ms Gilson said. These are arranged by the Social Worker, and again they are felt to be important for the individuals for whom they have been arranged. Rose Meadow DS0000034927.V283823.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 & 11 All residents have a care plan, and elements of these need to improve. The home ensures that the health care needs of residents are fully met. The home medicines are safe and the practice is sound. At the time of death residents and their families are cared for with the utmost sensitivity and respect. Rose Meadow DS0000034927.V283823.R01.S.doc Version 5.1 Page 11 EVIDENCE: All residents have an individual care plan and the Inspector read three of them. Each residents care plan is kept in an A4 ring binder folder, which has the residents name on. These folders are kept in a locked drawer in the office. Each care plan has the four essential elements of care planning, namely assessment, plan, implementation and review. The assessment consists of Physical, Mental, and Social profiles. Each of the three folders had a detailed social history and these are of a very high standard, in that they provide a very clear picture of the resident’s social background, and staff are commended for these. The element of mental health needs to be more comprehensive, e.g. has the person had depression or any other form of mental ill health. The Inspector recommends that the elements of planning care, i.e. what needs to be done for the resident, who is to do what, and when does it need to be done, needs to be more distinct. There are typed written annual reviews, which are very detailed and comprehensive. Reviews of care take place on a monthly basis. Residents and relatives are involved in reviews of care. The home maintains a Daily Record, and these records are very neatly written. A positive discussion took place on the entries in these records. The Inspector recommended that the Manager and Care Co-ordinators provide written guidelines for staff that write this record. The Inspector is not suggesting that a long series on notes are written, but brief succinct records should be made. For example, a number of entries were read which just said “Went out for the afternoon” but did not state whether the person returned and at approximately what time. During the Inspection the Inspector was given the impression that there is a strong sense of confidentiality in this home, and to further enhance this the Inspector recommends that the Care Planning files should be marked “Confidential Information” next to the resident’s name. One of the files read, had page separators in it, and it is advised that they all should have. This will make the management of the documentation easier, and keep the file tidier. Rose Meadow DS0000034927.V283823.R01.S.doc Version 5.1 Page 12 The home takes a wide range of steps to maintain the health of residents. The staff of the home provide personal care and oral health, Ms Gilson said. Staff have been trained in the prevention of pressure sores, and the home is commended for this. At present there are 4 residents who have pressure sores. The District Nurse, with whom the home has a good relationship, provides advice and any pressure relieving mattresses or other equipment needed. There are 11 residents who are incontinent, the Inspector was informed. The Continence Advisor calls at the home on a regular basis to advise and re-assess residents. Residents are weighed on a weekly or monthly basis and Nutrition Assessment training has been provided. Where required special nutritional drinks are given. Daily exercises are provided. If needed optical, dental, or hearing aid services would be obtained. Any additional services required would be arranged via a G.P services. Ms Gilson showed the Inspector the medicines used in the home. The medicines are kept in a dedicated room, which is kept locked and only the Care Co-ordinator on duty holds the key. The medicine trolley is kept locked, and in turn is locked to the wall when not in use. All staff who administer medicines have had training for this. The inside of the trolley was neat and tidy and there were no unaccounted for or loose medicines in the trolley. The home uses a Monitored Dosage System. The records of administration are neatly recorded. These records have a photograph of the resident on. There are no Controlled Drugs in the home at present. The home has specimen signatures of staff who administer medicines. There are additional medicines in the medicine room, which are used from time to time, and these are very neatly labelled and stored in a locked cupboard. There is a Drug refrigerator in this room, which was neat and tidy. There is one resident who self medicates, the Inspector was informed, and this is effectively managed and monitored. The resident keeps her medicines in a locked drawer in her room. If staff had any concerns about the effect of medicines on residents, they would contact the prescribing G.P. The home enjoys a good working relationship with the supplying pharmacist. Medicines are reviewed on a three monthly basis, and this is recorded. The home uses Norfolk County Council Guidelines for Medicines. Rose Meadow DS0000034927.V283823.R01.S.doc Version 5.1 Page 13 Ms Gilson said that care and comfort are provided to residents at all times but especially when the resident is dying. If needed, pain relief would be prescribed by the Doctor. Privacy and dignity are provided at all times, but especially at the time of death. The resident would stay in his or her own room. The home does not have a designated room for the terminally ill residents. Relatives and friends are welcomed, and may stay if they wish, with refreshments being provided. Representative of religious organisations would be contacted if desired. Friends and relatives may stay with the dying resident, if resident wishes them to do so. The wishes of the dying resident, with regard to funeral arrangements, are followed. Senior staff support junior staff at such times. The home follows Norfolk County Council Guidelines in this matter. Rose Meadow DS0000034927.V283823.R01.S.doc Version 5.1 Page 14 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): 15 Residents are provided with wholesome and nutritious meals. Special diets need to be recorded. EVIDENCE: The Inspector spoke to the head cook who told him how the residents were involved in the choice of meals. Residents are asked their choice of meals on a daily basis. Residents would be seen within forty-eight hours of admission, the cook said, and often before this, and asked their likes dislikes and preferences. A follow up of the meals provided is undertaken and residents are asked their opinion on a daily basis. Menus are reviewed on a regular basis. The Inspector was given a copy of the menus; the content appeared nutritious, varied and interesting. The Inspector advised that the fact that as special diets are provided it is required that this is recorded on the home’s menus, and the Cook undertook to ensure that this was done. Rose Meadow DS0000034927.V283823.R01.S.doc Version 5.1 Page 15 The residents, both in the home and in the Day Centre, who were interviewed spoke very highly of the meals. “They are always very nice”, “There is always enough”, “Hot meals are never served on cold plates”. Rose Meadow DS0000034927.V283823.R01.S.doc Version 5.1 Page 16 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): 16,17 & 18 The home has an effective complaints procedure. Residents’ legal rights are protected. Residents are protected from abuse. EVIDENCE: The home has a complaints procedure, and Norfolk County Councils booklet on this matter is in the main entrance lobby. There have been two complaints since the last inspection, and the Inspector was shown the record of both. The complaints were neatly written and inform the reader what the complaint is, and what steps have been taken to resolve the matter. Both complaints were effectively dealt with to the satisfaction of the resident. Residents interviewed told the Inspector what steps they would take if they wished to make a complaint, but generally most said that they would tell the first member of staff they met, whom they felt would “Sort it out”. Residents’ legal rights are protected Ms Gilson said. If needed advocacy would be arranged for residents. A number of residents go the Polling Station to vote, and other residents use their postal vote, the Inspector was informed. Rose Meadow DS0000034927.V283823.R01.S.doc Version 5.1 Page 17 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): 21 & 22 Some of the bathrooms and toilets need to be decorated. There is a rage of equipment in the home. EVIDENCE: There are 5 toilets and 1 bathroom on the ground floor. There are 4 toilets on and 2 bathrooms on the first floor. There are toilets seen were clean and tidy, some are adjacent to lounges. Some toilets, bathrooms have been upgraded, and the Authority is commended for this. Rose Meadow DS0000034927.V283823.R01.S.doc Version 5.1 Page 18 The remaining toilets can only be described as “Grim”, they do not provide privacy as there is a gap at the top of the dividing wall. They are painted “Battle ship grey”. In appearance they are dull and depressive. Over the years the Inspector has viewed many toilet facilities but in his opinion these are by far some of the worst he has seen. In the Inspection dated 25/7/05 it was required that these facilities should be “in sound order, comfortable and provide privacy”. This requirement has not been fulfilled. As an interim measure and on the understanding that the major improvements required would not be delayed, the Inspector requires that these facilities should be painted, and that the residents, who’s home this is, can see the improvement process has commenced. As well as visiting the facilities the Inspector saw a number of residents’ rooms. All were neat, clean and tidy, with photographs and ornaments to be seen. The difficulty with TV aerial sockets which was raised as a recommendation in the last persists, and the Inspector repeats this recommendation. Residents have access to all parts of the home. There are grab rails in place in corridors and toilets. Equipment which is mainly aimed at helping the mobility of residents, or equipment which will assist staff in moving residents safely is located around the home. This equipment includes walking frames and bath hoists. Recently two new mobile hoist were purchased. The Manager and the Authority need to monitor the decreasing mobility of the residents carefully. Many of them are already quite old, some are over 100 years of age. Others residents are also very frail and at risk of danger to themselves if they attempt to be mobile on their own. Out of the 28 resident in the home on the morning of the inspection, only 7 could walk unaided, 12 needed help with walking and 7 used wheelchairs. Age and very limited mobility is becoming more and more prevalent in homes for the elderly, and this is very noticeable in Rose Meadow. Rose Meadow DS0000034927.V283823.R01.S.doc Version 5.1 Page 19 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 There are not sufficient staff on duty in the mornings to meet the residents’ needs. The home uses the recruitment practices and procedures of Norfolk County Council. EVIDENCE: The staffing on the morning of the inspection consisted of 3 Care Assistants, 1 Care Co-ordinator, 2 Domestic, 1 Cook, 1 Kitchen Assistant, 1 laundry assistant and 1 handyman. There were 2 members of staff in the Day Centre. During the morning the Inspector carefully observed both staff and residents. The staff have to spend nearly all their morning providing personal care for residents, which because of age and frailty of the residents, must be done slowly and very carefully, at the expense of activities and social intervention. Seven residents use wheelchairs. Though physically frail, many of the residents spoken to by the Inspector were mentally alert, and activities which preserve this need to be provided. One resident interviewed, told the Inspector the “the staff are always busy” with residents. Rose Meadow DS0000034927.V283823.R01.S.doc Version 5.1 Page 20 Based on the observations of the Inspector, the information provided by staff and comments made by residents, it is obvious that the morning staffing should be increased by one care assistant for the five working days of the week, Monday to Friday. This would provide time for activities aimed at improving the quality of life for residents. The Inspector makes this a requirement. In the report dated 25/7/05 a requirement was made that staffing levels should be reviewed. There has been no increase as a result of this review. The Inspector was told the home follows the procedures and practices of Norfolk County Council in the matter of recruitment. Two satisfactory references are obtained. POVA and CRB checks are carried out. Interviews are carried out by two members of staff. Codes of Conduct are given to the successful candidates, as are Terms and Conditions. The Inspector was informed that three senior members of staff have recently successfully undertaken training in Recruitment and Selection. Rose Meadow DS0000034927.V283823.R01.S.doc Version 5.1 Page 21 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): 34 & 36 The home has the accounting and financial procedures of Norfolk County Council, and the home is covered by the appropriate insurance cover. The home uses the employment polices and procedures of Norfolk County. EVIDENCE: The home which is owned and managed, by Norfolk County Council, and uses the financial procedures, polices and practices of the Council. The home is appropriately insured and the Certificate of Insurance, which is displayed in the entrance hall was seen by the Inspector. The undertaking for legal liabilities is as required £5 million. The home uses the employment practices and procedures of Norfolk County Council. Rose Meadow DS0000034927.V283823.R01.S.doc Version 5.1 Page 22 Care staff receive supervision at least six times a year, the Inspector was informed, and this is recorded. Supervision covers aspects of practice, philosophy of the home and career development. Staff interviewed said that they saw supervision as an opportunity to discuss things, especially training. Rose Meadow DS0000034927.V283823.R01.S.doc Version 5.1 Page 23 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 X X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 X X 1 3 X X X X STAFFING Standard No Score 27 1 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 3 X 3 X X Rose Meadow DS0000034927.V283823.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP15 OP21 Regulation Sched.4 13 23(2)d j Requirement It is required that special diets must be recorded. The provider must ensure that adequate bathing and toilet facilities are available and that these are suitable, in sound order, comfortable and provide privacy. It is required that as an interim measure that the toilets and bathrooms be painted. The provider must increase the care staff on the morning shift. Timescale for action 01/04/06 31/08/06 3. 4. OP21 OP27 23 (2) d j 18(1)a 30/06/06 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations 1. The Mental Health assessment element needs to be more comprehensive complete. 2. The plan of care needs to be more descriptive. Rose Meadow DS0000034927.V283823.R01.S.doc Version 5.1 Page 25 3. The involvement of residents and relatives who should take part in reviews of care should be recorded. 4. The management team should develop guidelines for the Daily Record. 5. That the Care Plan folders should all have separators in them. 6. That the Care Plan folders should be clearly marked “Confidential Information”. The provider should have TV aerial sockets fitted in every service users room. Recommendation brought forward from the last inspection. 2. OP23 Rose Meadow DS0000034927.V283823.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rose Meadow DS0000034927.V283823.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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