Inspection on 27/09/05 for Roxburgh House

This inspection was carried out on 27th September 2005.

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

Roxburgh House 02/07/08

Roxburgh House 02/07/07

Roxburgh House 06/06/06

Roxburgh House 23/02/06

Similar services:

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 Roxburgh House Warwick Road Kineton Warwickshire CV35 0HW Lead Inspector Jo Johnson Unannounced Inspection 27th September 2005 09:30 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 Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 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. Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Roxburgh House Address Warwick Road Kineton Warwickshire CV35 0HW 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) 01926 640296 01926 640306 Pinnacle Care Ltd Care Home 32 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (32) of places Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. An upgrade of the homes décor is planned and implemented within 18 months, (31st October 2006) All outstanding requirements made at the October 2004 inspection are actioned within the recorded timescales. Date of last inspection Brief Description of the Service: Roxburgh House is in Kineton, which is a village on the ‘bus route to Stratfordupon-Avon and Leamington Spa. The original building dates back over 150 years. Accommodation is provided on two floors and there is a shaft lift. Both communal areas and bedrooms are to be found at each level. The home has gardens to the front and rear and car parking to the side. It is within easy walking distance of local amenities such as churches, doctors’ surgeries, the post office, pubs, banks and shops. The home is registered to provide specialist care to elderly people who have dementia. It does not provide nursing care, but residents have access to the community nursing service, as they would if they were living in their own homes. Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook the inspection over 5 hours and it was unannounced. This was the first inspection since the change of ownership of the home in April 2005. The acting manager was not present during the inspection; a senior care assistant was responsible for the management of the home. On the day of inspection there were 31 residents at the home. A majority of the inspection was spent talking with and observing the people who live at the home. Care records were inspected. Care staff, residents and three visitors were spoken to. What the service does well: What has improved since the last inspection? What they could do better: There are a number of areas that must be improved on to ensure that the residents are safe and get the care that they need. Important information about residents must be kept up to date and made readily available to staff in assessments, areas of risk, life history books and care plans. Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 Page 6 Records about the care of residents need to be kept accurately and stored safely. Suitable scales need to be purchased so that residents can be weighed. Staff must make sure that they sign the records for medication that is administered. Residents’ privacy and dignity must be maintained in their own bedrooms and when they receive personal care. Residents needs to more things to do and more staff time to keep them occupied and stimulated. Residents need to be given choices of drinks. Fire doors need to be kept clear of furniture and must not be propped open. The unpleasant smells needs to be eliminated and the home be kept clean. To ensure the safety, care and wellbeing of the residents the staffing levels need to be increased. The staffing levels must not continue to fall below the levels at the last inspection. Agency staff must be provided with enough information to be able to look after the residents. Documents relating to the fitness of staff must be kept in the home. 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. Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 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 Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 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): 3 Assessment format and procedures that are in place do not have sufficient information to ensure that the staff can meet the residents’ needs. EVIDENCE: There is a pre admission assessment format that is completed by the acting Manager who determines whether an individual’s needs can be met at the home. Five residents care records were seen. Assessments for residents with complex needs and dementia were not in sufficient detail for staff to be able to meet their needs. Assessments were incomplete for recently admitted residents, on two files there were not any photographs of the residents and assessments were not dated. Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 Page 9 A resident who was assessed as nutritionally at risk had no weight recorded or subsequent care plan to address the identified need. Another resident who has pressure sores has no pressure area assessment or care plan. Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 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, 9,10 Important elements of resident’s personal and social care needs are not set out in care plans. Staff do not have all the information required to fully meet residents’ needs. Poor standards of recording and storing of information means that care records provide very little protection to residents, particularly in terms of any evidence of care received. The shortfalls in the recording of administration and storage of medication potentially leave the residents at risk. Overall residents are treated with respect. Some practices place residents’ rights to dignity and privacy at risk. EVIDENCE: Individual care plans seen did not have sufficient information to ensure that residents personal care, health and social needs are planned for and fully met. There was a mix of styles of care plans as the plans are being changed over to the new provider’s care plan. The details recorded on the new care plans gave insufficient information for staff to be able to meet residents’ needs. Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 Page 11 Immediate action was required to ensure that staff have sufficient information to be able to meet the residents needs. From observations and discussions with staff important changes to residents needs have not been identified and plans adapted to meet these changing needs. Care plans have not been routinely been reviewed. Life story books were not seen for residents and the amount of resident’s life histories reflected in care records were varied. Life stories must be developed in order for staff to have sufficient information to understand the residents as individuals and to be able meet their social and psychological needs. Daily recording did not reflect the day-to-day lives of the residents. A resident’s care plan had not been recorded in for 3 days shortly after he was admitted to the home. One resident’s daily recording was found in another resident’s care plan. The record of a resident’s fluid intake was recorded on a loose piece of paper found on the shelf in the office. A deceased resident’s medication records were still in the medication record book. This is very poor practice and management of residents’ care records. All records must be maintained accurately to demonstrate what care and support has been provided. There were a number of gaps in the administration of medication records. So there is not accurate record of whether residents have been administered the correct medication. Staff must sign the medication administration records to demonstrate whether medication has been refused, administered or the resident was absent. Oramorph was not being stored and treated as a controlled drug and there were a number of occasions when Temazepam had not been countersigned on administration. Both of these medications should be managed and treated as a controlled drug. Medication in the drug cupboard was stored under a resident’s first name. This could lead to errors, as there may be a number of residents with the same first name. A GP visited during the inspection and he saw the resident in another resident’s bedroom. In one shared bedroom there was no screen to give the residents any privacy from each other whilst receiving personal care. One resident was sat in her bedroom in a state of half undress with the door open for a majority of the morning. These practices do not respect resident’s rights to dignity and privacy. Staff were observed to knock on residents’ bedroom doors and spoke to them kindly and with respect. Discussions with residents’ relatives reflected that staff are kind and courteous and treated their relatives with respect. Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15 The limitations of staff time mean that residents are not provided with adequate support to maintain their social, psychological and recreational interests and needs. Meals are well presented, wholesome and provide residents with a nutritious and balanced diet. The lack of adequate staffing, dining space, tables and seating, limits residents’ choice as to where they eat and the cramped and rushed atmosphere is not conducive to a pleasant eating experience. EVIDENCE: Some residents were unsettled and anxious at certain times during the inspection. Staff managed the situations sensitively. However, due to the time spent providing personal care, the staff had little time to problem solve, be creative, keep people occupied and be person centred in the ways in which they work with residents. There are no things or items of interest around for the residents to pick up and do, this means that there is very little stimulation for residents and that they are not able to do things independently. Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 Page 13 One resident was observed sat at the dining room table for his breakfast and was still there at lunchtime. He was not woken to drink his hot drink or interacted with due to the shortages of staff time. Residents spoken to commented on how good the food was. The food was tasty and freshly cooked and there was plenty of choice. The cook was aware of the numbers of residents on diabetic menus. The menus are planned by the organisation. It is recommended that residents at the home be consulted on their food preferences and this be used to produce the menu. There was no menu displayed on the day of inspection and residents did not know what was for lunch. However, at lunchtime staff offered residents a visual choice of meals when they were not able to make a verbal choice. Staff observed assisting residents to eat did so in a sensitive way, talking to them and sitting next to them. Since the upstairs lounge and dining room has been taken out of use there is insufficient space, tables or chairs for all of the residents to eat together if they so choose. There is only enough seating for half of the residents. Residents ate in the dining room that was cramped, in the lounge or in their bedrooms. This is not a conducive atmosphere for residents with dementia. During lunch a resident fell and it was difficult for staff to safely manoeuvre to assist the resident. The acting manager should consult and reconsider the decision to take the upstairs lounge and dining room out of use. A member of the care staff team is needed to dish and serve the meals at lunchtime. This left only four staff to assist and serve the residents. This use of care staff leaves the residents at risk, as four staff do not have time to safely assist and supervise 32 people with dementia eating appropriately. Residents were not offered a choice of drink mid morning. Milky ready-made coffee was given to residents from a large plastic jug. It is not acceptable practice for residents not to be given a choice of drinks or for them to be given in such an institutional way. Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection as planned due to the absence of the acting manager. EVIDENCE: Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 The home is in need of refurbishment in areas and the new owner has a plan of refurbishment. Progress has been made on the refurbishment and replacement programme. However, the general cleanliness of the home is not satisfactory and there are unpleasant smells on the ground floor. Unacceptable risks are taken with the propping open and blocking of fire doors. EVIDENCE: Residents, relatives and staff spoke positively of the investment in the refurbishment of the home. Comments about the new bedroom furniture and new linen were very positive. The fire door to the laundry was propped open with a fire extinguisher at the start of the inspection then staff promptly removed the extinguisher. A resident’s armchair was blocking one of the ground floor fire exits. These breaches in fire safety place residents and staff at risk Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 Page 16 There was an unpleasant smell in the ground floor carpets and on entering the home. The lounge carpet was stained in places and unpleasant matter was on the carpet. A soiled toilet brush was in the grab rail in a bathroom. There were no paper towels in the bathrooms and toilets. This poor standard of maintaining cleanliness means that residents are living in an unpleasant smelling and unhygienic environment. Residents’ bedrooms were pleasant and they were personalised. However, very few of the bedroom doors had names on them or were personalised. This makes it difficult for both residents and agency staff to orientate themselves as to the whereabouts of bedrooms. The upstairs lounge and dining room have been taken out of use. This limits residents choice as to where they want to spend there time and if they want a quieter space away from the hustle and noise in the main lounge. Again the acting manager should reconsider the decision to use only one lounge and dining room. Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 There are insufficient staff on duty at the home to safely support the needs of the residents. Staff shortages puts the safety and well being of residents at risk. The use of care staff to serve meals, laundry and be responsible for the home compromises the care, safety and well being of residents. EVIDENCE: During the inspection there were 5 care staff on duty including a senior who was responsible for the management of the home in the absence of the acting manager. There was a domestic and a cook on duty. The senior was called away from direct care with the residents to undertake day-to-day management and additional tasks including spending time with relatives, the GP, answering the phone and serving lunch. This left 4 care staff, including an agency member of staff on her first shift, to care for 31 residents with dementia. The staff did a commendable job providing basic care to the residents and they did not stop. They remained calm and sensitive to residents needs and all interactions that were seen were positive. They also had to do the laundry and make resident’s beds. The acting manager must ensure that there is adequate management cover in her absence that is supernumerary to the care staff numbers. The staffing levels must be reviewed against the needs of the residents and increased so as to meet the current needs of the residents. Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 Page 18 From rotas seen there were a number of times the previous week where there was only 3 staff on duty in the afternoon and evening. The staffing levels at the previous inspection had been: 5 staff in the mornings, 4 in the afternoons and evenings and 2 waking night staff. The registered owner was required to take immediate action to ensure that staffing levels were maintained at the previous inspections levels as a minimum. The agency member of staff was working for the first time at the home. She had been given no information about the home, fire safety procedures or any information about the residents. There was no up to date list of residents available meaning that the agency staff did not even have a list of which people were resident at the home. There was a file for agency staff induction that had been completed with other agency staff. This is not acceptable and placed additional pressure on the member of staff working with her and compromised the safety and care of the residents. Again this must be addressed by there being supernumerary management support to the care staff numbers. Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed at this inspection. EVIDENCE: Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 Page 20 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 X 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 2 STAFFING Standard No Score 27 1 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes carried forward as unable to assess. 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 OP3 Regulation 14 Requirement Assessment of needs must be completed in sufficient detail to ensure that staff can meet the needs of residents. Assessments must be signed and dated by the person completing the assessment. 2 OP7 15 Care plans must be produced sufficient detail to reflect resident’s current need. Nutritional and pressure area care plans must be in place following risk assessments. Care plans must be reviewed as and when a resident’s needs change. 3 OP7 14,15 Residents ‘Life stories and histories’ must be produced to ensure that staff have enough knowledge of the individuals to be able to meet their needs. All care records must be appropriately stored and maintained accurately to DS0000064118.V256423.R01.S.doc Timescale for action 01/11/05 27/09/05 01/01/06 4 OP7 14,15,17 01/11/05 Roxburgh House Version 5.0 Page 22 demonstrate what care and support has been provided. 5 6 OP7 OP8 17 14 A current photograph of the 01/12/05 resident must be included in care records. Suitable weighing scales must be 01/01/06 purchased so that moving and handling and nutritional assessments can be completed. (Previous timescale 31/01/04) Staff must sign the medication 01/11/05 administration records to demonstrate whether medication has been refused, administered or the resident was absent. Residents’ privacy and dignity must be maintained. • Residents must not use other residents’ bedrooms to be examined. • Screening must be provided in shared bedrooms. • Resident’s dignity must be maintained when they are in a state of undress. Provide items of interest, things to do, daily living tasks and additional staff time to ensure that residents are occupied and stimulated. Residents must be offered a choice of drinks. Residents must be assisted to drink at regular intervals. Hot drinks must cease to be provided ready mixed from plastic jugs. The registered person must ensure that hot water temperature checks are carried out weekly. The Legionella risk assessments must be updated/reviewed and actions DS0000064118.V256423.R01.S.doc 7 OP9 13 8 OP10 12,16 01/11/05 9 OP12 12, 16 01/12/05 10 OP15 12, 16 01/11/05 11 OP25 13 01/12/05 Roxburgh House Version 5.0 Page 23 12 OP19 13,23 taken to reduce any risks identified. (Previous timescale 31/12/04) Fire Doors must not be propped 17/10/05 open with fire fighting equipment or by other means. Fire doors and exits must not be blocked with items of furniture. Investigate and eliminate the unpleasant odour on the ground floor. Implement regular deep cleaning of the home including the shampooing of carpets. Ensure that toilets and bathrooms have the means for people to wash and dry their hands. The registered person must ensure that the records relating to each member of staff as required by the regulations are kept on the home. (Previous timescale 31/12/04) Staffing levels must be increased to meet the communication, psychological, personal and social care needs of the residents. The registered person must undertake a review of current staffing levels and determine how many staff are required to meet the needs of the residents. As part of the review the additional tasks that care staff undertake such as dishing/serving meals, laundry and bed making must also be considered. 13 14 15 OP26 OP26 OP26 13,16 13,16 13 01/12/05 01/12/05 01/11/05 16 OP29 19 01/11/05 17 OP27 18 01/12/05 18 OP27 18 There must be adequate arrangements in place to ensure that the absence of the manager does not take care staff away DS0000064118.V256423.R01.S.doc 01/11/05 Roxburgh House Version 5.0 Page 24 19 OP27 18 20 OP27 18 from residents. Staffing levels must be maintained with a minimum if four staff on duty in the afternoon and evenings. Agency staff must be provided with a basic induction that includes information about health and safety in the home and the residents’ needs. 27/09/05 01/11/05 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 OP9 Good Practice Recommendations Temazepam should be counter signed on administration. Oramorph should be treated, recorded and stored as a controlled drug. Residents’ full names should be used on labels in the drug cupboard. It is recommended that residents at the home be consulted on their food preferences and this be used to produce the menu. The menu should be displayed each day. The acting manager should consult and reconsider the decision to take the upstairs lounge and dining room out of use. Residents’ bedroom doors should be personalised and have their name on the door. A current list of residents should be made available for agency staff. 2 3 4 5 6 7 OP9 OP15 OP15 OP19 OP19 OP27 Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Roxburgh House DS0000064118.V256423.R01.S.doc Version 5.0 Page 26 - 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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