Inspection on 16/05/05 for Rushymead

This inspection was carried out on 16th May 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

Rushymead 04/06/09

Rushymead 01/07/08

Rushymead 10/07/07

Rushymead 19/07/06

Rushymead 28/11/05

Rushymead 05/01/05

Rushymead 20/09/04

Rushymead 12/02/04

Rushymead 15/09/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Rushymead Tower Road Coleshill Amersham HP7 OLA Lead Inspector Joan Browne Gill Wooldridge Unannounced 16th May 2005 9:30am 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 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. Rushymead Version 1.10 Page 3 SERVICE INFORMATION Name of service Rushymead Address Tower Hill, Coleshill, Amersham, Bucks HP7 OLA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Category(ies) of registration, with number of places 01494 727738 The Michael Batt Charitable Trust Mrs Janet Casselden Care Home Dementia (8) Old Age, not falling within any other category (28) Rushymead Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: YES Date of last inspection 20th September 2004 Brief Description of the Service: Rushymead is a care home providing personal care and accommodation for twenty older people with physical frailties and eight with mental frailties. The Michael Batt Charitable Trust owns the home, which is a registered charity. The home has an established senior team and appears to have a good relationship with the general practitioner and district nursing services. The home is located in the village of Coleshill some two miles south of Amersham. Public transport and local amenities are not easily accessible. The building has been adapted for use as a residential care home for over twenty years. It was first registered in 1991. It consists of three floors ground, first and second floor. There are twenty-six single rooms and one double room. Five bedrooms have en suite facilities. There is a passenger lift. The home has extensive gardens that are well maintained. Rushymead Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the home, which took place on the 16th May 2005 from 10.30 am to 4.30 pm. The lead inspector was Ms Joan Browne who was accompanied by Mrs Gill Wooldridge (Inspector) The inspection consisted of meeting with residents and staff, examination of care documentation and records. A tour of the communal areas and some bedrooms was carried out. The serving of lunch was observed on two units. The inspectors fed back to the manager, deputy manager and the project manager the out-come of the findings of the inspection. What the service does well: What has improved since the last inspection? Some lounges, toilets and bathrooms have been decorated. Staff have been proactive by ensuring that residents’ weights are recorded monthly. If a resident is loosing weight a food-monitoring chart is commenced and advice is sought from the general practitioner. Rushymead Version 1.10 Page 6 Some senior staff are undertaking an intensive training programme in the administration and recording of medication at the local college. The home now employs senior carers on night duty, which means that there is no need to have a senior member of staff doing a sleep in duty. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rushymead Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Rushymead Version 1.10 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 standard(s) 3 Residents’ needs assessments should have detailed and adequate information recorded to enable staff to meet residents’ needs fully. EVIDENCE: The inspectors examined the assessment record for a resident who was recently admitted to the home. The record did not detailed information. For example, under the heading “hearing” the entry recorded read “No aids but had one in the past”. This information did not appear clear and could be confusing to staff. It was noted that not all aspects of need had been identified. There was no moving and handling assessment in place. However, the “admission details heading” contained all the required information. Rushymead Version 1.10 Page 9 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 standard(s) 7, 8, 9, &10 Clear detailed information needs to be recorded in care plans to ensure that residents’ care needs are adequately met. Administration procedures need to reflect the home’s policy on administration of medication to ensure that residents’ health and well being are not put at risk. It is essential that staff be offered formal training in how to use the new tissue viability-monitoring tool. Tissue viability training will ensure that staff are confident to assess residents who may be at risk. Staff’s practices on the day of the inspection indicated that they respect residents’ privacy and dignity. EVIDENCE: Care plans need detailed information to enable to staff to fully meet residents care needs. However, further improvement is required to ensure that detailed information is recorded in plans to enable a new member of staff to provide adequate care to residents. It was noted that information in some plans was not always current. For example, in one care plan examined the identified needs relating to washing and dressing for a particular resident read as follows ‘needs full assistance when washing and dressing’. However, the action Rushymead Version 1.10 Page 10 recorded to meet the need read as follows ‘fill the sink with water and give him the flannel and he will wash himself’. This may be considered to be contradictory and confusing for a new member of staff or an agency staff member. In a second care plan examined the level of assistance and support needed was not identified. For example, in a particular resident’s care plan relating to incontinence there was no clear detailed information recorded for staff to follow to assist with the incontinence. It is required that a quality audit system in care plans be developed to support staff. This can be achieved through the development of a written care plan template, or through supervision, or training during the coming months. Medication administration record (MAR) sheets were examined and showed some concerning inconsistencies. These included staff not using codes to denote if medication or creams were administered as prescribed. Some entries were written over. Not all handwritten entries recorded on MAR sheets were dated and had two staff signatures. It was noted that some residents were on a calcium treatment. However, MAR sheets indicated that they did not receive treatment for sometime and there was no written explanation recorded on MAR sheets to indicate if the treatment had been discontinued. There was no written evidence to confirm that MAR sheets were being audited regularly and that staff competencies were regularly assessed. These issues were subject to a requirement at the previous inspection. The proprietor and registered manager must explain to the Commission why this requirement has not been met and what actions the manager will put in place to ensure that the standard is met. It was noted that Nitrazepam, which is a strong sedative was prescribed for a particular resident. As a good practice it is being recommended that it should be treated as a schedule drug and that two staff members administer the medication. The home has developed a tissue viability- monitoring tool. However, the inspectors were disappointed to note that to date staff have not been given formal training to use the tool. This requirement remains outstanding from the previous inspection Observation of staff’s practices indicated that residents were being treated with respect and dignity. Staff were heard addressing residents appropriately using the name that they wished to be called by. Rushymead Version 1.10 Page 11 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 standard(s) 15 Mealtimes need to be better managed and supervised to ensure residents abilities and preferences are acted upon. The arrangement in place for the disposal of waste food was institutional and spoiled the ambience of the mealtime. EVIDENCE: The inspectors observed lunch being served on two units. Tables were appropriately set with tablecloths, cutlery and condiments. A choice of lemon barley or orange cordial drink was on offer. Choices on offer in the main course were lamb casserole, cold gammon, sauté potatoes mushrooms and broccoli. Dessert was baked apple and custard or cheese and biscuits. Residents spoken to were complimentary about the lunch and said that ‘the food is always good’. There was not a lot of interaction amongst residents noted during lunch. On one particular unit there were two agency staff members who did not appear to know residents’ likes and dislikes and as a result were not confident to prompt those residents who needed assistance with prompting to eat their lunch. It was noted that at least two residents had eaten very little lunch. There was no clear plan in place to offer an alternative like for example, a bowl of soup or a protein drink. Staff were seen disposing of food in a plastic container, which gave the process an institutionalised feel. It is required that the manager must assess the meal periods and employ adequate staff if required to meet residents’ needs. The Rushymead Version 1.10 Page 12 practice of scraping food in plastic containers should be reviewed as it gave the process an institutionalised feel. Rushymead Version 1.10 Page 13 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 standard(s) 16 &18 The home’s complaints record folder was not accessible to residents, relatives and staff to ensure that comments, complaints and compliments are recorded and actioned. Staff have undertaken training in adult protection and abuse awareness. With clear guidelines and training this should ensure that residents are protected from any potential abuse. EVIDENCE: On the day of the inspection the complaints book was not accessible. The manager informed the inspectors that the home had not received any complaints since the last inspection. It is recommended that details of all verbal concerns be recorded. The manager informed the inspectors that all staff apart from one had undertaken training in adult protection and abuse awareness. A copy of questions used in the training to test staff’s knowledge was made available to the inspectors. Rushymead Version 1.10 Page 14 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 standard(s) 19, 20, 21, 24, & 26 Residents live in a building, which appears to be maintained and complied with the standards of the fire safety services to ensure that residents are in a safe environment. Communal areas in the home were welcoming and comfortable providing the residents with an attractive social environment. Staff were not always using the cupboards and storage boxes provided in residents’ toilets and bathrooms to store pads, gloves and aprons. This could potentially compromise residents’ privacy and pose a safety hazard. Overall residents’ bedrooms appeared well furnished and homely. However, the floor covering in one particular bedroom posed a health and safety problem to the resident. The communal areas in the home appeared free from offensive odours. Pedal bins are needed in toilets, bathrooms and kitchenettes to prevent the spread of cross infection that could potentially put residents health at risk. Rushymead Version 1.10 Page 15 EVIDENCE: The home is a large attractive building standing in several acres of private gardens and grounds. The gardens appear to be well maintained. At the time of inspection the building met the standards of the fire safety services. There was no use of CCTV in the home. The home is divided into three units. Each unit has a sitting and dining area. Rooms appeared well lit and ventilated. Furniture appeared satisfactory. Smoking is not permitted in the home. The home has adequate numbers of bathrooms and toilets on each floor with an additional shower room. Bathrooms are fitted with hoists to assist service users with transfers in and out of the bath. Cupboards and storage boxes are provided in bathrooms and toilets to store pads, gloves and aprons. However on the day of the inspection pads and gloves were visible in some bathrooms and toilets. In one particular toilet a packet of pads was left on the floor. This made it look like residents’ privacy and dignity was being compromised as well as posing a safety hazard. Staff are reminded that pads, gloves and aprons should be stored out of view. Four residents’ bedrooms were looked at during the inspection. Bedrooms were appropriately furnished and presented a homely feel. It was noted that in one particular bedroom there was a strong odour of urine. The inspectors were told that the carpet in this particular bedroom is cleaned regularly and was recently replaced. The manager should consider providing an alternative floor covering in this particular bedroom after discussion with the resident and relative to eliminate the offensive odour. There were no offensive odours noted in the communal areas The home has a dedicated laundry assistant who ensures that service users clothes are maintained to a high standard. The laundry room is situated away from areas where food is stored and prepared. On the day of the inspection the laundry floor and walls were clean. There were two washing machines and two driers. One of the washing machines had a sluicing facility to accommodate foul linen. It was noted that in some areas of the home for example, in the kitchenettes, toilets and bathrooms foot pedal bins were required. The manager is required to purchase foot pedal bins to reduce the risk of cross infection. Ceiling lights in some areas of the building needed attention. This was pointed out to the manager and inspectors are confident that action will be taken. Rushymead Version 1.10 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, & 30 Staffing numbers must be sufficient at all times of day and night to ensure residents’ needs are met. The home’s procedure for the recruitment of permanent staff appears robust and should provide protection for residents. Evidence that agency staff are appropriately trained should be available to ensure that residents are in safe hands at all times. Planned training needs to be programmed and take place to ensure residents’ needs are met. Shortfalls in agency staff training may be detrimental to meeting resident’s needs. EVIDENCE: On the day of the inspection there were five care staff on duty allocated to work on three units. This number included the senior carer who was leading the shift. Two of the five cares were agency members of staff. The manager and deputy manager were supernumerary to the rota. It was noted that the two agency workers were deployed to work in the same unit and were both males. It is strongly recommended that the manager discuss with residents their preference of personal care being provided with someone of the opposite sex. This should be recorded in individual’s care plans. There is also a concern that residents’ needs may not be adequately met, as staff members were not fully aware of individual’s needs. Inspectors were told that one of the cooks Rushymead Version 1.10 Page 17 had recently retired, which had an impact on the delivery of service in the kitchen. However, on the day of the inspection the cook had returned to work a bank shift. Residents were delighted to have her back. It is required that the proprietor and manager must consider recruiting more permanent staff to ensure that residents’ preference in gender care is provided. The most recent staff member file was examined. The documents in the file conformed to Regulation 19 and Schedule 2 of the Care Homes Regulations. The information on file relating to agency workers was examined. Criminal Record Bureau (CRB) clearance numbers were on file for individuals, as well as confirmation that two references had been received. However, there was no evidence that agency staff members working in the home had undergone mandatory training. For example, moving and handling training, first aid, food handling and hygiene, fire, infection control and adult protection and abuse awareness. The manager must obtain confirmation from the agency that all staff have undergone the mandatory training and that training is regularly updated. A new induction programme checklist for care staff has been developed. Staff have had updates in moving and handling training. There was evidence in place that some mandatory training is planned on a rolling programme. A copy of the home’s training matrix was forwarded to the Commission. However, the matrix was not supported by staff’s certificate seen on file. It is recommended that the manager include dementia and challenging behaviour training in the home’s training programme. Rushymead Version 1.10 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 & 38 The home does not have any quality assurance and quality monitoring systems in place to ensure that residents are given the opportunity to comment on the service provision. The home’s system of managing resident’s finances is not flexible enough to allow them access to their funds as and when required. Emergency lighting and fire doors need to be checked more frequently to ensure residents’ safety. The key for the COSHH cupboard should not be left in the lock. Sauces need to be labelled, dated and stored appropriately to ensure that residents’ health and safety is not compromised. EVIDENCE: The shortfalls in records pertaining to Health and Safety issues may put residents at risk. There was no evidence that the home has an annual Rushymead Version 1.10 Page 19 development plan. The manager is required to develop an audit system to ensure residents are involved and consulted about the operation of the home. The inspectors are pleased to report that Regulation 26 visits are now regularly taking place and copies of the reports are being forwarded to the Commission. The home has a system in place to look after residents’ money. However, improvement in the system is required. Residents’ money is pooled but appropriate records and receipts are kept. Inspectors were told that residents have access to their money as long as they request it in advance. Access is not available at the weekend. The proprietor and manager are required to explore a more flexible approach to ensure that residents have access to their funds as and when required. The manager must develop a clear protocol to ensure best practice is followed incorporating the home’s good practice. Evidence was in place to confirm that the fire panel was being checked weekly. However, it was noted that the emergency lights were being checked sixmonthly and the last entry recording when the fire doors were checked was the 25th February 2005. The manager must ensure that the emergency lights are checked monthly and fire doors weekly. The last fire drill was recorded as having taken place on the 28th January 2005. It is required that night staff should have a minimum of two fire drills yearly and a tabletop evacuation yearly. In one particular unit it was noted that the sauces were not appropriately stored and the key for the COSHH cupboard was left in the lock. It is required that sauces must be stored in the refrigerator once opened and they should be dated and labelled. The key for the COSHH cupboard should be removed from the lock after use. Rushymead Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 3 3 2 x x 2 x 2 STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x 2 x 2 x x 2 Rushymead Version 1.10 Page 21 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 7 Regulation 18(1)(c) (i) Requirement The registered manager must ensure that care staff are trained to use the new tissue viability tool that has recently been developed. (Previous timescale of 06.01.05 not met) The registered manager must monitor the content in the care plans and provide ongoing training for staff. The registered manager must ensure that staff record medication in accordance with the British Pharmaceutical Guidelines. (Previous timescale of 06.01.05 not met) The registered manager must assess meal times and employ adequate staff if required to meet residents needs. The registered manager must make every effort to eliminate the strong smell of urine identified in the residents bedroom on the day of the inspection. Alternatively the floor covering must be replaced after discussion with the resident and relative. The registered manager must replace swing top bins in the Version 1.10 Timescale for action 30.06.05 2. 7 18(1)( c) (i) 13(2) 30.06.05 and ongoing 30.06.05 and ongoing 3. 7 4. 15 12(1)(b) 30.06.05 5. 24&26 16(k) 30.06.05 6. 26 16(k) 14.07.05 Rushymead Page 22 7. 8. 27 29 18(1)(a) 18(1)(c ) (i) 9. 35 10(1) 10. 38 13(4)(c ) 11. 38 18(1)(c ) (i) 13(4)(c ) 12. 38 kitchnettes and some bathrooms and toilets with foot pedal bins to prevent the spread of crosss infection. The registered manager must consider recruiting more permanent care staff The registered manager must obtain written confirmation that agency members of staff have undergone the mandatory training and that training is regularly updated. The registered manager and the proprietor must develop a more flexible approach to ensure that residents have access to their money as and when required. The registered manager must ensure that the emergency lighting is checked monthly and fire doors weekly. The registered manager must ensure that night staff have a minimum of two fire drills yearly and a table top evacuation. The registered manager must ensure that sauces are appropriately stored in refrigerators and that they are dated and labelled. 06.05.05 and ongoing 6.05.05 and ongoing 14.07.05 06.05.05 and ongoing 06.05.05 and ongoing 06.05.05 and ongoing RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 9 7 15 Good Practice Recommendations It is recommended that the registered manager should treat the drug Nitrazepam as a schedule medication. It is recommended that the registered manager should discuss and record in residents care plans their preference in having personal care provided by staff of the same sex. It is recommended that the registered manager should review the practice of scraping waste food in a plastic Version 1.10 Page 23 Rushymead 4. 5. 6. 16 30 33 container at meal times. It is recommended that the registered manager should record all verbal complaints and outcomes It is recommended that the registered manager should include dementia and challenging behaviour in the homes training programme. It is recommended that the registered manager should develop an audit system to seek the views of residents regarding the service delivery. Rushymead Version 1.10 Page 24 Commission for Social Care Inspection Cambridge House 8 Bell Business Park Smeaton Close Aylesbury, Bucks HP19 8JR 01296 737550 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 Rushymead Version 1.10 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. 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