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Inspection on 16/06/05 for Ryedale Court Nursing Home

Also see our care home review for Ryedale Court Nursing Home for more information

This inspection was carried out on 16th June 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Those residents spoken to, who were able to express a view, were very happy with the quality of care, they were receiving in the home. Relatives were also very positive about the care and commented that staff are very welcoming when they visit and that they appreciated being able to visit whenever they wanted. Pre-admission assessments and care plans are detailed and comprehensive and the manager has a system in place for the regular auditing of care plans and other health related records. The manager and staff are committed to improving the standard of care people receive in the home and to make sure that the residents were "happy and well looked after".

What has improved since the last inspection?

The overall management of the home has improved, with the appointment of the current manager. The home has taken action to address all the requirements from the previous inspection, including the provision of dementia awareness training for care staff, improving the way complaints are recorded and reviewing the system for the recording and safe keeping of residents money and valuables. This represents a very positive response to the findings of the previous inspection and demonstrates the homes commitment to work with the Commission in order to further raise standards at the home.

What the care home could do better:

Areas where the home needed to improve were discussed and agreed with the manager. Residents, especially those with more specialised needs, for example dementia, would benefit from a more extensive programme of activities to ensure that all residents have a sufficiently stimulating and varied choice. Some areas of the home are in need of re-decoration and minor repair, to improve the comfort and safety of residents. The manager must ensure that all medicines in the home are safely administered and that all nursing staff abide by the home`s medication policy and the Nursing and Midwifery Council (NMC) Standard for administration of medication.

CARE HOMES FOR OLDER PEOPLE Ryedale Court Nursing Home Victoria Road Barking Essex IG11 8PE Lead Inspector Gwen Lording Unannounced Inspection 16 June 2005 10:00 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. Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ryedale Court Nursing Home Address Victoria Road, Barking, Essex IG11 8PE 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) 020 8514 2525 020 8514 2727 Avonpark Care Centre Ltd Mr Selvenaden Tiagarassa Pillay CRH Care Home 70 Category(ies) of DE(E) Dementia - over 65 (53) registration, with number OP Old age (17) of places Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. 17 beds for elderly frail. 2. 53 beds for elderly mentally ill. 3. Minimum staffing notice. Date of last inspection 09 December 2004 Brief Description of the Service: Ryedale Court Nursing Home provides nursing care and accommodation for older people who have dementia or physical fraility due to the ageing process The home is registered to accommodate seventy service users. The registered providers are Avonpark Care Centre Limited. The home has three separate units, two of which accommodate older people with dementia and one smaller unit for the frail elderly. The majority of the rooms are single and en suite with three double rooms on the elderly frail unit. There is a passenger lift. The home employs an activities co-ordinator, catering, laundry housekeeping, administrative and maintenance staff. The home is situated in a residential area of Redbridge on the borders of Barking and is well served by public transport. Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day and lasted six hours. The Inspector spoke to a number of residents on each of the three units of the home. In addition the relatives of five residents were interviewed to get their views and comments about the care in the home. Discussion took place with the manager, administrative, catering/ domestic staff and several members of nursing and care staff. A tour of the home was made and a number of staff and care records were looked at. An Immediate Requirement Notice was issued for action to be taken concerning the administration of medication on Oakland Unit. The manager took immediate action to address the issues identified and to ensure the safety of all residents in the home. The registered providers have also written to the Commission confirming the action taken. The Inspector would like to thank the resident’s, their relatives and staff for their input during the visit. What the service does well: What has improved since the last inspection? The overall management of the home has improved, with the appointment of the current manager. The home has taken action to address all the requirements from the previous inspection, including the provision of dementia awareness training for care Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 Page 6 staff, improving the way complaints are recorded and reviewing the system for the recording and safe keeping of residents money and valuables. This represents a very positive response to the findings of the previous inspection and demonstrates the homes commitment to work with the Commission in order to further raise standards at the home. 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. Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 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 Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 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 A comprehensive pre-admission assessment is undertaken for all residents prior to them moving into the home. Care plans are drawn up from this assessment, ensuring that the needs of the resident are identified, understood and met. EVIDENCE: The admission process was discussed with the son of one resident who had recently moved into the home from another care home. Her son had not been satisfied that his mother’s cultural and dietary needs had been adequately understood and met by staff in the previous home. He had visited Ryedale Court and discussed his mother’s needs with the manager and other staff before she moved in so that he could be sure it was the right place for her. With the assistance of her son interpreting the resident was able to say she was much happier and that her needs were being met. Her son visited daily and was surprised, but pleased how well his mother had settled in. Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 Page 9 This residents care plan set out in detail how her needs and wishes would be met. A recent review undertaken by her social worker also indicated that the resident had settled in quickly to the home and that her needs were being understood and met by staff in the home. Individual records are kept for each resident and a number of records were inspected on each unit of the home. All records inspected had full assessment information recorded. The records showed that residents, where capable, their relatives/ representatives are involved in the assessment process. Where appropriate, information provided by the placing authority was also included. The home does not offer intermediate care. Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 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 standard(s) 7, 8 and 9 Residents’ health, personal and social care needs are set out in individual care plans and provide staff with the information they need to satisfactorily identify and meet residents’ needs. There are clear medication policies and procedures for staff to follow. However, the unsafe practice of some staff around the administration of medication is of serious concern and could result in residents’ being put at risk. EVIDENCE: Individual plans of care were available for each resident. The records of four residents on each of the three units were examined. The records for these residents were found to be generally detailed and comprehensive, and followed on from a full assessment of the resident’s needs. There was evidence that care plans are reviewed on a monthly basis and updated to reflect changing needs. The records indicated that residents are seen by other health care professionals such as dentists, chiropodists, opticians, specialist nurses and doctors. Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 Page 11 The manager has a system in place for auditing a number of care plans in the home on a monthly basis and also monitors records related to wound assessment and medication. During the inspection a member of nursing staff was noted to have dispensed prescribed medication for two residents into plastic pots and left them unattended on top of the servery in the dining room (Oakland Unit). In addition the medication had been crushed and there was no authorisation by the prescriber indicated on the Medication Administration Record (MAR) charts. A Notice of Immediate Requirement for action was issued to ensure the safety of all residents in the home. The practice of crushing prescribed medication without the authorisation of the prescriber may adversely affect a resident’s health. In such cases, were for example a resident may have difficulty swallowing tablets, the manager must consult with the residents GP, as the medication could be prescribed in a more suitable form. The practice of dispensing medication into plastic pots and leaving it unattended is of serious concern. All nursing staff in the home must abide by the home’s medication policy and the Nursing and Midwifery Council (NMC) Standard for administration of medication. Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 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 standard(s) 12,13 and 15 There is a varied programme of activities available. More consideration needs to be given to planning activities which are suitable for those residents with specialist needs such as dementia to ensure that all residents have a sufficiently stimulating and varied choice of activities. Visiting times are flexible and people are made to feel welcome in the home so that residents are able to maintain contact with their family and friends as they wish. The meals in the home are good, offering both choice and variety for residents living in the home. EVIDENCE: Visiting times in the home are very flexible and visitors commented “ staff make them feel very welcome, at any time”. Residents are able to receive visitors in one of the lounges or in their own rooms. The relatives of several residents choose to visit and spend the whole day with their relative. This is well accommodated by staff and arrangements can be made for the provision of a meal. One relative said that he particularly appreciated this arrangement. Other relatives said that they were always offered a drink when they visited. Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 Page 13 Relatives are friends are encouraged and welcomed to be involved in special activities in the home for example, the annual Summer Fete and fund raising. The project for this year is to raise money towards a mini bus. There is a relative’s information board in the reception area of the home. As well as general information about the home it also provides relatives with information and leaflets about associations and support groups for relatives/ carers, for example Alzheimer’s Society. Relatives meetings are held about every three months and the minutes indicate that they are well attended. The home has a programme of activities and outings and employs a full time activity organiser. On the day of the inspection she was on a training day but there did not appear to have been any activities arranged to take place in her absence. Discussion with relatives indicated that the variety of activities on offer or suitable for residents with specialist needs such as dementia or those with limited capacity to be involved was limited. One comment being “ I think there could be more one to one activities”. Staff were observed sitting and talking to residents and asking small groups of residents about the choice of music tape they wished to listen to, but little alternative stimulation was noted during the visit. The home needs to provide a more extensive programme of activities to ensure that all residents have a sufficiently stimulating and varied choice. Meals are served in the dining rooms or residents may choose to eat in their rooms. A small number of residents eat off small tables in front of the lounge chairs, though it is not clear if this is through choice. Menus were inspected and found to be balanced and a choice is offered each day. During the serving of the lunchtime meal one resident commented that she had little appetite that day for the meal that she had previously chosen. The staff were keen to offer her a more suitable alternative. Several residents spoken to said that they enjoyed the food and that there was sufficient choice. The home has to cater for a wide range of diets including diabetic, low salt, soft and puree diets as well as religious or cultural dietary needs. In visiting the kitchen this information was available to the cook and catering staff and she was informed of changes on a daily basis. Information in care plans indicated that referrals had been made to a dietician where appropriate. Arrangements have been made for the Dietician to provide training/ information to staff around ‘Nutrition in the Elderly’, which will include attendance by kitchen staff. Staff are hand to assist individuals with eating when necessary. During the inspection residents were offered frequent drinks and staff responded to requests for drinks appropriately. Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 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 standard(s) 16 and 18 The manager and staff make every effort to sort out any problems or concerns and makes sure that residents and relatives feel confident that their complaints and concerns are listened to and will be acted upon. Staff working in the home have received training in Adult Protection/ Abuse Awareness to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: Since the last inspection the complaints policy has been amended and now all complaints, both verbal and written, are recorded and include full details of investigation, any action taken and the outcome for the complainant. Those residents and relatives spoken to considered that the manager and staff were always very responsive to any concerns or issues of dissatisfaction raised and were confident that they would be taken seriously and acted upon. One relative said “ If there’s a problem, I let the manager know and he tries his best to sort it out without any fuss”. The complaints policy must be amended to provide information for referring a complaint to the Commission, at any stage, should the complainant wish to do so. There is a written policy and procedure for dealing with allegations of abuse and whistle blowing. There is an ongoing programme of training in Adult Protection/ Abuse Awareness and this is now extended to all staff working in the home including administrative and ancillary staff. Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 Page 15 Those staff spoken to during the inspection were aware of the action to be taken if there were concerns about the welfare and safety of residents. Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, and 26 The overall atmosphere in the home is welcoming, with access to indoor and outdoor communal facilities which adequately meet the needs of the people living in the home. However, there are a small number of areas in the home in need of re-decoration and minor repair, to improve the comfort of the residents. EVIDENCE: The home has an ongoing re-decoration programme and since the last inspection a number of bedrooms have been decorated and carpets replaced in some communal areas, which has improved these facilities for residents. One bedroom in need of decoration was inspected whilst a relative was visiting. She had not been given a firm date for the work to commence in her mother’s bedroom however, the manager had discussed choices for colour schemes etc with her. Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 Page 17 The bathroom on Garden unit was noted to have some missing tiles, a torn shower curtain and some broken slats on the window blind. The floor covering on Park unit needs replacing as the floor covering has begun to lift in some areas and tape is being used to secure the floor covering in these areas. All areas of the home need to be adequately maintained to improve the comfort, privacy and safety of the residents. There are well-maintained garden areas to the front and rear of the home, which are fully accessible to residents. Throughout the inspection all areas of the home were found to be clean, tidy and free from odour. Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 and 30 The home employs sufficient staff that have the skills and training to meet the needs of the residents. EVIDENCE: The home has a relatively stable workforce and in discussion with staff it was evident that they fully support the main aims and values of the home. In addition to qualified nurses and care staff the home employs an activity coordinator, catering, laundry, housekeeping administrative and maintenance staff. Those residents and relatives spoken to commented that staff in the home are “kind and caring” and that there “ is always a member of staff available in dining rooms and lounge areas” Files showed that staff had completed training in essential areas, such as food hygiene, manual handling, adult protection and health and safety. At the last inspection a requirement was made for care staff to receive training in dementia awareness to ensure that the specialist needs of these residents was being adequately understood and met. A number of care staff have now undertaken training in ‘Dementia Awareness’. This training is provided through an external training organisation. The training is accredited and staff take an exam at the end of the course. The Inspector took the opportunity to speak to two carers who were due to complete the course. They both found the training “very helpful in understanding the type of behaviour shown by people with dementia” and “felt more confident when handling people”. Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 Page 19 Since the last inspection qualified nursing staff had received training and attended workshops on topics such as catheterisation and managing residents with swallowing difficulties. The registered manager with the support of the registered providers places a high emphasis on staff training and is committed to improving the skills of all staff to ensure that residents get a good quality of support and care from the staff in the home. Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) 31, 32 and 33 and 35 The manager of the home is a well qualified and experienced person and residents benefit as the home is run in their best interests. EVIDENCE: The manager is a registered nurse and has substantial clinical and management experience. He has a good understanding of the needs of the residents and the areas in which the home needs to improve and further develop. He has a visible presence in the home and relatives have commented that he is very approachable and helpful. There is a system in place for monitoring the standard of care plans and other health related records to achieve a consistent standard throughout the home. Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 Page 21 The registered providers also check the quality of care in the home through monthly monitoring visits. A comprehensive report is produced and a copy is sent to the Commission. The registered providers and the manager work closely together and demonstrate a clear commitment to achieve high standards for residents in the home. Since the last inspection the manager has reviewed the home’s system for recording money and valuables held in the safe. This new system ensures that secure facilities are provided for the safekeeping of money and valuables held on behalf of residents. Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 3 3 3 x 3 x x x Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 Page 23 NO 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 9 Regulation 13 Requirement All nursing staff involved in the administration of medication must abide by the homes medication policy and the Nursing and Midwifery Council (NMC) Standard for administration of medication. The home must provide a more varied programme of activities with particular consideration to those residents with dementia and cognitive impairments. The complaints policy must be amended to include information for referring a complaint to the Commission at any stage, should the complainant wish to do so. The registered providers must produce an action plan with timescales, for a programme of routine maintenance and renewal of the fabric and decoration of the premises. All areas of the home need to be adequately maintained to improve the safety, comfort and privacy of residents. Timescale for action 16/06/05 Immediate and ongoing 2. 12 16 31/08/05 3. 16 22 31/07/05 4. 19 23 31/08/05 5. 19 23 31/07/05 Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 Page 24 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 Good Practice Recommendations Ryedale Court Nursing Home G55_S0000015602_Ryedale Court_V233467_160605_Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford Essex IG1 4PU 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. 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