Inspection on 09/02/06 for St Margaret`s Care Home, Grimsby

This inspection was carried out on 9th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Margaret`s Care Home, Grimsby 17/12/08

St Margaret`s Care Home, Grimsby 14/12/07

St Margaret`s Care Home, Grimsby 18/01/07

St Margaret`s Care Home, Grimsby 25/01/05

St Margaret`s Care Home, Grimsby 04/08/04

St Margaret`s Care Home, Grimsby 05/03/04

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

CARE HOMES FOR OLDER PEOPLE St Margaret`s Care Home, Grimsby Littlecoates Road Grimsby North East Lincs DN34 4NQ Lead Inspector Mrs Kate Emmerson Unannounced Inspection 9th February 2006 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 St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Margaret`s Care Home, Grimsby Address Littlecoates Road Grimsby North East Lincs DN34 4NQ 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) 01472 241780 01472 250243 enquiries@sunhealthcare.org Sun Healthcare Limited Mrs Olivia McFerran Care Home 56 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (47), of places Physical disability (9) St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th June 2005 Brief Description of the Service: St Margaret’s is a purpose built residential and nursing home. The accommodation is provided over one level. Nursing care is provided in the home, and there are two specialist areas within the home that provides care for EMI and Huntingdon’s Chorea service users. The home is close to local services, shops and public houses. It is also on a bus route in to the town centre of Grimsby. St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one day in February 2006. To find out how the home was run and if the people who lived there were pleased with the care they got the inspector spent time on in the home watching how the care was given. The inspector spoke to the manager, of the staff working in the home at the time of the inspection and service users. Paper work kept in the home was also seen, this was to make sure that the staff are safe to work in the home and that they had been trained to their job safely. Records of the care provided were also examined. What the service does well: What has improved since the last inspection? St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 6 Records were now kept to show when the medication came into the home and what happened to it if it wasn’t taken. The home was working towards the targets for half the staff to be qualified carers. The home had people who have very different types of illnesses and the staff had received some training in Dementia to make sure they understand how this affects people and how care must be given. What they could do better: They must make sure that there are written plans for when people have problems that require medication to be given occasionally to help them calm down. The staff must make sure that when they give this medication they write down the reason why and the effect it had. This is to make sure that all the staff act in the same way, for the same reasons and the doctor can tell if the medication is working. The records that the staff write every day about the people who live there must more clearly show how the person has been and the care that was given. People who need special chairs for them to sit in must be properly fitted for these. Everyone must be checked to make that the right sort of chair is available to help him or her sit out of bed. The home has people who have very different types of illnesses and the staff must have training in Huntingdon’s Chorea to make sure they understand how this affects people and how care must be given. The lounges in one unit and the dining room in another should be made more comfortable and homely. Please contact the provider for advice of actions taken in response to this St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 8 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 St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 9 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): None of the above standards were assessed at this inspection. Please refer to previous inspection reports for information. EVIDENCE: St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 and 10 The service users health and personal care needs were being met but the records to evidence the care provided must be more detailed and consistent in the EMI unit. There were no records to support the decision making process of the administration of ‘as required’ medication and a lack of care planning to support the care of those with challenging behaviour. The medication records were now completed satisfactorily. Service users privacy and dignity was not upheld at all times. EVIDENCE: Five service users were case tracked during the inspection. The care plans on the nursing/residential unit were generally detailed and reflected the needs identified at assessment. The care plans on the EMI unit did not detail all the service users needs. Where intervention was required to manage challenging behaviour or self-harm there was little in the way of action plans to support the care needs. St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 11 Where one service user had shown challenging behaviour medication had been prescribed to modify this behaviour, which the nurses administered on an ‘as required’ basis. There were no care plans to support the management of the service user when displaying this type of behaviour and the administration of medication to modify behaviour. Daily diary records did not record decisionmaking process where this medication had been administered and there was no evidence of follow up by the administering nurse to indicate the effect of medication. The service users were not placed in nursing care but the nurses were involved in supporting the care staff with the care requirements of this group of service users and the management should assess if the service users requiring this type of input are appropriately placed/funded. Daily diary sheets were not adequately detailed and did not record details of the service users health and wellbeing and the care provided. In one case bruising was seen on a service users arm during the inspection. When checked, this had not been noted in the care records, even though regular personal care had been provided by at least two staff throughout the day, or staff handover records and the manager stated she had not been made aware of this. (As the service user was bed dependant with no communication and there was a clear lack of recording of any incident, which would explain the bruising, and the bruising had not been recorded or reported appropriately, the inspector reported this to the Protection Vulnerable Adults team.) There was some evidence that care plans had been regularly evaluated and updated as required. The evaluations were not detailed and generally consisted of a date and signature with little or no information as to the progress or otherwise of the service user. The evaluations were sometimes written on the care plan and updates to the care plan were occasionally written within the evaluation. Information relating to new care needs and care requirements could be missed with this approach. There was some evidence that the manager was trying to improve the quality of the care plans and educate staff and there was evidence of quarterly management audits within the care plans. There was little evidence in the care plans viewed that the service users had agreed their care plan. Care plans were kept in service users own rooms so they have access to them at all times but as these are not held securely so does any visitor to the home. Medication records were viewed. Records for the receipt, disposal and administration of controlled medication were maintained. Records for the administration, receipt and disposal of other medication were completed. The nursing staff administered all the medication. St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 12 Direct, and indirect observations during the inspection did not evidence that the service users are treated with dignity, and respect at all times. During the inspection on the EMI unit service users privacy and dignity was not promoted. There was very little interaction between staff and service users even when individual care tasks were being completed. There were no instructions given as to the care to that was to carried out or consent sought or choices offered by the staff even when service users were being hoisted or taken to the toilet. It was noted in this unit that service users had not had assistance to change clothing or tabards when these became soiled. Staff stated this was because they had insufficient supplies of tabards to change them as required, the manager denied this. Where service users were at risk of self-harm through scratching they had been provided with an odd pair of socks to cover their hands. Service users had access to a public telephone in the entrance area of the home or service users could use one of the office telephones for private calls. Service users could have a telephone in their rooms if required. Service users mail was given to the service users unopened or to families where this had been agreed. Screening is provided in all shared rooms to uphold, and maintain privacy and dignity to the service users. Staff were provided with training in promoting privacy and dignity during induction. St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 15 Visitors were encouraged to access the home. Service user received a wholesome and varied diet. The dining room in the nursing/residential unit was very unappealing. EVIDENCE: St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 14 Direct observations evidenced that visitors are encouraged to access the home, and that the staff are supportive, and welcoming to them. The manager and staff stated that service users are enabled to go out as they wish and for example visit their relatives, the local public house, and shops. Outside entertainment is brought into the home and relatives are invited. The manager stated that the last service users and relatives meeting was in 2005 but this was poorly attended partly due to the high dependency of the service users and a lack of interest by family. The menus in the home are rotated over a six-week period. Service users likes and dislikes were sought to influence any changes to the menus and meals provided. Nutritional assessments are recorded on individual service user case files. The inspector’s discussions with service users identified that if they do not want anything that is on the menu then an alternative meal will be provided. At least two choices were available at each meal. Staff were seen assisting service users in a sensitive manner. The majority of the service users were served their meals in their rooms or in the communal lounges. The dining room on the nursing/residential unit was dirty and uninviting and on the day of the inspection a bike was stored in this area. St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The service users had access to a complaints procedure. The service users were not adequately protected from abuse due to the lack of staff training in this area. EVIDENCE: The manager stated that there had been seven complaints recorded since the last inspection. These were mostly regarding service user abuse to staff and service user to service user issues. There had been one allegation of abuse, which was the subject of an internal investigation and was unfounded. The complaints procedure was displayed in the home. The staff were still a little vague on the procedures with regard to if they had a form to complete but all stated they would go to the manager or a senior member of staff. St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 16 The staff training records evidenced that only 12 of the 43 staff in the home had received training in relation to adult protection, interviews with the staff confirmed the lack of training but they showed some understanding of signs of possible abuse, and the appropriate methods to report their concerns. The manager stated that training had been arranged with the local authority and she was waiting dates for this to be completed. The home had clear policies and procedures for the Protection of Vulnerable Adults and this also relates to the reporting systems of the Local Authority. The home also has an appropriate whistle blowing policy. St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 EVIDENCE: The home is built on one level and is accessible to service users in wheelchairs. Generally the home was clean tidy and well maintained and there was evidence that the redecoration programme was continuing. There was a variety of communal space available to the service users. The communal space was generally homely and domestic in character. At the last inspection it was noted that the EMI lounge and quiet room and the dining room in main building were very utilitarian. The manager stated that there had been no work completed to improve any of these areas due to financial constraints placed upon her by the proprietors. During a tour of the building it was noted that there were some service users being nursed in bed, these service users had been well positioned through the use of pillows and looked very comfortable. At the last inspection the staff commented that some of the service users were not sat out due to the lack of St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 18 appropriate seating in the home. The manager stated that she was not aware of any issues relating to this situation and was advised to audit the provision of seating with the staff. The manager stated that she had consulted staff re this issue and had requested an Occupational Therapist assessment for some of the service users this had not been completed at the time of the inspection. The hot water in the home was not within an acceptable range in the EMI unit where with the exception of one bedroom the hot water was cold. The staff stated this had been an ongoing situation for some time. An immediate requirement notice was served for this to be addressed and the work to rectify the situation was completed with the set timescales. This situation may have compromised the infection control in the home and compromised the general comfort of the service users should have been dealt with more effectively by all concerned. There were varied comments from staff as to the consistency of the availability of continence pads, gloves and wipes in the home. On the day of the inspection the EMI staff stated that they had no wipes but the manager was able to show the inspector that there were stocks of wipes in the home. The manager must monitor this situation. The last two points raised in this section show a distinct lack of communication and leadership in the EMI unit. St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30 The staffing levels in the home were adequate to meet the needs of the service users. The organisation of the staff group in the EMI unit impacted on the nursing staff time. It is recommended that there is a appropriately trained individual nominated as in charge of this area on each shift. Staff training was provided in mandatory areas and some specific conditions of the service users cared for in the home. EVIDENCE: The staffing levels were appropriate for the service users accommodated at this inspection. However some of same concerns regarding the way staffing was organised in the home raised in the last inspection remain and must be addressed. At the time of the inspection there were 46 service users living in the home. The home also provided up to 4-day care places on the EMI unit Monday to Friday. The home had a high proportion of very dependant service users requiring two carers and others who required a high level of supervision due to behaviour or risk of falls. The staff were arranged into 3 groups of carers for each area. There were staggered start times in the morning and finishing times in the evening. Two nurses were on duty between 8am and 8pm and one nurse at all other times. The home had between 6 carers and 11 carers on duty at any one time and staffing was arranged to ensure that the busiest times of the day were St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 20 covered. Staff had varied opinions as to whether this was sufficient or not and did not always feel the busiest areas of the home had the appropriate staff ratio at times. There was evidence that the nursing staff supported the carers on the EMI unit in the provision of care to service users with residential funding. They administered all the medication, provided advice where service users exhibited challenging behaviour and dealt with doctors and district nurse visits. While this not a problem in its self it raised the following concerns. • These service users are not taken into account when determining the nursing staff levels required in the home and time taken in this way reduces the nursing input to those service users with nursing needs. Unless the coordinator was on duty in the EMI unit there was still no staff member indicated as being in charge on this area and thus the nurse was always approached for decision-making. This indicated a lack of training and leadership on the EMI unit. The lack of leadership in this unit was evident throughout the inspection and had led to very differing levels of quality in the care provided in the home. • The staff spoken with stated that they had received a variety of training in mandatory areas and some had received training in Dementia. The manager stated she had been unable to access any training in Huntingdon’s Chorea but would continue to look for this. The home had made a commitment to NVQ training, 6 were completing NVQ2 and 12 staff had been registered to start. Two staff were training for the Registered Managers award. St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 The service users financial interests were protected. EVIDENCE: The records of transactions where service users were assisted with their finances were clearly maintained and balanced with cash held. Receipts where appropriate were included with the records of individual service users transactions. Service users rooms include lockable facilities for them to safely store their money, and valuables. The home had a shop to sell toiletries and other items to service users, the manager was advised that to ensure transparency prices of these items should be displayed in the home or in information provided to service users. St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 22 St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X X St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7OP9 Regulation 15 17(1) Requirement The registered person must ensure that care plans and records support the decision making process of the administration of ‘as required’ medication and the care of those with challenging behaviour. (Previous timescale with immediate effect not met) The registered person must ensure that the daily care records consistently record details of the service users health and wellbeing and the care provided. (Previous timescale - 31 August 2005 - not met) The registered person must ensure staff in the EMI unit are instructed in maintaining care records. The registered person must ensure that the service users privacy and dignity is promoted at all times. Staff in the EMI unit to be instructed in maintaining service users privacy and dignity. The registered person must DS0000002802.V282755.R01.S.doc Timescale for action 09/02/06 2 OP7 17(1) 09/02/06 3 OP7 18(1) 12(1) 12(4) 01/05/06 4 OP10 01/05/06 5 OP15OP26 23(2) 01/06/06 Page 25 St Margaret`s Care Home, Grimsby Version 5.1 6 OP18 13(6) 7 OP22OP38 16(2) 13(4) 8 OP27 18(1) 9 OP30 18(1) review the dining room in the main area and the lounge and quiet lounge in the EMI unit and make these areas more domestic in character. The dining room must be kept clean. The registered person must ensure that staff receive training in signs and symptoms of abuse and appropriate action to take on suspicion of abuse. The registered person must ensure that all service users using specialised seats have been assessed, and where appropriate fitted for the equipment specific to their individual needs (Previous timescale of 1 March 2005 and 31 August 2005 not met). The registered person must ensure there is a suitably qualified person in charge working on the EMI unit on each shift. The registered person must provide training in the specific conditions of the service users accommodated in the home Huntingdons Chorea. (Previous timescale of 1 October 2005 not met). 01/06/06 01/06/06 14/04/06 01/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP35 Good Practice Recommendations The registered person should provide information or display prices of items sold in the homes shop. DS0000002802.V282755.R01.S.doc Version 5.1 Page 26 St Margaret`s Care Home, Grimsby St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 St Margaret`s Care Home, Grimsby DS0000002802.V282755.R01.S.doc Version 5.1 Page 28 - 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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