CARE HOMES FOR OLDER PEOPLE
St Margarets 17 Brookvale Road Portswood Southampton SO17 1PW Lead Inspector
Lorraine Parton Unannounced 21 June 2005 9:00 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. St Margarets H55-H03 S11792 St Margarets V218572 210605.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service St Margarets Address 17 Brookvale Road, Portswood, Southampton SO17 1PW 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) 023 8058 4877 02380 - 551089 Mr Thorne and Mrs Thorne Mrs J Francis Care Home 18 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (18), Mental disorder, excluding learning of places disability or dementia (4), Mental Disorder, excluding learning disability or dementia - over 65 years of age (18), Old age, not falling within any other category (18), Physical disability (4) St Margarets H55-H03 S11792 St Margarets V218572 210605.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1 - Service users in the DE and MD categories must be at least 55 years of age. 2 - A total of four service users may be accommodated between the ages of 55 and 64. 3 - A maximum of four services users may be accommodated at any one time in the PD (E) category Date of last inspection 6/12/04 Brief Description of the Service: St Margarets is a care home situated in Highfield, Southampton. The home is registered to provide care to eighteen service users within the categories of old age. The home also accommodates service users who have a physical disability, dementia, mental health issues and four service users over the age of 55. This has been agreed and has part of the conditions of registration. The home is a large detached property and comprises of accommodation in both single and double bedrooms arranged over two floors. The home also has two lounges, a dining room and a smoking room situated on the ground floor. The home has a stair lift which enables service users to access both floors of the home. To the rear of the property is a car parking area and to the front of the property is a large well maintained and pleasant garden. The home is situated close to local facilities and is a short journey away from Southampton. St Margarets H55-H03 S11792 St Margarets V218572 210605.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 21st June 2005 and took 6 hours. The previous inspection indicated no legal requirements were made. The inspection involved a walk around the home, discussions with service users, two visitors, visiting professionals and with the homes staff. The inspector was assisted by both the proprietor’s representative and the registered manager throughout the inspection. The home staff was found to be professional and helpful throughout the inspection. The inspection also involved an audit of some of the homes documentation relevant to the provision of care for the service users living at the home. The inspector received thirteen comment cards from service users and visitors to the home. Comments received in them were found to be positive about the services they or their relatives received. Service users confirmed that they were happy living at the home. What the service does well:
The home provides a homely and welcoming environment that enables service users to access all areas of the home and garden. The home is currently redesigning the kitchen in consultation with service users, to enable service users who are able, access to this area. Service users spoken to advised the inspector that the homes staff provide an excellent service and comments received included “nothing is to much trouble” and “ the staff are very caring and respectful to my needs”. The inspector witnessed staff interactions with service users and noted the obvious good relationships that were in place. Care plans were found to be in place and service users stated that the care that they received was good. Service user activities and leisure times provided by the home was found to be excellent. The home aims to promote individual choices and the promotion of independence. Service users are able to participate in the home and the home facilitates baking sessions and service users who wish to go out. The home provides books in large print and a range of games and leisure equipment. The home provides adequate staffing levels to ensure service users wishing to participate in local facilities are supported when necessary. Some service users go out alone and this is supported by suitable documentation.
St Margarets H55-H03 S11792 St Margarets V218572 210605.doc Version 1.30 Page 6 All staff working at the home are trained to NVQ 2 level and staff spoken to displayed a commitment to providing a high standard of care and support to the service users living at the home. All staff displayed an understanding of service user needs and their forward thinking attitudes noted by the inspector indicated that the homes staff are highly motivated. The home is committed to ensuring its staff team are trained and the home offers and supports staff in their training aspirations. Some further training has been suggested by the inspector, for example; moving and handling refresher courses and service user specific training around the current needs of service users. The home has set up a resource area in which they have ensured that the home meets the NMS by its policies and procedures in place for the homes staff. Practices by the homes staff are supported by good documentation. What has improved since the last inspection? What they could do better:
Whilst the inspector has made several legal requirements, this must not distract the reader from the homes good practices and standards of care. The home consults with service users about the running of the home on a daily basis, however, this has not been formalised and does not include service user meetings. The home is required to implement a quality monitoring system that takes into account the views of service users and other stakeholders of the home. The home has a small staff team that are able to access the homes manager on a daily basis. On discussion with the homes manager it was noted that whilst the home is offering supervision and appraisals to the staff this has not yet been implemented fully. A requirement for the home to implement supervision, appraisals and staff meetings has been made. The home is required to keep, maintain and have available records of food safety monitoring, fire drills undertaken and meals eaten by service users. The inspector was advised that the home usually keeps and maintains these records. The inspector noted that the homes medication policies and practices were satisfactory, however, this was difficult to assess and may be confusing to the homes staff, due to the home record sheets not being in line with the delivery/start of medication received. The home agreed to discuss this with their pharmacist.
St Margarets H55-H03 S11792 St Margarets V218572 210605.doc Version 1.30 Page 7 The home has not had any new staff. On audit of staff files it was noted that staff files did not contain all relevant information for example references. The home is required to ensure that they implement suitable recruitment procedures for any new member of staff employed by the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Margarets H55-H03 S11792 St Margarets V218572 210605.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection St Margarets H55-H03 S11792 St Margarets V218572 210605.doc Version 1.30 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 standard(s) 1,2,3,4,5 The home has a service user guide that is given to all prospective service users or their representatives before moving in. All service users have a contract which includes terms and conditions of tenancy. New service users are only admitted following an in depth assessment of their needs. The home offers prospective service users or their representatives an opportunity to visit the home prior to agreeing to move in. EVIDENCE: The inspector was able to see a copy of the home’s statement of purpose and service user guide. Service users confirmed that they had been given a copy of these, which were found in service users bedrooms. All service users have been issued with a contract. Service users confirmed that they had a contract of tenancy and that they keep them in their rooms or in their files. All contracts seen, had been signed by service users or their representatives.
St Margarets H55-H03 S11792 St Margarets V218572 210605.doc Version 1.30 Page 10 The home has had several new admissions and on audit of two new admission files these were found to contain an in depth assessment of needs undertaken by the homes manager. The manager had spoken to the service user either in their homes or hospital and had also ensured that family or carers views had been documented as part of the assessment. The home has a visiting policy that affords prospective service users or their representatives to visit the home prior to agreeing to move in. The inspector spoke to one new service user who confirmed that their family had visited the home on their behalf. St Margarets H55-H03 S11792 St Margarets V218572 210605.doc Version 1.30 Page 11 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 All service users have a care plan. Some care plans are in need of development to include specific issues and identified needs. All service users health care needs have been assessed and where necessary have access to relevant health care professionals. Service users confirmed that the homes staff, treat them with dignity and that their privacy is respected at all times. Medication practices were safe. EVIDENCE: The inspector audited five service user plans, which were found to contain relevant care planning information, risk assessments, health care professional involvement where necessary, occupational therapist assessments and guidance for moving and handling for service users requiring this assistance and records of monthly and 6 monthly reviews. One new service users file displayed that an assessment of needs had been undertaken, however, no care plan was in place as the service user had only just been admitted. One service
St Margarets H55-H03 S11792 St Margarets V218572 210605.doc Version 1.30 Page 12 user file did not include a falls assessment and guidance for staff despite a history of falls and a recent fall taking place. This was discussed with the home and it was agreed that all care plans would be reviewed and amended in accordance with service user needs. All service users are afforded access to relevant health care professionals and service users are registered with a general practitioner of their choice. The inspector had the opportunity to speak to a visiting health care professional who advised the inspector that the home provides a good level of care and support to service users who require assistance. One service user requires care from the district nurse for pressure care, however, this service user was admitted into the home receiving this care and this is ongoing. The home has provided pressure relief cushions and mattress to support the service user. The home has obtained an occupational therapist assessment and completed a care plan for moving and handling. Recently one service user has required more assistance with moving and handling and due to the home having no equipment to assist with this is finding it difficult at times. The home has referred the matter for assessment and is awaiting suitable accommodation to be found. Service users spoken to confirmed that the homes staff, respect their views and the need for their privacy and dignity to be up held. Staff were seen by the inspector to knock on doors before entering and interacting with service users in an equal and respectful manner. Service users confirmed that they receive personal care in private and are able to receive treatments and consultations in their bedrooms in private. The home operates within a medication policy and the home has a copy of the Royal Pharmaceutical guidelines. The home keeps a record of medication received, administered and returned to pharmacy. The home operates a monitored dosage system provided by the local pharmacist who visits the home on a regular basis. Only staff who are trained in the safe handling of medication course give medication. On audit of the homes medication and records they were found to be satisfactory, however, the mar sheets and medication received appeared confusing and did not tally together. The homes manager agreed to review this with the pharmacist so that it is less confusing for auditing purposes. St Margarets H55-H03 S11792 St Margarets V218572 210605.doc Version 1.30 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 standard(s) 12,13,14,15 Service users are supported in their chosen lifestyles and encouraged to make choices about their lives. Service users are supported in whom they choose to have contact with. All service users are supported if necessary with access to the community. Service users confirmed that the home provides excellent food of their choice. EVIDENCE: All service users choices in lifestyles and preferences in activities are clearly documented in service user plans. Service users spoken to advised the inspector that the home provides activities and facilities that meet their personal wishes. Service users confirmed that the homes staff ask them what they want and do their best to provide or support community access if needed. Several service users go out alone and access local facilities of their choice. This includes shopping and going to church. Service users, who are unable to go out alone are supported by the staff. Service users confirmed that the homes staff, take them out and that they enjoy this facility.
St Margarets H55-H03 S11792 St Margarets V218572 210605.doc Version 1.30 Page 14 The home offers a range of in house activities and this includes games, musical sessions, and singalongs. The home provides books in large print and has a range of videos and music suitable for the service users living in the home. Service users who wish participate in baking sessions and several service users were seen to be participating in the home during the inspection, which included laying tables and tidying up. Service users spoken to confirmed that the home supports their choices in involvement in the home. Service users informed the inspector that they had informed the manager that they didn’t like one of the employed activity co-ordinators and the home had made appropriate alternative arrangements. Service users who wish have personalised their rooms and some rooms contain service users own furniture and belongings. Service users confirm that they have access to television and music in their rooms if they wish. The home has a visiting policy, which affords and encourages visitors at any reasonable time. Service users confirmed that they are able to see visitors in private in their own rooms and elsewhere in the home if not in use by other service users. Two visitors to the home confirmed that they were able to visit when they wished and that the homes staff always made them feel welcome. Service users spoken to stated that the home provides good food and offers a choice of menu. Menus display a well balanced and nutritious variation, which, the staff stated are based on service users likes and dislikes. Individual choices and needs in food are catered for and this includes likes, dietary needs and special requests. The inspector was present for the lunch time meal and it was noted to be well presented and nutritious. Meal times were noted to be relaxed and service users who were being supported were not rushed and their dignity was maintained. The home was found not to be keeping food monitoring records and records of meals eaten by service users at the time of the inspection. The homes manager advised the inspector that the home does keep records and displayed past records. A requirement has been made. The home is also required to keep records of food eaten by service users who may be ill, losing weight or having a different meal to that on the menu. St Margarets H55-H03 S11792 St Margarets V218572 210605.doc Version 1.30 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 standard(s) 16,18 Service users are aware of how to make a complaint and to whom. The home has procedures and practices in place to protect where possible service users. EVIDENCE: All service users have a copy of the homes complaints procedure, which was found in service user bedrooms. Service users confirmed that they were aware of the complaints procedure and that the homes staff had gone through it with them. Service users advised the staff that they would speak to the homes manager or staff if they had any concerns and if unresolved would speak to their families or friends. Neither the home or the Commission for Social Care Inspection have received any complaints since the last inspection. A record of a complaint would be maintained if necessary. The home has a copy of Hampshires Adult Protection procedure and a whistle blowing policy. On speaking to staff they displayed their awareness of what constitutes abuse and the appropriate action to take if necessary. All staff have received training in adult protection issues. St Margarets H55-H03 S11792 St Margarets V218572 210605.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) 19,24,25,26 The home is clean, safe and well maintained and provides a homely environment for service users. Service users who wish have personalised their bedrooms with their own belongings. EVIDENCE: The inspector undertook a walk around the home and identified no issues in the rooms that were entered. The home was found to be homely, clean and suitable for service users. All areas of the home are accessible to service users and the front garden was found to be well maintained. At the time of the inspection service users were seen to be moving around the home and several service users were in the garden as they chose. The home had identified that both the laundry room and kitchen is in need of decorating and the inspector was informed that this will be done as part of the renovation works in progress.
St Margarets H55-H03 S11792 St Margarets V218572 210605.doc Version 1.30 Page 17 All rooms seen were found to include service users own possessions and some rooms contained service users own furniture. The inspector noted that these rooms were homely and service users own choice. The home has a maintenance programme and repairs are carried out as and when necessary. This provides a safe environment. The home has under taken risk assessments, however, these were not fully audited during the inspection. These will be audited at the next inspection. St Margarets H55-H03 S11792 St Margarets V218572 210605.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) 27,28,29,30 The home had adequate staff on duty, who were found to be well trained and competent to do their jobs. Service users are safe. The home is in need of reviewing its recruitment procedures for any new staff employed. EVIDENCE: Three staff and the homes manager were on duty at the time of the inspection. Staff confirmed that the home is covered by four staff in the morning and three staff in the afternoon. The inspector had access to the homes rota, which also confirmed the above. All staff working at the home had completed the NVQ 2 and some staff are wishing to do level 3. Staff advised the inspector that they have also completed additional training in 1st aid, moving and handling, medication, health and safety issues, infection control, basic food hygiene and fire. The inspector had the opportunity to speak to the homes NVQ assessor, who advised the inspector that the staff and the home are committed to a high level of training. Positive comments were received from the assessor regarding the care provided by the home and the competence of the homes staff.
St Margarets H55-H03 S11792 St Margarets V218572 210605.doc Version 1.30 Page 19 Service users confirmed that they felt safe in the home and that the homes staff are always supportive and professional in their approach. The home has policies and procedures in place to protect vulnerable adults and staff have received training in this area. On speaking and questioning staff they displayed their awareness and understanding of the homes policies on reporting any issues that may be abuse and how to maintain privacy and the dignity of the service users living at the home. Staff displayed an excellent awareness of service user needs and advised the inspector of the promotion of individual needs and how these are met. Several examples of how individual needs are being met were given by the staff and included supporting service users to participate in the home, promoting independence and listening to service users choices in meals, activities and accessing the community. On speaking to staff and through observation, staff had not received recent training or up dates in all service user specific areas including parkinsons, dementia, moving and handling and mental health. On discussion with the homes manager this was agreed to be completed. Three staff files were audited by the inspector and found to contain nearly all the relevant information. The home had not obtained references for staff who had worked at the home for many years. This was discussed with the homes manager and it was agreed that the home would ensure future employment of new staff would be undertaken in accordance with current guidance. The home is to review its recruitment procedures. St Margarets H55-H03 S11792 St Margarets V218572 210605.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) 32,33,36 The home is well run and has an ethos of a family environment. Service users are consulted about the running of the home, however, this needs formalising. The home needs to implement a system for staff supervision, appraisals and meetings. EVIDENCE: Staff, service users and visitors to the home all spoke positively about the homes manager. Service users confirmed that the manager is available in the home almost every day and that the manager seeks their views about changes to the home. The home does not hold service user meetings. On discussion with the manager it was agreed that this would be undertaken and that questionnaires
St Margarets H55-H03 S11792 St Margarets V218572 210605.doc Version 1.30 Page 21 would be completed for service users and visitors to the home to voice their views. The home had started to implement staff appraisals/supervision but found it to be cumbersome. The manager agreed to implement staff supervision and appraisals into the homes systems. The home only has a small staff team and had not implemented staff meetings. Staff advised the inspector that they are always kept up to date and aware of any changes in the home. Staff felt that communication between the all the homes staff was very good. St Margarets H55-H03 S11792 St Margarets V218572 210605.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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3
COMPLAINTS AND PROTECTION 3 x x x x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 2 x x 2 x x St Margarets H55-H03 S11792 St Margarets V218572 210605.doc Version 1.30 Page 23 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 9 Regulation 13(2) Requirement Review with the homes pharmacist the arrangements for ensuring the medication coordinates with the medication given sheets. Review staff training programme to ensure staff training in service user specific issues and moving and handling. Implement staff supervision and staff meetings. Implement a system for monitoring quality assurance within the home. This must take into account the views of service users and other stakeholders of the home. The home is required to keep a record of the meals eaten by service users. The home is required to implement procedures for food safety in accordance with Environmental Health legislation. This must include temperature monitoring. The home is required to keep a record of staff fire drills and fire training. Implement suitable recruitment procedures for new staff. This Timescale for action 31/8/05 2. 27 18(1)(c ) 31/9/05 3. 4. 36 33 18(2) 24 31/9/05 31/9/05 5. 6. 15 38 17(2) schedule 4 13 31/8/05 31/8/05 7. 8. 38 29 17(2) schedule 4 7,9,19 schedule 31/8/05 31/8/05
Page 24 St Margarets H55-H03 S11792 St Margarets V218572 210605.doc Version 1.30 2 9. 7 15 must include obtaining references. Review care plans to ensure all identified and specific needs are included and guidance is completed for staff. 31/9/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations St Margarets H55-H03 S11792 St Margarets V218572 210605.doc Version 1.30 Page 25 Commission for Social Care Inspection 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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