Inspection on 27/09/05 for St Raphael`s Christian Care Home

This inspection was carried out on 27th September 2005.

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

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

Other inspections for this house

St Raphael`s Christian Care Home 01/07/08

St Raphael`s Christian Care Home 24/05/07

St Raphael`s Christian Care Home 25/07/06

St Raphael`s Christian Care Home 07/03/05

St Raphael`s Christian Care Home 22/06/04

St Raphael`s Christian Care Home 06/11/03

St Raphael`s Christian Care Home 02/07/03

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

CARE HOMES FOR OLDER PEOPLE St Raphael`s Christian Care Home 32 Orchard Road Bromley Kent BR1 2PS Lead Inspector Sue Meaker Unannounced Inspection 27th September 2005 10:00 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 Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Raphael`s Christian Care Home Address 32 Orchard Road Bromley Kent BR1 2PS 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) 020 8313 1377 020 8460 1710 Trinity Care Ltd Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (58) of places St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Staffing Notice issued 28 July 1997 20 beds for nursing care Date of last inspection 7th March 2005. Brief Description of the Service: St Raphael’s is a large extended building situated in its own grounds with off road parking to the front of the building; and within easy reach of local shops. The own is also on a bus route giving access to Bromley shopping cantre and leisure facilities. St Raphael’s is divided into three units, one on two levels and the other on four levels, with passenger lifts for accessibility. The home offers good communal areas accessible to all its residents. The home is dual registered with an attached purpose built nursing wing on the ground floor. All of the bedrooms in the “Mellifont” unit have en suite facilities as do the majority of bedrooms in the nursing unit. The older part of the building, the “Orchard” unit are provided with a wash hand basin, with toilet and bathroom facilities within easy reach and therefore accessible to the residents. All the bedrooms are designed for single occupancy and are all centrally heated as is the rest of the home. There are grab rails and hand-rails on the stairs and in the corridors, toilets, showers and bathrooms. Specialist bathing, toilet and lifting aids are available for residents use. All bedrooms, toilets, shower rooms and bathrooms are fitted with a lock, to ensure privacy, these locks can be accessed from outside in the event of an emergency. St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a satisfactory, statutory unannounced inspection carried out over a six hour period, the manager was present during the inspection. A tour of the premises was undertaken, care plans, personnel records, training records, rotas ,health and safety records and the business plan were inspected on the day of the inspection. The Statement of Purpose, Service User Guide, Brochure and Newsletter were also seen and copies given for further information. Ten residents were spoken to along with five relatives who were visiting the home at the time of the inspection; the manager of the home, the activities co-ordinator, the residential manager and the nurse in charge, the laundry assistant and the cook and a domestic were all spoken to during the inspection. Residents and relatives appeared to be satisfied with the standard and quality of care within the home, particularly impressed with the activities available and also stated that the food and choice of food was good. Residents and relatives were also pleased that the home had begun the re-decoration and refurbishment programme and were looking forward to the completion. What the service does well: The information given to prospective residents is very good giving comprehensive details of the services provided by the home enabling them to decide if they want to live in the home. The pre-admission assessment is of a high standard and gives the basis for the in depth care plan; the computerised system is good but this is to be superceded by a new care plan format that is to be written and will therefore be more accessible to residents, relatives and staff. Activities are creative, varied and interesting a lot of thought has gone into developing a programme to suit the residents, who are involved in deciding what they would like to do, the residents spoken to were very supportive of the home in this area and stated that they enjoyed being involved in the planning of themed days and days out. The residents and relatives spoken to stated that they received a good quality of care, that the staff were very good and that their dignity a, privacy and choices were respected. The home has a lovely chapel of its own for religious observance and quiet contemplation, all faiths are catered for with services from different religious denominations. . St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4, and 5. The home provides the residents and their relatives with comprehensive information relating to how their assessed personal, healthcare and social needs are met; enabling them to make an informed decision about whether they wish to live in the home. EVIDENCE: The home has a comprehensive Statement of Purpose and Service User Guide that are available to all residents prior to admission to the home; the organisation Southern Cross Healthcare also provides a brochure that residents and their relatives found informative and the organisation also provides a newsletter that is available to all residents and their relatives. On speaking to residents and relatives and looking at care plans, it was evident that an in depth assessment had been undertaken prior to the home offering a placement to a prospective resident; this assessment provided the basis of the care plan and specified, in detail, the personal, health and social needs of the prospective resident. St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 Page 9 Contacts are provided to every resident whether they be privately funded; or funded by the local authority, the contract details all the terms and conditions of admission to the home. The home encourages prospective residents with their relatives to visit the home and spend the day enabling them to assess the facilities and suitability of the placement. All prospective residents are offered the opportunity to move in on a trial basis before they or their relatives make a decision to stay permanently. St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8.9 and 10 Care plans are personalised and therefore unique to the individual resident giving specific instructions on how the residents’ personal, healthcare and social needs are met by the staff in the home thereby giving the residents the opportunity to maintain their chosen lifestyle within the homes’ environs. EVIDENCE: Six care plans were looked at in detail, three from the residential units and three from the nursing unit. Currently all care plans are computerised and those seen detailed the residents specific needs and how they were to be met; care plans were personalised and unique to the individual. Risk assessments were incorporated as appropriate into the detailed plan of care; all care plans are evaluated on a daily basis and reviewed monthly. Residents are able to choose their own GP and also have access to specialised services from the primary care trust such as chiropody, dental, dietary, physiotherapy and optical. The home has a comprehensive policy and procedure relating to the safe administration of medication; the pharmacy provides medication in a blister pack format and all medication is recorded on the MARS sheet. The medication administration records were checked and found to be in order, no St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 Page 11 errors were found and all medication administered was signed off by a trained member of staff. The pharmacy regularly checks the medication procedures in the home and also provide training to the staff. All medication was stored correctly and the clinical room was clean and tidy; however the fridge in the clinical room needs to be replaced as it is not maintaining the correct temperature. All staff undertaking the administration of medication have received specialised training in the Safe Administration of Medication. Residents who self-medicate are assessed by the homes’ GP and written confirmation is obtained, residents who self medicate are provided a locked facility in their bedrooms for this purpose. Homely remedies are assessed by the residents GP ensuring that such medication is compatible with the residents prescribed medicines. All documentation seen at the time of the inspection relating to the administration of medication was found to comply with the National Minimum Standards. St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15. Social activities and meals are both well managed, creative and provide daily variation and interest for residents living in the home. EVIDENCE: The home employs an activities co-ordinator who provides and maintains an interesting and comprehensive programme of activities within the home, providing musical entertainers from outside the home and organising day trips for the residents. On the day of the inspection residents were enjoying a painting class and all those spoken to said how much they enjoyed this activity, much of the art work is on display around the home, residents also stated that they enjoyed activities arranged by the co-ordinator particularly the quizzes and musical entertainment and that they also particularly enjoyed themed activity days such as Valentines Day, Mothers Day and St Georges Day. Residents are encouraged to maintain their links with the church of their choice and there is a chapel within the home that caters for all denominations. Some of the residents spoken to preferred to remain in their rooms either reading or watching television, they said that their right to privacy was maintained and their choice respected. Residents spoken to commented on the food and were complimentary about the quality and choice of meals offered stating that if they did not like anything on the menu they were offered alternatives. Dietary needs were catered for St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 Page 13 and the catering staff were able to provide for special diets such as diabetic, reducing, low fat and gluten free. The menu was seen and provided nutritionally, healthy and balanced and interesting types of meals; and mealtime arrangements are also flexible enough to accommodate individual preferences. The kitchen in the home has been warded the Clean Food Award by the London Borough of Bromley Environmental Health department. St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 and 18. The home has systems in place to protect the residents enabling them to feel safe and secure in their environment. EVIDENCE: The home has a complaints policy and procedure that is accessible to the residents, their relatives or representatives; this is detailed in the homes’ Statement of Purpose and the Service User Guide and prominently the foyer of the home. Residents and staff spoken to on the day of the inspection demonstrated an understanding of the complaints policy and procedure and confirmed that they knew how to make a complaint if necessary, they also confirmed that any concerns they had were dealt with promptly and usually resolved without having to resort to the complaints procedure. On looking at the complaints documentation, the home had demonstrated that all complaints are recorded accurately, the investigation process detailed, the actions taken and the outcome of the complaint; to date no complaints about this service have been received by the Commission. The home has a policy and procedure relating to the Protection of Vulnerable Adults, that also included a policy and procedure on “Whistle-blowing. From staff training records seen and in discussion with staff that they had received training about all forms of adult abuse and they also demonstrated an St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 Page 15 awareness of how to identify different types of abuse and how to report and investigate any allegations of abuse. The home has a copy of Bromley’s Adult Protection inter-agency guidelines for the Protection of Vulnerable Adults, and a copy of the Department of Health “No Secrets”. The manager demonstrated that all staff are CRB and POVA checked prior to commencing employment in the home; this was evidenced by documentation found in the personnel files. The management and staff undertake risk assessments for individual service users as part of the initial assessment process and these documents are supplementary to the care plan; risks are identified and appropriate action recorded to minimise risks. St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 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 the following standard(s): 19,20,23,24,25 and 26. Recent investment has significantly improved the appearance of the home working towards creating a comfortable and safe environment for those living there and for visitors. EVIDENCE: Whilst touring the home, it was noted that considerable efforts had been made to improve the décor and furniture; carpets had been replaced, rooms decorated and new furniture purchased, this is an ongoing process and there are still areas in the home that are in need of refurbishment. It was noted that some of the bedrooms had been redecorated and that new curtains and counterpanes had been purchased, one of the relatives said that there had been significant improvements to the residents’ bedrooms and communal areas and that this was continuing. A new carpet was being fitted on the day of the inspection and the manager stated that this was part of the ongoing refurbishment plans for the home, also new furniture and soft furnishings had been ordered for the home and he was awaiting delivery; documentation seen supported this initiative. St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 Page 17 Currently the maintenance person is on sick leave and maintenance issues are being covered on a bank basis, records seen supported that all checks are being carried out and appropriately recorded; there have been problems with the call bell system that were being addressed on the day of the inspection. A toilet on the nursing unit was out of order and repairs need to be implemented as soon as possible. Residents bedrooms seen during the tour of the home, were found to be reasonably decorated and furnished; many of the rooms were personalised to the residents tastes with pictures, ornaments, photographs and small items of furniture; however some of the bathrooms and toilets seen, on the residential units were in need of deep cleaning and redecoration. The communal areas of the home were easily accessible to the residents and the gardens provided a pleasant environment for the residents weather permitting. The home was generally clean and tidy and free from any offensive odours; the laundry area of the home was well maintained; the equipment was working to a satisfactory standard. The laundry person followed a comprehensive policy and procedure relating to the operation of the laundry and clothing, bed linen and towels were maintained to a good standard. All cleaning materials were stored an d complied with COSHH regulations, the laundry person had a knowledge of the regulations as well as a knowledge of procedures relating to infection control. St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 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 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): 27,29 and 30. The management and staff of the home are competent and have the necessary skills and experience to met the needs of the residents; this is achieved by having effective policies and procedures relating to recruitment and selection, a comprehensive training strategy, and structured supervision and appraisal systems. EVIDENCE: Six personnel files were seen and were found to comply with schedule two of the National Minimum Standards – Care Homes Regulations. The home has robust recruitment and selection procedures that are stringently followed; this is supported by the comprehensive documentation included in the personnel files. From the rotas seen at the time of the inspection, it was evident that the home complied with the staffing levels agreed by the previous registration authority; these staffing levels need to be constantly reviewed and dependency assessments need to be undertaken for residents on a regular basis, to make sure that the home has staff competent to meet the needs of the residents. The training files have now been set up for all staff members and a comprehensive training programme is in place; induction and mandatory training is undertaken and documented in the training file, areas where training is required are identified and the staff undertake appropriate courses. The home has an NVQ training programme that is ongoing and currently 34 0f staff employed have an NVQ qualification. St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 Page 19 Team meetings and staff meetings are held on a regular basis and are documented appropriately. Supervision and appraisal systems are in place, these are structured and documented in compliance with the standards. St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 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 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): 31,32,34,37 and 38. The manager is in the process of implementing a development plan and vision for the home that he is in the process of communicating to the residents, relatives and staff. Compliance with health and safety legislation ensures that the residents, relatives and staff feel safe in the environment of the home. EVIDENCE: The manager of the home is not currently registered with the Commission, an application has been submitted but as yet an interview date has not been arranged. The manager is due to register at Greenwich University for the Registered Managers Award in September 2005; however the manager does have recognised nursing and management qualifications. The manager has not been in post very long and is in the process of implementing a development plan for staff relating to training and in organising the refurbishment of the home. The style of management is competent and St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 Page 21 residents, relatives and staff feel they can approach the management team with any concerns and issues they need to be resolved. Currently there is a staffing issue that needs to be resolved particularly concerning the recruitment of an administrator, however interviews are being held for this post and the manager is hopeful of employing an administrator soon. Records seen during the inspection complied with the standards and are stored and accessible in line with the Data Protection Act Maintenance records were checked and it was found that attention needs to be paid to documentation relating to updating the Fire Risk Assessment, fire safety training, fire equipment servicing, fire alarm servicing, nurse call servicing, fire alarm servicing and the health and safety audit. All certification relating to health and safety legislation needs to be checked to make sure that they comply with timescales set out in the National Minimum Standards. St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 2 X X 3 3 2 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 X 3 X X 3 2 St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 3 4 5 Refer to Standard 9 19 20 25 27 31 Good Practice Recommendations It is recommended that the fridge in the clinical room be replaced as it is not maintaining temperature. It is recommended that the maintenance and redecoration programme be ongoing. It is recommended that the refurbishment programme of replacing carpets, furniture and soft furnishing be continued. It is recommended that a cleaning schedule be devised and implemented in the home particularly for the bathrooms and toilets. It is recommended that dependency assessments be undertaken for all residents in the home. It is recommended that the manager pursues an appointment for his interview with the Commission regarding being appointed the Registered Manager for the home. It is recommended that the manager advises the DS0000010153.V250323.R01.S.doc Version 5.0 Page 24 6 32 St Raphael`s Christian Care Home 7 38 7 38 Commission when the RMA qualification is completed. It is recommended that the manager of the home reviews all fire safety procedures and ensures that servicing is carried out within the required timescales and informs the Commission once this has been achieved. It is recommended that all Health and Safety documentation be checked to make sure that all certificates for servicing are current; advise the Commission once this is complete supported by copies of the certificates in compliance with the standard. St Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Raphael`s Christian Care Home DS0000010153.V250323.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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