Inspection on 12/09/06 for Sydenham House

This inspection was carried out on 12th September 2006.

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

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

Other inspections for this house

Sydenham House 02/09/08

Sydenham House 17/03/06

Sydenham House 10/11/05

Sydenham House 15/02/05

Sydenham House 29/06/04

Sydenham House 09/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Sydenham House Frederick Road Bridgwater Somerset TA6 4NG Lead Inspector Jane Poole Key Unannounced Inspection 09:15 12 September 2006 th 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 Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 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. Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sydenham House Address Frederick Road Bridgwater Somerset TA6 4NG 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) 01278 422763 01278 433201 Somerset Care Limited Mr Michael John Vickery Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th March 2006 Brief Description of the Service: Sydenham House is a purpose built residential care home for older people. Situated on the outskirts of Bridgwater, the home is within a residential housing development close to shops, a family centre and public house. The home is owned by Somerset Care Limited and is registered to accommodate up to 43 persons aged over 65 years for personal care. The home currently accommodates 42 people as reconfiguration of the accommodation means that a former bedroom has become office space. The home also provides an intermediate care facility for up to six persons within the overall capacity of 43 (actual 42) persons. This unit is called The Willows. Sydenham House promotes an active lifestyle with a busy activities programme The home is well adapted for the current client group and has level access both inside and around the outside of the home. There is a shaft lift between floors. Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector over a period of 8 hours. The inspector was given unrestricted access to all areas of the home, was able to meet with staff, service users and visitors, was able to observe care practices and view records. The registered manager was available throughout the day. Prior to the inspection 13 questionnaires were returned from service users, 12 from visitors and relatives and 2 from healthcare professionals. What the service does well: Sydenham House has a warm and homely atmosphere. Service users spoken to stated that they continued to be in control of their day to day lives. People said that they would be comfortable to approach a member of staff if they had any worries or concerns. Service users felt confident that any concerns would be listened to and taken seriously. There is a wide variety of activities within the home and good links with local community groups. The activities worker was able to demonstrate an excellent knowledge of the interests of service users, including people who chose not to join in with organised activities. It was apparent that social stimulation is considered to be very important within this home. Throughout the day the inspector observed that there was much laughter and all service users appeared content and alert. Service users praised the kindness of the staff and more than one person said that “nothing is ever too much trouble for them.” Staff observed were confident and well motivated in their roles. Senior staff showed a good knowledge of the healthcare needs of service users. Systems in place for the administration of medication promote good practice. 6 service users have retained responsibility for the administration of their own medications. The building itself is pleasantly furnished and decorated. The standard of cleanliness throughout the home is very good. Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 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. Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 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 Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 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, 5 & 6. Overall quality in this outcome group is good. All prospective service users have their needs assessed before being offered a place at Sydenham House. Prospective service users and their representatives are able to visit the home before making a decision to move in on a permanent basis. EVIDENCE: The fee range at the home is between £361.00 & £460.00 per week. There have been no major changes to the statement of purpose since the last inspection. The inspector saw evidence that all prospective service users are seen and assessed by the homes manager before being offered a place. Service users spoken to confirmed this. Many service users also stated that they or their Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 Page 9 relatives had been able to visit the home before making a decision to make it their home. The home also offers day care and respite care which is an opportunity for prospective service users to spend time in the home, getting to know staff and other service users, before taking up permanent residence. All service users receive a service user guide when they move to the home. This document is clearly written and gives details of what a service user can expect from the home and what is not included in the basic fee. 10 of the 13 service users who completed questionnaires prior to the inspection answered YES to the question “Did you receive enough information about the home before you moved in?” Service users who are privately funding their stay at the home receive a contract from the company; those being assisted by the local authority have a financial agreement with the authority. Signed copies of both documents were viewed by the inspector. In addition to the main part of the home there is a small unit, which provides intermediate care for up to 6 people. This unit is self-contained and has a dedicated staff group. This unit provides rehabilitation for service users to enable them to return home. Service users spoken to stated that staff assisted them to regain their independence and self-confidence. Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 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, 10 & 11. Overall quality in this outcome group is good. Staff demonstrate a good understanding of the healthcare needs of service users and consult outside professionals for advice and guidance. Care plans focus on the physical needs of service users and give only minimal information on service users preferences or wishes. EVIDENCE: The inspector viewed the care plans of four service users. All plans contained basic information about the person and a very brief life history. There was a summary of the initial assessment, which had been signed by the service user and key worker. This assessment was extremely basic and gave limited information about the service user as an individual. Care needs identified all related to physical needs and there was minimal information about the wishes, preferences or views of service users. Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 Page 11 Care plans are reviewed monthly by staff and six monthly with the service user and/or their representatives. The inspector viewed the six monthly review documentation and again found it to contained very limited information about the individuals’ views or wishes. Service users spoken to stated that they had access to healthcare professionals in line with their individual needs. All appointments with medical professionals are recorded in care plans. The inspector was able to join senior staff for their handover session and noted that staff showed a good knowledge of the physical and medical needs of service users. There was evidence that healthcare professionals are regularly consulted for advice and support. The manager stated that they aim to care for service users as long as they are able to meet their needs, this maybe until their death. He stated that there are good relationships with district nursing teams and local GPs who support the home in caring for anyone who is terminally ill. It was apparent that the manager considers it important for the service user to have access to representatives of their chosen religious faith at the end of their life but this is not clearly documented in care plans. One community psychiatric nurse and one GP completed a comment card prior to the inspection both answered YES to the question “Do staff demonstrate a clear understanding of the care needs of service users?” Service users felt that their privacy was always respected. All bedrooms are lockable and service users are able to decide whether or not to lock their doors. The inspector noted that service users were able to see professional and personal visitors in private. The inspector observed interactions between staff and service users and found them to be warm and respectful. Some service users have personal phones in their rooms and there is a payphone in a private booth for others. The inspector saw that post was delivered unopened to individual rooms. One service user stated that staff offer assistance with correspondence if requested to do so. The home uses a Monitored Dosage System for medication. There are appropriate storage facilities for all medication, including controlled drugs and medication that requires refrigeration. All controlled drugs are checked by senior staff during their handover period. On the day of the inspection stocks held correlated with records kept. Lockable storage facilities are provided in bedrooms for service users who wish to maintain their own medication. Risk assessments are carried out in respect Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 Page 12 of anyone wishing to self medicate. Currently six service users in the home retain control of their medication, which is extremely commendable. Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 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): 12, 13, 14 & 15. Overall quality in this outcome group is excellent. There is a wide range of activities in the home and the staff ensure that everyone has social stimulation. Service users are encouraged to maintain contact with friends, family and the wider community. EVIDENCE: Service users spoken to were clear that they retained control of their lives. There are no set times to get up or go to bed and people are free to choose how they spend their day. Information is provided about independent advocates and this issue was raised at a service user and relative meeting. There is a full programme of activities in the home covering a variety of interests. The home has a mini bus and there is a regular trip out on a Wednesday. The inspector was able to spend time with the activity co-ordinator who demonstrated an excellent knowledge of individual service users and their interests. This worker was very aware that not all service users wished to join Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 Page 14 in with organised activities and appreciated the need to also provide social stimulation on a one to one basis. For example many people choose not to go out on trips so the activity worker takes photographs to share with people who prefer to stay at the home. Many people stated that they enjoyed spending their time socialising with staff and other service users. There are several lounge areas in the home and the inspector noted that the majority of people chose to sit in the sun lounge or the front hallway, there was no TV on and service users were happily chatting to each other and staff. Many service users stated that they preferred to go to their rooms if they wished to watch TV. Service users are able to have newspapers, magazines and library books delivered to the home. During the morning of the inspection there was a church service taking place which was well attended. One service user stated that they are visited by a Roman Catholic priest on a regular basis and another person attends church outside the home. In the afternoon many service users played skittles. Throughout the day the inspector observed that there was much laughter and all service users appeared content and alert. A hairdresser and manicurist visits the home on a regular basis and service users felt that this helped them to maintain their appearance and boosted self confidence. As well as daily activities there are many social occasions held at the home. Families and friends are invited to all social occasions, there has recently been a summer fair and there is a harvest supper planned for next month. Service users and their guests are not charged for social functions or trips but any money raised by raffles etc is used to provide further activities and trips. Contact with family and the wider community is considered very important and good links have been forged with local community groups. Two visitors were spoken to during the inspection. Both stated that they felt able to visit at anytime and were always made welcome. 12 visitors/relatives completed comment cards all answered YES to the questions “Do staff/owners welcome you in the home at anytime?” and “Can you visit your friend or relative in private?” Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 Page 15 The main meal is at mid-day with a lighter meal in the late afternoon. The majority of people spoken to were happy with the quality of food. Currently there is only one main meal on the menu although everyone spoken to stated that they could ask for an alternative, some people said they would feel more comfortable requesting a different meal if there were at least two choices on the menu board. After the first course a sweet trolley is taken round and service users are able to choose from a wide range of delicious looking puddings. There is a large pleasant dining room but service users are able to eat meals wherever they choose. Many people said that they had breakfast in their rooms but went to the dining room at lunch and teatime. Hot and cold drinks are served throughout the day and tea making facilities are available in the sun lounge for service users to help themselves to. The inspector noted that all personal rooms and lounge areas had jugs of fresh squash and clean glasses. The kitchen was not inspected on this occasion. An environmental health inspection carried out earlier in the year raised no concerns. Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 Page 16 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 & 18. Overall quality in this outcome group is good. The home have taken reasonable steps to minimise the risk of abuse to service users. Staff listen to service users concerns and complaints. EVIDENCE: The home has policies and procedures in respect of recognising and reporting abuse, whistle blowing and making a complaint. Service users spoken to stated that they would be confident to share any concerns or worries with a member of staff or the manager. 11 of the 13 service users who completed a questionnaire prior to the inspection answered YES to the question “Do staff listen and act on what you say?” Everyone spoken to during the inspection felt that staff always listened to their views. One complaint has been received in the last 12 months and there was evidence to show that the complaint had been taken seriously and action taken to ensure that the complainant was fully satisfied with action taken. The inspector observed that service users moved freely around the home and had unrestricted access to their private rooms and communal areas. Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 Page 17 All new staff are checked against the Protection Of Vulnerable Adults (POVA) register and all undergo an enhanced Criminal Records Bureau check. Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 Page 18 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, 21, 22, 24 & 26. Overall quality in this outcome group is good. Sydenham House provides a comfortable, clean environment for service users. All areas are well maintained. EVIDENCE: Sydenham House was purpose built some years ago and still provides comfortable accommodation. The home is divided into two parts, the main home and The Willows, which provides intermediate care. Service user accommodation is set over two floors with a lift between. There is a variety of communal lounges on both floors which gives service users a choice of socialising areas. To the front of the house there is an area where service users can sit outside. The manager stated that there are plans to redevelop the garden areas. Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 Page 19 All areas are fitted with a fire detection and call bell system. Various aids and adaptations have been fitted to encourage service users to maintain independence. There are assisted bathing facilities, raised toilets and grab rails. Individual physical aids have been provided for service users such as walking aids and perching stools. There are adequate bathing facilities in the home but, as one service user pointed out, no communal showering facilities. The home is in the process of updating all toilet and bathing facilities. One toilet area has already been refurbished to a high standard. All bedrooms are currently used for single occupancy although the home have the ability to accommodate a couple if requested to do so. Many of the rooms are below 10 square meters and do not have en suite facilities but service users spoken to stated that they were very happy with their rooms. The inspector viewed a large sample of personal rooms and observed that all had been personalised to reflect the individual tastes of the occupant. On the ground floor there is a laundry, which is appropriate to the needs of the service users. The Willows has its own domestic style kitchen with washing machine to enable service users to maintain their domestic skills. All areas seen by the inspector were well maintained and clean. Furnishings are of a good quality and appropriate to the needs of service users. Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 Page 20 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, 28, 29 & 30. Overall quality in this outcome group is good. There is a robust recruitment procedure in the home which minimises the risks of abuse to service users. Staff are well motivated and competent in their roles. EVIDENCE: All staff undergo a period of induction training and regular training courses in statutory health and safety issues such as moving and handling and fire safety. Many staff have also attended training courses on caring for people who have a dementia and continence. 28 care staff and 15 ancillary staff are employed at Sydenham House. 23 members of the care staff team have National Vocational Qualification (NVQ), in care, at level 2 or above. (Figures taken from pre inspection questionnaire) The manager stated that all staff employed at the home are expected to undertake NVQ training. Staff spoken to and observed during the inspection appeared confident in their roles and well motivated. Staff were seen to interact with service users in a warm and respectful manner. Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 Page 21 There is a clear staffing structure, which means that there is always a senior member of staff on duty to offer advice and support to less experienced members of the team. Both healthcare professionals who completed comment cards prior to the inspection answered YES to the question “Is there always a senior member of staff to confer with?” Staffing levels are determined by the needs of the service users and the majority of service users felt that there were adequate numbers of staff on duty. Service users said; “staff are kind” “ staff will do anything for you” “staff are excellent.” The inspector viewed the recruitment records of the two most recently appointed members of staff and found that they contained all required information. Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 Page 22 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, 33, 35 & 38. Overall quality in this outcome group is good. The home is effectively managed taking account of the views of service users. EVIDENCE: The registered manager is Mike Vickery who has managed the home for over 30 years. He has a CSS qualification and takes part in training arranged by the home. Staff and service users stated that the manager was open and approachable and constantly sought their views. At least once a fortnight Mike works alongside care staff to ensure that a high standard of care is delivered. The inspector observed that service users were extremely comfortable with the manager and all said that they could approach him at any time. Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 Page 23 There is also a deputy manager who is currently undertaking the Registered managers Award. (NVQ level 4) As previously stated there is a staffing structure in the home that gives clear lines of accountability. There is always a senior member of staff on duty. There are regular staff, service user and relatives meeting where people are kept up to date with happenings in the home and plans for the future. Twice a year questionnaires are sent out to all service users to gauge their views on the home. These questionnaires are audited and any matters arising investigated. The inspector saw a copy of the latest audit and returned questionnaires. There were many positive comments about the home and the staff. Systems are in place to ensure the health and safety of service users. All accidents in the home are recorded and audited by the manager on a regular basis. A fire log is maintained and this shows that alarms and emergency lighting is tested in house on a weekly basis and the system is regularly serviced by outside contractors. All lifting equipment in the home is regularly serviced. The home does not act as a financial appointee or power of attorney for any service user but does keep small amounts of cash in respect of some people living at the home. Records and receipts are kept for all transactions. Records kept correlated with monies held. Up to date certificates of registration and insurance were seen by the inspector. Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 Page 24 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 X 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 3 4 3 X 3 X X 3 Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 12 (3) Requirement The manager must ensure that care plans and reviews include the preferences and wishes of service users as well as the identification of physical needs. Timescale for action 30/11/06 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 2 Refer to Standard OP9 OP15 Good Practice Recommendations The minimum and maximum temperature of the medication fridge should be recorded. The manager should review the lunchtime menu to make it easier for service users to express choices. Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Sydenham House DS0000015992.V305433.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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