Inspection on 19/07/05 for The Royal Star and Garter Home

This inspection was carried out on 19th July 2005.

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

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

Other inspections for this house

The Royal Star and Garter Home 18/10/06

The Royal Star and Garter Home 10/02/06

The Royal Star and Garter Home 25/02/05

The Royal Star and Garter Home 12/10/04

Similar services:

Ashlong House

Spring Lane Care Home

Avenues (The) (Neave Crescent)

Barrington Lodge Nursing Home

Beacon House Nursing Home

St Mary`s Convent & Nursing Home

1-3 Frederick Gardens

Anthony Edwards House

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

CARE HOMES FOR OLDER PEOPLE The Royal Star and Garter Home Richmond Hill Richmond Surrey TW10 6RR Lead Inspector Simon Smith Unannounced 19 July 2005 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. The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Royal Star and Garter Home Address Richmond Hill Richmond Surrey TW10 6RR 020 8439 8000 020 8439 8002 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) The Royal Star and Garter Home Mrs Pauline Shaw CRH 120 Category(ies) of 12 PD (Physical disability) registration, with number 108 PD/E (Physical disability over 65 yrs) of places 5 SI (Sensory impairment) 38 SI/E (Sensory impairment over 65yrs) The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25.2.05 Brief Description of the Service: The home provides nursing, residential and respite care to men and women who have served in Her Majesty’s Forces. The charity’s motto is “Enhancing the lives of those who served”. The home occupies a commanding position on Richmond Hill. The location provides fine views from many of the communal and private rooms and affords easy access to Richmond Park and the shopping and transport facilities of the town centre. The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection comprised two visits, which took place on the 19th July and 29th July 2005. A CSCI pharmacy inspector assessed the home’s arrangements for storage and administration of medication at a separate visit, which took place on 17th August 2005. His findings are incorporated in the ‘Health and Personal Care’ section of this report. The inspection involved discussion with residents and their relatives and a cross section of staff, including the Director of Care, Practice Development Nurse, Director of Human Resources, Activities and Welfare Manager, Nurse Care Managers, nursing and care staff. The inspector was made welcome throughout the visit and wishes to acknowledge the time and consideration that residents, their relatives and staff provided during the course of the inspection. The home met 15 of 21 National Minimum Standards assessed at this visit, whilst 5 Standards were exceeded. One Standard was almost met. Residents said that they valued many aspects of life at the home, including the care provided by staff, the food and the activities and outings on offer. Comments made by residents and their friends/family members included: “I think this place is wonderful” “The people at the coal face are superb” “Standards are extremely high” “I’m impressed with the training the care staff receive” “They’re very proud of their skills” “I have every confidence in the carers and in the standard of care” There were enough staff on duty to meet residents’ needs. Staff interacted positively with residents and encouraged them to make informed choices where possible. Staff on duty knew residents well and had a good awareness of their needs. Residents spoken to during the visit said that they are consulted on issues that affect them at the home and were confident that any complaints they made would be listened to. The charity continues to search for suitable sites to develop three new homes. Residents and staff reported that they had been kept informed of events regarding the closure of the current home and the development of new services from 2008. What the service does well: Provides high quality, individualised care that reflects residents’ needs and preferences. The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 6 Encourages residents’ involvement in their local community and enables residents to maintain their military links if they wish. Communicates and consults effectively with residents and staff on issues that affect them. Provides excellent programmes of induction and training for staff. Promotes and facilitates effective communication amongst staff. Responds positively to complaints or allegations received and works cooperatively with other agencies where necessary. Provides an excellent range of in-house activities and outings. Provides excellent facilities for hobbies and social and leisure activities. Provides good quality food, which is enjoyed by residents and available in a variety of settings. 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. The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 6 Residents’ needs are accurately assessed at the point of admission. Assessments are used effectively to inform the care plan developed for each resident. EVIDENCE: Comprehensive assessments were in place on all residents’ files examined. Assessments record residents’ physical, emotional, social and spiritual needs and identify any specialist adaptations or equipment needed. Inspection confirmed that the assessment process is used effectively to inform the individual plan of care developed in respect of each resident. The home does not admit residents for intermediate care. The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 9 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 Care plans reflect residents’ needs and preferences. Residents’ needs and preferences in terms of care are known by staff. Care plans are regularly reviewed, with the input of residents and their representatives. Residents’ healthcare needs are met. Good arrangements for the ordering, storage, recording, administration, auditing and self-administration of medication by residents are in place and staff have access to a pharmacist for advice to protect the health of residents. Omissions and errors in recording were found although these had no impact on the health and welfare of the residents. Residents feel that they are treated with respect and that they have privacy when they want it. EVIDENCE: The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 10 An individual plan of care is in place for each resident. Care plans contained evidence of regular review and the involvement of residents and their relatives in their development. The home provides guidance for staff on recording and the quality of information within the care plans examined was consistently good. Individual care plans are developed where specific needs are identified, such as a high risk of falls or of developing pressure sores. The Practice Development Nurse is available for advice on the development of specific plans if required. Health Care Assistants complete daily notes for each resident, which are counter-signed by nursing staff. Residents’ files contained little evidence of ‘life history’ work. This issue was discussed with the Director of Care, who advised that staff from the Activities and Welfare department were currently developing a tool addressing this area to be used with residents in the future. A general practitioner visits the home twice each week and a dietician visits the home every two weeks. Other relevant healthcare professionals, including a dentist, optician, audiologist and chiropodist, visit the home regularly. Residents are able to access physiotherapist and speech and language services in-house. A visiting occupational therapy service is also provided. Staff on duty demonstrated a good awareness of residents’ needs and their care plans. Unit staff were updated at handover on the progress of any residents in hospital. The inspector was able to speak to a visiting dietician, who advised that staff were consistently well informed about residents’ needs and implement effectively any guidelines agreed at her visits. The home has a commitment to identifying and working to current best practice and monitors performance indicators in a number of areas, including falls prevention, infection control and palliative care. All medications in each unit and records relating to receipt, storage, administration and disposal of medication were examined. The person in charge of each unit and the clinical lead nurse were interviewed. Medication for ten residents was counted and compared to the receipt and administration records to ensure residents were receiving medication as prescribed. From these observations and discussions residents are encouraged to maintain control of their medication in a safe manner ensuring independence for residents. All medication in the home was stored securely and under appropriate conditions. Each resident has a folder containing the administration record and the front of the folder has a photograph and details information on allergies and any special considerations regarding medication. Records are kept of all medication received, administered and leaving each unit within the home and separate records are made of administration of Warfarin, medication prescribed when needed and homely remedies detailing how much to administer and when. The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 11 Monthly audits are done of stocks of medication and administration records. Regular medication forum meetings are held to discuss medication issues and medication is only administered by trained and designated staff. These measures ensure residents are given medication that is current and viable in accordance with the direction of a doctor. Alterations and discontinuations to medication were clearly recorded and corresponded with direction from the general practitioner. Two residents had not been sent the current medication from the pharmacist. Staff had picked up on this and ensured that a supply was available. The administration/non-administration of all medication had been recorded accurately on the current administration records except in seven instances. One service user on F floor had been recorded as receiving a medication daily for the last two days when the medication was prescribed once a week. From the amount of medication in stock the medication had been given correctly. Six residents on E floor had missing entries on the administration record indicating administration/non-administration of medication. The amount of medication in stock agreed with the amount that should be in stock. These indicated that residents had received the correct medication unless a reason had been recorded. Residents’ preferences in terms of care delivery are recorded and known by staff. Staff spoke to residents with respect and promoted individual choice during the inspection. Personal care needs were met promptly, with discretion and in a manner that preserved residents’ dignity. Comments made by residents confirmed that they are consulted about the care they receive. Residents also confirmed that they are able to spend time in private whenever they wish and that they are able to entertain visitors or consult with healthcare professionals in private. All residents are offered keys to their rooms. The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 – 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 The programme of events and activities is stimulating and varied. Residents receive good support to maintain links with friends, families and the local community. Residents enjoy the food provided by the home and are involved in developing the menu. EVIDENCE: The home provides an excellent range of in-house activities and events and regular trips to places of interest. The majority of outings and events are planned by the Activities and Welfare department, although there was evidence that care staff also provide activities for residents on individual units. The home also benefits from the input of many committed volunteers, around thirty of whom have received training to enable them to support residents during trips out. Residents are encouraged to maintain their military links where this is important to them. Many residents had participated in recent events to mark the 60th anniversary of VE day and the home has produced a booklet documenting residents’ views to mark the occasion. The home has extensive in-house facilities for arts, crafts and hobbies and an IT suite with internet The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 13 access, which is available to residents. Religious services are held regularly at the home. Many residents are actively involved in the local community. A number of residents advised that they make use of pubs, restaurants and other local community resources. One resident reported that he works as a volunteer one day a week and attends a local church on a regular basis. Residents reported that they are encouraged by staff to go out with their relatives when they visit. The home also liaises with other groups within the local community. For example, local schools visited the home as part of the recent VE day anniversary programme and schools have given concerts for residents at the home. Residents confirmed that their friends and families are made welcome when they visit. Relatives spoken to during the inspection reported that care staff are aware of residents’ needs and are willing to discuss and advise on their family member’s care. Residents are able to take their meals in their rooms, in their unit dining room or in the home’s main dining room. Residents are able to invite friends and families for meals at the home. initial needs assessments record any dietary needs and preferences and support required at mealtimes. The home is able to cater for specialist diets where necessary. Alternatives to the published menu are available. Snacks and drinks are available to residents at all times. Residents spoken to during the inspection reported that the food provided is good. All were aware that a new menu was to be introduced in the near future and advised that they are able to feed back comments about the menu through the Residents’ committee. The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 The Complaints procedure is clear and readily available. Residents feel that any complaints made would receive an appropriate response. The home is committed to protecting residents from abuse. EVIDENCE: The home has a clear Complaints procedure, including timescales for action and response. The system for the management of complaints is clear and a copy of the Complaints procedure is included in the Residents’ Handbook. A record of complaints received is maintained. Information provided by the Home states that “complaints are monitored monthly by the Chief Executive and reported quarterly to Governors”. Residents spoken to during the inspection confirmed that they felt any concerns raised by them would receive an appropriate response from the home. One relative reported that she had registered a complaint in the past, which had been resolved quickly and to her satisfaction by the home. There is a commitment to ensuring that all staff attend training in issues around abuse and the protection of vulnerable adults. Training in this area took place in June 2005 and is planned again for September 2005. The home has worked co-operatively in the past with other relevant agencies following the receipt of any allegations and has demonstrated a commitment to effective investigation and resolution. The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 23, 24 The home is safe, attractively decorated and well maintained. The home provides excellent communal facilities for hobbies and social and leisure activities. Residents’ bedrooms reflect their individual tastes and interests. EVIDENCE: The home is an imposing red brick building occupying a commanding position on Richmond Hill. The location provides fine views from many of the communal and private rooms and affords easy access to Richmond Park and the shopping and transport facilities of the town centre. A high standard of decoration has been achieved throughout the home and the terraces and grounds are well maintained. The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 16 The home provides a range of communal rooms, including some suitable for hosting large events. The main dining room provides a focus for socialising and interaction at mealtimes, although smaller dining rooms are also situated on each floor. The home has licensed bar and excellent facilities for arts, crafts, cookery, gardening and internet access. Residents’ bedrooms were personalised and reflected the tastes and preferences of their occupants. A number of bedrooms contained evidence of hobbies and interests. Residents are encouraged to bring personal items, including furniture, with them on admission and are able to install a private telephone line should they wish. A model of the bedroom layout proposed for the new homes has been constructed to enable residents to give their comments on its design. The Development Director advised that many residents, and their friends and families, had taken the opportunity to visit the model and had provided much feedback. The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 17 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, 30 Appropriately skilled staff are available in sufficient numbers to meet residents’ needs. Residents feel well cared for by staff who know their individual needs. The home provides excellent programmes of induction and training for staff. Staff communicate frequently and effectively. EVIDENCE: Staff were available in sufficient numbers to meet the needs of residents during the inspection. Staff interacted positively with residents throughout the visit, actively seeking their opinions and preferences engaging them in a meaningful way. Residents spoke highly of staff and the care they provide. The home has excellent programmes of induction, training and development, which is highly regarded by staff. All staff spoken to during the inspection reported that they had received a comprehensive induction to their role and to those in their care. Staff also confirmed that they receive individual supervision from their line manager every two months and that they are encouraged to attend training relevant to their role. Staff spoke positively of the support they receive from their line managers and felt that their teams functioned well as a unit. The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 18 Communication is encouraged and facilitated through regular team meetings and handovers. Staff reported that these meetings provided good opportunities to seek advice and support or to raise any issues that concern them. The inspector was able to observe a handover from staff finishing their shift to those beginning work. The senior member of staff provided clear information about residents and gave advice to staff on the management of any care needs identified. The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 37 The manager has skills relevant to her role and provides appropriate leadership for the service. Residents are consulted effectively about issues that affect them in the home. Residents’ interests and rights are protected by the policies and working practices of the home. EVIDENCE: The home’s manager is experienced, committed and has achieved qualifications relevant to her role. A registered nurse, the manager demonstrated a good knowledge of the home and individual residents. Staff spoken to during the inspection confirmed that the manager is approachable and supportive. The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 20 There is a commitment to maintaining open and effective communication throughout the organisation. Staff at all levels reported that they have opportunities to raise issues with their peers and their managers formally and informally. Staff also felt that they had been well informed about changes within the organisation and plans for the charity’s future. Residents reported that they are consulted about issues that affect them in the home. One resident commented, “They’re always up front with us”. Issues raised by residents are taken up by unit representatives at monthly committee meetings attended by the Chief Executive and senior staff. Residents also reported that senior staff are approachable on an informal basis. The Director of Care advised that residents will be surveyed in the near future regarding aspects of the home and the services provided. The home has a commitment to efficient good record keeping. Systems of administration are well organised and maintained. Staff work to clear written guidelines. Details of accidents and incidents are recorded and reviewed. The home has developed consistent documentation, recorded on standard formats, in respect of residents and staff. Operational policies and procedures are regularly reviewed and there is a commitment to ensuring that all staff are aware of and adhere to the working practices of the home. The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 x 15 3 COMPLAINTS AND PROTECTION 3 4 x x 3 3 x x STAFFING Standard No Score 27 3 28 3 29 x 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 4 3 x x x 3 x The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13(2) Requirement The Registered Person must ensure that the administration/nonadministration of medication is recorded accurately for all residents. Timescale for action 04.09.05 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 The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 The Royal Star and Garter Home G54-G04 S34157 R StarGarter V242429 190705 Stage 4.doc Version 1.30 Page 24 - 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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