Inspection on 09/06/05 for Tyspane Nursing Home

This inspection was carried out on 9th June 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

Tyspane Nursing Home 28/05/09

Tyspane Nursing Home 08/06/07

Tyspane Nursing Home 13/07/06

Tyspane Nursing Home 20/10/05

Tyspane Nursing Home 23/02/05

Tyspane Nursing Home 03/06/04

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Fairfields Country Rest Home

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Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Tyspane Lower Park Road Braunton North Devon EX33 2LH Lead Inspector Rachel Fleet Unannounced 09 June 2005 09:55hrs 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 and Care Homes for Adults 18 – 65*. 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. Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Tyspane Nursing Home Address Lower Park Road Braunton North Devon EX33 2LH 01271 816600 01271 812409 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) Barchester Healthcare Homes Limited Mrs Susan Dawn Harris Care Home with Nursing 69 Category(ies) of OP Old age (58) registration, with number PD Physical disability (11) of places Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 Notice of Proposal to Grant Registration for staffing/environmental conditions of registration issued 19/6/2000 2 That 11 places are provided for service users with a physical disability. 3 That from 16 October 2003 when a room becomes available in the new designated wing it can only be occupied by a person who fallswithin the service user category of physical disability (PD) and when a room becomes available within the remainder of the establishment then it can only be occupied by a service user falling within the category of service users, old age, not falling within any other category (OP). 4 That all service users who were accommodated with the service user category of PD as at 16 October 2003 who do not have a bedroom within the new designated wing will be offered a room when one becomes available before the room can be offered to any new potential service users. 5 That all service users who were accommodated with the service user category OP as at 16 October 2003 who do not have a bedroom outside the new designated wing will be offered a similar room when one becomes available before the room can be offered to any new potential service users. 6 As at the 16 October 2003 the home accommodated 58 service users with the service user category of OP which is 6 over the current maximum registered number for this category of service users. The National Care Standards Commission and future successor regulatory bodies will not seek to enforce the breach of this condition of registration subject to the registered provider using his best endeavours to achieve the transition within one year and not admitting any new service users in contravention of the conditions contained in this certificate of registration 7 That the registered provider will provide a temporary quiet area for the OP service users from the 16 October 2003 and that a new permanent quiet area will be provided by the 30 April 2004. 8 The total number of service users shall not exceed 69 in total. Date of last inspection 23 February 2005 Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc Version 1.30 Page 5 Brief Description of the Service: Tyspane Nursing Home is registered for 69 service users within the categories of old age (58 places) and physical disability (11 places), which includes younger adults. Barchester Healthcare Homes Limited owns Tyspane. It is a purpose built two-storey home, situated in a residential area of Braunton, North Devon. It is relatively near the town centre facilities (including shops, a library, and public houses) and coastal areas. There is a regular bus service to the larger town of Barnstaple. Most bedrooms are for single occupancy only, with en suite facilities. However, three rooms can be used as shared rooms if requested. There are 2 lifts giving access to all areas of the home. The home has a large lawn at the front, and a car parking area at the rear. Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Three inspectors visited the home for just over six hours, before discussing their findings to the Registered Manager and her Deputy. One inspector looked at care and facilities for younger adults, while the other two looked at care provision for older people. There were 56 residents at the home when they arrived. Between them, the inspectors spoke with 13 residents in depth, 4 visiting relatives, 2 visiting health or social care professionals, 7 staff and the manager, besides looking at care-related records and looking around the home. Two CSCI comment cards were completed by relatives/visitors. Residents, visitors and health / social care professionals consulted were happy with the overall care provided. Staff spoke of the improvement in morale and the reduction of sickness; all were happy and confident in the manager’s abilities. What the service does well: What has improved since the last inspection? What they could do better: Residents must be given the chance to be involved in the planning and review of their care, so that their wishes are known and they are given every opportunity to make decisions about the care they are to receive. More detail is needed in care plans, to ensure changing needs and social needs are met. Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc Version 1.30 Page 7 Aspects of medication practices must be improved to fully protect residents. Some residents would have a better quality of life if there were more things to do in the evenings and at weekends, and if they had more ‘one-to-one’ social time with staff. Systems for protection of vulnerable adults are not as robust as they could be, placing residents at possible risk of harm. Certain facilities for wheelchair-users within the home could be improved, to promote independent living. Staff need training in care needs of younger and physically disabled residents, to ensure they can understand their needs and care for residents safely and well (-some training is planned for the near future). 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. Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6-10 and 18–21) (Standards 11–17) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37–43) Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. 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. Prospective service users have an opportunity to “test drive” the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed. EVIDENCE: Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6-10 and 18 –21 (Adults 18-65) 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. Including their physical and emotional health needs. 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. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. Service users receive personal support in the way they prefer and require. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 7, 9, 18, 19 and 20 (Adults 18-65) are 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 (OP) and 6, 9, 18, 19 & 20 Residents’ health needs are well met, with evidence of good multidisciplinary working, and residents’ welfare promoted by staff with appropriate attitudes towards them. However, there is a risk that staff will not meet changing needs, and staff do not have the information they need to meet social and recreational needs of some residents. Residents could be more fully enabled to express their wishes and make decisions as to the care they receive if they were consulted during planning and review of their care. There is a good medication policy, but practices do not fully protect residents’ welfare. Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc Version 1.30 Page 11 EVIDENCE: Residents were happy with the care they received overall. Two visiting professionals were happy with the care being giving to residents they had responsibilities for. Care plans varied in detailing of needs - one didn’t include management of an infection, for example, and personal histories, social interests and preferences were missing from others. However, one contained a lovely personal history completed by family. The key worker for this resident was fully aware of their needs in terms of personal and psychological care, and showed respect and understanding for their past life. Care plans did not show whether residents were involved in care planning or reviews (although one relative had signed the care plan of one service user). Residents did not remember any involvement. It was good that diversion and deviation tactics were included in care plans for the younger adults. However, more detail was required here regarding causes of agitation. And also regarding care of residents on warfarin, or those admitted for palliative care. Wound care records varied in quality: plans were present, but some lacked detailed review of treatment or progress. The home is adopting an assessment tool that will include measurements of wounds. Risk assessments highlighted some environmental, physical and behavioural risks but did not always include management of the risk. Evaluations of care were often brief, not showing whether care had been appropriate or successful in meeting residents’ needs. One care plan for tissue viability stated ‘No change’ for nine months, although a separate wound care plan was commenced during that period. The medication policy is very comprehensive. Issues relating to storage and risk assessment were discussed regarding self-medicating residents. Some handwritten entries on medication administration sheets were not signed and dated, nor were codes always used to indicate why a medicine had not been given. Two residents said that staff always respected their dignity. Positive, respectful interactions were seen between staff and residents, with one exception that was discussed with the manager. One resident eating lunch seated on the landing by the lift said they did not mind this. It was a busy area, and the inspectors had been concerned that dignity was not being maintained. Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 11 – 17 (Adults 18-65) are: 12. 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. Including opportunities for personal development. Service users engage in appropriate leisure activities. Service users maintain contact with family/ friends/ representatives and the local community as they wish. And have appropriate personal, family and sexual relationships. 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. 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15, 16 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 14 The Home provides good opportunities for residents to satisfy their recreational, social and religious interests or needs, with their quality of life enriched by good links with families and the local community. However, some residents – especially younger adults - would benefit further if there were more things to do in the evenings and at weekends, and more one-to-one social time with staff. EVIDENCE: The home has an enthusiastic activities co-ordinator assisted by a volunteer. Entertainments are brought into the home. The new greenhouse and gardening club is very popular. One resident commented “This is a new hobby for me. I have never had a garden.” A local vicar visited during the inspection, several residents appreciating the regularly held service. Activities based on exercise and swimming are enjoyed by the younger adults, and a computer is available to residents. The activities staff work mainly in the week, so weekend and evening activities are limited. This was raised by one nurse regarding the younger adults. Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc Version 1.30 Page 13 A resident said they saw that their younger peers had very little to do with their time some days, needing others to help them pass their time happily. During the inspection, two younger adults were watching television in their own rooms all morning. The manager later said one of these had had a busy but tiring day the previous day, hence the quiet morning noted. Some residents felt staff didn’t have time ‘just to chat’. Visitors felt welcomed at any time. One resident said, “My family come when ever they want to,” and a care manager said staff work hard to involve families and maintain good relationships. One resident described the routine as ‘free and easy’. Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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. Including neglect and selfharm. The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) 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 home has a satisfactory complaints system, with some evidence that residents feel that their concerns or complaints are listened to and acted on. Systems for protection of vulnerable adults are not as robust as they could be, placing residents at possible risk of harm. EVIDENCE: Residents felt able to speak to staff, including the manager, about any concerns or complaints. One concern was raised with the inspectors during the inspection, regarding an issue between residents. The manager was aware and had spoken with the parties concerned, although was still trying to resolve the matter. Some staff have had training on protection of vulnerable adults, but not all. Two staff described forms of adult abuse and said that they would challenge and report any poor practice, but neither had received any training (as also said by a third staff member) or seen the Home’s policy/procedure. An issue between residents was discussed with senior staff, in relation to ensuring all parties involved received the protection and support they needed. Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) 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. Shared spaces complement and supplement service users’ individual rooms. Service users have sufficient and suitable lavatories and washing facilities. Provide sufficient privacy and meet their individual needs. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. And lifestyles. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20 & 22 Residents enjoy a well maintained home. Adaptations for wheelchair-users within the home could be improved, regarding the level of light switches and sockets in some areas. EVIDENCE: Since the last inspection, areas of the home have been refurbished (the ground floor lounge, for example), with improved ramp access at the entrance to the home. A minibus, with a lift for wheelchairs, has been bought. A resident spoke about the Home’s plans to alter the dining area, and improve garden access for wheelchair users. There are, in theory, separate lounges (in different parts of the home) for the two age groups accommodated at the home, but in practice anyone can use either. It is planned to add a kitchenette to the lounge for younger adults. Light switches and sockets in this room are not accessible from a wheelchair. Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc Version 1.30 Page 16 It is planned that, in time, residents will occupy bedrooms only in the area set aside for their age group. Sue Harris confirmed that conditions of registration are being observed: prospective residents are offered rooms only in the area of the home dedicated to either ‘younger adults’ or ‘older people’, as appropriate. However, one person said they were not made aware of the current arrangement, when they were admitted i.e. that younger and older people might be in rooms adjacent to each other, where they were admitted to the home prior to the condition being imposed and have chosen not to move to relevant areas. Residents were otherwise satisfied with their accommodation, and standards of cleanliness. Most rooms are personalised. Bedroom door locks (of a suitable type with regard to any safety issues, so subject to a risk assessment) can be fitted on request. The Manager confirmed all windows have restrictors fitted and working, to prevent falls from upper windows. Those randomly checked by the inspectors were satisfactory. The Home’s records showed that fire safety checks were carried out as required. Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 36 (Adults 18-65) are: 27. 28. 29. 30. • • • Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. 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. Service users benefit from clarity of staff roles and responsibilities. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30 Staffing levels are sufficient to ensure residents’ safety, but residents’ social needs are not fully met. Staff that support residents are caring, although they will benefit from further training in order to meet the needs of younger and physically disabled residents. EVIDENCE: Care staff levels have been increased in that four nurses now work in the morning instead of three. They are supported daily by a full team of ancillary staff. Two comment cards from relatives/visitors indicated they felt staffing levels were adequate. However, when discussing activities, staff said they’d like more time to spend with individuals. And some residents said staff were rushed. Specialist training relating to care of younger adults is still to take place, but is planned for July 2005. It will include physical disabilities and learning disability-related needs. Staff said they receive formal supervision now, and there are lots of training opportunities. This included record-keeping, palliative care, Parkinsonism and NVQs in Care. One member of staff said they would like some training in ‘Breakaway’ techniques. It was confirmed that this would be included in the planned training. Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc Version 1.30 Page 18 One nurse said they would not be undertaking the training in care of younger adults, but was training to become a Health and Safety representative at the home. The Deputy matron is currently studying for a Palliative care degree. Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc Version 1.30 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 37 – 43 (Adults 18-65) are: 31. 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 a well run home and from competent and accountable management of the service. 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. Service users are confident their views underpin all self-monitoring, review and development by the home. 32. 33. 34. 35. 36. 37. 38. • The Commission considers standards 33, 35 and 38 (Older People) and Standards 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 Residents and staff benefit from the competency and proactive approach of the Registered Manager. EVIDENCE: The manager is completing the Registered Managers Award, besides being a Registered Nurse. A care manager said the Manager had good interpersonal skills, and that she worked hard with relatives to ensure that things were “right”. Residents felt she was approachable, and staff felt she took action to deal with issues. A resident said a residents’ meeting had been held recently, but they had declined to attend. The minutes were not yet available. Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc Version 1.30 Page 20 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 x 2 x 3 x 4 x 5 x 6 x HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 3 3 x 2 x x x x Score Standard No 7 8 9 10 11 Score 2 2 2 3 x Standard No 27 28 29 30 2 x x 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 3 x 1 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 x 33 x 34 x 35 x 36 x 37 x 38 x Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc Version 1.30 Page 21 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 7 Regulation 12(2) & (3); 15(1) & (2)(c) Timescale for action You must - as far as practicable - 30 09 05 enable residents to make decisions with respect to the care they receive, ascertaining their wishes & feelings, by consulting them prior to writing & reviewing their care plan. This must include social care needs. You must record details of any 31 07 05 plan relating to a resident in respect of medication, nursing & specialist health care. This is especially with regard to use of warfarin, wound care, infections, palliative care, and detail in evaluations/reviews of residents needs recorded in their care plan documentation. You must make arrangements 31 07 05 for the safekeeping & safe administration of medication. This is especially regarding residents that self-administer their medication, & administration records. You must make arrangements, 31 08 05 by training staff or other measures, to prevent residents being harmed or suffering abuse, or being placed at risk of harm or abuse. Version 1.30 Page 22 Requirement 2. 8 17(1)(a) Sched.3: 3(m); 14(2) 3. 9 13(2) 4. 18 13(6) Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc 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 YA14; OP12; YA33; OP27 OP22; YA29 OP30 Good Practice Recommendations You should increase opportunities for residents for one-toone social time with staff, and for leisure activities at weekends and in the evenings.This should include a review of the numbers and skill mix of the staff team, to ensure they are sufficient. You should provide environmental adaptations such as lowered light fittings, to maximise residents independence. Staff should receive training appropriate to the work they are to perform, with regard to caring for physically disabled residents and those with a Learning Disability. 2. 3. Tyspane D54 D06_s26726_tyspane_v231504_090605 stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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 Tyspane D54 D06_s26726_tyspane_v231504_090605 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. 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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