CARE HOMES FOR OLDER PEOPLE
Victoria Care Home Victoria Street Rainford St Helens Merseyside WA11 8DA Lead Inspector
Miss Diane Sharrock Unannounced Inspection 10:00 25 November 2005 & 9 December 2005
th 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 Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Victoria Care Home Address Victoria Street Rainford St Helens Merseyside WA11 8DA 01744 88 6225 01744 886193 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) Four Seasons Healthcare (England) Limited (Wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Sharon Ahern Care Home 53 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (30), Old age, not falling within any other of places category (23) Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 23 OP and up to 30 DE(E) Service users to include up to 3 DE (out of 30 DE(E) category) Date of last inspection 28.06.05 Brief Description of the Service: Victoria Care Home is owned and managed by Four Seasons Health Care and is a two storey detached premises set in a residential area close to the centre of Rainford Village. A bypass is near by with links to motorways and the east Lancashire road. The home is registered to accommodate older people with nursing needs (Alexandra Unit) and Older people who experience mental health problems and also require nursing care (Emily Unit). Theses two categories of care are provided on separate floors. The Responsible Person for the Company is now Mrs Jane Rigg. The home’ s Manager seen during the previous inspection has left and the Company have now employed a new Manager Mrs Sheila Francis. The Company have submitted an application to CSCI for Mrs Francis to apply for registration as Manager for the home. Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 2 days and was unannounced with 2 Representatives of CSCI being present on both days. Following 2 adult protection investigations regarding separate incidents that occurred at the home in November 2005 it was agreed that the Inspector would carry out an unannounced inspection as a health and safety check to ensure the safety of Service Users in the home. Company Representatives have met with CSCI following this inspection on the 14/12/05 and have given further details of an ongoing action plan to meet the immediate requirements served on the 9/12/05 ands to show ongoing compliance in how they are to meet the Care Home Regulations 2001. A detailed tour of the premises took place and Resident care plans and various other records were inspected. All areas of the inspection and findings were discussed with the Manager and Representatives at the end of this inspection including written feedback. A number of concerns were found on the 25/11/05 which took precedent in this inspection, namely there had been problems with the heating and during the visit on the 9/12/05 other issues took precedent in this inspection as listed below. What the service does well: What has improved since the last inspection?
Care plans were noted to have improved and were more detailed in content. Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 6 What they could do better:
The Inspector conducted an inspection of the first floor environment. Each room on the first floor was checked. This inspection identified a number of issues as listed below, Inspection of first floor EMI unit 25/11/05 Most radiators were not on and were cold, Some radiators had loose and moveable radiator covers, One bedroom had no cover to the radiator, Two toilets were dirty and had faeces on the seat, Some bedrooms smelled of urine, Some beds were positioned away from the nurse panel; no bedrooms on the first floor had a cord attached to the nurse panel, Some bedrooms had portable electric heaters plugged into the wall but not switched on and some Residents were seen wandering around the EMI unit going into unlocked bedrooms, One Resident was in bed with bed rails and the bed was positioned away from the nurse panel, approximately 2 meters away. A portable heater was switched on and very hot to touch, there was no television on or access to a radio, The linen cupboard on the first floor had just 15 thin blankets and every bedroom on the first floor had very thin “summer type” duvets, not all bedrooms had a blanket provided by staff. One basin hot water measured 49.5 c and one other measured 44.9 c. Care Staff stated they did not have thermometers to check the water temperatures. The maintenance person was able to provide his thermometer to test water during this visit. Later in the afternoon, the Manager SF stated the heating had broken the night before (24/11/05) and she had produced a regulation 37 report. Which gave brief details and stated the home was “warm and comfortable.” Some staff at the home stated that the heating had been broke since last Friday (18/11/05) they stated the heating was broken downstairs and some radiators were on upstairs but they had more portable heaters to put in the rooms. They stated the engineers were not back until Monday to fix the system. One Resident stated the heating had been broken since Tuesday (15/11/05) and that they had received a portable heater the day of the inspection. The Manager stated they that they had enough portable heaters for every bedroom. She stated she was unaware that the radiators were not working upstairs but knew that downstairs they were broke and not being fixed until Monday (28/11/05). Instructions were given to the homes Maintenance person to “bleed” radiators to try and get them working. Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 7 The Manager stated they had not implemented a risk assessment for the heating being broken or for the use of portable heaters. One heating maintenance sheet showed the heating had broken on the 18/11/05, which was fixed, but further parts had been ordered. JD stated the engineers had been out since the 18/11/05 and had fixed the heating. The Inspector and Representative of St Helens Social Services discussed the identified risks, and prompted the Managers to implement a risk assessment that would be appropriate to ensure the health, safety and well being of all Residents in the home. I.e.; Identify exactly how many bedrooms had radiators that did not work, Identify what Residents could have their beds moved into a room with a working radiator as an emergency measure ensuring they are compatible with other Residents and identify with the Companies sister home any available facilities. Provide appropriate “winter” type duvets for all Residents and further supplies of blankets for each bedroom, The Regional Manager purchased a supply of thicker duvets and accessed further supplies of duvets in an outside store room. Increase staffing levels due to the use of portable heaters in the bedrooms, given the category of residents (D) and their inability to comprehend the risk of portable heaters. Implement and organise risk assessments taking the appropriate action to reduce any risks, Representatives of St Helens Local Authority and PCT were present during this visit and a Senior Representative of CSCI. The Manager conducted a risk assessment and review of the home and provided a number of initiatives to improve the heating of the home and to reduce any identified risks prior to any party leaving the building. Unannounced Inspection to Victoria Care Home, Victoria Street, Rainford. 9/12/05 This visit was arranged to check on health and safety issues in the home. This visit identified various concerns throughout the visit, which had been discussed with the Nurse in charge the regional Manager J D and L M, Manager of Alexandra care home who was asked to come to the home and provide assistance. Written feedback was given to L M and 3 immediate requirements. Mrs L M relayed all information to Ms J D. The Inspectors discussed concerns with the Nurse in Charge late morning when it became obvious that there were problems in the home. 1) The environment was unclean and had not been maintained and had various smells of incontinence in several bedrooms. There was no domestic on duty as 2 domestic staff was off sick. The staffing rotas showed that there had been no domestic since Monday 6/12/05. Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 8 2) Health and safety checks on the home identified a number of concerns. Various radiators within the home, including bedrooms did not have radiator covers, some radiators had covers that were loose and unattached to the wall. Some hot water taps dispensed hot water over 43 ‘. All bedrooms on the EMI unit had no nurse cord attachments and some bedrooms on the ground floor had no cord attachment. Some bedrooms had beds positioned away from the nurse call panel. 1 Resident was seen smoking in their room and no risk assessment was seen or produced by Senior Staff. 3) General care issues noted during this inspection were of concern. Some Residents were still in bed on the EMI unit aprox 12md. Some female Residents in the EMI unit were seen without stockings, there were no activities organised. Prescribed creams were seen displayed in some bedrooms on the ground floor. 4) The Nurse in charge was unable to access the fire book, the homes maintenance book, and maintenance records. Risk assessments had not been produced for all issues identified during the unannounced visit 25/11/05. 5) The management of the home was of concern. The Nurse in Charge did not realise late morning that she was short of 1 care staff in the morning, evening. And had not organised any domestic cover to clean and maintain an environment that was very poor. JD the Regional Manager contacted the home and instructed KL to arrange for staff and agency staff to be booked to cover the shortfall and to provide an extra shift for the afternoon to make up for the shortage that morning. The duty rotas also identified that there was no laundry assistant for Saturday 11/12/05. Three immediate requirements were served and full written feedback was given to Mrs LM during this visit. Mrs LM gave verbal feedback of what actions they were taken to meet the immediate requirements. Mrs LM was asked to visit the home by the Regional Manager and address the issues raised. A meeting took place with CSCI and Representatives of the company on the 12/12/05. Each point contained within this report had been discussed and action taken by the company with an ongoing action plan to show evidence of compliance with the National Minimum Standards ands Care Home Regulations 2001. Regular contact has been submitted by the Company to update the homes ongoing action plan. Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 9 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. Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 10 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 Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 11 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): Not measured during this inspection. EVIDENCE: Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 12 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. There continues to be progress made within care plans, which include details for health, personal and social care needs of Residents. There were no records of nurse calls being assessed as not needed or risk assessments for one Resident smoking, one resident staying in bed refusing treatment. EVIDENCE: The care records seen had detailed information and had improved since the last inspection this was also highlighted in PCT nurse assessor’s views of clinical care plans. General care issues noted during this inspection were of concern. On the 9/12/05 1 Resident was in bed, unshaven, had not had anything to eat or drink, no access to a nurse call panel, TV not switched on. Some ladies had no stockings on. 3 Residents were sat in “kirton style” chairs but all had no support for their feet, their feet were seen dangling. Company Representatives have explained they purchase and supply theses chairs and do not always provide a foot support however they agreed to review this with individuals needs and take professional advice. Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 13 During both visits it was noted that some Residents did not have access to a nurse cord and some had their beds positioned away from a nurse call panel. The Regional Manager stated after the visit on the 25/11/05 that all beds had been position next to nurse calls and she did not know why they had been moved again. This issue was again discussed and company representatives agreed to carry out further review and investigation as to why beds had been moved yet again away from nurse calls. Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 14 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): Not measured during this inspection EVIDENCE: Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not measured in full during this inspection. EVIDENCE: Although there are currently 2 Adult Protection investigations at present, each one is being managed within the guidance of St Helens Local Policy. Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19.26 During both visits various issues of health and safety were noted. During the visit of the 9/12/05 the home was found to be in an unacceptable standard of cleanliness. EVIDENCE: The environment was unclean on the 9/12/05 and had not been maintained and had various smells of incontinence in several bedrooms during both visits. There was no domestic on duty on the 9/12/05 as 2 domestic staff were off sick. Remains of vomit were seen in one bedroom on the ground floor. The home needed further supplies of bedding, towels and linen. The Regional Manager organised for a local Manager to visit the home and arrange Staff cover to clean the home over the weekend following the 9/12/05. Risk assessments had not originally been produced for the heating breaking in the home during November 2005 and no risk assessments were produced for the use of portable electric heaters. A generic risk assessment has now been produced for the heating.
Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 17 Company Representatives have explained that their advice has been that generic risk assessments are sufficient and they have now produced assessments for the Resident who smokes, with further maintenance work carried out to the fire alarms, Water heaters, heating system, radiator covers and records to be developed and included in care plans for those Residents assessed as being unable to use their nurse cord and a supply of cords have also been ordered. Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 On the 9/12/05 Staffing levels were found to be lower than the levels the home had set and no domestic staff were on duty. EVIDENCE: On the 9/12/05 The Nurse in charge of the home K L had not arranged any cover and when asked what can she do, she said she would try and get one of the “Polish” staff to do some hours as she said she had 3 kitchen assistants in that day. She acknowledged that the carer she was asking to do domestic work had never done this job before. The management had not produced a domestic on the rota since 6/12/05. The duty rota and staff stated that they were one carer less than their usual numbers in the morning and afternoon that day. The Nurse in charge KL stated she had not realised they were short staffed, the time was now aprox 12md. When asked what she would do, she stated she would ask staff if they could work any extra hours for the afternoon to 8pm. When asked what about the morning hours that had not been covered, would she arrange extra hours for the afternoon for staff to then carry out those jobs they have not done in the morning, she stated they do not usually do this. DS asked KL to contact the regional manager about the concerns the Inspector had. Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 19 Staff also pointed out that the maintenance man had been off for a week due to sudden unforeseen circumstances. Mrs LM stated that her maintenance person was suppose to help the home in the absence of their own maintenance person, however no member of staff had contacted her to need a maintenance person at Victoria care home. During the visit on the 25/11/05 while the use of portable heaters were put in the home, the Manager eventually brought in extra staff to try and reduce any potential incident of risk. Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31.38 During both unannounced visits concerns were noted on both occasions. The ongoing management of the home should be reviewed to evidence improvement to the ongoing management of the home. Health and safety issues were noted during both visits and ongoing review and evidence should be in place to ensure the health, safety and welfare. EVIDENCE: During the visit on the 9/12/05 The Nurse in charge was unable to access the fire book, the homes maintenance book, maintenance records. The Nurse in Charge could not locate risk assessments. Health and safety checks on the home identified a number of concerns during both visits. The fire alarm went off during this visit 9/12/05 due to one Resident smoking in their room, the exit doors were only accessible by those staff and visitors who knew the key code. J D stated they should automatically open, however
Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 21 staff had to open the door for staff and there was no information displayed to advise visitors of the key code action of these doors especially in the event of a fire. J D stated that they had carried out a check of the home following the last unannounced visit 25/11/05 and all beds had been positioned next to nurse calls and she did not know why they had been moved again. On the 25/11/05 later in the afternoon, the Manager SF stated the heating had broken the night before (24/11/05) and she had produced a regulation 37 reports. Which gave brief details and stated the home was “warm and comfortable.” Some bedrooms on the 25/11/05 had portable electric heaters plugged into the wall but not switched on and some Residents were seen wandering around the EMI unit going into unlocked bedrooms. The Manager stated they that they had enough portable heaters for every bedroom. She stated she was unaware that the radiators were not working upstairs but knew that downstairs they were broke and not being fixed until Monday (28/11/05). Instructions were given to the homes Maintenance person to “bleed” radiators to try and get them working. The Manager stated they had not implemented a risk assessment for the heating being broken or for the use of portable heaters. The Inspector and Representative of St Helens Social Services discussed the identified risks, and prompted the Managers to implement a risk assessment and to carry a various actions that would be appropriate to ensure the health, safety and well being of all Residents in the home. I.e.; Identify exactly how many bedrooms had radiators that did not work, Identify what Residents could have their beds moved into a room with a working radiator as an emergency measure ensuring they are compatible with other Residents and identify with the Companies sister home any available facilities. Provide appropriate “winter” type duvets for all Residents and further supplies of blankets for each bedroom, Increase staffing levels due to the use of portable heaters in the bedrooms, given the category of residents (D) and their inability to comprehend the risk of portable heaters. Implement and organise risk assessments taking the appropriate action to reduce any risks, On the 9/12/05 Mrs LM brought a male carer from her home to conduct a health and safety check to the home, test all hot waters and secure all broken radiator covers. Mrs LM stated she would also check the duty rotas and contact the nurse KL and book the staff to cover the shortfalls in carers, domestics and laundry staff. Mrs LM stated the management cover for the weekend would be herself and JD having phone contact and letting staff know they can contact them with any issues. Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 x COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x 1 X X X X X X 1 STAFFING Standard No Score 27 1 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X X X X 1 Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 23 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 OP31 Regulation 10 1 Requirement The Responsible Person must identify suitable management and supervision of the home from present date to ensure the health and safety and welfare of all staff, residents and visitors to the home. To submit a written response to CSCI of all management arrangements and responsibilities of this home. Timescale for action 09/12/05 2 OP38 13 3 OP27 18 1 a) The responsible person must carry 12/12/05 out a comprehensive health and safety check of the home, Environment, and of resident’s care and facilities. A report of all actions taken to reduce and eliminate risks must be submitted to Commission for Social Care Inspection. The Responsible Person must 09/12/05 provide domestic staff, laundry staff and the appropriate number of care staff for all shifts identified on staff Rotas from 9th December 2005 to the 11th December 2005. To submit written evidence that staffing levels have been provided to C.S.C.I.
DS0000005474.V269107.R01.S.doc Version 5.0 Page 24 Victoria Care Home 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 OP26 Good Practice Recommendations To replace worn bedding/linen throughout the home. Victoria Care Home DS0000005474.V269107.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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