Care Home: Glendale Residential Home

What the care home does well Glendale is a small, clean, comfortable and homely place to live, with a Manager and staff team who make every effort to provide a service that is individualised. Routines in the home are flexible and varied according to individual needs and wishes i.e. there are no restrictions on when residents get up, or go to bed etc. New admissions to the home are only made following a thorough assessment of the person`s needs. The Manager does not admit people to the home if their needs cannot be met. Care plans are personalised, and contained good detail of individual needs, and are regularly reviewed to make every effort to keep people healthy, and care for them when they are sick. Policies and procedures relating to complaints, and safeguarding are good, and residents spoke highly of the staff team that support them. One person said "It`s a nice home, I feel safe here, and looked after." What has improved since the last inspection? The service has been registered with the Commission for Social Care Inspection to offer a service to people who suffer from dementia. This means that the staff in the home will have training relating to working with people with dementia, and will be skilled to meet the extra demands this may place on the service. The Home is maintained to a good standard. All communal areas have been decorated. Toilets and flooring have been replaced where necessary. One resident stated that the curtains looked shabby in the lounge. They have now been replaced. CARE HOMES FOR OLDER PEOPLE Glendale Residential Home 14 Station Road Felsted Dunmow Essex CM6 3HB Lead Inspector June Humphreys Unannounced Inspection 12th September 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glendale Residential Home Address 14 Station Road Felsted Dunmow Essex CM6 3HB 01371 820453 01371 820453 glendale@residentialhome.wanadoo.co.uk 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) The Oaks Residential Homes Ltd Mrs Julie Fitch Care Home 16 Category(ies) of Dementia (16), Old age, not falling within any registration, with number other category (16) of places Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service: Care home - CRH to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is 16. 18th September 2006 2. Date of last inspection Brief Description of the Service: Glendale Residential Home is a large detached property situated in the village of Felsted in the county of Essex. The home is in keeping with the surrounding area and is close to the local amenities. The property has been registered as a care home since 1988 to provide personal care for 16 people over the age of 65. Service users are accommodated in 14 single rooms and there is one room available as a double if required. The service users bedrooms are situated on both floors of the home and there is a through the floor passenger lift to the first floor. The home presents itself as welcoming and clean with pleasantly decorated communal areas that are furnished to a good standard. To the outside of the property there is a well maintained and private rear garden laid to lawn with flower beds and mature trees and there is a patio area central to the extended part of the premises. To the front of the home there is ample off street parking for several cars. A copy of the most recent inspection report issued by the Commission for Social Care Inspection was displayed on the notice board in the dining room. Fees charged for care and accommodation at Glendale Residential Home are £600 per week as at September 2008. Not included in the fee are personal items such as chiropody, hairdressing, and toiletries. Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that people who use this service experience good quality outcomes. This was a routine unannounced inspection, which included a visit to Glendale on the 12th September 2008. One inspector undertook the site visit, and all of the key national minimum standards were addressed. Opportunity was taken to speak with residents, relatives, staff, and the registered Manager. The Manager completed and returned the Annual Quality Assurance Assessment to the Commission, which is a self-assessment of how the service is doing. Information from the document has been included in the report. As part of the inspection 7 staff surveys, and 9 residents/relatives surveys were returned. The comments made have been useful, and have helped in understanding what it is like to live at Glendale. Records and documents were looked at in detail, including a sample of care plans, Two staff files and supervision records, the staff rota, complaints, medication and accident records. What the service does well: Glendale is a small, clean, comfortable and homely place to live, with a Manager and staff team who make every effort to provide a service that is individualised. Routines in the home are flexible and varied according to individual needs and wishes i.e. there are no restrictions on when residents get up, or go to bed etc. New admissions to the home are only made following a thorough assessment of the person’s needs. The Manager does not admit people to the home if their needs cannot be met. Care plans are personalised, and contained good detail of individual needs, and are regularly reviewed to make every effort to keep people healthy, and care for them when they are sick. Policies and procedures relating to complaints, and safeguarding are good, and residents spoke highly of the staff team that support them. One person said “It’s a nice home, I feel safe here, and looked after.” Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Storage space within the home is poor and must be reviewed, particularly the bathroom area which could become a safety hazard. The home continues to have a shortfall in the number of N.V.Q qualified staff. This relates to a number of older staff declining to undertake the training. Two further staff members have now completed the NVQ 2 in care, and another staff member is starting N.V.Q 3. The manager will continue to actively recruit qualified carers, and seek further funding for staff that are inexperienced, and would benefit from such training. . 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 summary of this inspection report can be made available in other formats on request. Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective Residents can be assured that a through assessment will be completed, and admission to the home will only be agreed if their needs can be fully met. EVIDENCE: Two assessments were looked at on the day of inspection, both contained information that was clear, precise and outlined the amount of support that would be needed. One assessment was of a person recently admitted in March 2008. The person had initially received respite at the home, so they already new what to expect. The relative was included in the process both prior to respite, and when the placement was made permanent. Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 Page 9 The manager showed a good awareness of the needs that the home is able to meet and clearly took this into account when considering prospective admissions. The manager stated in the AQAA “Prior to admission all potential residents have been visited, and visited Glendale. We gather as much information as possible about them to ensure that Glendale is the right place for them to live in and call home. We ensure they know as much about the Home and how we operate as possible. We do not want anyone moving into our Home and realise they have made a mistake. We talk to people who know them, their family and friends and obtain their input.” Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents health and personal care needs, including the management of medication, were met by a staff team that showed a caring approach, treating people with sensitivity, dignity and respect. EVIDENCE: Two care plans were looked at as part of the inspection. They were personalised, and contained good detail of individual needs. The care plans had been updated, and were easy for staff to access. Residents spoken with reported that staff gave them the level of support and assistance they required and provided care in the way that they preferred. One resident said, “The staff here are very caring, and always try to help”. A relative stated, “Dad is given great support. He had shingles in January and staff have continued to support his treatment”. Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 Page 11 The Manager spoke of good working relationships with all health care professionals. Health care needs were recorded appropriately. Opticians, dentists and chiropodists visit on a regular basis. The Doctor reviews all residents’ medications on a regular basis. . There was clear, recorded evidence of district nurse visits, GP interventions, emergency services being called when required. Two residents medication was case tracked as part of the inspection and found to be accurate. Medication is not supplied to the home in blister packs, but all boxes are marked with the date upon which it was opened. Medication is stored in each person’s bedroom in a locked cabinet. Some cabinets are placed in the on-suite facility within the bedroom. Residents do not have shower facilities in their bedrooms, and humidity was observed to be low on the day of inspection, with no cause for concern re the storage of the medication seen. Medication is administered to each resident on an individual basis. An auditing process is in place that is regularly completed by the manager. Residents spoken with commented on how good staff were, and how well they were treated. Residents knew most of the staff, has many had been in post for a number of years. The staff was knowledgeable of the residents needs, and quick to identify any health issues, which could then be acted upon. Staff interaction with residents was observed and confirmed that they were respectful and polite when assisting residents with their daily activities. Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff recognise and support individual rights and responsibilities, and assist them when needed to experience a life style which encourages involvement in the home, and contact with family and friends. EVIDENCE: All staff support and encourage service users to maintain and develop social skills. Residents were observed undertaking a variety of tasks throughout the inspection. Dedicated activity staff are employed to work in the home to ensure a range of activities are offered, including puzzles, crosswords, games and reminiscence type activities. The manager stated that prospective residents are encouraged to bring photographs and personal belongings into the home. Relatives are wherever possible encouraged to provide information about the person’s interests, family friends and social history. This is often helpful when encouraging residents to join in. The activities co-ordinator said residents were keen to share photographs and their personal memories. “People often find they have a lot in common.” Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 Page 13 Outside entertainers also regularly visit the home. Residents always given a choice to take part in any activity, one person said “I like to take it easy, but the staff encourage me to join, and they what I enjoy!” A key worker system is in operation in the home, and this tries to ensure residents receive a ‘person centred’ service. Residents are given opportunity to, and assisted to be involved in the running of the home through talking to their key worker. It was noted that residents meetings had not always been recorded. The manager acknowledged this, and said that most people liked to talk on a one to one basis to their allocated key worker. Due to different residents levels of communication this had been difficult. The activity cocoordinator has now agreed to do this as one of the groups that she offers to residents, and will minute actions and outcomes. Contact with relatives and friends is encouraged by the home and visitors made welcome. One relative spoken with said she was always made welcome when they visited and was kept up to date with any relevant information. People living at the home were spoken with during lunch- time. All residents said they enjoyed the food presented, had a choice of meals available and were supported by staff if they needed it. The food on the day was of a very good standard. There was a main meal offered, with two possible choices. The home operates a six -week menu. The cook was new to the home, but indicated that she would speak to people living at the home about menu planning. Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an open culture where individuals feel safe and supported to share any concerns in relation to their protection and safety. Residents and their relatives are encouraged to make their concerns and complaints known. EVIDENCE: The home’s complaints procedure is regularly reviewed, updated and a copy is provided on admission, and when any changes are made. The complaints procedure is also on display in the home. Residents have regular contact with their allocated key worker, and concerns are addressed immediately wherever possible. Residents spoken to did appear to know how to make a complaint, and staff said that they actively encouraged residents to ‘speak out’. Any complaints made within the home, are logged, verbal or written. The out comes, and actions are also recorded. Three verbal complaints had been made this year; all had been clearly recorded, including the response to the resident. One example was of a call bell not being answered quick enough, another the pancakes served were not hot. The Manager spoke to staff, and then the Resident. Recorded the action taken and if the resident was satisfied with the outcome. Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 Page 15 Policies and procedures relating to the protection of vulnerable adults were in place with appropriate guidelines for staff to follow should a complaint of abuse be made or they observe an incident of abuse taking place. The manager has attended comprehensive training, and ensures new staff are trained as part of induction. All staff are updated of any changes in policies and procedures, and staff spoken to were aware of how to use the home’s procedures, and of the Whistle Blowing policy. Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Glendale is a well maintained and attractive home that meets the needs of the people who live there. EVIDENCE: At the time of the inspection the home was comfortable, and staff had worked hard to make the home cosy, and domestic in style. The general cleanliness of the home was maintained to a high standard. The manager stated in the AQAA “We ensure that the home is maintained to a good standard. Decorating and refurbishing as appropriate. We replace items as required. We do our utmost to ensure there are no unpleasant odours by cleaning spillages immediately. Laundering soiled clothing and bedding immediately and using appropriate air freshening products. Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 Page 17 We employ a housekeeper six days a week to maintain our high standards.” Residents are accommodated in 14 single rooms and there is one room available as a double if required. All of the décor was fresh and clean and of a good standard. Bedrooms were personalised by residents with photographs, pictures and ornaments. However there is an obvious shortage of storage space that should be addressed, and one bathroom looked cluttered with incontinence pads and similar items. Storage capacity in the home must be reviewed, and managed as this could become a safety hazard. Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29,and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels by day and night are sufficient to meet resident’s needs. Staff have appropriate skills, knowledge and experience to identify and respond to individual needs in a consistent way. EVIDENCE: A range of different staff work at Glendale, some of which have been in post for many years. All the members of the care staff spoken with during the inspection were enthusiastic about their work in the home, and one said, “that there is an open and happy atmosphere here”. Rotas examined on the day of the inspection showed that there was sufficient staff on duty during the day and night to meet the needs of people living at the home. If further residents were admitted i.e. further people with dementia who require greater care, or the home increases it numbers, then the manager gave assurance that staffing numbers would be reviewed. The manager advised that no agency staff were used; shifts were covered by the staff in post. Several Staff spoken to say they had been in post for a considerable period of time, and that this made a difference to the quality of care that they were able to provide to residents. Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 Page 19 This was also re stated in three surveys. One person said “The staff have a nice repore with residents, there a nice atmosphere, sitting and talking with residents”. Another person said “They know the residents well, and have an interest in each individual.” The home continues to have a shortfall in the number of N.V.Q qualified staff. The manager has encouraged staff to undertake NVQ training, but a number of older staff have declined to complete the training. The Manager stated that she prioritised training updates for these staff and that they were “a valuable part of the team”. Two further staff members have now completed the NVQ 2 in care, and another staff member is starting N.V.Q 3. The manager will continue to actively recruit qualified carers, and seek further funding for staff that are inexperienced, and would benefit from such training. Two staff files were looked as part of the inspection. All staff files identified the training staff had undertaken. The home’s mandatory training i.e. first aid, manual handling, safeguarding and medication administration, had been completed by staff. Staff felt that they had good access to relevant training opportunities, and new staff undergo a thorough induction programme adapted from the Skills for Care booklet (12 weeks and beyond). Part of this familiarises staff with the policies, procedures and routines of the home. The records of all of new staff currently in post were inspected and found to hold all of the required checks and information i.e. criminal record disclosure and references. Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is experienced in the care of the elderly and has completed the Registered Managers Award. The Manager said that she regularly updates her practice by attending training; and then provides training to the staff team. The manager has attended training on The Mental Capacity Act, and is ensuring staff understand what this means when caring for residents in the future. She has a strong commitment to raise and sustain standards, and residents’ personal wellbeing and safety is promoted through staff training, comprehensive policies, procedures, and regular health and safety checks. Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 Page 21 A random sample of health and safety documents were examined and these were up to date. The home had a completed fire risk assessment, which had been regularly updated, and there was evidence of fire drills and fire alarm tests. However as stated earlier in the report the storage space within the home must be reviewed, particularly the bathroom area which could become a safety hazard. Feedback from residents and staff about the registered manager was positive with comments received about her being approachable, supportive and always on hand for advice. The Manager stated that both herself and the assistant manager work as part of the care team providing guidance and direction to staff when necessary, to ensure that residents receive consistent, quality care. Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP22 Regulation 23(2)(l Requirement Suitable provision must be made for storage in the home to ensure residents live in an environment, which remains safe and free from clutter. Timescale for action 01/01/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP27 OP28 Good Practice Recommendations The registered manger must ensure that staffing levels are kept under review to ensure the changing needs of residents can be met. The registered manager should continue to recruit, and train staff to an appropriate level to ensure they are able to perform the work they are employed to do, and adequately support residents. (N.V.Q 2) Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Glendale Residential Home DS0000067783.V371338.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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