Care Home: Higher Ravenswing

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What the care home does well What has improved since the last inspection? Plans of care detailed more clearly the number of staff required to assist each resident to ensure their personal care needs were met. There was a copy of the British National Formulary to aid staff in medication issues. The home had purchased sit on scales to enable staff to accurately weigh all residents. CARE HOMES FOR OLDER PEOPLE Higher Ravenswing 251 Revidge Road Blackburn Lancs BB2 6DT Lead Inspector Mr Graham Oldham Unannounced Inspection 16th July 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 Higher Ravenswing DS0000061156.V366033.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. Higher Ravenswing DS0000061156.V366033.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Higher Ravenswing Address 251 Revidge Road Blackburn Lancs BB2 6DT 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) 01254 670115 care@ravenswinghomes.com Ravenswing Homes Ltd Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Higher Ravenswing DS0000061156.V366033.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Fourteen elderly service users requiring personal care can be accommodated at the home. The home must, at all times, employ a suitably qualified and experienced manager registered with the Commission for Social Care Inspection. 18th July 2007 Date of last inspection Brief Description of the Service: Higher Ravenswing is a detached house situated on the outskirts of Blackburn. The home is located in a semi-rural position with views overlooking a golf course. Higher Ravenswing is a Ltd company with Mr George Daniels nominated as the Responsible Individual. The house has been converted to provide accommodation for up to 14 residents. Car parking facilities are provided at the front of the property. Gardens are accessible to residents. There are separate lounge and dining facilities for residents to choose company or privacy. There are ten single bedrooms and two shared rooms. There is a stair lift. The weekly charges for the home are from £390 - £410. Additional charges are made for hairdressing, newspapers and personal items such as perfume. Additional charges would also be made for items of medical equipment if these were needed for specific problems. A statement of purpose and service users guide is available for residents or their families to be informed of the facilities and services the home provides. Higher Ravenswing DS0000061156.V366033.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 star. This means the people who use this service are experiencing good quality outcomes. This unannounced key inspection, which included a visit to the service, took place on the 16th July 2008. Much of the information gained was obtained from talking to residents and staff members. The views of residents were obtained on a variety of topics. Two residents were case tracked. Case tracking gave the inspector an overall view of the specific care for the individual resident by checking the plans of care, other documentation and talking to residents and staff. One staff member was questioned about the care needs of the resident’s case tracked. Some of the views have been reported collectively with specific comments contained within the body of the report. The inspector took detailed notes during the inspection, which have been retained as evidence. Staff were directly and indirectly observed carrying out their tasks and interacting with residents. Paperwork examined included plans of care, assessment documentation, policies and procedures or documents relevant to each standard. A tour of the building was conducted. The care service provided a lot of information to us in a form called the Annual Quality Assurance Assessment or AQAA. Five staff member returned survey forms to the CSCI All five thought they were always kept informed about the needs of residents. Four thought recruitment checks were robust and one did not. Three thought the induction process covered all topics very well and two mostly. All five thought training was relevant to the role, helped understand the diversity of residents and kept them up to date. Three thought support was regular and two often. All five knew how to make a complaint. Four thought communication was always good and one usually. Higher Ravenswing DS0000061156.V366033.R01.S.doc Version 5.2 Page 6 Three thought there was always enough staff to meet the needs of residents and two usually. Three thought support was always sufficient to meet the diverse needs of residents and two usually. The positive response from staff demonstrated a supportive and responsive management team. Seven relatives returned survey forms to the CSCI. All seven thought information was always sufficient to make informed decisions about their relatives. All seven thought the needs of their relative was always met. Four thought they were always kept in touch with their relatives and three usually. All seven thought they were kept up to date with important issues. All seven thought the care and support given to residents was always enough. All seven thought staff had the skills and experience to meet the needs of residents. All seven thought the diverse needs of residents were met. All seven knew how to make a complaint but had not needed to. All seven thought the response to a concern would always be appropriate. Five thought the care service always supported people to live the life they chose and two usually. The positive response from relatives demonstrated they were satisfied with the service and facilities at this care service. What the service does well: The assessment process ensured residents who were admitted to the home had their needs met. Plans of care were developed with the aid of families and residents to provide staff with sufficient knowledge to help meet the needs of residents accommodated at the care service. Residents had access to specialists to ensure their health care needs were met. Higher Ravenswing DS0000061156.V366033.R01.S.doc Version 5.2 Page 7 The care home was warm, clean, tidy and free from offensive odours. The furnishings were domestic in character and helped provide a homely atmosphere. Health and safety policies, procedures and maintenance of equipment helped protect the welfare of residents and staff. Care plans demonstrated the wishes of residents were used to promote independence. Residents case tracked said, “I do most things for myself – I like to remain independent” and “I like to be independent so do a lot of things for myself. I get to choose my own things. I can go to bed and get up when I want”. Residents were encouraged to remain active and had choice within the daily routine of the care service. Resident’s case tracked said, “My family and I chose here. I came for a look around” and “I had been to four or five homes and did not like them so we came here. I liked it here”. Residents were able to look around and test-drive the home to see if they liked it. Residents case tracked said, “I get treated fine – I have no complaints but if I did I would complain. I would talk to my son first of all if I had a problem” and “I would talk to the senior care staff if I had any complaints”. Residents felt able to voice any concerns they had. Four residents taking a meal said the food was good. The inspector ate a meal and found it to be warm, nutritious and tasty. Resident’s case tracked said, “The food is all right” and “The food is not so bad. I never leave any”. Food was suitable to resident’s tastes. Both residents case tracked said they felt safe at the care home. Policies, procedures and staff training helped protect the welfare of residents. Resident’s case tracked said, “The girls are nice and if they were not I would not be nice to them. We have meetings with staff and other residents. I talk to my key worker” and “The staff are very nice. The senior carer takes me walks. The owner is all right too. I think they like me”. Residents were pleased with the attitude of staff. Resident’s case tracked said, “My family can come when they want” and “My daughter comes every day. They can come in and out when they like. I have a room full. The staff treat my family very well”. Staff welcomed visitors to encourage residents to mix. Residents case tracked said, “I like my room – I have a good view. I like to have my say. I am happy here and if not I would say something” and “I am sharing a bedroom and do not like it. They are going to find me a room. I like to play the games. We all have a do at the games. The doctor comes to see me. They treat me privately when they are giving me personal care. I am happy here”. In general residents case tracked were satisfied with the services Higher Ravenswing DS0000061156.V366033.R01.S.doc Version 5.2 Page 8 and facilities offered at the home although one lady would like to move into a single room when this is possible. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Higher Ravenswing DS0000061156.V366033.R01.S.doc Version 5.2 Page 9 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 Higher Ravenswing DS0000061156.V366033.R01.S.doc Version 5.2 Page 10 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): OP3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The thorough assessment process ensured staff had sufficient information to be able to meet the needs of residents admitted to the care service. EVIDENCE: The care service did not provide intermediate care. Two residents were involved in the case tracking process. A suitable staff member completed an assessment of each individual. The documentation of the two residents case tracked was up to date and fully completed. Each residents needs were assessed prior to admission and staff were able to develop plans of care from the information gained. Higher Ravenswing DS0000061156.V366033.R01.S.doc Version 5.2 Page 11 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): OP7, OP8, OP9 and OP10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Plans of care had been developed and reviewed to ensure staff were up to date with each residents health and social care needs. Residents had access to specialists to meet their health care needs. Policies, procedures and safe administration of medication protected the health and welfare of residents. Residents were treated with respect and dignity to ensure they were comfortable with the personal care they received. EVIDENCE: Two residents were involved in the case tracking process. This involved examining the plans of care, talking to residents and discussing care issues with one staff member. Care was delivered by staff, written accurately in the plans and met the expectations of residents. Plans of care had been developed with residents or their families. Plans of care had been reviewed on a monthly basis. Although plans of care were generally good some items had not been completed. Plans of care enabled staff to care for the holistic needs of residents. Higher Ravenswing DS0000061156.V366033.R01.S.doc Version 5.2 Page 12 Two residents case tracked had their needs risk assessed. This included an assessment for pressure area care; nutritional needs and moving and handling needs, including a falls risk assessment. Equipment was provided for residents where a risk was demonstrated such as pressure relieving mattresses, hospital type beds or frames and wheelchairs. Outpatient and other appointments were recorded within the plans of care. Residents had access to specialists to receive up to date care or advice. Policies and procedures for the administration of medication had been reviewed in line with the Royal Pharmaceutical Societies guidelines. Medication records were up to date and contained no unexplained gaps. Staff had access to current medication publications and their local pharmacist to gain advice. There was a safe system for the ordering, administration and disposal of medication. There was a Controlled Drug register and appropriate cupboard. There was a fridge for the storage of medication. The temperature of the fridge was recorded. There was a signature list for all staff who administered medicine. Two staff signed for any hand written prescriptions. The safe administration of medication helped protect the health and welfare of residents. Resident’s case tracked were satisfied their care was given in a private manner. Residents were indirectly observed to be treated with privacy and dignity. All doors had a lockable facility and staff were instructed to keep doors closed when giving personal care. During the case tracking process a staff member described the way they encouraged some independence for the benefit of residents. Higher Ravenswing DS0000061156.V366033.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP12, OP13, OP14 and OP15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Leisure activities provided were suitable to resident’s tastes and helped provide a fulfilling life. Visiting was open and unrestrictive to encourage socialising with family and friends. Residents were able to exercise choice to retain some independent living. The food served at the home met residents nutritional needs. EVIDENCE: Meals provided were hot, nutritious and tasteful. Resident’s case tracked and four further residents said food was good. There was a choice of meal. The cook carried out necessary environmental health checks. Special diets were catered for. Meals were recorded at teatime but were not recorded for any resident requiring something different at lunchtime. No resident was observed who required feeding. The member of staff on duty said any resident who required feeding was given their diet individually and discreetly. The dining room was pleasant for residents with the table set with cloth and condiments. The food served at the home was suitable to resident’s tastes. Higher Ravenswing DS0000061156.V366033.R01.S.doc Version 5.2 Page 14 Leisure activities were provided with more variety than at past inspections. The owner had spent quite a lot of money to find more interesting and stimulating activities. Residents listened to music, played games, read and watched television on the day of the inspection. Residents were observed taking part in activities. Residents case tracked were satisfied with the level of activities on offer. The activities each resident attended was recorded within the plans of care. Leisure activities provided stimulation and interest for residents. Visiting was unrestricted and allowed residents social contact with family and friends. Choices residents could make within the routine was described in the plans of care and gave a good account of what people wanted and their preferences. Staff were indirectly observed offering residents choice at meal times or attending activities. Resident’s case tracked said they had a choice within the daily routines of the home. Choices within the routine gave residents some independence. Higher Ravenswing DS0000061156.V366033.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): OP16 and OP18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents or their families were aware of their right to complain and confident to approach management with any concerns. Robust policies, procedures and staff training protected residents from possible abuse. EVIDENCE: One member of staff interviewed had been trained in the protection of vulnerable adults (POVA) and was aware of the whistle blowing policy. Two staff files showed staff had undertaken POVA training. There were available copies of the policies and procedures for protection of adults. The home used the Blackburn with Darwen social services policies to follow a local initiative. There was a copy of the ‘No Secrets’ document to advise staff on adult protection issues. Resident’s case tracked felt safe and protected from abuse. One member of staff interviewed was aware of the complaints procedure. The complaints procedure was easily accessible, met current timescales and gave residents the option to contact the CSCI. There had not been any complaints made to the CSCI since the last key inspection. The owner said he had dealt with some minor issues before they became a complaint and believed being available to talk to residents or their families reduced the need for formal complaints. Higher Ravenswing DS0000061156.V366033.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): OP19 – OP26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents lived in a clean, tidy and safe environment. Fixtures, fittings and furnishings were domestic in character and provided a homely atmosphere. The services and facilities provided a comfortable setting and met resident’s environmental needs. EVIDENCE: A tour of the building was conducted on the day of the inspection. The home was observed to be warm, clean and tidy with no offensive odours. All areas of the home remain well decorated. There was a plan of routine maintenance. Outdoor space was accessible to residents and furniture was provided for to sit out weather permitting. Communal space was modern and suitable to the needs of residents. There were two lounges. The dining room contained sufficient furniture for residents Higher Ravenswing DS0000061156.V366033.R01.S.doc Version 5.2 Page 17 to socialise at mealtimes. Lighting was domestic in character and sufficient for residents to be able to read or attend leisure activities. There were good areas of natural lighting. Furnishings were domestic in character and met resident’s needs. Baths had equipment to treat disabled residents. Toilets were near to communal areas. Disability equipment was sited in key areas to assist residents maintain independence. A pair of scales had been purchased which enabled disabled residents to be weighed. There was a good level of equipment observed in each room. Doors were lockable, windows were restricted and radiators guarded. Three water outlets tested did not pose a scalding risk to residents. All rooms were carpeted or had suitable flooring. Residents had a lockable space to help secure their personal belongings. Rooms had been personalised to resident’s tastes. All rooms had natural lighting. Rooms were centrally heated. Emergency lighting was provided and maintained throughout the home. In general the home had been upgraded to provide better facilities and services for residents. The laundry is sited well away from food preparation areas and walls and floor can easily be cleaned. There were washing and drying facilities with machines that reach current specifications. Infection control policies, procedures and staff training helped protect the health and welfare of staff and residents. Higher Ravenswing DS0000061156.V366033.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): OP27, OP28, OP29 and OP30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Robust recruitment procedures protected residents from possible abuse. Resident’s needs were met by the numbers and skill mix of a well-trained staff group. Induction and foundation training was undertaken in a professional manner to ensure staff are competent to meet the needs of residents. EVIDENCE: Two staff files were examined during the inspection. All necessary documentation and checks had been obtained for the employment of staff to help protect the health and welfare of residents. The staffing rota demonstrated sufficient numbers of well-trained staff were on duty throughout the day. Staff received training in many aspects of caring for the resident group accommodated at the home. Over 50 of staff had attained NVQ. Supervision was being carried out regularly. Completed induction was observed in staff files although the training could not be verified as meeting current specifications. Staff questioned said they were receiving good training. Training improved the knowledge of staff to meet resident’s needs. Higher Ravenswing DS0000061156.V366033.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP31, OP33, OP35 and OP38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and staff benefited from the open and transparent leadership of management. Quality assurance systems allowed management to react to the views of residents, staff and stakeholders. Policies, procedures, the maintenance of equipment and staff training helped protect the health and safety of staff and residents. EVIDENCE: The registered manager said they did not handle any resident’s monies but did handle pocket money for two residents and receipts were issued for any money spent. Residents were protected from financial abuse. There were health and safety policies and procedures. Health and safety legislation was available at the home for staff to access. Staff were trained in Higher Ravenswing DS0000061156.V366033.R01.S.doc Version 5.2 Page 20 health and safety, fire awareness, first aid, moving and handling, food hygiene and infection control. All electrical and gas appliances and installation had been maintained. Fire tests and drills had been carried out. Accidents were recorded. Health and safety systems protected the health and welfare of residents and staff. The registered manager held regular recorded meetings with staff and residents. There was a business plan. Quality assurance surveys had been undertaken for residents, staff and stakeholders and were available for interested parties to view. Some specific questionnaires for the preferred leisure activities residents wished to attend had been undertaken and equipment provided to help fulfil their needs. Staff and residents were very satisfied with the open and transparent way the home was being run and enjoyed working at the home. The responsible person needed to employ a suitably qualified and experienced person to manage the home. Higher Ravenswing DS0000061156.V366033.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME 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 4 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 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 4 X 3 X X 3 Higher Ravenswing DS0000061156.V366033.R01.S.doc Version 5.2 Page 22 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 OP31 Regulation 8 Requirement The responsible person must appoint a suitably qualified and experienced manager who is registered with the CSCI. Timescale for action 30/10/08 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. 3. Refer to Standard OP7 OP15 OP30 Good Practice Recommendations The responsible person should ensure plans of care are fully completed such as the property record or last wishes. The responsible person should ensure a record is maintained of all meals taken at lunchtime. The responsible person should ensure the induction program meets current specifications. Higher Ravenswing DS0000061156.V366033.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Port way Preston PR2 2YQ 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 Higher Ravenswing DS0000061156.V366033.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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