Key inspection report CARE HOMES FOR OLDER PEOPLE
River Court Residential And Nursing Home Explorer Drive Watford Hertfordshire WD18 6TQ Lead Inspector
Marian Byrne Unannounced Inspection 21st May 2009 10:00
DS0000019511.V375716.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. River Court Residential And Nursing Home DS0000019511.V375716.R01.S.doc Version 5.2 Page 2 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address River Court Residential And Nursing Home DS0000019511.V375716.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service River Court Residential And Nursing Home Address Explorer Drive Watford Hertfordshire WD18 6TQ 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) 01923 800178 01923 230 891 kanes@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd Manager post vacant Care Home 120 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (60) of places River Court Residential And Nursing Home DS0000019511.V375716.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. This home may accommodate (in Gade House) 30 older people with dementia who require personal care. This home may accommodate (in Colne House) 30 older people who require personal care. This home may accommodate (in Chess house) 30 older people who require nursing care. This home may accommodate (in Hampermill House) 30 older people with dementia who require nursing care. 5th November 2008 Date of last inspection Brief Description of the Service: Rivercourt Residential and Nursing home is a purpose-built care home owned by BUPA Care Homes Limited. It is situated in a residential area close to the town of Watford. There are local shops and transport facilities nearby. The home is registered for 120 residents in the Old Age category, some of whom may require nursing or dementia care. The buildings are set around a central courtyard with parking facilities. Facing the entrance to the courtyard is the central administrative office block; The main kitchen, laundry and hairdressing facilities are in the administrative block. The Residential Units are to the right and the Nursing Units are to the left of the courtyard. Each building has 2 floors served by a lift. The home may accommodate 30 residents who require residential care (Colne House on the first floor), 30 residents with dementia (Gade House on the ground floor), 30 residents who require nursing (Chess House on the first floor) and 30 residents who require nursing and dementia care (Hampermill House). All bedrooms have en-suite toilet facilities and they are all of single occupancy. The surrounding grounds have mature trees and gardens with seating. The grounds are wheelchair-accessible. Further information including fees can be obtained from the Statement of Purpose and the Service User Guide. A copy of the CSCI inspection report should be available in the care home. River Court Residential And Nursing Home DS0000019511.V375716.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 one star. This means people who use the service experience adequate quality outcomes. This inspection was conducted by three inspectors. A Pharmacy Inspector carried out an inspection on the administration, recording and storage of medication on the 23rd April 2009. Two inspectors visited Rivercourt on the 19th May 2009. The inspection lasted one day. We spoke to people who use the service, their visitors and the management of the service and the staff. We inspected records on the recruitment and training of staff. We looked at care plans. We attended meetings with Adult Care Services where the care of the residents at Rivercourt was discussed. What the service does well:
In Hampermill where people who have the highest needs we observed the care to be mostly good. We watched staff provide care and comfort to the people who live there. People were engaged in gentle activities and staff were observed to smile at the residents and include them in the activities on the unit. During the time we were there all the residents had one to one time with staff. Staff accompanied residents when they walk around the corridors of the Unit. This happens very regularly with some of the residents. While it is good practice to accompany residents consideration needs to be given to the environment in the corridors, these lack items to engage the residents physically or emotionally. On the other units Gade and Colne we were aware that staff offered kindness to the people who lived there. Colne was lively in the afternoon when we visited. The residents were engaged in an interactive television quiz. It was very clear that they were enjoying themselves. We spoke with visitors and residents who assured us that they were well cared for. We were told by one resident that they were very pleased with the new Manager as she had worked in the home previously and they remembered her with affection. All the people we spoke with said that they found the Manager easy to talk to. River Court Residential And Nursing Home DS0000019511.V375716.R01.S.doc Version 5.2 Page 6 The Manager makes time every day to visit each unit to ensure that BUPA policies and procedures are followed and to show staff and residents that she is available to them should they need to speak to her. During the inspection snacks were always available and BUPA has a policy of food being available to residents 24 hours per day. This is important because some of the residents have very frail appetites and it is often best for their welfare to eat little and often. What has improved since the last inspection? What they could do better:
While good progress is being made the home needs to recognise that the care plans need to be drawn with (where possible) the resident or/and their families. Personal histories are important and we found that little has been done to address this. We spoke to the relative of one resident who during their working lives had a very high profile career. None of this was on their care plan. When caring for this person when their dementia progresses this information will assist staff in understanding them and enable them to deliver better care. This is because when a person has dementia they can loose their most recent memories first and remember the past better than the present.
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DS0000019511.V375716.R01.S.doc Version 5.2 Page 7 We saw that the environment in Hampermill could be improved particularly in the corridors to distract and give comfort to some of the residents who continually walk along the corridors. More training needs to be done in the care of people who have dementia. The Manager is aware of this and has booked training in the near future. More care must be taken when recruiting staff to ensure the minimum standards in recruiting staff are met. This includes a full work history of the prospective member of staff. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. River Court Residential And Nursing Home DS0000019511.V375716.R01.S.doc Version 5.2 Page 8 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 River Court Residential And Nursing Home DS0000019511.V375716.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home can be sure that their needs will be recognised and met. EVIDENCE: Appropriate information regarding the service is included in the Statement of Purpose and service User Guide. This has been recently reviewed. The records we inspected showed us that a full assessment of needs is carried out prior to the resident being admitted to the home. This assessment is ongoing and is reviewed at six weeks. Where possible the resident or their relatives (or representatives) are involved in the process.
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DS0000019511.V375716.R01.S.doc Version 5.2 Page 10 River Court Residential And Nursing Home DS0000019511.V375716.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home receive the care they need and are treated with dignity and respect at all times. However they cannot be sure that their social and emotional needs will be recognised and met. People can be sure that they will get their prescribed medication and that records of their medication will be accurate. EVIDENCE: River Court Residential And Nursing Home DS0000019511.V375716.R01.S.doc Version 5.2 Page 12 We looked at care plans on all four units and we found that health care needs were recognised and that staff were given instructions on how to care for the residents. We found that pressure areas were managed and the progress of recovery recorded. We found details on nutrition, and health care needs. However we found that there was very little social history of the residents on their care plan. Social history is important especially for people who have or may develop a dementia, this is because staff will have a better understanding of the person and how to meet their needs if that person memory is mainly of past events. This is particularly important for the residents who live in Hampermill. There we found that all the residents to have high needs. While the staffing levels appeared to be adequate the staff group need more training in the care of people who have a dementia. We found some of the residents well cared for and staff to be kind and caring, however, many of the residents spent considerable time walking the corridors of the unit. Staff did not have the skills or knowledge of the residents to offer distractions. The lay out of Unit makes caring for these residents difficult as they cannot be seen or monitored easily. There was nothing in the corridors to distract the residents from their continual walking. More expertise in needed in understanding the importance of layout of a dementia care unit, and how this impacts on the care of people with advanced dementia. The Manager is aware of this and has booked training for staff in the near future. We saw that people were cared for in a manner that promoted their dignity. We saw staff show kindness and consideration to the residents. We spent time in Chess where at the last inspection we had concerns about the care of the residents. We found there to be an improvement to the management of the unit with staff now working in the best interests of the people who live there. The medication inspection found that medicines were stored appropriately and at the correct temperature. Records that show that medicines are received and disposed of appropriately. We found that medicines that must be given at least 30 minutes before the first food, drink and medication of the day was recorded as been given at the same time as other medication and a senior member of staff confirmed that the medicine was given with a drink and with other medication. This could have serious consequences for the individual and their health and an immediate requirement was left. We were told at the second inspection visit that this practice had ceased and that medication was given as prescribed. Medication is on given by trained staff and was observed to be done to a high standard with regard to the dignity of the person. Throughout the inspection we observed staff interact well with the residents and they understood the importance good interaction with the residents. Care was administered in a person centred manner, by this we mean that staff focused on the person they were caring for and not the task they were carrying out. River Court Residential And Nursing Home DS0000019511.V375716.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all the people living in this home will have their expectations and preferences recognised and met. Residents can be sure that their relatives and friends will be welcomed into the home and that they can expect to receive a wholesome diet at a time that suits them. EVIDENCE: As already stated care plans did not have a personal history or much detail on the social, spiritual and cultural aspects of the resident therefore it is not possible to say if those needs are being met. We spoke to a resident’s relative who told us the personal history of the person they were visiting. This person who now has dementia had a very high profile career. None of this was in their care plan. This information is vital for staff to meet the person’s needs in a person centred manner because as their dementia progresses and the person’s
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DS0000019511.V375716.R01.S.doc Version 5.2 Page 14 short term memory decreases and most people tend to remember their strongest long term memories. On the day to day care we saw residents watch television where they were well placed to see the screen and to hear the programme. Subtitles were on screen to assist those who have a hearing impairment to ensure follow and enjoy the programme. On the day of the inspection there was an opportunity for some of the residents to go into Watford town centre to have coffee. Meals are available over the 24 hour period to assist those who may not want to eat their lunch and tea at the schulued times. Good quality food is available through the day and night. The lack of training and expertise in dementia means that people who have dementia may not always have choice in how they spend their days. Other residents were clear with us that they have control over their lives and are encouraged to be independent. We saw visitors welcomed into the home. We saw staff offer the resident somewhere quiet to meet and to offer refreshment. It was clear that the residents were very happy to have their visitors treated with kindness. We saw staff give one to one time to the residents through chatting, playing dominos and where appropriate encouraging them to eat. We saw that some residents in Hampermill had objects of comfort with them or close by. However the staff on Hampermill do not have up to date training on how to care for residents who have dementia. We noted a slight deterioration in the care given to those people on Hampermill. This could be due to the fact that there is not a stable staffing unit working there. The manager is aware of this and was actively seeking a new unit manager to manage Hampermill. The Unit needs expert input to assist staff to meet the needs of the residents and to ensure the environment meets their needs. River Court Residential And Nursing Home DS0000019511.V375716.R01.S.doc Version 5.2 Page 15 River Court Residential And Nursing Home DS0000019511.V375716.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care is now taken to ensure that the people who live in the home will be protected from abuse and that their complaints will be investigated. EVIDENCE: Since the last inspection where we referred the care of a resident to be investigated under the Safeguarding of Adults policy by the Adult Care Services department of Hertfordshire’s Local Authority. This should have been instigated by the home. At the time of the incident the home did not have a dedicated manager. No new allegations have been made since the new Manager took over the management of the home and other incidents are being investigated in an open and transparent manner. All the staff we spoke with were aware of the safeguarding adults policy and their responsibilities under it. Complaints are investigated under BUPA’s complaints procedure. Care needs to be taken with recruiting staff to ensue all the appropriate checks are in place to ensure the safety of the residents. (This is explored later in this report). River Court Residential And Nursing Home DS0000019511.V375716.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally most of the people who live in this home can be sure that the lay out of the home meets their needs. They can be sure that it will be clean and hygienic. EVIDENCE: The home had recently been re-furbished and the different units were bright, clean and hygienic. The home is offers safe accommodation to the people who live there. Communal rooms are set out in a manner that allows people to pursue different social engagements and entertainment. A sensory room has recently opened in the area where the people who have the highest needs.
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DS0000019511.V375716.R01.S.doc Version 5.2 Page 18 However this room is not set out in a manner that attracts people – particularly with a dementia – to sit in. We found that the lay out of Hampermill while clean and hygienic not to meet the needs of people who have a dementia. By that we mean that it has long corridors that have little or no distraction to people who walk continuously. We were told that a staff member always accompanies a resident who may be walking this can take more than one staff member out of the sitting room where there are people with very high needs. A importance of environment to people who have dementia is not fully understood. The Manager is aware of this and has access to expert knowledge within BUPA and assured us that she will be using this expertise. River Court Residential And Nursing Home DS0000019511.V375716.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home can be sure that there are sufficient staff on duty to meet their needs, EVIDENCE: On the day of the inspection there were sufficient staff numbers on duty. We saw good interaction between staff and residents. We saw staff deliver care with kindness and affection. We saw staff allow the resident to set the pace when walking, taking and eating. However as already mentioned in this report staff are not sufficiently trained in the care of people who have a dementia to ensure that they have optimum care by having their needs recognised and met in a manner that improves their state of being. Staff must have training in the care of people who have a dementia to ensure the residents have optimum state of being. The people who were continually walking were kept safe but staff were not sufficiently trained to recognise or meet their needs. More care must be taken when recruiting staff to ensure that a full work history is produced with any gaps in dates pursued and
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DS0000019511.V375716.R01.S.doc Version 5.2 Page 20 explanations given. We looked at four staff records and found that two of them did not have full employment records. We spoke to the Manager about this and were assured that this would not happen in future. Staff were aware of safeguarding issues. The home does not have a full compliment of staff yet. The Manager is diligent in pursuing new staff appointments and is very aware of the importance of employing the right staff who have the appropriate qualifications and experience and is prepared to use Agency staff until the appropriate staff are appointed. We have not left a requirement on training as the Manager understands that training is needed and she had already booked training. We will check that the training has been carried out at the next inspection. River Court Residential And Nursing Home DS0000019511.V375716.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home can be assured that in the future the Management of the home will endeavour to meet their needs and will ensure that the home will be run in the best interests of the people who live there. EVIDENCE: A new manager was appointed in January 2009. It is too soon to comment on her ability as a manager however, she has made good progress in very difficult times, she is aware of the work that needs to be done to ensure the residents have optimum care. This includes recruiting trained nursing staff that have the
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DS0000019511.V375716.R01.S.doc Version 5.2 Page 22 skills to deliver care to very vulnerable people, dementia training for all staff and ensuring all staff have appropriate supervision. She told us that she was well supported by senior management and that senior management understands that the home needs extra support until it reaches a state where all the resident’s needs are met. The staff and residents told us that the manager is easy to talk and that they would not hesitate to speak to her should the need arise. Good progress has been made to ensure all of the home is run in the best interests of the people who live there. As already stated earlier in this report more care need to be taken to ensure that staff are recruited appropriately. The Manager appears to work in a manner that is open and transparent this is important because relatives and representatives of the people who live there must have confidence that their views are listened to and acted on. The Manager has set up meetings for relatives and representatives to listen their views and for them to hear plans for the future of the home. The home does not look after any residents monies. All health and safety procedures are followed. Checks are regularly carried out on fire equipment and other equipment. There are regular fire drills. All the appropriate checks are carried out. River Court Residential And Nursing Home DS0000019511.V375716.R01.S.doc Version 5.2 Page 23 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 X X X X X 2 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 3 River Court Residential And Nursing Home DS0000019511.V375716.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 13(2) Requirement To ensure the safety of residents ensure special instructions for the administration of medicines are followed. This will safeguard the health and welfare of residents. An immediate requirement was left on this. This requirement is now met. Timescale for action 24/05/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations River Court Residential And Nursing Home DS0000019511.V375716.R01.S.doc Version 5.2 Page 25 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastern@cqc.org.uk Web: www.cqc.org.uk
We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. River Court Residential And Nursing Home DS0000019511.V375716.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
