Inspection on 12/10/07 for Addenbrooke Care Home

This inspection was carried out on 12th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Addenbrooke Care Home 19/06/06

Addenbrooke Care Home 21/09/05

Addenbrooke Care Home 20/04/05

Addenbrooke Care Home 19/11/04

Addenbrooke Care Home 22/07/04

Addenbrooke Care Home 25/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Addenbrooke Care Home Willis Road Gosport Hampshire PO12 1NA Lead Inspector Mrs Michelle Presdee Key Unannounced Inspection 09:35 12th October 2007 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 Addenbrooke Care Home DS0000039545.V347479.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. Addenbrooke Care Home DS0000039545.V347479.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Addenbrooke Care Home Address Willis Road Gosport Hampshire PO12 1NA 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) 023 9258 1088 susan.webber@hants.gov.uk Hampshire County Council Susan Joan Webber Care Home 35 Category(ies) of Dementia - over 65 years of age (35) registration, with number of places Addenbrooke Care Home DS0000039545.V347479.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th June 2006 Brief Description of the Service: Addenbrooke is a registered care home providing personal care to 35 service users who are over the age of 65 years and who have dementia. The home is situated close to the town of Gosport, the water front and some local amenities. Accommodation is arranged in four units, each with a number of bedrooms, a bathroom and toilet facilities, lounge, dining area and kitchenette. A passenger lift and stairs allow access between the two floors. All service users have single rooms that are fitted with wash hand basins. The service also benefits from gardens that are enclosed and accessible to service users. At the time of the inspection the fees for the home were at the Hampshire County Council rate of £446 per week. Addenbrooke Care Home DS0000039545.V347479.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this unannounced inspection, we met with many residents, four were spoken with in more depth, staff on duty, one visitor and members of the management team were spoken with. All four units with bedrooms randomly chosen were viewed as was all communal areas including the large lounge, sensory room, the kitchen and laundry room. Surveys were received from two residents, five relative/carer surveys, one health survey, one care manager survey and five staff surveys. Pre inspection material in the form of the Annual Quality Assurance Assessment was received from the home prior to the inspection. What the service does well: What has improved since the last inspection? The care plans of residents seen reflected their current needs and wishes and changes had been recorded as necessary. Care plans had been reviewed on a regular basis. Staff have received training on abuse and fire protection and are Addenbrooke Care Home DS0000039545.V347479.R01.S.doc Version 5.2 Page 6 aware of the differing types of abuse and what action should be taken if they detect a fire. 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. Addenbrooke Care Home DS0000039545.V347479.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 Addenbrooke Care Home DS0000039545.V347479.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): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are always assessed before moving into the home to ensure the home can meet their needs. EVIDENCE: Assessments of three residents were looked at, and discussions were held with each of these residents and one family member who was visiting on the day. Another resident had been chosen but on the day of the inspection the resident advised staff she did not want to share her assessment and care plan with the inspector and did not want to meet the inspector. Care staff respected her choice and left the assessment and care plan with her in her room. A care management assessment is completed, before any resident comes into the home. The manager explained most admissions are planned and most Addenbrooke Care Home DS0000039545.V347479.R01.S.doc Version 5.2 Page 9 residents have been in the home on a respite basis or attended the day centre next door before coming into the home on a permanent basis. Care management assessments gave a clear account of a residents need enabling the home to know if they could meet the resident’s needs. The manager explained if they were unsure they would always visit the resident to carry out their own assessment. The home does not provide intermediate care. Addenbrooke Care Home DS0000039545.V347479.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, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans provide care staff with all information needed ensuring service users needs are met and are regularly reviewed. Health care needs are well documented with a range of services available to meet service users needs. Medication procedures are reasonably well managed in the home, but care needs to be taken where records are signed as this could lead to mistakes being made. The core values of privacy and respect are promoted in the home. EVIDENCE: The service user plans of the three assessments viewed were looked at. These are kept in each resident’s room and it was clear the resident has been involved in the care plan, management staff share the view that the service user plan belong to the resident. The service user plan included information on the unit the resident was on, the room number, meal times, charter of rights, complaints leaflet, vision statement, a photograph of the resident a personal history of the resident and a care plan. Care plan included detailed information in the areas of abilities, strengths, communication, important Addenbrooke Care Home DS0000039545.V347479.R01.S.doc Version 5.2 Page 11 relationships/social contacts, interests and activities, spiritual cultural practices, health, physical activities, memory, routines and preferences, nutritional preferences and requirements, medication, washing, dressing, shaving, oral hygiene, foot care and optical audio care. Care plans had been reviewed on a monthly basis with the resident and all changes had been recorded. Care plans were split into day and night and detailed how independence could be encouraged and dignity could be maintained. The three residents spoken to and one visitor all stated how satisfied they were with the home and felt staff worked really hard to meet their needs. All felt the home had lived up and one stated exceeded their expectations. Observations on the day clearly illustrated staff were aware of residents needs; one staff member was seen constantly reassuring a resident who was hearing impaired. Health care needs are met in the home by a variety of visiting health professionals, including doctors, district nurses, community psychiatric nurses, opticians, chiropodists and dentists. All visits by health professional are carried out in private and are recorded on each person’s medical notes, which are maintained in the office. One health professional survey was received and all feedback from this was good. The home has a medication policy and procedure. We were advised only members of the management team are responsible for the medication in the home, who have received training. Each unit has it’s own medication trolley, which is fixed to the wall. Medication is delivered to the home on a monthly basis in blister packs. The only controlled medication used in the home is temazepam, which is being stored as a controlled drug but not recorded as a controlled drug. A photograph of each resident is available to avoid errors being made. We checked one medication trolley, and looked at the medication stored and the medical administration records. It was clear the blister packs had not all been started at the same time and the medication had not been dispended in sequence, making it difficult to establish if the amount of medication left was correct. It was established by looking at records held in the office the blister packs did hold the correct amount of medication. Medication must be taken in sequence of the blister packs. Signatures must be clear when medication is dispensed as it was sometimes difficult to establish if medication prescribed to be taken as necessary for example paracetamol had been administered or refused. Whilst walking around the home is was noted staff always knocked on a door and waited for a response before entering. All observations of residents talking with staff was in a respectful manner. All written correspondence including daily notes was written in a respectful manner. All residents are offered a key to their door when they move into the home. A couple of residents hold keys. One resident spoken with confirmed he was offered a key, but he stated he declined, as he did not think it would be a good idea. All communal bathrooms and toilets are fitted with privacy locks. Choice is clearly promoted in the home and recorded in care plans. The decision of the resident who did not want to Addenbrooke Care Home DS0000039545.V347479.R01.S.doc Version 5.2 Page 12 share her care plan was supported. On arrival to the home some residents were still having breakfast, as they preferred a later breakfast. Addenbrooke Care Home DS0000039545.V347479.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): 12, 13, 14, 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides a wide range of social activities to meet resident’s needs in and the home. Resident’s are encouraged to exercise choice and be independent in their daily lives. Visitors are made welcome to the home and they can see service users in private. A varied menu is available and good quality food is served to service users. EVIDENCE: All residents spoken with were happy with the home and felt there was enough social activities in the home. One visitor stated she felt there was plenty going on in the home and was surprised by the number of different activities. The home has two full time workers who are employed to provide social care support. The home has its own large activity room, which also has an area where visitors can meet and help themselves to coffee and biscuits. The manager explained this area can be used for family celebrations of set up for a meal for a couple on their anniversary. The home also has a sensory room and both social care support workers stated they enjoyed their job and found it really rewarding how they could change the mood of a resident with some positive intervention. The manager explained residents meetings have recently Addenbrooke Care Home DS0000039545.V347479.R01.S.doc Version 5.2 Page 14 been started. Residents engage in reminiscence therapy and as a result conkers and marbles were brought into the home. Individual and group activities are arranged. Activities are displayed on a notice board in each of the four units. Social activities are recorded in care plans. A range of religious services are offered in the home and visits to church can be arranged. Visitors are welcome at the home anytime and residents can see their visitor in private or in the communal areas. We were told a resident would always be supported if they did not want to see a visitor. It was clear from observations and discussion with staff on the day, the ethos of the home is to promote choice for service users and give them as much freedom as possible. Residents have access to all units of the home and can access the garden by themselves. Residents are encouraged to choose their clothes on a daily basis. One staff member explained they always did personal tasks when a service user was ready and they would not push them into anything; this was recorded on care plans. Rooms have been personalised and residents can choose to bring some small items of furniture into their rooms. Meals are served in the dining area of each unit. Residents can sit on the unit they like at meal times. If they chose residents can have meals in their rooms but are encouraged to have most meals in the dining areas. A choice is offered at all meal times and a record is maintained of each meal eaten. The cook explained she has just changed the summer menus to the winter menus and uses a four week rotating menu. Residents were consulted and more traditional meals have been added to the menu. The cook also arranges theme nights were residents have a wider choice to try more meals. Residents spoken to stated they liked the meals and could have what they liked. One resident stated he did not like a lot of meat, so only ever received a small portion of meat. Addenbrooke Care Home DS0000039545.V347479.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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive complaints procedure is available, which residents and visitors felt able to use. Staff have knowledge and training on abuse, which offers protection for service users. EVIDENCE: The home has a comprehensive complaints procedure, which details all the necessary information including names, addresses, telephone numbers and timescales. Details of the complaints procedure are included in the service user plan, which is given to all residents. One resident indicated she would talk to the care staff if she was unhappy and one visitor stated she would feel very comfortable discussing any concerns with the manager. The home has received no complaints since the last inspection. The home has relevant procedures and information relating to abuse and adult protection. Staff receive regular training on abuse from an outside trainer. Staff spoken to on the day confirmed they had a good knowledge of the different types of abuse and the procedures they would take if abuse were suspected. Addenbrooke Care Home DS0000039545.V347479.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, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a clean, safe, pleasant and well-maintained environment for the enjoyment of resident’s. EVIDENCE: The home provides accommodation for thirty-five service users in single rooms. Accommodation is on two floors, with a passenger lift and stairs providing access to each level. The rooms are divided into four units, each having a number of bedrooms, lounge and dining area with kitchenette, bathroom and toilet facilities. There is also a large lounge on the ground floor that is used for activities and group events. A tour of the building was undertaken, several bedrooms were viewed at random and several residents were spoken with in their bedrooms. All areas seen on the day were clean and no offensive odours were detected. Bedrooms Addenbrooke Care Home DS0000039545.V347479.R01.S.doc Version 5.2 Page 17 were clean and tidy and had been personalised by residents. All bedroom doors have locks and currently four residents hold their own key. Bed linen was clean and in good condition. One resident explained they enjoyed spending time in their bedroom and not being interrupted. Each unit has its own bathroom two have recently been totally refurbished and plans are in place to refurbish the remaining two, making one into a wet room, providing more choice for residents. Window restrictors had been fitted and radiators were covered. The temperature in some areas was hot; residents did not state they were too warm, but some staff did say at times it can get very warm and were not aware thermostatic valves were fitted under the radiator covers. The home is equipped with one large lounge, which is used for group activities, a sensory room, a hairdressing room and a smoking room in which two residents smoke. Addenbrooke Care Home DS0000039545.V347479.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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels and a well trained staff group ensure all service users needs can be met. Recruitment procedures are followed for all staff ensuring the safety of all service users. EVIDENCE: The home employs thirty four care staff; twenty five have achieved a National Vocational Qualification in Care Level 2. The home has just been informed it can now recruit more permanent care staff, previously to this it could only recruit temporary staff. The home tries to ensure there is always a member of the management team on duty, and five care staff on duty during the daytime. At night time one care co-ordinator and two care assistants work a waking night duty. The home also has 42 hours for the laundry, a full time administrative officer, four domestic who work over the seven days, 60 hours for a cook, 29 hours for a kitchen assistant and tow full time social care support workers. The manager explained recently they have had to use agency staff to fill the hours and sometimes there has only been four care staff on duty, one on each unit. All surveys received all commented about the staffing levels. Comments from relative, carers included “need more staff”, “staff cover needs to be addressed”, “and it would be of more benefit if there were more staff “,” agency staff do not have the skills”. Staff surveys included the following comments “staff shortages mean the mornings are rushed”, “trouble Addenbrooke Care Home DS0000039545.V347479.R01.S.doc Version 5.2 Page 19 covering the shifts, usually work shifts short of staff”, all five stated the staff ratios need to be higher. One member of staff on duty stated it needed more than four carers on the floor to make sure all the resident’s needs were met. The manager confirmed the staff rota is arranged so there is always at least five care staff on duty working in the units and staffing levels has not been brought up as an agenda item at staff meetings. The recruitment of the last two members of staff to join the home were viewed. It was found all necessary checks, references, proof of identity and paperwork had been completed. Staff had contracts stating how many hours they were employed for and what job they had been employed for. Induction records were seen and had bee signed by the staff member and a member of the management team. A full programme of training is offered all staff and includes annual manual handling, first aid, infection control, health and safety, fire training, food hygiene, abuse and first aid. Members of the management team have just completed training on the Mental Capacity Act. All staff surveys and staff spoken to on the day stated the training is very good. Certificates are kept on staff files. Supervision is held on as regular basis, with records maintained of each session. Addenbrooke Care Home DS0000039545.V347479.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, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed. Service user views are always considered when decisions are made in the home. Health and safety procedures in the home ensure service users are protected. EVIDENCE: The registered manager, Sue Webber, has the experience and qualifications to run the home and is supported by her line manager. It was clear from discussions and observations on the day people respect her management style and she has a clear picture of the future of the home. One visitor on the day expressed how happy she was her relative had settled so well and how she felt she had been supported by the management and staff in the home. Addenbrooke Care Home DS0000039545.V347479.R01.S.doc Version 5.2 Page 21 From discussions with the manager and the staff it was clear the aim of the home is to meet service users needs. Care staff spoken to were aware service users needs come first and the routines of the home come second. On the day residents were seen to be part of the home, one resident helped dry the pots, whilst another helped clear the tables in one of the units. One lady carried a large doll around, which was here baby, which clearly gave her a lot of pleasure. One resident who is hard of hearing has been given picture cards to help her communicate her wishes. The home manages small amounts of monies for most residents; no more than fifty pounds for each resident. The records and monies held for three residents were viewed and found to be correct. The amount held matched the records, with all details of monies in and out recorded. From observations on the day it was clear health and safety is promoted in the home. All areas were safe and staff were aware of maintaining a safe environment for service users. Control of substances harmful to health had been carried out and all hazardous products were locked away. Practices in the kitchen complied with health and safety legislation. The temperature of the fridge and freezers were recorded on a daily basis. There was a good selection of food, which was being stored appropriately. The laundry room was clean and kept locked. Disposable gloves and aprons were seen around the home and were used appropriately by staff. The home keeps up maintenance contracts for equipment in the home. The fire records demonstrated regular checks are maintained and recorded. Fire drills take place on a monthly basis and training is undertaken on a regular basis, which all staff undertake. Addenbrooke Care Home DS0000039545.V347479.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 2 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 X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Addenbrooke Care Home DS0000039545.V347479.R01.S.doc Version 5.2 Page 23 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 Requirement Medication must be dispensed in sequence. Signatures must be clear so it is possible to establish if medication that has been prescribed as necessary has been refused or administered. Timescale for action 30/12/07 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 Addenbrooke Care Home DS0000039545.V347479.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Addenbrooke Care Home DS0000039545.V347479.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. Re-publishing this information is in breach of the terms of use of that website. 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