Inspection on 04/01/06 for Alexandra Rose Residential Care Home

This inspection was carried out on 4th January 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Alexandra Rose Residential Care... 09/05/07

Alexandra Rose Residential Care... 14/11/06

Alexandra Rose Residential Care... 12/07/05

Alexandra Rose Residential Care... 04/03/05

Alexandra Rose Residential Care... 16/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Alexandra Rose Residential Care Home 358 Havant Road Farlington Portsmouth Hampshire PO6 INE Lead Inspector Jan Everitt Unannounced Inspection 4th January 2006 09:30 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 Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 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. Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Alexandra Rose Residential Care Home Address 358 Havant Road Farlington Portsmouth Hampshire PO6 INE 02392 382944 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) Riva Limited Mrs Lorraine Ann Cleeve Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th July 2005 Brief Description of the Service: Alexandra Rose Care Home is a residential home that is registered to accommodate 29 service users over the age of 65 years. The home is situated in the Farlington area close to shops and transport links to the city of Portsmouth. The home fits well into its residential surroundings. The building is set out over two floors and has a shaft lift to enable service users access to the first floor. The home now has a sole proprietor and responsible individual Mr. R Bray, is trading under the company name of Riva Ltd. The appointed registered manager is Mrs. Lorraine Cleeve. At the time of the inspection the home was undergoing a building extension to decrease the number of double rooms and the company have applied to vary their registration to enable the home to accommodate up to 32 service users. The ethos of a caring homely service was demonstrated throughout the inspection and service users and relatives spoke positively about the home. Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second unannounced inspection of Alexandra Rose to take place over the inspection year 2005/6. The inspection was undertaken in 5.5 hours and the registered manager assisted the inspector throughout the process. The inspection, following closely to the Christmas festive season, allowed the inspector to observe and ask the service users how the home had celebrated the festive time. All service users spoken with and also a number of relatives reported a ‘wonderful time’ one service user choosing not to go to her family ‘in case she missed the fun’. The inspector toured the home and spoke with a considerable number of residents and relatives and also met with the provider in the afternoon. A visiting district nurse was also spoken with and she reported to visit the home regularly and considered that the care and service were ‘very good’. The service users and relatives all reported a high degree of satisfaction with the services and care and praised the staff for their ‘care and hard work’. Eleven standards were assessed on this occasion, ten being core standards. One standard was assessed as having a minor shortfall. What the service does well: The home provides a warm homely environment for the elderly people in residence. The atmosphere is friendly and service users and their relatives report a very happy home where staff are kind and caring. The service users speak highly of the registered manager and relatives reported that they are confident that their loved ones received a high standard of care. From observation and conversation with the service users it can be concluded that the staff have good relationships with the service users and work well as a team. The home must be commended for the activities that are arranged for the service users, which accommodate all tastes and expectations and the home life revolves around the needs of the service users. Staff have a comprehensive induction period when they are first employed and ongoing training is available. All staff are encouraged to undertake their NVQ level 2 qualification and are supported in other outside training. Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 Page 6 The care plans are comprehensive and well recorded by the staff that have gained confidence with training. The home checks the repeat prescription sheets before they are taken to the pharmacist for completion, ensuring correct medication is delivered. The staff group report that they have the support of a good manager who leads a team of employees on the ethos of service user focused care. The manager is ensuring that service users, staff and visitors are well informed about the building works that are taking place and daily information is shared with everyone and notices prominently displayed to warn people of any risks. A new walk-in shower has been installed on the ground floor. The manager has undertaken a service user survey, which has been analysed and the results published. A copy of this was made available to the inspector. What has improved since the last inspection? What they could do better: The medication administration record (MAR) sheets must be recorded every time a service user is administered medication or a record of why the medication has not been taken. Stocks of medication not being used must not be stored in the medicine cupboards and must be returned to pharmacy. The coordinator for the ordering and checking of medication must ensure that medication for ‘as needed’ (PRN) use in not overstocked in the home. A specific code should be used on the MAR sheet for identifying if a service user does not need the prescribed ‘as needed’ (PRN) medication. Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 Page 7 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. Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 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 Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed on this occasion. EVIDENCE: Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&9 Service user’s health, personal and social care needs are set out in individual plans detailing their needs. Service users are protected by the home’s policies and procedures for dealing with medication. However, there are minor shortfalls in record keeping. EVIDENCE: The inspector viewed a sample of the care plans for service users. A comprehensive assessment of the service user is undertaken on admission to the home and care plans are based on identified needs following risk assessments. The care plans detail the service user’s abilities and the level of support they may need and would suggest that the service users’ independence is promoted. There has been a significant improvement since the last inspection on staff documenting in the care plans. Staff appeared more confident in using the care plans as a working document. All staff report they have had training in how to use the care plans. The inspector observed that care plans were being reviewed appropriately and regularly. Social care plans are recorded and these document the service users social history, hobbies they enjoyed in the past and what their preferences are for their Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 Page 11 activities of daily living. Two family members were spoken with and they reported that they have been involved with the planning of their relative’s care and that they are informed of any changes in the service user’s condition. One family member informed the inspector that her mother was waiting to see the GP as she had not been too well over the previous day. The home had called the GP promptly and they had informed her of this and she was visiting and would stay to see what the GP reported. The medication prescription sheets were viewed. The inspector noted that there were some gaps where signatures were required. This was discussed with the manager who identified to the inspector a notice on the front of the file reminding staff that they must sign for all medications that are administered and document a code to correlate with the reason why it was not administered or taken by the service user. The manager reported that she audits these sheets on a regular basis and she speaks with the appropriate person who has omitted to sign the chart. The drugs that are prescribed on an ‘as needed basis’ (PRN), if the service user refuses or did not need this drug the coding used could be mistaken for a signature, therefore it will be recommended that a specific universal code be used to easily identify that a drug has not been taken and to avoid the staff assuming that it has been taken. The cupboard in which medications are stored was viewed. The inspector observed a large stock of medications for a lady that was in hospital. Storage of this amount of medication was discussed with the manager and deputy manager as being a risk of drug errors and confusion on administration, when the lady returned to the home. It was agreed that all these medicines must be returned to the pharmacist, as the service user would leave hospital with 28-day supply of the current drugs that were prescribed. The deputy manager coordinates all the ordering, checking, storage and return of medications. She reports that they have an excellent service from their local pharmacist and that she and the manager view the prescriptions before they are dispatched to the pharmacist for distribution. The inspector commented that this was good practice and avoided unwanted medications being delivered to the home. The inspector discussed with the deputy manager the amount of medicines being stored in the home and that she must only store the minimum of PRN prescribed drugs at any one time for any one service user. Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 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. EVIDENCE: There were five relatives visiting the home on the day of the inspection and the visitor’s book evidenced that the home is visited by a number of relatives each day. The Christmas festivities had just finished at the time of the inspection and it was the topic of conversation between the service users and the inspector. The service users were very enthusiastic to talk about the ‘marvellous Christmas’ they had experienced and one lady commented that ‘if people did not enjoy themselves it was their own fault, we had everything we could wish for’. Another service user had chosen not to go to relatives for the day because, she reported, ‘ there was too much going on here and I did not want to miss the fun. I have no regrets about not going out and the whole Christmas was full of activities, drink and food and the staff were so much fun’. The manager showed the photographs of the lunch on Christmas day and the tables were festively dressed and relatives were invited in to share lunch. On Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 Page 13 the day of the inspection a pantomime group was visiting the home from London to perform and the service users and relatives’ conversation was full of the evening ahead. The activities programme is displayed on the notice board and the inspector observed a variety of activities being provided for service users to choose if they wish to participate. The manager is dedicated to providing a good activities programme to stimulate the service users, who she considers, are far happier, more motivated and who readily participate in the life of the home. The inspector evidenced this throughout the inspection. Service users were mobilising about the home and talking to one another and generally interacting with staff and visitors. The inspector observed that a carer was playing a quiz game with some of the service users during the late morning. The relatives spoken with reported that they were very happy with the care their loved one was receiving and that they had travelled from a distance at Christmas and had been invited to stay the whole day, which they had thoroughly enjoyed. They commented that the staff were great and especially the manager who puts so much effort into ensuring that the resident’s lives are happy and fulfilled. Likewise many of the residents commented on the manager and her dedication to the home and the work she puts in to make their lives good and one comment was ‘she’s the one that makes things happen’. Many of the service users are practising Christians and the clergy visit the home to give communion and this was confirmed when speaking with a service user who has close connections with the local church. Service users have the freedom and choice when they get up or go to bed. The inspector evidenced a lady who buzzed to request her breakfast because she likes to get up later, and this is documented in her care plans as her preference and is respected by staff. The inspector observed that service users’ interests and preferences are documented as part of the assessment process. Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Service users and their relatives are confident that their complaints will be listened to and taken seriously and acted upon. EVIDENCE: The home has a complaints procedure that is part of the Statement of Purpose, which states that the manager is the person who would initially investigate any complaints received by the home. The home maintains a file to record any complaints. The inspector viewed this and no complaints have been received. The inspector observed a number of complimentary letters and cards that the home has received praising the care of past residents. The CSCI has not received any complaints about this home since the last inspection. Service users and relatives spoken with reported that if they had any complaints or wished to discuss an issue about the care, they would readily speak to the manager, as they would be confident that she would listen and put into place any action necessary. Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Service users do live in a safe, well-maintained environment. EVIDENCE: At the time of the inspection the home was undergoing structural alterations and an extension providing four extra single rooms was being built. The building works were encroaching on the some of the resident’s private space but the home must be commended for the health and safety precautions they have put in place and there are notices prominently displayed throughout the home informing everyone of the works in progress. The manager reported that she has kept all service users and their relatives informed on a day-to-day basis of what is happening and liaises daily with the builder. Service users and relatives spoken with confirmed that they were aware of the alterations and it was to improve the home and that there was really minimal disruption to their daily lives. A relative spoken with said that the building works was a bit ‘bothersome’ but that the manager had kept her well informed of the progress of the work. The anticipated result of these changes is that there will be less Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 Page 16 double rooms and the responsible individual has applied for an increase of numbers of residents to be accommodated by three. This will be given consideration and discussed when the application for the variation is being processed. The ground floor bathroom has been converted into a walk-in shower and the manager reports, is very popular with those residents unable to get in and out of the bath easily. The extension will take some of the garden away but the remainder of the garden will be maintained for the service users’ use. The accommodation is homely in appearance and maintained to a high standard of cleanliness. Service users spoken with were generally very happy with their rooms, which are decorated and maintained well. The manager reported that the Fire Officer visited the home recently to view the building works. Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 & 30 Service users are cared for by appropriately trained staff and are in safe hands at all times. Service users are supported and protected by the home’s robust recruitment practices. EVIDENCE: All of the care staff are either qualified to NVQ level 2 or are in the process of undertaking this training. Staff spoken with are satisfied with the training and support they receive from the manager and senior staff. The training matrix was viewed by the inspector who observed that all staff training, and who has undertaken this, has been identified on this matrix with dates of when appropriate updates are due. The inspector considered that there was wide range of training, appertaining to the client group that are accommodated in this service, available to staff. The induction programme was viewed for the two most recent employees. The programme is comprehensive in content and follows the training skills standards. A sample of the two most recently employed members of staff’s recruitment files were viewed. The manager undertakes a robust recruitment process. All the necessary information stated in Schedule 2 of the Care Home Regulations was present. One of the files did not have the original application form as this appointment was done through a management company, because the position was a management position. A letter of application and CV were in the file. Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 Page 18 There will be a recommendation that for management appointments that the application forms be maintained along with the persons CV. Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 & 36 The home is run in the best interests of service users. The management of the service users’ financial arrangements are not dealt with by the home. Staff are appropriately supervised. EVIDENCE: The home has a quality control system in place to monitor standards. The manager undertakes internal audits of documentation. A service user satisfaction survey has been distributed in November 2005 and the manager presented the inspector with a copy of the analysed results. 22 questionnaires were returned representing a 70 n return. The results of the survey were detailed and very positive and areas covered were environment, care, attitude of staff, meals and choice of food, cleanliness, complaints, laundry and social activities. Service users were invited to make further comments. Comments Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 Page 20 made were ‘ I feel I am well cared for’,’ ‘I am happy here’. ‘Sometimes I have to wait for my buzzer to be answered but do realise at times that this can’t be helped’. ‘I would not like to go anywhere else’. ‘The home has improved and the staff work hard’. ‘I know if I complain something will be done’. Laundry is good, sometimes things get lost’. 68 said the social activities were good another service user commented they are ‘good but get noisy at times’. The results of this survey would suggest that there is a high degree of residents being satisfied with the services and care delivered in this home. The manager intends to undertake these surveys twice yearly and is anticipating distributing a separate survey to relatives. A district nurse visiting the home was spoken with, she reports that she attends the home frequently to take bloods and that she has no concerns about the home and considers the care and the home in general to be ‘very good’. Regulation 26 visits and a copy of the report from these visits are received every month and are undertaken by an independent management company appointed by the proprietor. All policies and procedures are in the process of being reviewed and will be completed by the end of January 06. The home does not manage any of the service users’ monies and none are stored at the home. Staff supervision is taking place. The manager receives supervision monthly and the two deputy managers twice monthly. The care staff are supervised by the manager and deputy managers who also undertake their appraisals. The supervision is documented. The proprietor discussed the supervision of the management team and wishes to explore training options for them to undertaken more formal training in supervision and appraisal. Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X X X STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 3 X X Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 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 OP9 Regulation Reg 13(2) Requirement Prescription sheets must be recorded with a signature when medication has been administered to and taken by the service user. Timescale for action 15/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP9 Good Practice Recommendations It is recommended that a specifically identified code be used on the MAR sheets for drugs that are prescribed on a PRN basis and are not needed. It is recommended that medication being stored in the cupboard for service users who are in hospital, be returned to pharmacy to avoid confusion when the service user returns home with 28 days supply of medication from the hospital. It is recommended that a copy of the application form for any management position applied for, be maintained in the recruitment file for that person. 3. OP29 Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 Page 23 Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 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 Alexandra Rose Residential Care Home DS0000055562.V254754.R01.S.doc Version 5.1 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. 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!