Inspection on 18/10/06 for Bay Court Nursing and Residential Home

This inspection was carried out on 18th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Bay Court Nursing and... 14/10/08

Bay Court Nursing and... 13/11/07

Bay Court Nursing and... 15/11/05

Bay Court Nursing and... 17/06/05

Bay Court Nursing and... 05/01/05

Bay Court Nursing and... 23/08/04

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

CARE HOMES FOR OLDER PEOPLE Bay Court Nursing and Residential Home 16-18 West Hill Budleigh Salterton Devon EX9 6BS Lead Inspector Caroline Rowland-Lapwood Key Unannounced Inspection 18th October 2006 08:50 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 Bay Court Nursing and Residential Home DS0000026700.V306285.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. Bay Court Nursing and Residential Home DS0000026700.V306285.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bay Court Nursing and Residential Home Address 16-18 West Hill Budleigh Salterton Devon EX9 6BS 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) 01395 442637 Court Healthcare Limited Miss Susan Rosemary Stevens Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Bay Court Nursing and Residential Home DS0000026700.V306285.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Notice of Proposal to Grant Registration of staffing/environmental conditions of registration issued 1/3/1999 15th November 2005 Date of last inspection Brief Description of the Service: Bay Court is situated in the centre of Budleigh Salterton within East Devon. The home has level access to the local shops some 200 metres from the home. Bay Court has three communal sitting areas in addition to a dining room. There are 23 bedrooms, all centrally heated with colour television and nurse call. Qualified staff are on duty 24 hours a day. The ethos of the home is to provide a relaxed homely environment in which the staff are able to care for service users over the age of 65 years who are suffering from acute and chronic medical problems. The average cost of care is £480.00 to £590.00 per week. Additional costs, not covered in the fees, include chiropody, hairdressing and personal items such as toiletries and newspapers. Current information about the service, including CSCI reports, is available to prospective residents. Bay Court Nursing and Residential Home DS0000026700.V306285.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took six and a half hours to complete. During this time the inspector case tracked 3 residents, which helps us to understand the experiences of people using the service. A number of other residents (7) were met and spoke with at length during the course of the day. There were 23 residents living at the home. The inspector also spent time observing the care and attention given to residents by staff. The inspector spoke with 8 members of staff including the manager, nursing and care staff, and ancillary staff. Two relatives and one visiting health professional were also spoken with during the day. Prior to the inspection surveys were sent to 12 residents; 9 were returned. Surveys were also sent to 12 staff members; eight were returned. Seven surveys were sent to health and social care professionals; four were returned. Records relating to recruitment, training, health and safety and maintenance were looked at and a tour of the premises was taken. The manager had completed and returned a pre-inspection questionnaire before the inspection visit; this is a document, which the home sends to the regulation inspector before the inspection, which provides current detail of the home. Staff were very helpful on the day of the inspection and a lot of positive discussions, advice and suggestions took place throughout the inspection. The atmosphere in the home was warm, welcoming and friendly. Residents were relaxed, content and spoke highly of the care they received in the home. What the service does well: Residents who completed survey forms prior to this inspection said they “always” or “usually” receive the care and support they need. Some comments made by residents included, “staff are very caring and do a first class job”, “ staff are polite and helpful” and “the staff are helpful and kind”. The health and personal care needs of the residents are well met by good care planning and competent staff. Health professionals contacted were satisfied with the overall care provided; all felt that the home communicated clearly and that staff had a good understanding of the residents needs. Several residents praised the nursing care provided at the home. Bay Court Nursing and Residential Home DS0000026700.V306285.R01.S.doc Version 5.2 Page 6 Visitors are always made welcome at the home and relatives spoken with described the home as “friendly” and “welcoming”. The majority of residents were happy with the quality and variety of food provided at the home. The home is well managed and organised. Records needed as part of the inspection procedure were made readily available. Many of the staff have worked at the home for several years. This provides continuity of care. They are keen to ensure the well-being and comfort of the residents and were observed treating them with great respect and kindness. The staff were able to demonstrate a confident, open and positive attitude to their work. They had a thorough understanding of the personalities, needs, likes and dislikes of each resident. They were attentive, patient and friendly towards both residents and their visitors. The home provides comfortable accommodation for residents What has improved since the last inspection? What they could do better: Medication that needs refrigeration is currently kept in the kitchen fridge. This is adequate but not best practice. It is recommended that a dedicated fridge be purchased so that medication can be stored securely and appropriately. Activities appear to lack direction and management at present. Activities should be planned around residents’ individual interests or previous hobbies and interests, and take into account individual abilities. The home is responsible for some residents’ monies. The record of these monies must be kept up to date. Bay Court Nursing and Residential Home DS0000026700.V306285.R01.S.doc Version 5.2 Page 7 Some of the staff have not received regularly updated training in fire prevention – this is required. 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. Bay Court Nursing and Residential Home DS0000026700.V306285.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 Bay Court Nursing and Residential Home DS0000026700.V306285.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 at least once during a 12 month period. 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. Information about the home is available for prospective residents, which enables them to make an informed choice before moving into the home. Resident’s benefit from a good admission and assessment process, which ensures that the home can meet their needs. EVIDENCE: Residents said that they chose Bay Court by either visiting themselves or their relatives doing it for them. A copy of the last inspection report was available for all to see in the hallway of the home. The Manager and whenever possible, the keyworker, visits prospective residents before admission in their own homes or in hospital in order to complete detailed assessments and be sure that the home can meet their Bay Court Nursing and Residential Home DS0000026700.V306285.R01.S.doc Version 5.2 Page 10 needs. The three assessments looked at were comprehensive and demonstrated that all needs were covered in the areas of health, personal and social care. The majority of residents responding with surveys confirmed that they had received enough information about the home before moving in so they could decide if it was the right place for them. The home does not offer intermediate care. Bay Court Nursing and Residential Home DS0000026700.V306285.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 & 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ care is well planned, providing staff with information they need to meet residents’ needs. Residents’ health needs are met and supported by the appropriate involvement of other health professionals. There are good systems for managing medications, but one aspect of practice could be improved upon. Staff and the management team promote residents’ privacy and dignity. The home has clear and robust practices for the care of residents who are dying. EVIDENCE: Residents spoken with were happy with the care, and relatives and health and social care professionals indicated they were also satisfied. Comments from Bay Court Nursing and Residential Home DS0000026700.V306285.R01.S.doc Version 5.2 Page 12 residents included, “I am very pleased with all aspects of care” and “the staff are very supportive.” Visitors spoken with felt that their relatives received good care, one said, “ The staff are really caring”. Care plans seen provided a good description of residents’ needs and how they should be met. Staff spoken with and observed demonstrated a good understanding of the residents needs; for example, staff managed a difficult situation with a resident with acute psychological problems very well. The matron identified a need and it was acted upon immediately to the residents benefit. Relatives that were spoken with were aware that there is a care plan in place, not all had seen it but felt confident that if they requested to do so they could. Residents that were unable to get out of bed were clean and comfortable. However, in several rooms the televisions had been left on and were loud and obtrusive. There was no evidence in the care plans to suggest that the resident would enjoy this. Personal histories have been developed by the staff and with the relatives that contain important information about residents’ past lives and occupations, which gives a sense of who this person is. Personal histories are particularly important for residents with diminished communication and this work is to be commended. Residents’ health needs are met; four health care specialists asked said they were happy with the overall care and felt that the home always works in partnership with them. Care plans and daily notes show good monitoring of health needs, for example wound care appears to be good with considered evaluation of treatment and progress. All residents were well dressed in styles reflecting individual choice. Staff spoken to were aware of the need to treat residents with respect and knew of ways of protecting their privacy. They were seen to knock on residents’ bedroom doors and speak to residents respectfully. Residents and staff confirmed that when general practitioners or nurses visited they were able to receive their treatment in a private place. Medication is generally well managed by the home; all health and social care professionals felt that residents’ medication was appropriately managed. Currently medication needing refrigeration is stored in the kitchen fridge. It is recommended that a dedicated medication fridge be purchased ensuring safer and more appropriate storage. Bay Court Nursing and Residential Home DS0000026700.V306285.R01.S.doc Version 5.2 Page 13 Only trained nurses administer medication. Medication records were inspected; these were in good order. Care plans contain clear information about the residents’ wishes with regard to death and dying. The privacy and dignity of the service user who is dying is respected and maintained at all times. There are arrangements in place, which enable family and friends of the resident to stay with them. One relative said she was “overwhelmed by the staffs’ thoughtfulness”. Bay Court Nursing and Residential Home DS0000026700.V306285.R01.S.doc Version 5.2 Page 14 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): 12,13,14 & 15 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Routines are flexible but social activities do not fully meet residents’ expectations or preferences. Residents benefit from contact with their family and friends, which is encouraged and supported by the home. Residents enjoy a balanced diet which takes into account the likes and dislikes of most individuals. EVIDENCE: The home is working towards providing a flexible service that meets individual requirements. This is partially achieved by regular residents’ meetings at which individual requests can be made. For instance a resident requested that they have a prawn curry one day, this was facilitated and twelve residents thoroughly enjoyed the meal. Bay Court Nursing and Residential Home DS0000026700.V306285.R01.S.doc Version 5.2 Page 15 Some residents said there were “usually” activities on offer. Not all residents are able or want to participate in organised activities and it is less clear how meaningful social engagement is achieved with these residents. One resident told the inspector they would enjoy being able to go out more. The manager told the inspector that the home was trying to organise more appropriate activities. Able residents are supported to make decisions about their daily lives. Several residents were seen undertaking their own hobbies including tapestry and crosswords. Staff must ensure that less able residents are offered the same opportunities for choice, for example for residents cared for in bed their preferred choice of leisure should be considered whether it is listening to music or television to be left peacefully. The menu is quite varied. Residents’ comments on food included: “generally very good” and “very nice”. Specialist diets are provided if required so that health care needs can be met. Some residents eat in the attractively laid dining room; some choose a tray in their own room. The main meal of the day is fixed although alternatives are offered if it is not to the individuals liking. There is a menu displayed in the dining room. Staff ask all the residents in the morning what they would like for their supper that day and a wide choice is available. Visitors were made welcome at the home, and there are no visiting restrictions. . Bay Court Nursing and Residential Home DS0000026700.V306285.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The home has a satisfactory complaints process with evidence that complaints are listened to and acted upon. Residents are safeguarded from abuse. EVIDENCE: All residents spoken with and those responding with surveys felt that staff listen and act on what they say. All knew who to speak with should they have any concerns or complaints. A good record of complaints and outcomes is kept. No complaints have been received by CSCI since the last inspection. Residents say they feel safe at the home. Staff spoken with demonstrated a good understanding of abuse and would report any concerns to the manager. The manager has a good understanding of the procedures to be followed and is aware of her responsibilities. The majority of staff has received training in the prevention of abuse and the inspector was told that training is on going. Risk assessments have been completed and consent has been sought prior to the use of bed-rails, which is good practice. Bay Court Nursing and Residential Home DS0000026700.V306285.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. Resident’s benefit from living in a clean, well-maintained, comfortable home. EVIDENCE: The home has a well-maintained environment, which provides aids and equipment to meet the care needs of elderly people. The home is decorated to a very good standard. The communal areas are very nice. There is ongoing decoration programme, residents’ benefit from pleasant surroundings. A tour of the building found the home was clean throughout and generally free from odour on the day of the inspection; residents confirmed that it was ‘always’ or ‘usually’ like this. There are two members of staff responsible for the cleaning within the home, which includes carpet cleaning. Bay Court Nursing and Residential Home DS0000026700.V306285.R01.S.doc Version 5.2 Page 18 Both sluicing areas were clean and gloves and alcohol gel were freely available to ensure good infection control. The home deals with clinical waste appropriately. The laundry facilities are old but well organised. The domestic staff are generally responsible for the laundry and demonstrated a good knowledge of their responsibilities. There is a system in place for dealing with soiled laundry, which reduces the risk of infection. The garden looked well cared for. Bay Court Nursing and Residential Home DS0000026700.V306285.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29, & 30 Quality outcome in this outcome is good. This judgement is made using available evidence including a visit to this service. The needs of residents are met though the number and dedication of the staff. Staff are trained adequately to do their jobs. EVIDENCE: On the morning of inspection there were three trained nurses, (including the matron), three care staff, a cook, a kitchen assistant and a cleaner to care for twenty-three residents. Staff appeared busy, but residents appeared well cared for and those spoken with confirmed this. Information received from the manager, prior to the inspection, indicates that nine of the staff have NVQ 2 or above, this equates to 64 of care staff. This will protect residents by ensuring that they are cared for by competent staff. All new staff have had induction training. Existing staff are continually updating and refreshing their knowledge by way of in house training DVDs and visiting organisations. Most recently staff have benefited from a training and information session given by a representative from the Alzheimer’s Society. Bay Court Nursing and Residential Home DS0000026700.V306285.R01.S.doc Version 5.2 Page 20 The home employs staff from overseas; these staff are checked appropriately before they commence work. The home operates a good recruitment procedure that clearly highlights the processes to be followed. Three staff recruitment files were looked at during the visit. The documentation was consistent with evidence of a safe and robust recruitment process being carried out before a person is employed at the home. Bay Court Nursing and Residential Home DS0000026700.V306285.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Resident’s benefit from an experienced manager. Residents’ are involved in the running of the home. There are systems are in place to ensure that residents’ personal monies are correctly managed. However, these accounts are not always up to date. Systems are in place to promote the safety and health of residents and staff. EVIDENCE: The manager has the required qualifications and experience to run the home. Bay Court Nursing and Residential Home DS0000026700.V306285.R01.S.doc Version 5.2 Page 22 Some personal allowances are managed for residents by the home. A record is kept of all transactions and receipts of purchases are kept. The file was inspected and the records were inaccurate. There was too much money in some accounts. Whilst no inference of malpractice is intended these records must be kept up to date and accurate at all times. The home has quality assurance systems to ensure that residents will benefit from influencing the way the home is run. Resident meetings have been held to encourage discussion and feedback, and residents have just completed a satisfaction questionnaire; these are sent out bi-monthly. Fire safety equipment, for example fire extinguishers, had been regularly serviced and the fire log showed regular checks and maintenance on emergency lighting and fire alarms. The pre-inspection questionnaire demonstrated that mandatory training was well managed at the home. However following discussion with staff it was found that not all staff were up to date with fire prevention training. Devon Fire & Rescue Service visited the home in May 2006 and a satisfactory standard in fire safety was found. Bay Court Nursing and Residential Home DS0000026700.V306285.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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Bay Court Nursing and Residential Home DS0000026700.V306285.R01.S.doc Version 5.2 Page 24 NO Are there any outstanding requirements from the last inspection? 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. 2 Standard OP34 Regulation Schedule 4(9)(a) Requirement A record of all money or other valuables deposited by a service user for safekeeping or received on the service user’s behalf, which – (a) shall state the date on which the money or valuables were deposited or received, the date on which money or valuables were returned to a service user or used, at the request of the service user, on his behalf, and where applicable, the purpose for which the money or valuables were used. (This relates to service user individual money accounts being up to date and accurate). The Registered person shall make arrangements for persons working at the care home to receive suitable training in fire prevention. (This relates to all staff having fire prevention training). Timescale for action 30/11/06 2 OP38 23(4)(d) 30/11/06 Bay Court Nursing and Residential Home DS0000026700.V306285.R01.S.doc Version 5.2 Page 25 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 OP12 Good Practice Recommendations It is recommended that a fridge be purchased specifically for medication. Activities should be planned around residents’ individual interests or previous hobbies and interests, and take into account individual abilities. Bay Court Nursing and Residential Home DS0000026700.V306285.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Devon Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Bay Court Nursing and Residential Home DS0000026700.V306285.R01.S.doc Version 5.2 Page 27 - 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. 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