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Inspection on 03/05/06 for Chester House Care Home

Also see our care home review for Chester House Care Home for more information

This inspection was carried out on 3rd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Chester House manages to successfully support people with mental ill health issues. Service users were observed to be making their own decisions within a safe environment, they were able to take acceptable risk and develop their own routines for daily living. Service users mixed well and a stable staff team provides the stability they require. The older service users spoke positively about the home and received an equal amount of attention as the more active service users. Chester House is, in the main, appropriately maintained and furnished, offering service users homely and pleasant surroundings.

What has improved since the last inspection?

This was the first inspection undertaken by the current inspector, therefore it was difficult to assess any significant developments. The registered manager stated that he had continued to develop care plans and was continuing to work on improving administration systems.

What the care home could do better:

On the whole, there were no major shortfalls in the day to day service provision, however the home has yet to meet the required standard for completing quality assurance procedures. The registered providers visit the home regularly, however, they do not formally complete Regulation 26 visits as required. These visits should be completed monthly, ensuring the registered providers assess the services and consult with service users regarding their satisfaction. Though supervision procedures and staff appraisals are in place, staff should receive one to one supervision as part of the overall process. Staff training records need to be more accurately maintained if they are to be used to evidence that staff are fully trained. All information relating to service users` daily lives should be maintained individually and on their personal files. Such records should include details regarding all daily activities their personal preferences, accidents and incidents. Some parts of the home need additional aids and adaptations to ensure it meets the required standards for older people. The manager has yet to complete the registered manager`s award and systems need to be introduced to ensure medication procedures and good practice standards are known and followed.

CARE HOMES FOR OLDER PEOPLE Chester House Care Home 138 Chester Road Hazel Grove Stockport Cheshire SK7 6HE Lead Inspector Sylvia Brown Unannounced Inspection 3rd May 2006 08:30 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 Chester House Care Home DS0000043970.V290688.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. Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Chester House Care Home Address 138 Chester Road Hazel Grove Stockport Cheshire SK7 6HE 0161 456 8500 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) assrafally@hotmail.com Mrs Bibi Toridah Assrafally Mr Mohedeen Assrafally Abhimanew Nookanah Care Home 14 Category(ies) of Dementia - over 65 years of age (2), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (14) Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The Registered Manager must be supernumerary and not included in staff:resident ratios. The Registered Manager to achieve the level of qualification required for Registered Managers by 2005. The ratios of care staff must be determined according to the assessed needs of service users and in accordance with guidance issued by the Department of Health. Domestic staff must be employed in sufficient numbers, with a minimum equivalent of one part time domestic appointed. The home is registered for a maximum of 14 service users to include: *up to 14 service users in the category MD(E) (Mental disorder excluding learning disability or dementia over 65 years of age). *up to 2 service users in the category DE(E) (Dementia over 65 years of age). Service users can be under the age of 65 years but not under the age of 50 years in both categories 14 MD(E) and 2 DE(E). 9th February 2006 4. 5. Date of last inspection Brief Description of the Service: Chester House is a care home providing personal care and accommodation for 14 people from the age of 50 years and upwards who have, or had, a mental illness. The home is located in the Hazel Grove area of Stockport. Local shops, cafes, restaurants, public houses, swimming baths and post office are approximately a 15 to 20 minute walk away. Other amenities, such as banks, churches, library and opticians, are a short car ride. Stockport town centre and motorway network are easily accessible by car. Hazel Grove train station is situated approximately a mile from the home. The bus service nearest to the home is infrequent and none are available on a Sunday, therefore a short walk is required to access an alternative service. The property is a modern detached house that has been extended. The accommodation consists of ten single rooms and two shared rooms spread over three floors; none of the rooms has an en-suite facility. There is one large combined lounge and dining room, and a conservatory. No passenger lift is available so the majority of service users must be able to climb the stairs. There is a fairly large garden to the rear of the house and a small car park to the front of the building. Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection process of Chester House included a site visit to the home which was unannounced and completed in one day. Time was spent sitting and talking with service users and observing the day-to-day routines of the home and care staff as they provided support. The inspector looked around the building to assess its suitability to provide a comfortable, homely environment for the enjoyment of all service users and ensure their safety. Two service users were case tracked, which means that their care files were inspected and the care provision evaluated to ensure care support was provided as detailed within the care file. Where possible, the service users were spoken with and their views sought regarding their opinions on the service. Staff files, health and safety records and servicing certificates were evaluated. Time was spent talking with staff and the registered manager. Comment cards were left at the home for all service users and their relatives, and a staffing survey was undertaken for all levels of staff. At the time of writing the report, seven questionnaires had been returned by service users, two by relatives and one from a staff member. Where applicable and relevant, comments received have been incorporated into the report. Comments received after the completion of the report will be included in the next inspection process. What the service does well: Chester House manages to successfully support people with mental ill health issues. Service users were observed to be making their own decisions within a safe environment, they were able to take acceptable risk and develop their own routines for daily living. Service users mixed well and a stable staff team provides the stability they require. The older service users spoke positively about the home and received an equal amount of attention as the more active service users. Chester House is, in the main, appropriately maintained and furnished, offering service users homely and pleasant surroundings. Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 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 Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 5 Quality in this outcome area is good. Prospective service users receive information and have their needs assessed prior to being accommodated. Contracts of residency are issued. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: At the site visit the registered manager stated that service users are able to visit and receive information about the home prior to making any decisions about moving in. Comment cards received from service users confirmed this. The inspector has recommended that the home records the pre-admission process, including visits to the home and any evaluations made at that time. Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 Page 9 Evaluation of service users’ files and case tracking identified that they have their needs assessed and recorded and these are kept under review. Files contained a contract of residency, which had signatures of agreement in place. Chester House Care Home DS0000043970.V290688.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, 8, 9 & 10 Quality in this outcome area is good. The individual health and personal care needs of service users are met in a respectful and dignified manner. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Evaluation of two care files confirmed that service users’ needs are known, recorded and kept under review. Staff were knowledgeable about the service users’ individual needs and were observed supporting them appropriately. Care plans were detailed; service users’ mental health condition and emotional well-being were addressed, they also reflected the individuality of each person. Records demonstrated that routine dental, optical, hearing and chiropody services are provided and service users are able to have their hair styled each week by the visiting hairdresser. Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 Page 11 Notwithstanding those details, the home did not record service users’ personal preferences for bathing, bedtimes and activities to the same standard. In the main, daily records recorded generalised statements, such as ‘care given’, ‘ no change to care needs’; they did not reflect the day to day achievements and activities of the individual. Comments from service users were positive. At the inspection one service user stated ‘They (staff) are very good, they are lovely with you’. Service users confirmed they were supported to make health care appointments, which are planned for and recorded. All comment cards received from services users stated they were listened to and had their care needs met. Both relatives’ comment cards confirmed they were appropriately kept informed, one relative stated ‘Carers seem to care and encourage a warm caring environment’. Medication administration practices were adequate and records kept were, in the main, satisfactory. It was evident that where medication is periodically required, incorrect coding was used. In addition, the home had not developed a system which evidences how medication practice and records are monitored to ensure the competency of staff and safeguards service users. There was no signature reference document to indicate staff with responsibility for administering medication and their signature. Service users’ photos were not in place on the medication records. The registered manager was unfamiliar with the Royal Pharmaceutical Society’s guidance for the safe managing, recording and administering of medications. Furthermore, no copy of the guidance was on the premises for reference purposes. Chester House Care Home DS0000043970.V290688.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, 13, 14 & 15 Quality in this outcome area is good. Service users are able to choose their lifestyle, social activities and keep contact with family and friends. Service users receive a varied and enjoyable diet. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: There are no routine activities provided at the home. It was evident that a number of service users benefit from routine and, as a consequence, disruptions to that routine can cause anxiety. It would appear that the home’s flexible arrangements seem to suit most service users. Of the comment cards returned, four of the seven stated they were, in the main, satisfied with the activity arrangements. One resident commented they were not interested in activities at all. Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 Page 13 At inspection service users were observed occupying themselves and having one to one time with staff. It was evident that service users are supported to visit local shops and places of interest. Friends and family are able to visit and a record of visitors to the home is maintained. Each service user decides their own rising and retiring routines. At inspection one service user was observed getting up early afternoon, with arrangement in place to ensure they received their meals at different times. All routines are recorded and monitored to ensure they do not compromise the service users’ overall health and emotional wellbeing. One service user stated at inspection that she retires to bed when she likes and that night-time staff support her when required. She spoke positively of the night-time staff, stating they were kind. Service users have a varied menu that offers choice. Service users were observed to have their main meal at lunchtime, which was a full roast dinner. Without exception, all service users spoken with on the day stated they liked the food served. Comment cards from service users confirmed they enjoyed the food provided. Chester House Care Home DS0000043970.V290688.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 & 18 Quality in this outcome area is good. Service users have access to the home’s complaints procedure and are protected from abuse. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Since the last inspection the registered manager has completed adult protection training. He confirmed that all staff have received such training within the previous 12 months. Notwithstanding, the registered manager and staff were not familiar with Stockport’s procedures, which are to be followed if an allegation is made. Comment cards received confirmed that service users feel safe and protected at the home. The home has a formal complaints procedure in place, which is known to both service users and visitors. Evaluation of the complaint record indicated that the home has not received any complaints within the previous 12 months. The registered manager confirmed this as accurate. Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 Page 15 Returned comment cards from service users and relatives confirmed that they knew about the complaints procedure and had no cause for complaint. One service user stated ‘A great place to live’ another ‘No complaints to make’. Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 23, 24 & 26 Quality in this outcome area is good. Chester House is clean and fairly well maintained. Rooms are furnished in a homely manner and offer service users comfort and security. Some aids are required to ensure all parts of the home meets the needs of older people. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The inspector observed the home to be fairly well maintained and clean. Since the last inspection the home has invested in automated air deodorisers that have dramatically reduced the odours within the home. There were limited odours and cleaning routines appeared sufficient to meet the demands of the home. Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 Page 17 The registered manager was able to state what action is to be taken to maintain the building. Standards of hygiene in the laundry area were sufficient, however the area would benefit from a little more organising to ensure correct and safe storage of equipment. Service users’ bedrooms were personalised according to their own tastes and personal preferences. They were clean and bright and individually arranged. Call points were observed to be without cords, and whilst most active younger adults may not require the additional support, the older people in the home should have additional aids and adaptations to meet their needs. One service user stated that though she could reach the call button near her bed, she would find a call extension cord helpful. The inspector also observed that the main lounge was without a call point. Whilst it is recognised that Chester House is small, there should be sufficient call points throughout the home and in all rooms used by older people to aid them to summon assistance when required. Some bedrooms did not have bedside lights available. Again, whilst it is recognised these may not be required for some service users, they should be in place for the older people to aid their comfort when reading and support night-time routines. Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. Service users’ needs are met by staff who are appropriately recruited; they are in appropriate numbers and are trained and competent. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Evaluation of staff records confirmed that appropriate recruitment procedures are in place. It was evident that staff complete induction training, however there were insufficient records maintained to confirm that staff had completed induction training to the standard set by Skills for Care. The one returned staffing survey confirmed that staff had completed a threemonth induction programme. Evaluation of staff files identified staff attend meetings and have appraisals periodically throughout the year. Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 Page 19 At inspection staff confirmed their training and day to day supervision and guidance they receive. Staff files identified that whilst there was some evidence of training, there was insufficient detail to identify staff completed mandatory training. Without exception, feedback from service users and relatives was positive about the staff. One relative stated ‘Carers seem to care and encourage a warm caring environment’. The registered manager stated that three staff were awaiting places to complete NVQ level 3 training to further their knowledge and two staff planned to commence NVQ level 2 training in the near future. Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36, & 38 Quality in this outcome area is good. Chester House is a well run and managed home which ensures, as far as possible, the health, safety and welfare of service users. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Though the registered manager has completed NVQ training at level 4, he has yet to achieve the registered manager’s award as required. He confirmed that he is waiting for funding and arrangements are underway to secure such training in the near future. Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 Page 21 Quality assurance procedures have commenced, however the registered manager was not fully aware of what is required by regulation regarding completion of a quality audit. Guidance was given at inspection regarding this matter, with a further requirement to ensure it is completed within an acceptable timeframe. It was also evident that the registered provider does not complete Regulation 26 visits as required. The home supervises staff, however it was confirmed that staff do not receive formal individual supervision at the required frequency. Policies and procedures were in place and there was some evidence that staff had seen them and signed to say they understood them. Health and safety records were evaluated and found to be accurate and up to date, which ensures, as far as possible, the health and safety of both service users and staff. Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 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 3 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 3 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 3 Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 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 OP33 Regulation 24 Requirement The registered person must produce a quality assurance report, which includes an analysis of the questionnaires. A copy of the report must be sent to the Commission and a copy made available to service users. (Timescale 1/8/05 not met). The registered person must complete Regulation 26 visits at the required frequency and produce a report of the findings. The registered person must ensure that the registered manager achieves the registered manager’s award. Timescale for action 31/10/06 2 OP33 26 01/07/06 3 OP31 9 & 10 31/10/06 Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP5 OP7 OP7 OP9 OP9 Good Practice Recommendations The registered person should detail the pre-admission process undertaken by prospective service users and record any observations made. The registered person should detail all the personal preferences of service users, including bathing, rising and retiring times and activities on their individual file. The registered person should ensure sufficient details are recorded daily to reflect the service users’ individual day to day routines and achievements. The registered person should ensure correct coding is used when medication is not administered as prescribed. The registered person should develop formal procedures for monitoring medication administration records and staff’s competency in management and administration of medication. The registered person should ensure all staff with responsibility for administration of medication have sample signatures on file for reference purposes. The registered person should ensure that the registered manager is familiar with the Royal Pharmaceutical Society’s guidance for care homes and that an up to date document is available to staff at all times. The registered person should ensure that records are maintained to confirm staff commencement/completion of induction training as set by Skills for Care. The registered person should maintain accurate training and development records for all staff which demonstrate mandatory and other training has been provided for the work they are individually employed for. The registered person should commence formal supervision of staff at the required frequency. 6 7 OP9 OP9 8 9 OP28 OP30 10 OP10 Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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 Chester House Care Home DS0000043970.V290688.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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