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Inspection on 20/07/05 for Chichester Court Nursing Home

Also see our care home review for Chichester Court Nursing Home for more information

This inspection was carried out on 20th July 2005.

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

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

The Home provides a spacious and comfortable environment for residents to live in with staff that are friendly, courteous and professional. Some comments received from residents and relatives were: "we are happy with the way the staff treat my mother", "my mother is happy here, she`s been to four other homes and this one`s the best". Staff receive appropriate training to do their jobs and are always trying to find ways to improve the service and the quality if life in the Home for residents. The Home offers varied and good nutritious food.

What has improved since the last inspection?

The Home continues with its planned programme of decoration and refurbishment. The corridors have been decorated and new carpets have been laid, three bedrooms have been decorated and two shower rooms.

What the care home could do better:

Whilst a good level of information is generally available in the residents care plans, staff must make sure that all information regarding all areas of care and treatment is documented in the individuals` records. The systems and procedures for the control of medicines are generally satisfactory, but some administration practices, indicated by inaccurate stock balances, were not satisfactory on the day of the inspection. Immediate steps were taken by the Manager to investigate the reasons for this, at the request of the Inspector. A report was sent by the requested time to the Commission giving the results and actions taken, which were satisfactory. It was recommended that self-closing devices are fitted to the dining room fire doors so that they can remain open to allow easy access during meal times, and in order to ensure continued fire safety in the Home. It was suggested that the Manager monitors the time it takes staff to answer call bells, as some residents and relatives feel it takes too long.

CARE HOMES FOR OLDER PEOPLE Chichester Court Chichester Road South Shields Tyne and Wear NE33 4HE Lead Inspector Mrs P A Worley Announced 20 July 2005 10:00am 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 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. Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Chichester Court Address Chichester Road South Shields Tyne and Wear NE33 4HE 0191 454 5882 0191 454 6455 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Grandcross Limited (wholly owned subsidiary of Four Seasons Healthcare Limited) Valerie Ann Ralph Care home with nursing 52 Category(ies) of OP Old age - 52 registration, with number PD Physical disability - 15 of places DE(E) Dementia - over 65 - 1 Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 22/2/05 Brief Description of the Service: Chichester Court Nursing Home was purpose designed and built in 1997. It is registered to accommodate up to 52 older people with personal care and nursing needs. The building is single storey with wide corridors and doors providing good access for people with mobility difficulties, or wheelchair users. All bedrooms have en-suite toilet facilities. A variety of lounges and sitting areas are available, also two dining rooms, and two internal courtyards that provide pleasant outdoor seating areas. An additional, paved outdoor seating areas provided at the top end of the home. The home is located close to public transport facilities including the Metro railway system, and buses, and is within easy reach of local shops and amenities, and the town centre. Local parks and the seacoast are approximately two miles away. Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced, was carried out over one day, by one Inspector. Before the inspection a questionnaire had been completed by the Manager, which gave up to date information about the Home to allow more time to be spent with residents on the day. A tour around the home to check the cleanliness, maintenance and decoration was carried out. The Inspector spoke with a seventeen of the residents, four visiting relatives, and nine staff, plus the Manager. One Inspector also had lunch in one of the two the dining rooms with some residents. Discussions with the Manager took place about the requirements from the last inspection, all of which have been dealt with. A number of records and documents were examined including residents’ care plans, medication records and staff training records. The requirements from the last inspection have been dealt with. During this inspection not all standards were looked at and of those that were, two requirements were made and two recommendations. What the service does well: The Home provides a spacious and comfortable environment for residents to live in with staff that are friendly, courteous and professional. Some comments received from residents and relatives were: “we are happy with the way the staff treat my mother”, “my mother is happy here, she’s been to four other homes and this one’s the best”. Staff receive appropriate training to do their jobs and are always trying to find ways to improve the service and the quality if life in the Home for residents. The Home offers varied and good nutritious food. Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 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. Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 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 standard(s) 1 &4. The Home does not provide intermediate care. A range of information is available, which enables prospective service users to make an informed choice about whether they would like to move into the Home. The assessment information and admission procedure confirms that the Home can meet service users’ needs. Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 Page 9 EVIDENCE: The Home’s Statement of Purpose and Service Users Guide is available to provide prospective and current service users with information about the Home. The Service Users Guide has been reviewed and updated and contains a summary of the Homes’ Statement of Purpose, also a copy of the revised terms and conditions/contract. Staff indicated, and the care plan records confirmed, that appropriate assessments are carried out to ensure that the Home can meet the needs of service users, before admission and thereafter. Service users and/or their representatives are consulted about their needs and a number who were spoken with confirmed this. Staff were able to demonstrate knowledge about service users care needs and how to cater for those needs. Following training, staff have gained confidence and skills which was evident in the way they approached service users, their families and other visitors to the home. Comments received from one service user and relative included: “I get good care and attention” and “my wife is well looked after”. Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 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 standard(s) 7,8,& 9 Service users appeared well and spoke of staff meeting their health and personal needs. Service user’s care plans are in place and reflect their needs but all information regarding treatments and care actions need to be recorded in individuals’ records. Without this, a complete picture of the care is not available. Medication procedures generally ensure that the service users health care needs are addressed. However, the Home must ensure that administration procedures are carried out safely and consistently at all times. Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 Page 11 EVIDENCE: A sample of service users care plans were examined and were up to date, generally well written and provided a good level of detailed information to guide staff on the care needed for individual service users. Appropriate health and risk assessment documentation was also in place and evidence of evaluations and reviews. A good level of wound management and health care treatment documentation was in evidence for the nursing residents with supporting evidence such as photographs and progress notes. Core care plans have been introduced for the management of some nursing treatments but not all were completed, or followed the core actions that were stated, whereas a particular care plan without core statements, was well documented. Some treatment/wound dressings regimes were not documented in the service users’ care plans but were in the communications diary. Discussion took place about this with the nursing staff present and it was agreed that this was inappropriate, and they took immediate steps to ensure they such information was available in the care plans. Health related risk assessments were carried out and care plans as to how they were to be acted upon with reference to falls, nutrition and pressure damage assessment were available. The care plans contained information and records of the input by GP’s and other relevant professionals. Residents who were spoken with described how their health care needs were met. One resident said, “they tend to my health very well”, and a relative who visits daily said “my husbands health is better since he came here”. The procedures and systems for the ordering, receipt, administration and disposal of medicines were discussed and examined and were satisfactory. Actions had been taken regarding the recommendations made at the last inspection. However, an audit trail of five different service users’ medicines was carried out during this inspection and all were unsuccessful. In the case of three service users prescribed the same analgesics, the total count of tablets in stock was correct indicating that tablets were administered from one individuals’ packet. In the case of another medicine the count indicated that the tablet was signed for but not given, and the fifth audit trail indicated that only one of two tablets appeared to have been given on occasions as the count exceeded the number signed as administered. Examination of the Home’s weekly audit count records of medicines in stock, which were well kept and up to date, indicated that these discrepancies occurred after the last check. An Immediate Action Requirement notice was issued to the Manager requiring investigation into the matters and a report to the Commission of the outcome, Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 Page 12 within a stated time. A report was subsequently received into the Commission indicating that appropriate actions had been taken. Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 &15 Service users are offered the opportunity of participating in range of social activities and are able to spend their day as they wish. Residents are offered and receive varied, wholesome, nutritious and wellpresented meals, in pleasant surroundings. Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 Page 14 EVIDENCE: The Activities Co-ordinator is further developing social activities within the Home, and there was evidence to suggest that activities are planned and offered everyday. Residents spoken to stated that they were encouraged to participate but their wishes were respected if they did not wish to do so. Activities taking place during the day, included participation by some residents in the knitting group, drawing and musical shows. The Inspector was shown the progress of seeds and plants that were planted months earlier by residents, and were now planted in the internal courtyards of the grounds for all residents to see. The Activities Co-ordinator spoke of a recent VE Remembrance Day event, which demonstrated input and participation from a number of residents who recounted their experiences at that time. A lottery grant had been applied for and granted to the Home to assist in the funding of the event. He also demonstrated awareness of individuals’ likes and preferences and described a variety of events and outings that had taken place or were planned. Some residents in the home stated that they find their own amusement and like to read books/magazines/newspapers, do the crossword or watch TV. A visiting library comes into the home and ministers from local churches also visit to bring Communion. The Inspector shared a meal with service users in the small dining room. The atmosphere was pleasant and unhurried. Food was served from the hot lock trolley according to the choice of the individual and portion sizes were dependent on what individuals’ felt they could manage. The meal was tasty and appetising and staff were observed to support service users where they needed help with eating, and this was carried out sensitively. Two meal choices were available from the menu, which was displayed on white boards outside the dining rooms and residents confirmed that alternative choices were provided if requested. This practice was observed in the case of three residents who requested different choices. Comments received from residents included: “meals are always nice” and “different things are given if you want them”. The tables were attractively set in both dining rooms with tablecloths, serviettes, milk, sugar and condiments. Fruit juice/water or tea/coffee was offered to residents during the meal. Staff demonstrated a good knowledge of individual preferences and dietary needs of service users where specific intervention is required. Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Appropriate Adult Protection procedures and staff training have been implemented in the home to guide staff and ensure the protection of the service users from abuse. EVIDENCE: The Home has a Protection of Vulnerable Adults Procedure (POVA) in place and a copy of the Local Authority’s Procedural Framework for the Protection of Vulnerable Adults, is available to staff. Staff who were spoken with confirmed that they had received POVA training and were able to satisfactorily describe what actions and procedures should be taken on suspicion of abuse or if abuse was seen to take place. Evidence of staff training in this area was seen in some staff files. Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 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 standard(s) 21,22,25 & 26 Service users live in a clean, safe, well-maintained Home that is comfortable, and provides suitable and sufficient facilities and equipment to meet their needs. EVIDENCE: A tour of the premises was carried out and a number of bedrooms were viewed. Some bedrooms have been decorated and all rooms seen were homely and personalised with evidence of residents’ own items and possessions. No offensive odours were detected. All bedrooms are provided with en-suite toilets and communal toilets are provided throughout the Home. The corridors have been decorated and new carpets have been provided. Some carpets in lounges were stained and in need of replacement but the Manager advised that they were on order and soon to be fitted. The two shower rooms identified at the last inspection to need repair and decoration have been repaired and re-decorated. Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 Page 17 The home is single storey and the premises provide good access for wheelchair users to all areas with its wide corridors and doors and spacious communal areas. Grab rails are available throughout the home and appropriate adaptations and equipment such as hoists and assisted baths are provided. An emergency call system is available throughout the home and four pull cords in different toilets and bathrooms were loosely tied up and out of reach despite the Manager’s clear notices to staff not to do so. In one toilet the cord needs to be lengthened to allow access at skirting/floor level should that be necessary in the event of a fall. Adequate signs are available to assist service users in orientation around the Home. The heating, lighting, water and ventilation supply to the home was satisfactory, meeting the required standards. Water temperatures are checked on a regular basis and records to confirm this are kept. Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 &30 Staffing levels and skill mix are sufficient to effectively meet the needs of service users living in the Home. Staff receive appropriate training in relation to the care needs of service users and to enable them to competently do their jobs. Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 Page 19 EVIDENCE: Discussions with the manager and inspection of staffing rotas indicated that appropriate numbers of staff are provided and maintained over the twenty-four hour period to meet the needs of the current residents. On occasions however, where short notice absenteeism occurs, particularly at weekends, this is sometimes difficult to cover, but is generally achieved. The Manager works supernumerary to the rota, and a good level of ancillary/support staff are in post. In conversation with some residents they said they felt safe living in the Home and were well cared for. They commented that the staff were kind and helpful but that when they were very busy it sometimes took a long time for them to answer call bells. A number of Commission for Social Care (CSCI) comments cards were received from service users and relatives that also indicated this was the case and it therefore appeared that to them that there were not always sufficient staff on duty. This information (where names were provided, these were not given) was shared with the Manager in order that she can address the situation with the staff. The call system was tested on two separate occasions during the inspection and response times by staff were acceptable. An ongoing training and development programme is in place to include all statutory training requirements and other training in clinical subjects associated with the care of the client group catered for. In recent months the NVQ training for some care staff has been suspended by the training agencies concerned. However, the company is setting up training facilities to enable all training, including NVQ training to be sourced and completed internally. A rolling programme of all statutory and specific training remains in place. Individual training needs are identified through the supervision and appraisal systems and inspection of some staff files confirmed that the training is carried out. Induction training is provided for all staff. Staff who spoke with the Inspector confirmed that they receive a level of training to enable them to effectively care for the service users needs. Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The health, safety and welfare of service users and staff is promoted and protected through training and staff practices. Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 Page 21 EVIDENCE: Staff who were spoken with confirmed that they received health and safety training that includes moving and handling, fire safety, food hygiene, Control of Substances Hazardous to Health (COSHH) and infection control. During the inspection staff were observed to carry out good and appropriate moving and handling practices using appropriate equipment. The domestic supervisor was spoken with and stated that immediate action had been taken following the last inspection when the issue of containers of chemicals were inappropriately labelled was observed. The domestic trolleys were examined and all containers are now correctly identified and labelled. In areas where there were potential hazards, doors were locked and bedroom doors were held open only where self-closure guards were fitted. The main dining room door, which is a fire door, was held open by means of a large black plastic waste bin and holder, although the room was occupied whilst staff assisted the movement and transit of residents in and out of the dining room. As this was a procedure carried out to assist in operational procedures, the provision of a magnetic self-closure device would be beneficial and safer, and would also assist those residents who can mobilise independently, but need the door to do so. Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION x x 3 3 x x 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x x x x x x 3 Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 Page 23 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. 1. Standard 7 Regulation 15(1) Requirement The Home must ensure that all information is provided in the service users care plan to confirm how their health care needs are met. The Home must ensure the safe handling and administration of medicines at all times. Timescale for action 20/7/05 2. 9 13(2) 20/7/05 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 27 38 Good Practice Recommendations The Manager should monitor the call bell response times by staff to ensure they are answered within a reasonable time. Magnetic self-closure devices should be fitted to the dining room fire doors. Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Baltic House Port of Tyne, Tyne Dock South Shields NE34 9PT 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 Chichester Court B52 B02 S272 Chichester Court V193248 20 Jul 2005 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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