Inspection on 14/09/05 for Clarendon Manor

This inspection was carried out on 14th September 2005.

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

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

Other inspections for this house

Clarendon Manor 23/02/09

Clarendon Manor 16/03/07

Clarendon Manor 13/03/06

Clarendon Manor 14/09/04

Clarendon Manor 28/04/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Clarendon Manor 37 Golf Lane Whitnash Leamington Spa Warwickshire CV31 2PZ Lead Inspector Lesley Beadsworth Unannounced Inspection 14th September 2005 11:40 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 Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 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. Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Clarendon Manor Address 37 Golf Lane Whitnash Leamington Spa Warwickshire CV31 2PZ 01926 426758 01926 426758 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) Greentree Enterprises Ms Emma Clayton Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th September 2004 Brief Description of the Service: Clarendon Manor provides residential care accommodation for 30 older people aged 65 years and over. It does not offer specialist services for dementia care or any other provision apart from its registration category. Clarendon Manor is on a quiet residential road in Whitnash, on the outskirts of Leamington Spa. Shops and a post office would be accessible to any service user who was able to walk to these facilities, otherwise a bus route is nearby. The forecourt of the home has parking for cars. The home consists of a period house, which has been extended by joining it through a ground floor corridor to a more modern house next door. A further extension has added 4 bedrooms to the third floor of the house; these are accessible by use of a lift. The home has two passenger lifts and a stair lift. Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day from the hours of 11:40 and 20:20. The registered manager was present for all of the inspection. The registered manager, and the other members of staff present, cooperated fully with the inspection process. The inspection included a tour of the premises, talking with the registered manager, staff and residents; looking at resident records; looking at staff records; looking at policies and procedures, but most of the time was spent talking to residents and becoming familiar with the home on what was a first visit. Five residents, one relative, a Community Psychiatric Nurse and three members of staff were spoken with at this inspection. What the service does well: What has improved since the last inspection? The home was required to ensure that all mandatory training be refreshed appropriately. Since then the manager has been undertaken training to enable her to train staff in moving and handling and eight of the 19 care staff have undertaken this training in 2005; all staff have undertaken fire and evacuation refresher training; all care staff have undertaken food and hygiene refresher training. There was a requirement that records are stored securely to ensure compliance with the Data Protection Act and this has been met. Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 Page 6 The outside of the premises has been decorated and looks very smart. The staff room has been decorated and new cupboards fitted. Some bedrooms have also been decorated and some have been fitted with new carpets. At the last inspection residents were being charged for incontinence products if they had not been assessed by the Primary Care Trust as needing them. This has now discontinued. 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. Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 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 Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 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): 4, 7 The amount of specialised training undertaken by staff is limited but the residents feel that the home meets their needs. EVIDENCE: Residents spoken with said that they felt that their needs are met with comments such as, “this is better than being at home.” The registered manager provided a training matrix for the purposes of inspection. This demonstrated that although twelve care staff have undertaken dementia training most of this was undertaken between 1998 and 2002, with only two members of staff having attended this training since the last inspection, consequently most staff will either not have undertaken any training or not be up to date in this subject. This would impact on the level of care provided to those residents who have dementia or other cognitive impairment. Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 Page 9 Only one member of staff has attended continence training and only the manager has attended training related to pressure area care, which is of particular concern as a resident currently has pressure sores that were sustained whilst in hospital. Similarly lack of training related to needs in the home will affect the care provided. There was no evidence of there having been any training related to other specialist needs such as sensory impairment or physical disabilities. The organisation addresses some of these subjects in their general training but there is insufficient time in the session for this to be addressed any more than briefly. The home does benefit from the services of a Community Psychiatric Nurse (CPN) for specific residents and who was visiting the home at the time of the inspection. The nurse was able to say that “the care for the residents is very good”; the care given is “individualistic and person centred.” She added that the registered manager did not mind to asking for advice. Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 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, The home meets the residents’ health care needs. Systems for the management and administration of medication are satisfactory. Care plans need some improvement. EVIDENCE: Some work is needed to ensure that the care plans include sufficient detail for staff not to have to rely on good verbal communication and staff memory. For example there is not enough detail in the plans of a resident with pressure sores regarding how to ensure pressure relief and or to meeting the needs of someone with a catheter for instance regarding the frequency of emptying the drainage bag or what to do if there is poor drainage. The plans are written in a narrative style and therefore it is difficult to focus on specific needs and to extract the information required to meet those needs. Care files were viewed. All residents have a plan of care. These are written in the narrative and it is not straightforward to extract the required information from them. Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 Page 11 The registered manager advised that residents are able to keep their own GP when they come to home as long as the GP agrees. There are four surgeries used by the people living at the home. The registered manager also advised that the residents have access to dental, optical and chiropody services. This was confirmed when talking with residents and in care files viewed. At the time of the inspection the medication trolley was locked and secure in the laundry room. This was not a suitable location as temperatures were too high for much of the medication in the trolley and could affect their effectiveness. The registered manager moved this to a better location promptly. There is also a second cupboard for storing other medication but this had a less than fully secure lock. The registered manager contacted the handyman during the inspection and confirmed that this was made secure the following day. It was noted that there was not a list of signature samples to identify who has administered medication, but the registered manager provided this straight away. Medication Administration Record Sheets were seen to be satisfactory but some ‘as required’ medication did not describe when the medication needed to be administered and one resident had three different painkillers without explanation from the GP or pharmacist as to how these need to be administered. The senior staff spoken were able to describe accurately the correct use of the medication but are relying on memory and good communication, which could be a risk to residents. There is up to date medication literature in the home. There is not a home remedy policy at the home and this needs to be provided to ensure that there is a safe system to administer treatment for minor ailments. Staff were seen to treat residents with dignity and respect and those residents spoken with confirmed this to be the case. All residents were suitably, and well, dressed on this unannounced visit. Their preferred names were heard to be used and care files included this preferred name to inform staff. Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 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): 12,15 The home provides sufficient activity and stimulation to match the residents’ expectations and preferences. EVIDENCE: The home provides a variety of activity and this is evidenced in albums of photographs taken at times of entertainment, activities and outings. Residents spoken to about being suitably occupied said, “there is plenty to do here if you want it” and “it’s marvellous”. Up to date information regarding forthcoming events were displayed on the notice board in reception and a system of checking if the latest activity was enjoyed was also on this notice board. However this system involved the use of movable star shapes, which have been frequently rearranged by those people living at the home with limited understanding. Residents confirmed that they are able to choose their food and this was observed at the inspection. Although the standard related to food was not fully assessed it was noted that sandwiches and cakes were being served by hand, without the protection of serving tongs. This is not a hygienic practice and poses a risk of cross infection. Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 Page 13 However a resident told the inspector when asked if she enjoyed the meals, “I haven’t had anything here that I haven’t liked, in food or attention.” Discussion with residents demonstrated that they were able to make choices about their daily routines, such as getting up and going to bed. One resident, when asked, said that, “it’s like being at home.” Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 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): EVIDENCE: No standards were fully assessed from this section on this occasion but residents spoken with said that they knew who to speak to if the had any concerns, one adding that she had never had anything to complain about. The registered manager and staff present on the day of the inspection demonstrated openness and advised the inspector that complaints were welcomed in order to improve the service. Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 25, 26 The home provides clean, comfortable, well-maintained and pleasant surroundings both indoors and out of doors. There have been improvements in the exterior and some interior décor of the premises. EVIDENCE: The outside of the home has been redecorated and looks attractive and gives a good first impression to anyone visiting the home. The gardens are reasonably well maintained but are still being developed to be attractive in all areas. There is ample garden seating for residents to use to enjoy the gardens. An outbuilding is currently being added and will be used for storage. Decorating the staff room and adding new storage cupboards have made further improvement. The registered manager advised that this makes for more comfortable surroundings for the staff. Some bedrooms have been decorated and fitted with new carpets to improve private accommodation for residents. Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 Page 16 The manager’s office is without natural light and ventilation and although a window has been added looking into the adjacent staffroom the room is oppressive and became quite hot if the door was closed. There is ample sitting and dining areas for the number of residents living at the, all of which is attractively decorated and with furniture that is of a good quality and domestic in nature. The small lounge/dining room accommodates six residents and also has tea making facilities and a fridge for residents and their visitors to make drinks. Lighting in communal areas is domestic in appearance but as the inspection took place in daylight the brightness could not be assessed. The majority of radiators have guards to prevent accidental burning to residents. Those without guards have a low surface temperature, although the inspector was unable to test this, as the heating was not on. The standard related to infection control was not fully assessed at this inspection but it was observed that several of the staff had chosen to provide alcohol gel for their own use to minimise the risk of cross infection. Staff are aware that this needs to be in conjunction with good hand washing procedures to prevent cross infection. The recommendation regarding the home’s infection control policy and procedures being developed in line with the Department of Health Guidelines on the Control of Infection in Residential and Nursing Homes will be carried over in this report. Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 30 The home has not achieved 50 of care staff having completed NVQ Level 2 in Care to confirm their competence in their work. EVIDENCE: All staff have undertaken induction training but the home has not yet achieved the required 50 of care staff with NVQ Level 2 in Care qualification before the end of the year with only 5 of the 19 staff having completed NVQ Level 2 and one having achieved Level 3. Having this qualification demonstrates that the holders are considered competent to carry out their work and that residents are in safe hands. The organisation has an Induction and Foundation training programme that has been cross-referenced with National Training Organisation specifications and which all new staff undertake. Not all staff have updated mandatory training, although some progress has been made. This is further discussed in the following section. Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 Page 18 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): 31,35,37,38 A person with the appropriate experience and qualifications manages the home. There are in general safe working practices to protect the residents of the home. Procedures for the management of residents’ monies ensure that financial interests are safeguarded. EVIDENCE: The registered manager has the Registered Managers Award, has been at the home since 1996 and has been the manager for about five years. The registered manager demonstrated a clear understanding of the areas in which the home needed to improve and showing clear leadership and direction so that residents’ needs are delivered in a consistent manner. Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 Page 19 Residents spoke well of her and a relative spoke of how she would stay to help his mother to eat, because there were specific feeding difficulties, until the family arrived. He was impressed with her dedication to the residents and her decision for his mother to return to the home from hospital to spend what were thought to be her final days in her own room and with the carers who knew her. Procedures are in place to manage residents’ money, where they are unable or do not wish, to look after their own money. A transaction took place whilst the inspector was present and money received was recorded and signed for by two members of staff. Records were checked against money kept and were accurate. Procedures are in place to manage residents’ monies and valuables so that their interests are safeguarded. Transactions took place in the presence of the inspector and were seen as appropriate and for records and money totals to tally. Records, including residents’ care plans, are kept in a secure location and those viewed were in good order. The registered provider continues not to send regulation 26 reports following unannounced visits by himself or his representative, and is reminded that this is an offence. The registered manager advised that the appropriate visits are made to the home but copies of the reports must be forwarded to the Commission for Social Care Inspection, to partners in the organisation and the manager of the home. The home was generally free of health and safety risks when visited for this inspection. The laundry and kitchen doors were wedged open and although the registered manager advised that this is only when the rooms are occupied these are high-risk areas with regard to fire. Hold open devices that are inked t the alarm system need to be fitted if these doors need to be kept open. One bedroom door was also wedged open and if this is a resident’s wish a similar device needs to be fitted to their door. A wheelchair used for a resident was without footrests. This is a very dangerous practice as feet or legs can become trapped under the wheelchair and serious injury can be sustained. Although good progress has been made, not all staff have undertaken updated mandatory training. All but one of the care staff have undertaken first aid training, although the cook and domestic staff have not. Food and hygiene training has been taken by all care staff and the cook and all but one care assistant have attended refresher courses this year. Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 Page 20 The domestic assistant and seven care staff have attended training related to Control of substances hazardous to Health (COSHH). This training gives staff the knowledge and skills they need to promote and protect the health, safety and welfare of residents and themselves. Domestic staff and catering staff would benefit from first aid training and domestic staff would also benefit from food hygiene training. All care staff need to have up to date moving and handling training to ensure that correct techniques are used at all times to protect the residents and themselves from injury. The inspector observed poor moving and handling procedures used when first arriving at the home and the procedure has been made obsolete for some time as it is considered unsafe. The majority of care staff have undertaken Moving and Handling training. Three of the care staff have not undertaken this training and only eight of these staff have done since February 2004. Non care staff have not undertaken any lifting training which is recommended if they need to lift any loads, for example in the kitchen, to prevent injury to these staff members. All staff in the home, which needs to include any maintenance personnel, need to undertake Health and Safety training to further protect people living and working at the home. Documentation regarding maintenance and safety checks will be examined at the next inspection. Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x 2 x N/A 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 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 X X X X 3 X STAFFING Standard No Score 27 X 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X X X 3 X 3 2 Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP4 Regulation 18(1) Requirement The Registered Person must demonstrate that the staff have the skills and knowledge to meet any specialised needs of the service users or provide an action plan demonstrating how this will be achieved. The care plans must set out in more detail the action which needs to be taken by care staff to ensure all aspects of the health, personal and social care needs of the service user are met. The Registered Person must ensure that there is a Home remedies policy in place to ensure that the service users’ health needs are met. The registered manager must ensure that food is served in a hygienic manner. Timescale for action 31/12/05 2 OP7 15 (1) Sch 3(1)(b) 31/11/05 3 OP9 12(3) 13(2) 31/11/05 4 OP15OP26 16(2)(j) 15/10/05 Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 Page 23 5 OP28 18(1) The registered persons must 31/12/05 ensure that 50 of the care staff have achieved NVQ Level 2 by 2005. An action plan with timescales as to how this is to be achieved must be forwarded to the Commission for Social Care Inspection in response to this report. The registered persons must 31/12/05 ensure that all staff undertake all mandatory training and this is appropriately updated. The registered provider must ensure that visits are made to the home under Regulation 26 specifications and a copy of the report sent to the Commission for Social Care Inspection. The registered manager must ensure that staff replace all wheelchair footrests unless individual risk assessments suggest otherwise. The registered provider, following consultation with the Fire Authority, must provide devices to hold doors open as required, that do not pose a risk in the event of a fire. 31/10/05 6 OP30 OP38 13,23,16 7 OP37 26 8 OP38 13(4) 31/10/05 9 OP38 23(4) 31/10/05 Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 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 Refer to Standard OP26 Good Practice Recommendations It is recommended that the home’s infection control policy and procedures be developed in line with the Department of Health Guidelines on the Control of Infection in Residential and Nursing Homes. Domestic, maintenance and catering staff should be considered for mandatory training. 2 OP30OP38 Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Clarendon Manor DS0000004310.V252656.R01.S.doc Version 5.0 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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