Inspection on 19/12/05 for Cole Valley Nursing Home

This inspection was carried out on 19th December 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cole Valley Nursing Home 22/10/08

Cole Valley Nursing Home 02/10/07

Cole Valley Nursing Home 16/10/06

Cole Valley Nursing Home 16/05/06

Cole Valley Nursing Home 28/06/05

Cole Valley Nursing Home 25/11/04

Cole Valley Nursing Home 09/06/04

Cole Valley Nursing Home 27/01/04

Cole Valley Nursing Home 20/08/03

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Inspirations

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

CARE HOMES FOR OLDER PEOPLE Cole Valley Nursing Home 326 Haunch Lane Kings Heath Birmingham West Midlands B13 0PN Lead Inspector Yvonne Reay Unannounced Inspection 19th December 2005 11:30 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 Cole Valley Nursing Home DS0000024835.V266358.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. Cole Valley Nursing Home DS0000024835.V266358.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cole Valley Nursing Home Address 326 Haunch Lane Kings Heath Birmingham West Midlands B13 0PN 0121 444 8887 0121 441 1959 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) Cole Valley Care Limited (Mr Kapil Rajja) Care Home 45 Category(ies) of Dementia - over 65 years of age (45), Old age, registration, with number not falling within any other category (45) of places Cole Valley Nursing Home DS0000024835.V266358.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 45 males and females over the age of 50 years for general nursing care. 28th June 2005 Date of last inspection Brief Description of the Service: Cole Valley Nursing Home is a purpose built 45 bedded home on two levels, with a passenger lift for access to the first-floor. The Home is located within the Kings Heath district of Birmingham, and is situated in a residential neighbourhood close to local amenities including shops and public transport. The Home is pleasantly furnished and decorated and aims to offer a warm, homely environment for elderly people requiring nursing care. There is a small car park adjacent to the Home and sheltered, private gardens for service users and their visitors. Cole Valley Nursing Home DS0000024835.V266358.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection was carried out over one day and the Manager was present throughout the process. At the time of writing this report she is scheduled to undertake the CSCI Fit Persons assessment. There were 44 residents in the Home during the inspection and one resident was in hospital. Three care plans were examined and the Inspector spoke with three visitors to the Home, and six residents. Information was also gathered by observing staff performing their duties and informal discussions. Ongoing discussions throughout the inspection process took place with the Manager. Two staff personnel files were examined. A partial tour of the premises was carried out and the rooms were inspected for those resident whose care was looked at in detail. Requirements made following the last Inspection in June 2005 were assessed for compliance. What the service does well: What has improved since the last inspection? The Manager provided records, which showed that the required mandatory training had been delivered to most staff and there was an ongoing programme of training planned. Cole Valley Nursing Home DS0000024835.V266358.R01.S.doc Version 5.0 Page 6 The record keeping in relation to recruitment had improved however further development is still required to ensure the ongoing protection of Service Users. Of those care files examined all had comprehensive pre admission assessments in place. This had been a requirement from the last inspection, which had been addressed. 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. Cole Valley Nursing Home DS0000024835.V266358.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 Cole Valley Nursing Home DS0000024835.V266358.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): 3, 4, 5 The information gathered prior to admission of residents is sufficient to adequately assess needs. EVIDENCE: On the three care files inspected adequate records were in place to support a full pre admission assessment having been undertaken. The relatives and friends of prospective residents have an opportunity to visit the Home prior to admission, and all residents are offered a trial period of 12 weeks which may be cancelled by either party. One resident who was suffering from Dementia had sustained a significant number of falls over a short period of time. The Manager informed the Inspector that her condition had recently rapidly deteriorated. An urgent review must be arranged to assess whether the Home can continue to meet this residents needs. Cole Valley Nursing Home DS0000024835.V266358.R01.S.doc Version 5.0 Page 9 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, 10 The standard of care plans was variable and did not consistently reflect residents current care needs. Residents appeared to be mostly satisfied with the care provided by the Home. EVIDENCE: One relative spoken to did not have any problems with the care given to his wife and stated that the carers were kind. Another relative spoken to stated that her mother seemed quite happy at the Home and some of the staff are very good to her mother. On the day of the visit staff were observed to address residents with respect however one Service User, who had only been at the Home for a few months, said ‘It was OK at the Home except she felt one member of staff did not communicate well and just did the job without much feeling for her as an individual’. This was discussed at length with the Manager who is to carry out an investigation onto the matter and take any action required to ensure a satisfactory outcome for the resident. She then went on to say that ‘The food is OK and I get choices’. Cole Valley Nursing Home DS0000024835.V266358.R01.S.doc Version 5.0 Page 10 Other comments from residents included: ‘It’s quite Ok here and most of the carers are Ok too, just one or two who just do the job and do not communicate well enough’ ‘The Manageress is good’ ‘The girls are good and they do look after you-they made me cheese on toast for tea as a treat’ ‘We had a lovely sing song yesterday’ ‘The staff are good to me, I have no complaints and there is plenty of food here’ ‘All is well for me and I have no complaints’. Records demonstrated that residents have access to GP’s and other Health Professionals as and when required. Care plans were in place and those inspected were of a variable standard. For example: One resident who had been diagnosed with Bi-Polar Disorder did not have a care plan in place for the management of this condition. On admission it was recorded that she must have regular social interaction as a goal but there was no detail of this in her plan as to how it may be achieved. For one resident, who was being nursed in bed the appropriate care was being delivered however the care plan and risk assessment for her Manual Handling needs had not been updated to reflect her current care needs. There did not appear to be a ‘turn chart’ in her room so staff coming on duty did not know which side to turn her on to equally minimise any pressure damage. Nutritional assessments are carried out. One resident had been assessed as at risk and had lost weight. Measures had initially been put into place to monitor the situation, however the monitoring had stopped and there did not appear to be a sufficient increase in her weight to justify the cessation of this monitoring. For those resident who were a low weight and clearly at risk the records did not demonstrate in sufficient detail whether the diet was adequate. The wound care file was looked at and initially presented some cause for concern, as there appeared to be 20 residents with some type of wound/pressure sore. However on closer scrutiny not all were pressure sores, some were skin tears and some old pressure sores which had healed and had a protective dressing secured over the area. Of those wounds that were pressure sores 7 had been obtained whilst in the Home and six whilst in hospital. It must be noted however that none of the sores appeared to be significant enough to raise concerns about the Home’s treatment and dressing regimes. The Home also has a number of very frail and very elderly residents. Cole Valley Nursing Home DS0000024835.V266358.R01.S.doc Version 5.0 Page 11 Appropriate treatment appeared to be in place for these wounds/sores however attention is required to the recording. In some instances it was not easy to determine the exact condition of the sore in particular the size and grade, which entry referred to which sore. In addition some wounds had healed but the photographs remained in the file. It was not clear if the Home had sought the recent advice of the Tissue Viability Nurse. Residents weights are done monthly where there are no concerns and records are kept. It was suggested these records be streamlined to make it easier to track a residents weight gain or loss and a weekly weight sheet be introduced for use when required. The quality of some of the paperwork in the Home was poor. Records had been photocopied numerous times and the typed wording was very faint. Cole Valley Nursing Home DS0000024835.V266358.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 Overall, the current limited range of activities offered does not fully meet the resident’s needs, expectations or abilities. EVIDENCE: The Home does not have a formal programme of activities in place and there has been no success in the recruitment of an activities co coordinator. There is some organised entertainment, which is provided from time to time, and there was a Christmas Programme planned. Records are not kept of any activities participated in by residents. The staff need to focus on the individual’s social needs, wishes and preferences on admission to the Home, which should be recorded in the care plan, perhaps involving care staff in the process. To demonstrate the daily social interaction with residents, which the Inspector was informed, takes place it was suggested that for each resident care staff keep a daily/weekly diary of activities participated in. Cole Valley Nursing Home DS0000024835.V266358.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Service Users can be confident that their complaints will be listened to, taken seriously and acted upon. However the record keeping in relation to the investigation must be improved and include full details of the investigation process to support outcomes and subsequent action taken. EVIDENCE: The Home had received a complaint in October 2005.An allegation of verbal abuse had been made by a relative about a member of staff. The Manager had reported this appropriately to all agencies and advice from Social Care and Health suggested she carry out an internal investigation. The Manager had not recorded this conversation therefore it was not possible to verify this. However an investigation was carried out and outcomes sent to the complainant by letter. The member of staff was dismissed and records show that a disciplinary hearing was held. The record keeping however did not demonstrate a full investigation of all the matters raised in the original letter of complaint. Cole Valley Nursing Home DS0000024835.V266358.R01.S.doc Version 5.0 Page 14 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, 23, 26 The overall quality of the furnishings and fittings in the Home is of an acceptable standard and provides residents with a comfortable home to live in. EVIDENCE: Cole Valley Nursing Home is purpose-built and provides accommodation on two floors with a passenger lift for access to the first-floor. There are three separate lounge areas and a dining room and the areas of the Home seen at this inspection appeared to be clean, warm and odour control was good. Communal areas had been tastefully decorated for Christmas. The rooms seen for those residents whose care was looked at in detail contained equipment necessary to meet their assessed needs and were clean, warm and fit for purpose. En suites were clean and tidy with little or no odour. Cole Valley Nursing Home DS0000024835.V266358.R01.S.doc Version 5.0 Page 15 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): 29, 30 The process for the recruitment of staff was mostly sufficient to ensure the protection of residents however further development is still required in some areas. Staff are provided with Mandatory training however records do not demonstrate that a full Induction is carried out for all new staff. EVIDENCE: The staff files inspected were mostly of satisfactory standard and contained sufficient information to establish the authenticity of the applicant. There were however some areas for improvement for example: On both files there was no record of interview; On one file there was no evidence of the applicants right to work in the UK. The Manager informed the Inspector that she had seen this document however had not kept a copy on file; The file for a trained nurse did not contain any original certificates of qualification however confirmation of current registration with the NMC had been verified; One file had only one written reference. It was suggested the Home requests confirmation of vaccination status for all new staff and that the application form be developed further to allow the applicant to record in detail their previous work history. Training records showed that staff mostly receive the required Mandatory training. Individual records were in place along with a training matrix giving an overview of training both delivered and planned. Cole Valley Nursing Home DS0000024835.V266358.R01.S.doc Version 5.0 Page 16 The Inspector was informed that all new staff receive a full Induction programme however beyond an initial one-day induction records do not appear to be maintained. There are no Induction workbooks in place to show when competencies have been achieved or at what stage any member of staff is at in their Induction. The Home needs to implement an Induction programme in line with ‘Skills for Care’ standards and records must be kept. Cole Valley Nursing Home DS0000024835.V266358.R01.S.doc Version 5.0 Page 17 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, 38 Residents live in a Home, which is run and managed by a person who appears to be able to discharge her responsibilities fully. There were no significant Health and Safety matters identified during this visit however a full tour of the premises was not conducted. EVIDENCE: The Manager is an experienced qualified nurse and has worked in the care home environment for several years however this is her first Management post. She is currently undertaking the Registered Manager’s Award and at the time of writing this report is scheduled to undertake the CSCI Fit Person’s assessment. The maintenance records were not inspected on this occasion as this had been undertaken at the last Inspection. Cole Valley Nursing Home DS0000024835.V266358.R01.S.doc Version 5.0 Page 18 Fire drills are being carried out and recorded however the Manager needs to ensure she captures all staff currently working at the Home to ensure they all have a fire drill at least every six months. There was evidence of recent fire training for some staff and the attendee list was seen. The Regulation 26 report seen on the day of the Inspection indicated that automatic fire door closures have now been fitted on 16 doors with the remainder or be fitted on a phased in basis. This was a requirement from the last Inspection. A record is kept of every accident, which happens in the Home. These records were seen and whilst it did appear that quite a high number of residents had sustained skin tears, the Home currently has a number of residents who are very frail with skin, which appears very fragile. However the Manager must ensure she regularly audits these records to identify any trends in falls or accidents, which happen to residents. This can then inform any future management of residents with a history of falls with the purpose of preventing or minimising any further and possible unnecessary trauma. This also may include regular observations of staff when transferring residents using equipment. Cole Valley Nursing Home DS0000024835.V266358.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 3 X X X 3 X X 3 STAFFING Standard No Score 27 X 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X X 2 Cole Valley Nursing Home DS0000024835.V266358.R01.S.doc Version 5.0 Page 20 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 OP4 Regulation Requirement Timescale for action 16/01/06 2 OP7 3 OP7 4 OP8 5 OP8 14(2)(a,b) The Registered Person shall ensure an urgent review is carried out for the service user identified who has Dementia, to assess whether the Home can continue to meet this residents needs. 15(1)(2) The Registered Person must (b) ensure care plans and risk assessments are regularly updated to reflect the changing care needs of the service users and current objectives for health and personal care. (Previous timescale 19/07/05) 15(1)(2) The Registered Person shall (b) ensure the care plans and risk assessments for the resident SL are fully updated to reflect her current care needs. 17(1)(a) The Registered Person shall Sch3 ensure the resident LF has close (3)m monitoring of her weight and nutritional intake until her weight stabilises. 17(2) The Registered Person shall Sch4 ensure records are kept of food (3)(m) provided for service users (who are at risk nutritionally) in DS0000024835.V266358.R01.S.doc 31/01/06 26/12/05 20/12/05 31/12/05 Cole Valley Nursing Home Version 5.0 Page 21 6 OP8 17(2) Sch4 (3)n 7 OP10 12(1)(a) 12(4)(a) 8 OP12 16(2)(n) 9 OP16 22(3) 17(2) Sch4(11) 7 9 19 Sch2 10 OP29 11 OP30 18(1)(c) (i) 12 OP31 9 sufficient detail to enable any person inspecting these records to determine whether the diet is satisfactory. The Registered Person shall ensure the records in place in relation to the incidence of pressure sores clearly reflect the condition and progress of each wound/sore. The Registered Person shall ensure staff are instructed at induction and through the supervision programme how to treat Service Users with respect at all times. The Registered Person shall ensure that Service Users have the opportunity to exercise choice in relation to leisure and social activities. Service Users interests are to be recorded and they are given opportunities for stimulation suited to their preferences and capabilities. (Previous timescale 18/09/05) The Registered Person shall ensure that the record of complaints includes details of the investigation findings and any action taken. The Registered Person shall ensure all new staff are confirmed in post only after all the appropriate checks have been undertaken as detailed in Schedule 2 Care Homes Regulations 2001. (Previous timescale 18/07/05) The Registered Person shall implement induction training for all new staff in line with Skills for Care standards and records must be kept. (Previous timescale 18/10/05) The Manager must achieve a recognised management qualification. The completion DS0000024835.V266358.R01.S.doc 31/01/06 20/12/05 28/02/06 31/01/06 31/01/06 28/02/06 19/12/06 Cole Valley Nursing Home Version 5.0 Page 22 13 OP38 14 OP38 15 OP9 16 OP9 17 OP33 date to be agreed with the CSCI. The Registered Person shall ensure all staff currently employed at the Home receive a fire drill at least twice a year. 12(1)(a) The Manager must ensure she 13(4)(c) regularly audits the accident record in order to identify any trends in falls/accidents. 13(2) All nursing staff must receive training to develop their knowledge in the indications, adverse effects, cautions and drug interactions of medicines. (This requirement was not inspected on this occasion and has been brought forward) 13(2) Medication reviews must be sought on a regular basis for all Service Users in line with the NSFOP. (This requirement was not inspected on this occasion and has been brought forward) 24(1)(a,b) The Acting Manager must ensure that all accidents and incidents that occur that affect the health and well being of residents are notified to the Commission without delay. (This requirement was not inspected on this occasion and has been brought forward) 23(4)(e) 28/02/06 31/01/06 18/08/05 18/08/05 08/10/05 Cole Valley Nursing Home DS0000024835.V266358.R01.S.doc Version 5.0 Page 23 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 Refer to Standard OP8OP37 OP37 OP12 OP37 OP29 Good Practice Recommendations Weight records are streamlined to make it easier to track a residents weight gain or loss and a weekly weight sheet be introduced. The quality of the Home’s pre printed paperwork to be improved. To demonstrate the daily social interaction with residents which the Inspector was informed takes place it was suggested that for each resident care staff keep a daily/weekly diary of activities participated in. It was suggested the Home requests confirmation of vaccination status for all new staff and that the application form be developed further to allow the applicant to record in detail their work history. 4 Cole Valley Nursing Home DS0000024835.V266358.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Cole Valley Nursing Home DS0000024835.V266358.R01.S.doc Version 5.0 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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