Inspection on 23/02/07 for Cookham Riverside Nursing Home

This inspection was carried out on 23rd February 2007.

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

Cookham Riverside Nursing Home 13/01/09

Cookham Riverside Nursing Home 05/01/06

Cookham Riverside Nursing Home 16/08/05

Cookham Riverside Nursing Home 09/12/04

Cookham Riverside Nursing Home 29/06/04

Cookham Riverside Nursing Home 16/03/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Cookham Riverside Nursing Home Berries Road Cookham Berkshire SL6 9SD Lead Inspector Julie Willis Unannounced Inspection 23rd February 2007 09:00 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 Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cookham Riverside Nursing Home Address Berries Road Cookham Berkshire SL6 9SD 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) 01628 521249 www.hamiltoncare.com Hamilton House Medical Limited Mary Taylor Clay Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th January 2006 Brief Description of the Service: Cookham Riverside is, as its name suggests, situated on the bank of the river in the Thames-side village of Cookham. The home provides nursing care for up to 35 older people. It was purpose built in the 1970s and lies towards the end of a private road just off Cookham High Street. Many rooms within the home overlook the River Thames, thus enabling residents to enjoy the pleasant river views. To the front of the property is a car park and to the rear a patio area, with well maintained lawns and gardens stretching right down to the river. The gardens have level walkways for residents to enjoy and areas to sit, relax and delight in the constant interest and scenery that this unique riverside setting provides. Cookham has public transport, shops and amenities within walking distance of the home; the larger town of Maidenhead is approximately three miles away. The cost of this service ranges from £825 to £1150 per week. This excludes hairdressing, chiropody and newspapers Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspection took place on Friday 23rd February 2007 between 09:00am and 4:45 pm and covered all the standards for older people. Prior to the visit a questionnaire was sent to the manager along with survey and comment cards for residents, relatives and visiting professionals such as doctors and nurses. Any replies were used to help form judgements about the service. Consideration has also been given to other information that has been provided to the Commission since the last inspection. The inspector toured the building, examined records and met most of the residents and five relatives that were visiting at the time of the inspection. The inspector also spent time talking to staff and observing how care was being delivered to the residents. The inspector gave feedback about her findings to the home’s deputy manager at the end of inspection. There were no outstanding requirements from previous inspections and only one legal requirement was made as a result of this inspection. The Commission has not received any information concerning complaints about this home since the last inspection. What the service does well: The home is clean, homely and pleasantly decorated and furnished throughout. Users are encouraged to personalise their own rooms and these are spacious, have lovely views and are decorated and furnished to a good standard. Service users say that the staff are thoughtful, warm and caring and provide personal care to users with sensitivity and kindness. The staff team is well trained and professional and there is sufficient staff on duty to effectively meet the needs of residents. Recruitment practices are well carried out and the staff files contain all the information needed to ensure the safety of users. Written records are well kept and up-to-date and provide staff with the information they need to provide good quality care. Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 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 Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 Quality in this outcome area is good. Service users are fully assessed prior to admission to ensure that their needs can be met effectively by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From examination of the pre-admission assessment of four service users it is evident that the home gathers as much information as it can before admitting a new resident. Admission will only take place if the management is confident that it can meet the needs of users effectively. Information is gathered from the service user, their relatives, advocates and a range of health and social care professionals that can provide information about the user. The pre-admission assessment is thorough and holistic. Health and personal care needs are sought, along with information about the user’s dietary needs, communication needs, mobility needs, history of falls, continence, medication regime and mental state. Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 Page 9 Service users and their relatives, friends or advocates are always offered an informal visit to the home where they can meet staff and other residents and observe and experience the routines and general ambience of the home. A tour of the home is offered, in order that users may see what services are available and they are shown a choice of rooms (if available). The visit is organised by a member of management or the administrative staff. Service users confirmed that they had been provided with the opportunity to visit the home and experience living at the home for a trial period before making a decision to make their stay permanent. One user told the inspector “I was impressed, the moment I saw it. People are so friendly here. I love it, staff are kind and I particularly like my view across the river”. Another said, “I’ve no regrets. If I can’t be at home this is the next best thing”. Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 Quality in this outcome area is good. Sufficient information is in place to enable staff to effectively meet the health and personal care needs of users. Service users are encouraged to participate in the care planning and review process from the outset. Service users are provided with care in a manner, which maintains their right to dignity, privacy, independence and choice. The system for the administration of medication is good with clear and comprehensive arrangements in place to ensure the safety of users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector examined four care plans and case tracked the users from pre-admission assessment to date. There was evidence that the written records were detailed, comprehensive and well documented. They provided staff with sufficient information to enable them to offer the appropriate level of care to users of the service and to oversee self-care in order to maintain the users’ independence. Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 Page 11 The home reviews care plans monthly and any changes in users’ need was well documented and was responded to appropriately. The plan is working tool and staff are involved in writing the daily report and keeping the care plan up to date. Risk assessments had been routinely undertaken on a range of risks including manual handling, risk of falls and bathing. Clinical tools were being used to assess and monitor tissue viability, nutrition, dependency levels and mental state. Where a risk had been identified there were effective risk reduction measures in place to reduce the likelihood of occurrence. The care plans gave clear instruction on how staff should reduce the risks identified. Staff were observed to be polite and courteous to users at all times. Staff routinely knocked and waited until they were invited in, before entering users’ bedrooms. Observation of care practice concluded that staff were mindful of the need to encourage users to remain as independent as possible by providing appropriate levels of support. Gentle encouragement and persuasion were used to encourage residents to mobilise. The users’ privacy, dignity and autonomy were maintained at all times. Service users confirmed that they were provided with access to health and social care professionals when required. Most users were receiving regular sessions of physiotherapy in order to maintain their health and mobility. Service users confirmed that screening and preventative treatments are offered routinely. Several users confirmed that they had been given a ‘flu vaccination prior to the onset of winter. There was evidence on file that users have regular chiropody treatments, hearing tests and sight tests. From examination of the medication administration system and discussion with staff it is clear that the home follows best practice guidance in relation to the storage, administration and disposal of drugs. Users made various comments to the inspector about the quality of services including, “I see my doctor when I need to” and, “I feel safe because I know they will know when I’m ill and need help”. Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15 Quality in this outcome area is good. Service users are provided with the opportunity to participate in a range of leisure activities suited to their needs. Service users are encouraged to maintain contact with the local community, their friends and relatives. The meals in the home are satisfactory but could be improved to offer users more choice and variety. Special dietary needs can be catered for effectively This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the morning and afternoon of inspection users were sitting chatting to friends, watching TV or reading. The home is currently trying to recruit to the vacant post of activity organiser and so activities are limited at the moment. Service users said that they enjoyed parties and other celebrations and looked forward to more games and quizzes, “When staff have time to organise them”. One user said, “I didn’t come here to be entertained, I like it quiet, I watch the comings and goings on the river and I like to listen to the radio. I wouldn’t want to join in with activities downstairs even if they were on”. Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 Page 13 Service users confirmed that their visitors are made most welcome at any time and are offered appropriate hospitality during their visits. A number of social events are held throughout the year which promotes community involvement and which provide residents’ families with the opportunity to engage with the staff and users on an informal and regular basis. The home’s routines are flexible and can be adapted to meet the needs of individual users. Meals tend to be at set times but alternative arrangements can be made if users request it. Service users can rise and retire at a time of their choosing. The food is considered by service users and their relatives to be of ‘variable quality’. Service users are encouraged to take meals in the dining rooms to aid socialisation. The users were eating lunch of sausage casserole, parsnips, mushrooms, Swede, Brussels sprouts and mashed potatoes or alternatively steamed fish & creamed potatoes were available, followed by apple crumble with whipped cream and custard. One user said that the food wasn’t as good as they would have expected and another said, “It’s OK sometimes”. Tea was cauliflower cheese, mushroom soup with bread & butter followed by rice pudding. There are always alternatives available each day and these can be arranged specially with the cook. A range of special diets can be catered for including soft diets, diabetic and vegetarian meals if required. Generally service users were happy at the home but a number felt that they would like a change in the menu as it appeared to them to be ‘repetitive and predictable’. The Proprietors of the home have already identified that catering is an area of weakness and have taken major steps to address this issue. Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 Quality in this outcome area is good. The home has a satisfactory complaints system. Service users feel that their views are listened to and acted upon. Service users are protected from abuse and exploitation by staff who can demonstrate knowledge of the home’s abuse of vulnerable adults and whistle-blowing policies. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaint policy in the home meets the requirement of Regulation and Standard. Service users are provided with information on how to make a complaint and the stages and timescales for action. Examination of the complaint records indicated that there have been 13 concerns/complaints made to the home since 1st August 2006. The issues recorded were in the main minor concerns that had been easily remedied by management. The details of each concern/complaint were well documented and evidenced outcomes provided to complainants. Service users said that that they felt confident that any concerns or complaints would be taken seriously by the home and efforts would be made to remedy any problems in a timely fashion. Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 Page 15 There was evidence in staff files and from discussion with staff that they receive training in the protection of vulnerable adults as part of their formal induction to the home. Their learning is later consolidated when undertaking NVQ training in which it forms a core module. Staff interviewed understood the importance of protecting users from abuse and exploitation at all times and were conversant with the ‘whistle-blowing’ policy. One service user said, “I know if I ever wanted to make a complaint that I would be listened to”. Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26 Quality in this outcome area is good. The standards of décor and furnishings in this home offer residents a comfortable and homely place to live. Standards of hygiene are good throughout. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users were complimentary about the quality of décor and furnishings in the home. They said that the home was always clean, comfortable and hygienic. They said that the domestic staff always kept the toilets and bathrooms clean and fresh and vacuumed and dusted their rooms regularly. The communal lounges and dining area are pleasantly decorated and furnished in a homely manner. Lighting is domestic in character and bright enough to meet the needs of users with visual impairment. All rooms are centrally heated and the occupants may adjust the thermostats in bedrooms. All rooms, corridors and communal areas are sufficiently lit to provide sufficient light for reading and to provide a safe environment for users. Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 Page 17 Service users said, “I like it here, what a view” and, “In the summer its lovely, you can watch boats on the river”. The gardens look out over the Thames and one user said, “I go out everyday if I can, I like the fresh air and in the nice weather its lovely”. Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29, 30 Quality in this outcome area is good. Staff were able to demonstrate that they have the necessary skills and experience to effectively meet the needs of service users in their care. Staff recruitment procedures are robust and transparent and protect service users from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of the recruitment files for five staff indicated that all necessary checks are undertaken on prospective staff to ensure the safety and protection of service users. Records were well kept and met the required standard. Staff interviewed informally by the inspector appeared to have a good understanding of how their individual role benefits the work of the team and a thorough knowledge of the key values that underpin their work with service users. The staff seemed motivated and caring and clearly knew the needs of individual users well. Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 Page 19 There was evidence that care staff have been properly inducted to Skills for Care Standard and have received training in core skills such as fire safety, first aid, manual handling, food hygiene, health & safety, COSHH and infection control. All staff have received training in POVA (protection of vulnerable adults) as part of their induction and as a core module in NVQ training. All staff at the home are well motivated and have either achieved or are working towards a National Vocational Qualification at Level 2 or 3. All staff receive ongoing support and are formally supervised at least six times a year. They have additional opportunities to air their views and to have a say in the way the home is run in the regular team meetings. Staff said that they felt ‘well-supported’, ‘happy’ and ‘valued’. Service users were very complimentary about the qualities of the staff that they said were ‘friendly’ and ‘attentive and caring’. They made positive comments about the abilities of staff. They told the inspector that staff were ‘friendly’, ’warm’, ‘helpful’, ‘understanding’, ‘kind’ and ‘responsive and well trained’. Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 & 38 Quality in this outcome area is good. Service users benefit from living in a well managed home, where there is evidence that their health, welfare and safety are of primary importance. The registered manager is qualified, competent and experienced to run the home for the benefit of residents. The policies and procedures regarding service user finances safeguard the interests of residents. This judgement has been made using available evidence including a visit to this service. Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 Page 21 EVIDENCE: Staff confirmed that the home’s manager is an effective leader and demonstrates skills and vision. Staff said that the manager is always prepared to talk and listen to staff views and to support individual staff member’s personal and professional development. Staff confirmed that they have the opportunity to express their opinions openly in staff meetings, supervision sessions and staff handovers. They say that they are provided with plenty of opportunity to express concerns, share information and to feel included and involved in the way the service is delivered. Service users are highly complimentary about the management of the home and feel that they are kept well informed of what is going on. Service users say that the office is always open and accessible and the managers always make time to speak with them. Examination of a sample of service user cash accounts indicates that a safe procedure is followed for deposit or withdrawal of residents’ monies. Receipts are kept of all cash spent. Most service users have family members that deal with their financial affairs. Service users confirm that financial matters are dealt with efficiently by the home. Examination of health and safety records indicated that they were up to date and in good order. Routine servicing and maintenance of equipment is undertaken at appropriate intervals to maintain the home as a safe and risk free environment for users. All risks to users are effectively risk assessed and managed. The home has recently surveyed it residents to see if they are satisfied with the quality of services on offer. The home received responses to 17 surveys out of a possible 27 questionnaire sent out. The surveys returned were generally positive about the home; a number of users commented about the food. This was broadly reflected in the surveys returned to the CSCI before the inspection and demonstrates some dissatisfaction with the menu in the home. Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Cookham Riverside Nursing Home DS0000010981.V322254.R01.S.doc Version 5.2 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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