Inspection on 03/10/06 for Court House Retirement Home

This inspection was carried out on 3rd October 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Court House Retirement Home 12/10/07

Court House Retirement Home 21/03/06

Court House Retirement Home 16/06/05

Court House Retirement Home 03/02/05

Court House Retirement Home 10/08/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Court House Retirement Home Church Street Cheddar Somerset BS27 3RA Lead Inspector Alison Philpott Unannounced Inspection 3rd October 2006 09:30 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 Court House Retirement Home DS0000016113.V311077.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. Court House Retirement Home DS0000016113.V311077.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Court House Retirement Home Address Church Street Cheddar Somerset BS27 3RA 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) 01934 742131 01934 742054 Mr Brian Dando MRS PEARL DANDO MRS MARGARET ANNE THOMAS Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Court House Retirement Home DS0000016113.V311077.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21.03.06 Brief Description of the Service: Court House Retirement home is a large Georgian House situated in the heart of the town of Cheddar in Somerset. Accommodation is arranged in three buildings. The main house, which can accommodate 12 service users, The Courtyard is made up of 6 rooms and The Cottage which accommodates 8 service users. The Courtyard and the Cottage are situated in the grounds of the main house. The home is registered with the Commission for Social Care Inspection to provide personal care for up to 29 service users over the age of 65 years. The home is not registered to provide nursing care. The registered providers are Mr B. & Mrs P.Dando. The current fee range is £360 to £460 per week. Court House Retirement Home DS0000016113.V311077.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The previous inspection took place on 21 March 2006. This unannounced key inspection took place over 8 hours on 3 October 2006. Chrysta Moss, the manager was available throughout the inspection. There were twenty three residents living in the home. During the inspection, twelve residents and five members of staff were spoken with. Comment cards were received from six residents, three relatives, the home’s General Practitioner and Community Psychiatric Nurse. The Inspector viewed the home. There was a comfortable and homely atmosphere. Staff were friendly and were observed being kind and caring toward residents. Records viewed included care plans; risk assessments; accidents; medication; staff recruitment & training. The Inspector would like to thank the residents and staff for their involvement and participation in the inspection process. As a result of this inspection the home has four requirements and two recommendations. What the service does well: Residents living in the home are generally very happy with the care and support that they receive. One resident said “..everything is fine and only wish I had come sooner”. All residents spoken to confirmed that their visitors are made to feel welcome at the home. One relative commented “this is a wonderful residential home. My relative is very happy and well cared for”. Residents are offered a choice of menu. The home caters well for residents with special dietary requirements. Staff are friendly and caring. Through discussion staff demonstrated a good knowledge and understanding of resident’s individual needs. Staff respect resident’s privacy and were observed offering support and choices to residents. Court House provides spacious accommodation which is beautifully furnished and well maintained. The walled gardens and patio areas are attractive. The Court House Retirement Home DS0000016113.V311077.R01.S.doc Version 5.2 Page 6 home was clean and provides a homely environment with comfortable furnishings. 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. Court House Retirement Home DS0000016113.V311077.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 Court House Retirement Home DS0000016113.V311077.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6. The quality in this outcome area is good. The home undertakes a pre-admission assessment to ensure it can meet the needs of prospective residents. EVIDENCE: The inspector viewed a comprehensive pre-admission assessment for a new resident. The manager advised that the home’s brochure is sent to prospective residents. The home has a comprehensive statement of purpose. The home encourages prospective residents to visit Court House, prior to admission and spend some time in the home. The home has not introduced intermediate care since the last inspection. Court House Retirement Home DS0000016113.V311077.R01.S.doc Version 5.2 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, 9, 10. The quality in this outcome area is adequate. Care plans contain some good detail but need to provide clear guidance for staff to follow in relation to bathing. Risk assessments are in place but the changing healthcare needs of one resident had not been recorded. Medicines are stored securely. The management of medication procedures protects residents. Staff respect resident’s privacy and dignity. EVIDENCE: The Inspector viewed four of the residents care plans. These were in a printed format and contained some good detail, highlighting individual resident’s preferences. Three of the care plans identified the need for some assistance with bathing or showering. However, there was no detailed guidance for staff to follow in order to meet the resident’s needs or information relating to their Court House Retirement Home DS0000016113.V311077.R01.S.doc Version 5.2 Page 10 preferences. This was discussed with the manager. There was evidence that the care plans were reviewed monthly. Where a risk to a resident was identified, the home had completed a risk assessment. The care plans viewed contained risk assessments relating to manual handling and falls. However, one falls risk assessment stated a resident was ‘low risk’. The assessment was last updated in 2005. The home’s accident records reported that this resident has fallen five times since the previous inspection in March 2006. The changing needs of the resident had not been recorded on the risk assessment. Risk assessments must be updated and action taken as required, to ensure that the risk to the resident is minimised. Through discussion staff demonstrated a good knowledge and understanding of resident’s individual needs. The comments received from residents confirmed that they are happy with the care they are receiving. One resident said “..everything is fine and only wish I had come sooner”. Residents have access to a range of professionals including GP, District Nurse, Dentist, Social Worker, CPN, Optician and Chiropodist. The home’s GP commented that the home provides “a high standard of care. Excellent relationship between staff at the home and surgery”. The CPN confirmed that there is clear communication and partnership working with the home. Medication is stored securely. The home uses a monitored dosage system. Medication Administration Record (MAR) sheets that had been hand transcribed were signed by two members of staff and dated. The MAR sheets were fully completed. Controlled drugs were double locked. The balance of one medicine was checked and found to be correct. Staff spoken with demonstrated a good awareness of how to respect resident’s privacy and dignity. Residents confirmed that they are treated with respect. All residents are offered the choice of having a private telephone line in their bedroom. Court House Retirement Home DS0000016113.V311077.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. The quality in this outcome area is good. The home offers activities for residents. Visitors to the home are made to feel welcome. Residents are generally very happy with the food at the home and the choices available to them. EVIDENCE: The home’s activities include gentle keep fit, a weekly coffee morning and a film afternoon. Communion is held regularly at the home for those residents that wish to participate. One resident was observed helping out in the garden. The Inspector observed warm and friendly interaction between staff and residents. A number of residents commented on the staffs’ kindness. Several residents said that they would like to go on an outing. They confirmed that they were able to raise this at the residents meeting. On the day of the inspection, the home was holding its weekly coffee morning. Seven residents were in the drawing room. The coffee and biscuits were beautifully presented on trays with doilies. Court House Retirement Home DS0000016113.V311077.R01.S.doc Version 5.2 Page 12 Some of the residents spoken with walk to the nearby shops and library. All residents spoken to confirmed that their visitors are made to feel welcome at the home. One relative commented “this is a wonderful residential home. My relative is very happy and well cared for”. The provider advised that visitors are always welcome. Residents’ families and friends are invited to parties and functions. Visitors are invited to stay for meals at no extra cost. The Inspector observed staff offering resident choices at lunchtime and throughout the day. Residents confirmed that they can spend their time as they wish and that they are given choices. Some residents choose to spend time in their own room during the day. Residents were observed listening to the radio and reading the newspaper. Resident’s rooms are very homely and personalised with their own possessions and furniture. The home has a four week menu. The tables in the dining room of the cottage and the main house were laid attractively for lunch. Staff were observed offering residents a glass of sherry or soft drink. There was a relaxed atmosphere. Residents had a choice of beef or quiche with potatoes and a selection of fresh vegetables. The meals looked and smelt appetising. All residents spoken with confirmed that the food is generally very good and there is always a choice of dishes. The cook confirmed that all meals are freshly prepared and food is sourced from local suppliers. One resident who has special dietary requirements confirmed that they are offered alternative dishes. Homemade cakes were available for afternoon tea. Fresh fruit is available in the dining room throughout the day. Court House Retirement Home DS0000016113.V311077.R01.S.doc Version 5.2 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, 18. The quality in this outcome area is good. The home’s has a complaints procedure. Residents are protected from the risk of harm. EVIDENCE: The home’s complaints procedure is referred to in the resident’s contract. The provider advised that the full complaints procedure is included in the service user’s guide. The home had received one complaint since the last inspection. This had been recorded and the provider had resolved the issue. Residents confirmed that they knew who to speak to if they had any concerns. Three staff files were viewed. These all contained evidence of POVA first checks and completed Criminal Record Bureau checks. The members of staff did not commence work until the home had received the POVA first check. The home has policies relating to whistleblowing and abuse. Staff spoken with demonstrated a good awareness of the steps to take if they witnessed or discovered abuse. Court House Retirement Home DS0000016113.V311077.R01.S.doc Version 5.2 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, 26. The quality in this outcome area is good. Court House provides spacious, beautifully maintained accommodation. The home has systems in place to control the spread of infection. EVIDENCE: The inspector viewed the home’s communal areas, and spent time chatting with residents in their bedrooms in the cottage, courtyard and main house. Court House is a Georgian property. The drawing room and dining room are spacious and are beautifully furnished and maintained. Fresh flower arrangements were on display in the home. The walled gardens and patio areas are well maintained and attractive. The home has widened the footpath in the garden to improve access for all residents. Seating areas are provided and residents confirmed that they enjoy spending time in the garden. The home is centrally located in Cheddar near to shops, amenities and the library. Court House Retirement Home DS0000016113.V311077.R01.S.doc Version 5.2 Page 15 When a bedroom becomes vacant, the room is redecorated and new carpets are fitted prior to a new resident moving in. The inspector viewed a room that had been recently completed. The room was decorated to a high standard, light, airy and spacious. New residents are able to furnish their bedroom with their own furniture. The home was cleaned to a high standard throughout. Aprons and gloves were available for staff. Liquid soap and hand towels were provided. Court House Retirement Home DS0000016113.V311077.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. The quality in this outcome area relating to staffing levels and recruitment is good. However, the quality in relation to staff training is poor. The overall quality in this outcome area is adequate. The home appeared to have sufficient staff on duty to meet resident’s needs. Staff recruitment procedures are robust and protect residents. All staff are clear regarding their role and what is expected of them. Residents report that staff working with them know what they are meant to do, and that they are able to meet their needs. Staff training provided is very limited, with areas not being identified and not targeted at relevant individuals. EVIDENCE: The inspector viewed the rotas. There were sufficient staff on duty during the inspection to ensure that resident’s needs were met. The home employs four care staff in the morning; three care staff in the afternoon; two care staff in the evening; one waking and one sleeping care staff at night. Residents confirmed that staff are available when assistance is required. New staff had been recruited since the last inspection. Three staff files were viewed. One file included all of the required documentation listed in Schedule 2 of the Care Homes Regulations 2001. The other two files contained all of the Court House Retirement Home DS0000016113.V311077.R01.S.doc Version 5.2 Page 17 required documentation except for a recent photograph of the member of staff. The home must ensure that a photograph is placed on the staff files, as proof of the person’s identity. The home has a comprehensive induction programme. New staff shadow more experienced staff and observations are undertaken. The home has a training matrix. The training areas include moving and handling; first aid; food hygiene; infection control and health & safety. However, a number of staff have not received training in these areas within the last twelve months. Three members of staff had recently undertaken first aid training and some staff had undertaken oral health training. The home must ensure that staff receive mandatory training annually so that they are equipped to meet the needs of service users and keep up to date with current and best practice. The home should ensure that staff sign off the areas they are trained in to evidence that they have completed the training. Some staff had completed fire training in April and June 2006. Other members of staff had not completed fire training since 2005. The home must ensure that all staff undertake fire training at least once or twice a year. 24 of the care staff have obtained an NVQ at level 2 or above. One member of staff is currently undertaking an NVQ. The home did not have an NVQ training programme detailing how it plans to achieve the minimum ratio of 50 trained members of care staff. The inspector discussed training requirements and possible sources of training with the manager. Despite the lack of formal training, staff spoken with demonstrated a good knowledge of residents’ needs. Residents comments were generally positive and confirmed that staff are very kind and that staff knew how to meet their needs. Court House Retirement Home DS0000016113.V311077.R01.S.doc Version 5.2 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, 33, 35, 38. The quality in this outcome area is good. The home seeks the views of residents. The health, safety and welfare of residents and staff are generally promoted and protected. EVIDENCE: Chrysta Moss, the acting manager was available and assisted at the inspection. Standard 31 was not fully assessed at this inspection. The home’s management arrangements will be reviewed in more detail at the next inspection. The home held a residents’ meeting in August 2006. The inspector viewed the minutes of the meeting. The minutes detailed the issues discussed and the Court House Retirement Home DS0000016113.V311077.R01.S.doc Version 5.2 Page 19 action taken or being taken. Residents spoken with confirmed that they had attended meetings and enjoyed being involved in the running of the home. The provider confirmed that they had recently distributed a survey to residents. The home should now further develop its quality assurance systems to measure its success in meeting its aims, objectives and statement of purpose. The home should seek feedback at least annually from family and friends and stakeholders in the community through the use of a survey to seek views on how the home is achieving goals for residents. The inspector viewed the home’s health and safety records. The fire alarm system is tested weekly. The manager sounded the alarm system in the main house during the inspection. Emergency lights are tested monthly. The fire alarm system was last serviced on 13.10.05. A fire door in the corridor of the main house was held back by a large stone which potentially places residents and staff at risk in the event of a fire. The provider advised that since the inspection the home has fitted a self-closing mechanism to minimise the risk of harm. The gas safety certificate was issued on 08.06.06 and the electrical safety is due to be checked during October 2006. Portable appliance testing was carried out in February 2006. Boilers were serviced on 26.05.06. Hot water temperatures were last checked in September 2006 and were close to 43 degrees Celsius. The kitchen was clean and tidy. Fridge and freezer temperatures are checked and recorded daily. Food is temperature probed before serving and records are maintained. The home ensures the grounds to the home are made more secure by locking the gates at night. The home does not keep a record of visitors to the home. The home must implement a system that records all visitors to the home in order to protect residents, staff and visitors welfare and security. The home must ensure that staff received training in all safe working practice topics (see Standard 30) in order to protect the health, safety and welfare of residents and staff. There had been twenty eight accidents since the last inspection. These were fully documented. The home’s accident book complies with the Data Protection Act 1998. One resident had fallen five times since March 2006 but their falls risk assessment had not been reviewed or updated (see Standard 7). The home should audit accidents so that it can identify trends and take action where necessary to minimise the risk of harm. Court House Retirement Home DS0000016113.V311077.R01.S.doc Version 5.2 Page 20 Cleaning chemicals were stored securely in locked cupboards. Control of substances hazardous to health (COSHH) sheets were available for the products used within the home. Court House Retirement Home DS0000016113.V311077.R01.S.doc Version 5.2 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 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 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score N/A X 3 X N/A X X 3 Court House Retirement Home DS0000016113.V311077.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15(1) • Requirement Timescale for action 03/01/07 2. 3. OP29 OP30 19(1)(b) (i) 18(1)(a) 18(1)(c) 23(4)(d) 17(2) Schedule 4 - 17. 4. OP38 The registered person must ensure that individual care plans are fully reflective of assessed needs, personalised and that instructions for staff are clearly documented. (This timescale has been previously unmet.) • Individual risk assessments must be updated when the residents needs change and action taken as required, to ensure that the risk to the resident is minimised. A photograph must be placed on 30/11/06 staff files as proof of the person’s identity. The home must ensure that staff 03/01/07 receive mandatory training annually so that they are updated and equipped to meet the needs of service users. The home must implement a 03/01/07 system that records all visitors to the home in order to protect residents, staff and visitors DS0000016113.V311077.R01.S.doc Version 5.2 Court House Retirement Home Page 23 welfare and security. 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 OP33 Good Practice Recommendations The home should seek feedback at least annually from family, friends and stakeholders in the community through the use of a survey to seek views on how the home is achieving goals for residents. The home should audit accidents so that it can identify trends and take action where necessary to minimise the risk of harm. 2. OP38 Court House Retirement Home DS0000016113.V311077.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Court House Retirement Home DS0000016113.V311077.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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