Inspection on 13/02/07 for Ennerdale Nursing & Residential Home

This inspection was carried out on 13th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ennerdale Nursing & Residential... 31/07/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Ennerdale Nursing & Residential Home Longmoor Lane Fazakerley Liiverpool Merseyside L9 7JU Lead Inspector Les Smith Unannounced Inspection 13th February 2007 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 Ennerdale Nursing & Residential Home DS0000069159.V329369.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. Ennerdale Nursing & Residential Home DS0000069159.V329369.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ennerdale Nursing & Residential Home Address Longmoor Lane Fazakerley Liiverpool Merseyside L9 7JU 0151 530 1457 0151 524 3160 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) ANS Homes Limited Care Home 61 Category(ies) of Dementia - over 65 years of age (13), Old age, registration, with number not falling within any other category (48) of places Ennerdale Nursing & Residential Home DS0000069159.V329369.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Up to 24 of the 61 beds can be used for Intermediate Care, 3 of which can be used for service users of 60 years old and over. Old age, not falling into any other category (48) Up to 5 persons under the age of 65 years can be accommodated. Date of last inspection Brief Description of the Service: Ennerdale stands in the grounds of University Hospital Aintree (Fazakerley Hospital site) but is an independent care home, owned by a national company, BUPA Ltd. It is a large two-storey building with its own gardens and there is car parking at the front of the home. The home consists of three units. It provides personal care for 13 older people with dementia in a separate unit on the ground floor. A further unit on the ground floor is used to provide intermediate care for up to 14 older people and the first floor is nursing care unit for 34 older people, of which 10 beds can be spot purchased by the PCT to provide intermediate care. All bedrooms are for single occupancy and each unit has its own lounge and dining facilities. Fees at the home are in the range £385 to £397 depending upon the category of service required. The home is not far from rail and bus routes to Liverpool city centre, shops and other community facilities. These are not however within easy walking distance for most older people. Ennerdale Nursing & Residential Home DS0000069159.V329369.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day for a total of 6 hours. A full tour of the premises took place in the company of the manager and records such as care plans, staff personnel files and policies and procedures were also examined. A number of staff, relatives and residents were spoken to during the course of this inspection. Comments from relatives were unanimous in their view that the home has seen substantial improvements in the previous year and that there was a continuing improvement. Comments included ‘everything is great, it has improved a great deal’, ‘I was given all the right documents and everything was explained, I couldn’t fault the home’. What the service does well: 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. Ennerdale Nursing & Residential Home DS0000069159.V329369.R01.S.doc Version 5.2 Page 6 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 Ennerdale Nursing & Residential Home DS0000069159.V329369.R01.S.doc Version 5.2 Page 7 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): 1,2,3,4,5,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have sufficient information to make an informed decision on where they wish to live and can be confident that their needs will be assessed prior to accepting a place at the home. EVIDENCE: Both the Statement and Purpose and Service User Guide have recently been reviewed and updated. The home has distributed copies to all residents and their representatives where appropriate and copies are made available in the reception area and all rooms. Residents files were examined (excluding residents in the intermediate care unit) and were seen to have a copy of a contract or Statement of Terms and Conditions. There is a mechanism in place to ensure that contracts are received back at the home after being sent out for signature. Intermediate care is provided under a contract with the Primary care trust. Intermediate care residents may be admitted from home or hospital and may at times be admitted as an emergency. Ennerdale Nursing & Residential Home DS0000069159.V329369.R01.S.doc Version 5.2 Page 8 All residents have their care needs assessed prior to admission by the manager or appropriately qualified member of the nursing staff. Pre-admission assessments seen were not always completed to a sufficient level of detail that enabled the construction of an initial robust care plan. The organisation has introduced new documentation that will allow for comprehensive pre-admission assessments if completed correctly. The home has a comprehensive range of specialist equipment such as assisted baths, shower rooms, hoists and slings and a lift available to promote independence. Intermediate care residents benefit from a fully equipped life skills kitchen which is used every day. Training for staff has included specialist areas such as wound care, dementia and protection of the vulnerable adult. This specialist training must be continued to include all staff e.g. all staff including ancillary staff should have training in protection of the vulnerable adult. Prospective residents and their representatives are encouraged to visit the home at any time for as long and as often as they wish. Residents admitted to the intermediate care unit usually stay for a period of between one and six weeks and there is a clear focus and input in maximising independence and facilitating a speedy return home. Ennerdale Nursing & Residential Home DS0000069159.V329369.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning process is comprehensive but lacks the consistency required to fully support residents health and welfare. Medication management meets statutory requirements and residents are treated with respect with the right to privacy upheld at all times. EVIDENCE: A range of care plans and associated documentation was examined on the day of inspection. These included residents with varying levels of dependency and disability. The introduction of the ‘Quest’ care planning documentation is a substantial improvement over the previous system. Care files were reviewed for residents in all three units at the home in both the old and new formats. In all cases risk assessments were seen to be inaccurate. Two examples were seen of Waterlow assessments with omissions creating low risk scores when the residents were in fact at very high risk of developing pressure area problems. Similar problems were evident in falls and manual handling risk assessments. Ennerdale Nursing & Residential Home DS0000069159.V329369.R01.S.doc Version 5.2 Page 10 The promotion of independence invariably involves an element of risk, which is managed via the completion of relevant risk assessments but errors in the assessments inevitably place residents at risk. Care plans were seen to be present in the care files examined and included plans for all identified problems in relation to the activities of daily living with regular evaluations having been carried out. The standard of evaluations has improved with a good level of detail. Changes required in the care required as identified in the evaluations were not always reflected in the care plan. Daily reports were also much improved but examples were seen in the intermediate care unit were daily reports had not been written and this was addressed by the acting manager on the day of this visit. Several care files were also examined in the new format. It is a concern that it was evident in all units that the transfer of information had not addressed the errors seen in the old files. Discussions with the manager showed a good awareness of this problem and plans were seen for ongoing audits of care files with a minimum of 10 per month being reviewed by senior management. Evidence was seen that referrals to GPs, specialist nurses and therapists were made in a timely and effective manner with recommendations made acted upon. Medication management has improved in all areas. Examination of the MAR (Medication Administration Record) sheets showed that the number of gaps in signatures is now minimal and procedures are in place to identify any individuals responsible and take appropriate action. On the nursing unit one record was seen were application of the prescribed cream had been changed from twice daily to ‘as and when required’. There was no supporting authorisation for this change and the home is reminded that only an appropriate prescriber can change a prescription. It is strongly recommended that handwritten transcriptions are witnessed by a second person in order to meet best practice guidelines. Appropriate storage cupboards and trolleys were available within dedicated medication rooms and there was no evidence of excessive stocks. Staff members were observed interacting with the residents in a manner that respected their dignity and always addressed residents appropriately. Residents were all dressed appropriately in their own clothes and all personal care was always be carried out in private. Members of the care staff have recently attended appropriate training in relation to bereavement and policies and procedures are in place that promotes care, sensitivity and respect. Ennerdale Nursing & Residential Home DS0000069159.V329369.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. As far as possible residents have choice and flexibility in how they spend their day in the home, and participate in leisure and recreational activities according to their choice and preferences thereby promoting independence and individuality for each resident. Meals at Ennerdale are good, offering choice and variety whilst catering for residents’ dietary needs or cultural preferences EVIDENCE: There is no activities co-ordinator in post at present but the home is actively recruiting a full time replacement. The range of activities is good with visiting entertainers supplementing the in-house activies. Group activities have included trips out to the theatre and local pubs. These activities are instrumental in maintaining the residents links with the community and are particularly enjoyed by the residents. Individual activities include pampering, craft work and one to one reminiscing. The previous activities co-ordinator started developing life style histories for all long term residents and establishing personal preferences and this will be continued when a repacement is in post. The home also has themed days such as Valentines day and residents birthdays are always celebrated with a party. Ennerdale Nursing & Residential Home DS0000069159.V329369.R01.S.doc Version 5.2 Page 12 The home receives regular weekly visits from members of the clergy who see residents on an individual basis. It would be beneficial for the residents if the possibility of a periodic service held at the home could be explored which would help promote a more inclusive provision of spiritual care. Visitors are welcome at the home at any time and evidence of this was seen with visitors arriving at the home throughout the day. Residents may see their visitors in their own room or in one of the communal ares as they wish. The opportunity for making decisions and exercising choice in many aspects of daily life is limited for the residents assessed as having impaired cognitive ability but staff are encouraged to promote choice wherever possible e.g. choosing a set of clothes for the day. Daily routines are as flexible as possible and autonomy is encouraged and assisted whenever possible. Meals at ennerdale are good. Residents made comments of excellent, lovely home cooking just as I like it. The menus show a good variety of dishes with a range of alternatives and fresh fruit always available. The home has recently introduced a ‘nite bite’ service were residents can order a variety of light snacks for supper. Ennerdale Nursing & Residential Home DS0000069159.V329369.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their families may be certain that complaints are taken seriously and protection of residents from abuse is in place. EVIDENCE: The complaints process is robust with a comprehensive complaints register and continuous monitoring of complaints by senior management. The provider organisation has a comrehensive complaints procedure that allows for escalation of complaints to the highest level if required. Complaints made directly to the home have all been dealt with in a timely and effective manner. There has been a marked reduction in the number of complaints made since the last inspection and this is a reflection on the general improvement in all aspects throughout the home. All residents are registered on the electoral roll and assistance is provided if required if a resident wishes to exercise their vote. A comprehensive training programme has been commenced and 33 of staff members have received appropriate training in adult abuse, its recognition and the procedures to follow should any form of abuse be alleged or suspected. The home is required to ensure that all staff receive this training. The acting manager stated that two members of staff are being trained as trainers and all staff would be fully trained in the near future. Ennerdale Nursing & Residential Home DS0000069159.V329369.R01.S.doc Version 5.2 Page 14 The home has appropriate policies and procedures in place including the relevant copies of the Liverpool and Knowsley inter agency adult protection procedures. Ennerdale Nursing & Residential Home DS0000069159.V329369.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The major redecoration and refurbishment programme currently in progress has made substantial improvements and Ennerdale is now a homely, comfortable and safe environment for residents. EVIDENCE: During a tour of the home it was evident that a major redecoration and refurbishment programme was in progress. A substantial amount of furniture has been replaced including all the dining room tables and chairs. On the nursing unit all 42 beds have been replaced with new profiling beds. Bathrooms were seen to be clean and absent of any toiletries. Work is commencing on conversion of a bathroom into a walkin shower and plans are in place for a designated and separate smoking area to meet the requirements of new legislation later this year. Ennerdale Nursing & Residential Home DS0000069159.V329369.R01.S.doc Version 5.2 Page 16 The stairs leading into the Dale unit remain secured by metal barred gates and these whilst ensuring safety do little for the aesthetic appearance and should be replaced by a more homely arrangement. An good maintenance service was demonstrated by the lack of minor problems seen. The external grounds are now in good order and residents will benefit from being able to make use of the garden area in the warmer weather. The work being undertaken at Ennerdale is extensive and includes building work with its associated disruption. It is clearly evident that the organisation is committed to providing an environment for residents that supports and promotes a quality lifestyle. The laundry was found to be tidy and well organised as was the kitchen Ennerdale Nursing & Residential Home DS0000069159.V329369.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are employed and deployed in sufficient numbers and skill mix to meet the assessed needs of the residents and recruitment policies are in place to promote the protection and safety of residents. EVIDENCE: The three units at Ennerdale are staffed seperately and each appears to have sufficient staff in an appropriate skill mix to meet the assessed needs of the residents. The use of agency staff has been reduced significantly from an average of 72 hours per week to 26. The week prior to this visit the use of agency was 0. The home does not currently meet the 50 target of NVQ2 qualified care staff with only 44 . However, there are currently another 3 members of staff working towards the qualification and on completion the home will have achieved the 50 minimum target level. A selection of staff files were examined and all contained the required documentation thereby demonstrating that residents are supported and protected by a robust recruitment procedure. The induction of new staff is ow being managed using the BUPA Skills for Care Induction and Foundation training handbook which is comprehansive and Ennerdale Nursing & Residential Home DS0000069159.V329369.R01.S.doc Version 5.2 Page 18 meets all of the relevant requirements. Induction is completed within the first six weeks of employment and foundation training within the first six months. A comprehensive training programme is now in place and is ongoing. Whilst the training of staff has improved this must be ongoing to enable all staff members to gain the knowledge and skills necessary to care for the residents in accordance with best practice guidelines. Ennerdale Nursing & Residential Home DS0000069159.V329369.R01.S.doc Version 5.2 Page 19 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): 31,32,33,35,36,37,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a sound management structure that promotes their health, safety and welfare. EVIDENCE: The organisation has carried out a restructuring of the management function at Ennerdale in line with their corporate policies. The acting manager is an experienced first level nurse and is commencing the course for the registered managers award in May 2007. Each distinct unit has a responsible unit manager who is appropriately qualified and experienced for their role. Staff meetings are held on a regular basis with heads of department meetings every two weeks and full staff meetings every month. Meetings for residents and their representatives have not held due to the lack of support for such meetings in the past. The acting manager has plans to Ennerdale Nursing & Residential Home DS0000069159.V329369.R01.S.doc Version 5.2 Page 20 reintroduce the holding of such meetings to involve the residents and their representatives by obtaining and taking into account their views. Relevant maintenance contracts and service certificates were seen for: Lifts Boilers Bedpan washers / Disinfectors Gas safety certificate Electrical safety check Hoists General waste, Clinical waste and special waste contracts Fire extinguishers Fire alarm Nurse call Bed rail checks Water temperatures Legionella tests on water storage Portable appliance tests Mandatory staff training in fire, and manual handling is ongoing. Monies held for residents have been transferred to an appropriate interest bearing account and under the BUPA system interest is allocated to individual account records. Staff supervision is in place and records seen show that this is up to date with staff receiving supervision a minimum of six times per year. Records are securely stored and kept in accordance with the Data Protection Act. All records and information held on residents is accessible and available to residents or their representatives on their request. BUPAs’ Operations manager makes regular unannounced visits to the home and forwards reports to the CSCI. Ennerdale Nursing & Residential Home DS0000069159.V329369.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 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 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 3 18 2 2 3 3 3 3 3 3 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 2 3 3 X 3 3 3 3 Ennerdale Nursing & Residential Home DS0000069159.V329369.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 Requirement The registered person must ensure that all care plans and related documents pertaining to the care of service users are relevant and up to date at all times. (Previous timescale of 31/08/06 met in part) 2 OP18 13(6) The registered person shall make 31/03/07 arrangements, by training staff or other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse (Previous timescale of 31/08/06 met in part) Timescale for action 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Ennerdale Nursing & Residential Home DS0000069159.V329369.R01.S.doc Version 5.2 Page 23 No. 1 Refer to Standard OP9 Good Practice Recommendations There should be clear, personalised directions for the use and administration of when required and variable dose medication for all service users prescribed such items. A second member of staff should witness and countersign all hand written entries on Medication Administration Record charts Verbal dose changes and new medication should be accurately entered onto Medication Administration Record charts with staff signature, date and authority where appropriate. Verbal dose changes should be confirmed in writing by the prescriber Ennerdale Nursing & Residential Home DS0000069159.V329369.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Ennerdale Nursing & Residential Home DS0000069159.V329369.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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