Inspection on 17/07/07 for Gibraltar Road Nursing Home

This inspection was carried out on 17th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Gibraltar Road Nursing Home 08/08/06

Gibraltar Road Nursing Home 09/03/06

Gibraltar Road Nursing Home 31/10/05

Gibraltar Road Nursing Home 23/02/05

Gibraltar Road Nursing Home 27/07/04

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

CARE HOME ADULTS 18-65 Gibraltar Road Nursing Home 35 & 64 Gibraltar Road Halifax West Yorkshire HX1 4HE Lead Inspector Liz Cuddington Key Unannounced Inspection 17 & 27th July 2007 13:00 th 17/07/07 Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 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 Gibraltar Road Nursing Home DS0000001052.V342738.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 Adults 18-65. 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. Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gibraltar Road Nursing Home Address 35 & 64 Gibraltar Road Halifax West Yorkshire HX1 4HE 01422 352418 01422 322552 linda.gibson45@ntlworld.com 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) Mayfield Trust Mrs Lynda Gibson Care Home 13 Category(ies) of Learning disability (13), Learning disability over registration, with number 65 years of age (13) of places Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 9 service users accommodated between 35 and 64 Gibraltar Road, Halifax HX1 4HE 4 service users accommodated between 334 and 336 Hopwood Lane, Halifax, HX1 4HE 8th August 2006 Date of last inspection Brief Description of the Service: The two houses at Gibraltar Road provide both nursing and personal care to people with learning disabilities. The houses are domestic dwellings, situated within the local community. Both the houses have accommodation over two floors and 35 Gibraltar Road has a passenger lift. The houses are on bus routes and are within easy reach of Halifax. There is ample parking on the street near both houses. The weekly fees are between £384.78 and £391.45. Personal items and transport are not included in the fees. Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of the inspection was to assess the quality of the care and support received by the people who live at the two houses on Gibralter Road. The methods I used to gather information included conversations with the people living at the homes and the staff, looking at care plans, examining other records and a visit to both houses. I sent questionnaires to the people who live at the houses and their relatives. I received five completed questionnaires back from the people who live at Gibralter Road and four from relatives. I also received the home’s self-assessment questionnaire. These questionnaires provide a lot of valuable information to help me form a judgement about the quality of the care and support offered to the people who live at Gibralter Road. I would like to thank the people who live at both of the houses, and the staff, for their welcome and hospitality and for taking the time to talk to me during my visit. What the service does well: The interaction between staff and the people who live at Gibralter Road is relaxed and friendly. Staff maintain people’s dignity and privacy. They spend time with people, but respect their right to be left alone if they wish. One relative wrote in the questionnaire that Gibralter Road ‘Provides a caring and homely environment where people are treated with respect and dignity…’. Visitors are welcomed to the home. One relative said how welcoming the staff are and also wrote I cannot fault them, they all do a grand job. In answer to the question asking what the home does well, one relative simply wrote ‘Everything’. Each person develops their own care plan, with support from the staff and their family. The plans clearly reflect the individual’s preferences and the goals and activities they wish to pursue. The plans also show that people’s healthcare needs are understood and how each person is supported to achieve the best health they can. During my visit I observed that everyone receives the level of support and care they need, in accordance with their wishes. Changing needs are acted upon and professional advice is sought, where necessary. The nursing, support and outreach staff, all work towards supporting people to do what they want and to achieve their goals. One relative commented that ‘All the staff are fantastic. People are protected by the organisation’s recruitment procedures, which are safe and thorough. There is suitable training for staff, to give them the skills Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 6 and knowledge to provide good quality care and support for the people who live at the home. All the answers in the questionnaires that I sent out agreed that the staff have the skills and experience to look after people properly. All but two of the staff have a recognised nursing or care qualification. No staff have left since the last inspection in August 2006. Everyone who commented said they enjoy their meals. The house and grounds are well maintained. The house is clean and fresh and good hygiene and infection control measures are in place. 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. Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home carries out a thorough pre-admission assessment procedure; to make sure the home can meet the individual’s needs. EVIDENCE: There is a comprehensive pre-admission procedure, to make sure the home can meet the person’s needs. An assessment of the person’s care and support needs is carried out by senior members of staff and used as the basis for their care plan. Social Services assessments are also used to help determine the care needs of the individual. Each person has a placement agreement, through Calderdale Social Services. On the completed questionnaires, everyone said that they had sufficient information to allow them to make a decision before moving to Gibralter Road. People are welcome to visit the home before reaching a decision. Two people said on their questionnaires that they came for visits and an overnight stay before moving in. One person said they had a choice of bedroom and colour scheme. Another confirmed that they were asked if they ‘..would like to live with one person, or more’, and said what choice they had made. Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. To maintain their autonomy and independence, staff support people to make choices and decisions about all aspects of their daily lives. People are involved in planning their care and are supported to take risks. Care plans clearly show they have been reviewed and updated regularly, to make sure that they reflect people’s current needs. EVIDENCE: The individual plans show that people have been involved in developing and reviewing the plan and they reflect their preferences and needs. The plans are designed to be person centred and clearly demonstrate the person’s involvement in making all the decisions that affect them. People are involved in making decisions about the way home they live in is run, and the manager and staff make sure their views are at the centre of any decisions. In the questionnaires people confirmed that they are able to make Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 10 their own decisions and that staff assist them to do so, if needed. The relatives who commented confirmed that the service always supports people to live the life they choose and agreed that the service meets people’s different needs. Where any activity involves a potential risk, a detailed assessment is made and plans are agreed to minimise the risk, while still supporting people’s right to independence and choice. All the written information is securely stored and confidential information about people is only shared with those who need to know. Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to attend a range of activities, to make sure each person’s recreational, educational and leisure needs and expectations are being met. People are offered a good choice of meals, and other foods, to make sure their dietary needs and preferences are met. EVIDENCE: In their questionnaires four of the people who live at Gibralter Road said they always make their own decisions about what they do and one person said they sometimes do. Two people confirmed that the staff help them if needed. Three relatives said that the service always supports people to live the life they choose. Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 12 One person gave examples in their questionnaire of the things staff help them with, such as going out and going on holiday. When I visited everyone had recently been away on holiday and had made their own decisions about where they went to and who they went away with. Everyone who spoke to me about their holiday said they had enjoyed themselves. The care plans include each person’s choice of recreational and leisure pursuits and their goals. In their questionnaires everyone said they can do what they want to at all times. They all gave examples of the things they like to do. These included; ‘..see my mum..’, ‘..bake biscuits for the church..’, ‘go for a walk or drive’, ‘..go shopping..’, ‘…visit old friends..’, ‘..go to the local club’. One person did comment that they can do what they like ‘if we have staff here’. The manager is currently asking everyone who lives at the homes within the Mayfield Trust, what leisure activities they would like to follow. This could include small groups of people who like to be involved in, for example, music making and other pursuits. The aim is to expand the range of opportunities available for everyone. The people who commented said they enjoy their meals. The people who live at the two houses at Gibralter Road say what they would like to eat and staff are aware of individual preferences and any special diets. People who need assistance to manage eating and drinking are offered help discreetly and at the person’s own pace. Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. To maintain their health and well-being, peoples’ personal and healthcare needs are met. People are fully protected by the home’s medication systems. Medications are stored safely and administered accurately. To maintain their privacy and dignity, the staff treat people with respect, care and consideration at all times. EVIDENCE: People’s health and well-being is observed and monitored, and any concerns are followed up with relevant health or social care staff, or the family, and their advice is followed. The plans contain a lot of detail about the individual’s physical and emotional health. The plans that I looked at, and conversations with staff, confirmed that people’s cultural and individual preferences are understood by everyone and form an integral part of the care and support they are offered. Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 14 Each plan is individually designed to enable people to understand their plan. The plans reflect in words and pictures, their choices for all aspects of their life. The way people prefer their care and support to be provided is clearly detailed. All the relatives said in their questionnaires that the home always meets people’s needs. People are supported to be independent in their daily lives and any adaptations they need are made available. A number of the people who live at Gibralter Road have their own cars, which means that staff are able to drive people to the places they wish to go at times that suit them. The medication is stored securely and safely. The Medicines Administration Record (MAR) charts are accurately completed and the quantities of medicines received, in stock and returned to the pharmacy are recorded correctly. The staff that administer medication have all received suitable training. Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at the home are aware of how to raise a concern or make a complaint if they are dissatisfied with the service. Staff have received suitable training and understand the adult protection policies and procedures, which makes sure that people staying at the home are safe. EVIDENCE: The surveys I received from the people who live at the home, confirmed that everyone is aware of how to raise a concern or make a complaint, should they need to do so. There is a complaints log to record any complaints or concerns. The complaints procedure is clear and easily available. One relative commented that they had ‘Never had any concerns…’ and two relatives confirmed that any concerns are dealt with appropriately. The staff are aware of the need to report any concerns they have about care practice and there are clear guidelines for reporting such incidents. All of the staff have had Adult Protection training. Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28, 29 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Both houses offer a safe, comfortable and well-maintained environment, planned to suit people’s needs. The gardens are tidy and attractive, providing a safe and sheltered place for people to sit and enjoy the fresh air. EVIDENCE: There is a programme of re-decoration for the two houses. Several areas have recently been painted and look fresh and attractive. All areas of the houses are fresh, clean, comfortable and well looked after. Everyone who commented agreed that their home is well kept. They all said that the home is fresh and clean and two people said they sometimes help with the cleaning. Since my last visit more rooms in the houses have been re-decorated. The living rooms at number 35 Gibralter Road have each had a wall mounted television fitted, which people enjoy and find easier to see. Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 17 The gardens at both houses are tidy and well looked after. The garden at number 35 has had a lot of attention since my last visit. It is very tidy and well laid out, providing an attractive place for people to use. There is a patio area outside the back door where people can sit and enjoy the fresh air. Some of the people who live at number 35 help the gardener to maintain the garden and they grow a wide range of vegetables for everyone to enjoy. One person wrote that they like helping with the gardening. There are grab rails and other adaptations in both houses, to make sure people can retain the maximum level of independence. The downstairs shower room at number 35 has a level floor, so that people who need to sit in a wheeled shower chair when using the shower can use it easily. There are good infection control systems in place and staff use protective gloves and other measures, where needed. Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are employed to meet people’s needs. People are protected by thorough recruitment procedures, which ensure that staff are suitable to work with the people who live at the home. Suitable training is provided; to make sure staff have the skills and knowledge they require to meet people’s needs. EVIDENCE: The staff rotas confirmed my observations that there are plenty of staff on duty to meet the care, social and leisure needs of the people who live at both houses. The staff I spoke to confirmed that the number of staff on duty is adjusted to reflect people’s needs. All staff complete an application form and provide two written references. Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) register checks are obtained and no new staff begin work until these checks have been completed satisfactorily. Staff retention is very good and no staff have left the home since the last time I visited in August 2006. The home is Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 19 fully staffed and does not use any agency staff. This means that the people who live at the two houses benefit from having people who they know well providing their care and support. The manager makes sure that staff have the necessary training to help them do their work as well as possible, and records are kept of the courses staff have attended. There is a wide range of courses available and the records confirmed that the staff are allowed the time to attend. The manager said that dementia care, healthy eating and diet, epliepsy and computer skills are currently being studied by the staff. A first aid at work course is booked to start in September 2007. Protection of vulnerable adults and fire safety training is provided by the Mayfield Trust’s own staff. Training in the implications of The Mental Capacity Act is being provided by Calderdale Social Services in the near future. The majority of the support staff have a relevant National Vocational Qualification (NVQ) at level 2 or above. The remaining two staff are working towards achieving an NVQ award at either level 2 or 3. New support staff take the Learning Disabilities Award Framework training as part of their induction and foundation training. This makes sure they have a good understanding of their role and responsibilities, and provides a sound basis for NVQ study. Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 & 42 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is safe and well managed and everyone who lives and works at the home can contribute to the decision-making processes. EVIDENCE: The manager has the qualifications and the skills to manage the home effectively. There is a good management structure within the home and the organisation, which supports the manager. The manager promotes an open and inclusive management style and everyone is involved in the decisionmaking processes. My own observations, and comments from other people, confirm that everyone’s views are valued and taken into account. The policies and procedures are kept up to date; to make sure they provide relevant information to guide staff on how to act in every situation. All the Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 21 regular health and safety checks for the home are carried out in a timely manner. Staff have basic health and safety training. All these measures make sure that the health, safety and welfare of the people at the centre is promoted and safeguarded. The home sends out questionnaires to relatives and carers each year, in order to gain information about how people view the service and what improvements they would like to see. Other visitors to the home are also asked to give their views on the care and support offered to the people who live at Gibralter Road. All the comments I saw were positive and reflected the answers in the questionnaires I sent out. Gibraltar Road Nursing Home DS0000001052.V342738.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 Adults 18-65 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 X 2 3 3 X 4 X 5 X X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 4 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 3 X LIFESTYLES Standard No Score 11 3 12 3 13 4 14 4 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 4 X 4 3 X 3 X Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 23 NO Are there any outstanding requirements from the last inspection? 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 Gibraltar Road Nursing Home DS0000001052.V342738.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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 Gibraltar Road Nursing Home DS0000001052.V342738.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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