Inspection on 31/10/06 for Gordon Lodge Nursing Home

This inspection was carried out on 31st October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Gordon Lodge Nursing Home 10/07/07

Gordon Lodge Nursing Home 18/01/06

Gordon Lodge Nursing Home 22/09/05

Gordon Lodge Nursing Home 28/02/05

Gordon Lodge Nursing Home 08/09/04

Gordon Lodge Nursing Home 09/03/04

Gordon Lodge Nursing Home 24/06/03

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

CARE HOMES FOR OLDER PEOPLE Gordon Lodge Nursing Home 102 Gordon Road Ealing London W13 8PS Lead Inspector Mrs Rekha Bhardwa Key Unannounced Inspection 31st October 2006 09:45 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 Gordon Lodge Nursing Home DS0000010948.V313967.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. Gordon Lodge Nursing Home DS0000010948.V313967.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gordon Lodge Nursing Home Address 102 Gordon Road Ealing London W13 8PS 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) 020 8997 8967 020 8997 3548 Mrs Maudlyn Cecilia Andall Mrs Maudlyn Cecilia Andall Care Home 17 Category(ies) of Dementia (0), Mental Disorder, excluding registration, with number learning disability or dementia - over 65 years of of places age (0), Old age, not falling within any other category (0), Physical disability (0), Physical disability over 65 years of age (0) Gordon Lodge Nursing Home DS0000010948.V313967.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users to indicate up to 7 MD(E)`s and up to 17 Service Users in total 18th January 2006 Date of last inspection Brief Description of the Service: Gordon Lodge Nursing Home is registered to provide care for seventeen service users. It is a stand alone home in an attractive, detached house in West Ealing close to the local amenities in West Ealing and Ealing Broadway. The home provides a warm and comfortable environment consisting of five single and six double bedrooms. There are five bathrooms and a passenger lift. Hand washing facilities are available in each service users bedroom. The home has a medium sized lounge and dining area with an attached Victorian conservatory. There is an attractive garden to the rear of the building that can be accessed via the conservatory. The fees range from £577 to £615 per week, dependent on assessed need. At the time of the inspection 17 service users were accommodated at the home. Gordon Lodge Nursing Home DS0000010948.V313967.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of 7 hours was spent on the inspection process. A tour of the home was carried out, and service user plans, staff records, management records, administration records, medication records, maintenance and servicing records were viewed. 10 service users and 6 staff were spoken with as part of the inspection process. The pre-inspection questionnaire completed by the home has also been used to inform this report. It must be noted that it is sometimes difficult to ascertain the views of service users with mental health or dementia care needs. What the service does well: What has improved since the last inspection? What they could do better: Shortfalls have been identified in relation to the identification of moving and handling equipment on moving and handling assessments. Generally care plans are well completed. There must be evidence that the service user or their representative have been involved in the formulation of the care plan. Where a Gordon Lodge Nursing Home DS0000010948.V313967.R01.S.doc Version 5.2 Page 6 pressure sore risk assessment identifies the service user as being at high risk there must be a care plan in place in relation to skin integrity. Pressure sore risk assessments must be regularly reviewed. Shortfalls have been identified in the kitchen area, which, must be addressed. Water temperature readings must be undertaken and recorded at regular intervals. Shortfalls in the training provision for staff have been identified, to include Induction training. 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. Gordon Lodge Nursing Home DS0000010948.V313967.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 Gordon Lodge Nursing Home DS0000010948.V313967.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): 2 and 3. The home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Copies of the homes terms and conditions are available in the service users records, thus providing clear information for service users and their representatives. Service users are fully assessed prior to admission to the home, to ascertain that the home is able to meet their needs. EVIDENCE: There is a written contract/agreement with the Primary Care Trust and local Social Services for service users being funded by these departments. Contracts were available for service users funded privately. The home has a pre-admission assessment that is carried out for all routine admissions to the home. These were seen in some of the service user plan documentation viewed and were comprehensive, giving a clear picture of the service user and their needs. Copies of Social Services and Primary Care Trust assessments, plus hospital discharge information were also available. Gordon Lodge Nursing Home DS0000010948.V313967.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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall the service user plans were up to date, thus providing staff with a clear picture of the service users needs and how these are to be met. Shortfalls in risk assessment documentation could potentially place service users at risk. Medications are being well managed at the home, however some shortfalls need addressing to fully safeguard service users. Staff care for the service users in a gentle and courteous manner, thus respecting their privacy and dignity. EVIDENCE: Two service user plans were examined during the course of the inspection. Generally these were comprehensive and reflected the needs of the service users. There was evidence that care plans were being reviewed monthly or sooner. It was not clear whether the service user or their representative had Gordon Lodge Nursing Home DS0000010948.V313967.R01.S.doc Version 5.2 Page 10 been involved in the development of the care plan. Assessment information had been completed in full. Nutritional assessments had been carried out and monthly weights had been recorded. Moving and handling risk assessments had been carried out and the need to ensure that details of the handling equipment to be used were recorded was discussed with the Registered Manager. Pressure sore risk assessments had been carried out, where service users had a skin break this had been identified in the assessment. For one service user with a long standing wound the pressure risk assessment placed the service user at high risk. This had not been reviewed since the wound developed. There was no accompanying skin integrity care plan to reflect the high level of risk. This was discussed with the Registered Manager at the time of the inspection. A wound care plan was available for this service user with clear details of the dressing regime and the pressure relieving equipment in use. Continence assessments had been carried out and associated plans had been formulated. Risk assessments for falls had been completed. Risk assessments for the use of bedrails had been carried out and for two service users written consent had been obtained. The CSCI Pharmacist Inspector carried out an inspection on 18/08/06 and a separate report is available. The requirements and recommendations resulting from that inspection have been reviewed at this inspection. Where requirements have not been fully addressed they have been restated in this report. The home uses a Monitored Dosage System. Medications are securely stored in the home. The room temperature had been recorded as 25˚ centigrade or below. The Registered Nurses within the home had only been recording the minimum temperature reading of the medication fridge. No maximum readings were being taken. Dates of opening were written on some oral liquids and some eye drops. All eye drops and oral liquids must have the date of opening documented. Medication was stored securely and the clinic room was tidy. A record of disposed medication is maintained. A stock check was carried out for a sample of medications and stocks and records were accurate and up to date. All receipts, administration and disposal of medications are recorded. A sample of MAR were viewed by the inspector. Generally these were well recorded. For one service user medication had been omitted. It was not clear from the records the reason for this omission. Some as required medicines were being administered on a regular basis. The Registered Manager reported that this has been reported to the GP who is in the process of reviewing this. The abbreviation ‘MAR’ stands for medication administration record. The medicines policy had been reviewed but did not refer to the procedures for as Gordon Lodge Nursing Home DS0000010948.V313967.R01.S.doc Version 5.2 Page 11 required medicines and any poor recording. Whilst improvements have been noted in the area of medication management areas have been identified which require further improvement. Staff were seen to care for service users in a caring, polite and professional manner. Service users spoken with said that they are well cared for at the home and staff are helpful and kind. Staff knock on doors prior to entering service users bedrooms. Where service users require assistance with their meals this was done discreetly and sensitively. Staff spoken with said that they work well together as a team. Service users can bring in personal possessions, subject to fire safety. Gordon Lodge Nursing Home DS0000010948.V313967.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides an activities programme to keep the service users active and stimulated. Visiting is encouraged and this enhances the service users lives and keeps them in touch with their families and friends. Information regarding advocacy services is available, thus ensuring service users rights and interests are upheld. The meals in this home are good offering both choice and variety. Shortfalls in maintaining essential records in the kitchen potentially place service users at risk. EVIDENCE: Since the last inspection the training co-ordinator has also taken on the role of the activity co-ordinator. At the time of inspection activities were taking place to include armchair exercises. Clear records of activity participation by service users are maintained. The activity co-ordinator stated that the level of participation by the service users varied from day to day. Service users can receive visitors in their own rooms or in the lounge area, according to their wishes. Gordon Lodge Nursing Home DS0000010948.V313967.R01.S.doc Version 5.2 Page 13 The home has information on advocacy services available in the main hallway. At the time of inspection none of the service users were able to manage managing their own finances. Bedrooms viewed were personalised and service users are encouraged to bring in some of their own possessions in line with fire safety. The kitchen was clean and tidy. Kitchen records to include cleaning schedules, temperature records and a record of food taken were available. These records were not up to date. It was not clear what diets were being provided by the home. The need to have a list of diets provided should be available in the kitchen. The fly screen in the kitchen had been removed from the window and was in the process of being refitted. Service users spoken with confirmed that they enjoyed the meals provided by the home. The cook stated that choices of meal are offered. Cold and hot drinks, with snacks are available throughout the day. Gordon Lodge Nursing Home DS0000010948.V313967.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system with evidence that service users and representatives concerns are listened to and acted upon. Staff have knowledge and understanding of adult protection issues which protect service users from abuse. EVIDENCE: The home has a complaints procedure in place. The pre-inspection detailed that there had been no complaints since the last inspection. The Commission has received no complaints. The home has policies and procedures in place for the protection of vulnerable adults, and this dovetails with the Local Authority Safeguarding Adults documentation. There have been three POVA allegations since the last inspection. Two have been investigated and the third is in the process of being investigated. There was evidence that staff had received POVA training. Gordon Lodge Nursing Home DS0000010948.V313967.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,23,25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally the environment is in good condition, thus providing service users with a homely environment to live in. The provision of equipment in the home is good, thus ensuring the service users moving & handling needs can be met. Systems for infection control are good and protect service users. Shortfalls in the recording of water temperatures potentially place service users at risk. EVIDENCE: The Inspector undertook a tour of the premises. Generally the home was being maintained. The rear garden was well maintained and a seating area is available for the service users to use. The Registered Manager stated that there was an ongoing programme of renewal and redecoration. Gordon Lodge Nursing Home DS0000010948.V313967.R01.S.doc Version 5.2 Page 16 The home has a large lounge/dining area on the ground floor. The furnishings in the communal area were satisfactory, and the Registered Manager said that replacements are ordered as necessary. The home has a passenger lift available. The front door is alarmed for security. Suitable moving & handling equipment was seen in the home. There is a call bell system in each room and this had been serviced. Samples of bedrooms were viewed on each floor and these were personalised and suitably decorated. The furnishings viewed were generally of good quality. All bedroom doors are lockable, and the home has in place a programme for the purchase of height adjustable beds. The home was pleasantly warm. The lighting was satisfactory throughout the home. Records of hot water temperature checks are maintained, the Inspector noted that the last hot water temperatures readings were dated May 2006. The laundry room was clean and tidy. Infection control information was available and the laundry assistant was aware of infection control procedures. Overall the home was clean and tidy, and smelled fresh. Staff had received training in infection control. Protective clothing to include gloves and aprons was available in all bathroom and toilet areas. Gordon Lodge Nursing Home DS0000010948.V313967.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is appropriately staffed to ensure that the needs of the service users can be met at all times. Systems for vetting and recruitment practices are in place. Shortfalls identified should be easy to address. There is an ongoing training programme for staff and this ensures that staff have the skills to meet the needs of service users. Shortfalls in relation to induction training should be easy to address. EVIDENCE: The home was staffed to meet the needs of the service users. Staffing rosters were available. No changes have been made to the staffing levels since the last inspection. The Registered Manager was clear that staffing is based on the dependency needs of the service users. The Registered Manager has confirmed that 8 care staff are qualified to NVQ level 2 in care or the equivalent. Two sets of staff employment records were viewed. One file contained all the information required under the Care Homes Regulations 2001 with the Gordon Lodge Nursing Home DS0000010948.V313967.R01.S.doc Version 5.2 Page 18 exception of a photograph. The other file viewed contained only one reference and the Registered Manager stated that these had been obtained but could not be located at the time of the inspection. Subsequent to the inspection the Registered Manager confirmed that both these items had been located. The induction and foundation training programmes within the home do not meet the revised Skills for Care (formerly TOPSS) common induction standards, which were revised in September 2006. The home has a training programme in place and this evidenced that staff had undertaken mandatory training. Training records were available. The training matrix provided by the home indicated that trained nurses had received training in pressure ulcers, wound care and tissue viability. Gordon Lodge Nursing Home DS0000010948.V313967.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager has the qualifications and experience to manage the home. Systems for quality assurance are in place, thus providing an ongoing process of system and practice review. Service users monies are well managed and securely stored. Systems for the management of health and safety throughout the home are good, thus safeguarding service users, staff and visitors. EVIDENCE: The Registered Manager is a first level registered general nurse and a registered mental nurse with several years experience of managing care homes for older people. She has completed the Registered Managers Award, Gordon Lodge Nursing Home DS0000010948.V313967.R01.S.doc Version 5.2 Page 20 NVQ level 4. The Registered Manager is also one of the proprietors of the home. A service user and representative satisfaction questionnaire had been undertaken and the results have been collated. The deputy Manager informed the Inspector that the return of questionnaires had been very poor. Staff meetings are held. No service user/representative meetings are held. The Registered Manager stated that as the home is small and also that she is on duty during the week service users and their representatives raise any issues that require addressing directly with her. A suggestion box is also available in the main entrance. Two service users personal monies are managed by the home. The deputy Manager reported that records are kept along with receipts. Servicing and maintenance records were sampled and all viewed were up to date. Fire drill records viewed indicated that both night and day staff receive regular fire drill training. The training matrix provided with the pre-inspection questionnaire detailed that all staff had received health & safety training to include moving & handling, fire safety, First Aid, Infection Control and food hygiene. Gordon Lodge Nursing Home DS0000010948.V313967.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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 3 X 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Gordon Lodge Nursing Home DS0000010948.V313967.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 5 Requirement Service user plans must be formulated with the involvement of the service user if able or their representative. Pressure sore risk assessments must be reviewed monthly. Where a service user is assessed as being high risk, there must be in place a care plan in relation to skin integrity. Moving and handling assessments must include the details of the specific equipment that is to be used. (previous timescale of 17/02/06 not met) The medicines policy must be extended to include local procedures for managing as required medicines and any poor recording. The management of medicines away from the home and refusal of medication is outstanding. (previous timescale of 01/10/06 has been partially met) DS0000010948.V313967.R01.S.doc Timescale for action 01/01/07 2. OP8 13 15/12/06 3. OP8 13(5) 15/12/06 4. OP9 13(2) 15/12/06 Gordon Lodge Nursing Home Version 5.2 Page 23 5. OP9 13(2) The dates of opening must be recorded on eye drops and liquid medications. (previous timescale of 01/09/06 not met) Medicines must be recorded accurately when administered. (previous timescale of 01/09/06 not met) The home must record the minimum and maximum temperature of the fridge. (previous timescale of 01/09/06 not met) Records of cleaning schedules and fridge temperatures must be available and up to date. Records of the food provided for service users must be maintained and kept up to date. Hot water temperatures must be taken at regular intervals and records maintained. 15/12/06 6. OP9 13(2) 15/12/06 7. OP9 13(2) 15/12/06 8. OP15 12 15/12/06 9. 10. OP15 OP25 17(2) 13(4) 15/12/06 15/12/06 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 Gordon Lodge Nursing Home DS0000010948.V313967.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West London Area Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Gordon Lodge Nursing Home DS0000010948.V313967.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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