Inspection on 09/09/05 for Holbeche House Nursing Home

This inspection was carried out on 9th September 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Holbeche House Nursing Home 12/03/09

Holbeche House Nursing Home 23/07/07

Holbeche House Nursing Home 02/08/06

Holbeche House Nursing Home 08/02/06

Holbeche House Nursing Home 14/12/04

Holbeche House Nursing Home 20/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Holbeche House Nursing Home Wolverhampton Road Wall Heath Kingswinford West Midlands, DY6 7DA Lead Inspector Richard Eaves Announced 9 September 2005 th 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 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. Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Holbeche House Nursing Home Address Wolverhampton Road Wall Heath Kingswinford West Midlands DY 6 7DA 01384 288924 01384 296733 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Care Home No2 Limited Care Home 49 Category(ies) of DE(E) - Dementia - over 65 (22) registration, with number OP - Old People (27) of places PD(E) - Physical Disabilities - over 65 (8) Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 27 OP, 8 PD(E), and up to 22 DE(E) 2. One service user (male) accommodated at the home may be in category A. This will remain until such time that the service users placement is terminated. 3. One service user (female) accommodated at the home may be in catergory LD(E). This will remain until such time that the current service users placement is terminated. 4. The home meets the following minimum staffing levels: EMI Unit for 22 DE(E) service users: 08.00 to 20.00 hrs - 1RMN/RN and 4 care staff, 20.00 - 08.00 hrs - 1RMN/RN and 3 care staff General Nursing Unit for 27 service users: 0.800 - 14.00hrs 1RN and 5 care staff, 14.00 - 20.00 1RN and 4 care staff, 20.00 - 8.00 1RN and 2 care staff. 5. A RMN or RN with an ENB N11 or equivalent qualification is on duty for at least 40 hours each week to plan and evaluate the care for service users with dementia. 6. All care staff will have training in the care of service users with dementia. 7. Service users in the category DE(E) may be aged 60 years and over. Date of last inspection 14th December 2004 Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 5 Brief Description of the Service: Holbeche House Care Centre is a large Jacobean style Grade Two listed building. The home has recently undergone a major refurbishment programme to provide accommodation for up to forty-nine residents. The home provides accommodation on two floors, the first floor can be accessed by a passenger lift. The home has two lounges, two dining rooms and two lounge/dining rooms. The home has a separately staffed Dementia Care unit, which provides accommodation for up to twenty-two mentally infirm residents.The home has one double bedroom, all other bedrooms are single occupancy with many having ensuite facilities. The grounds are extensive and pleasant. Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of a statutory announced inspection undertaken by one inspector over a full day during the summer 2005 and involved a full tour of the bedrooms, communal rooms and service areas. Other information was gathered through observation, meeting with staff and examing records. Inaddition the manager completed a pre-inspection questionnaire and a small number of service users and relatives comment cards were received . The responses in the comment cards were overall most positive, one service user wanted more influence in the choice of food provided and another thought the activities were not suitable for their needs. Relative responses, while overall satisfied with care, all felt there were not sufficient staff always on duty and a number were unaware of the complaints procedure or the availability of the inspection reports. One wished to meet their relative in private without use of the bedroom and one observed that staff should assist more at meals (the example given to cut food up). The inspector took the opportunity to speak with most service users and those able to communicate their views were positive regarding all aspects of the home and care provision. What the service does well: What has improved since the last inspection? The home has been very receptive to previous guidance and requirements and has been proactive in implementing these. These include extending the fire alarm system, providing staff with a toilet (although this arrangement remains temporary) and the pre-employment checks have improved to ensure these are completed in advance of staff commencing work. Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 7 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. Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 9 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 standard(s) 1 - 5 The homes statement of purpose and service user guide are good sources of information providing details of the service enabling service users and families to make informed decisions about admission to the home, this is confirmed at admission by contract. The staff group collectively have the knowledge and skills to assess needs and to meet these assessed needs of the current service users. Confirmation that assessed needs can be met furthers enables service users to make informed decision about entering the home as does the opportunity to visit and trial the services offered. EVIDENCE: The statement of purpose and service users guide were reviewed and updated during June last year and will be further reviewed on completion of the registration process of the manager. The documents provide current and prospective service users with a good source of information from which to make informed decisions about the suitability of the home and the services they offer. The information is also available on audio cassette and in large Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 10 print. A copy of the service user guide was seen in each of the bedrooms visited and both were available in the reception area. A sample of residents files were inspected in both the general nursing and EMI areas and were seen to include a contract and a letter of confirmation that service users needs can be met by the service. The case files for each of the areas of the home were inspected and found to include a pre-admission assessment and further in depth assessments at the time of admission using Ropers model of activities of daily living and including individual risks such as falls, pressure sores, nutrition and continence. All assessments are subject to monthly review by means of raising a care plan for each assessment undertaken. Introductory visits and trial stays are encouraged by the home, ensuring that people have time to make decisions, which are right for them. The home does not provide intermediate care. Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 11 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 standard(s) 7, 8 & 9 Health care needs of service uses are fully met and care planning in the home is overall of a good standard adequately guiding staff in the delivery of care needs. There remains scope to improve if service users are not to be at risk of needs not being fully met. Arrangements for the administration of medication are good and ensure service users medication needs will be safely met. EVIDENCE: A sample of case files were selected at random in each area of the home to be inspected and case tracked. The care plans were seen to be drawn from the assessed needs process and were relevant and maintained to a good standard. The care plans reflect actual care requirements and the service users preferences of how it is to be given. It was observed that a contingency plan was available for the care of diabetes but requires to be more directive to staff on actions to be taken if a complication arises. The files show that the care plans are reviewed monthly. All service users are registered with a GP who provide a weekly visit routinely, other allied health care providers also attend on a regular basis. Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 12 The home has a good range of pressure relieving equipment and these were observed to be in use. Where mattresses were in use an equivalent cushion was seen to be provided. No service users are identified as able to self-medicate. Arrangements for medication management are robust and undertaken by the nursing staff using a monitored dosage system for most medicines. The processes are audited weekly by the manager and quarterly by the pharmacist. There was evidence of re-sheathing of used hypodermic needles. Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 13 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 standard(s) 12, 13 & 15 The home provides a limited but varied social and recreational activity programme that provides interest and pleasure for service users. Visitors are welcome and help to keep service users informed about the wider community. The meals are wholesome and meet the nutritional needs of service users while providing for choice and personal taste. EVIDENCE: Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 14 The home is currently advertising for an activities co-ordinator, meantime the care staff maintain the programme. An exercise to music class is held once per week, quizzes, arts and crafts continue. Trips out are arranged but currently there is no driver to drive the mini bus but the manager says this is being addressed. A hairdresser visits once per week and a local church service is held at the home monthly. The inspector spoke with many service users who were satisfied with the current level of activities. One respondent on the comment cards said that the activities were not suitable but gave no additional comment. The home has open visiting and many were seen to come and go over the day and a number of visitors were met and all spoke well of the home. Comment cards were received from 7 relatives and all indicated they were made welcome at the home. One commented that visiting in private is difficult the bedroom is the only place at the moment. The home has a 4-week rolling menu that is well thought out and offering variety and a balanced diet to service users, choice of meal including a cooked option is always available. A record is kept of individual service users intake and meals are taken in the setting of their choice. On the day of inspection service users that were able to communicate their needs expressed their satisfaction with all meals provided. One service user responding through the comment card said that they did not like the food and requested that there be more chicken and mashed potato. Nutritional assessment is included as part of the admission process and is kept under review; service users are weighed monthly or more frequently if required and any action taken documented. Drinks and snacks are available outside of mealtimes. Special diets are catered for and food for special occasions provided. Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 15 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 standard(s) 16 - 18 The home has a satisfactory complaints policy and service users and their supporters can be confident that their views will be listened to and acted upon. Service users rights are protected and staff demonstrate excellent knowledge and understanding of adult protection issues which contributes in providing an environment safe from abuse. EVIDENCE: The home has a complaints policy and procedure, a copy of which is available in reception and included in the service user guide. Timescales are given for response and the CSCI address and telephone number is included as an alternative source for complainants. Out of the seven comments cards received by the inspector prior to the inspection taking place, five indicated that they were unaware of the complaints procedure and this was brought to the attention of the manager for action. Arrangements were made to enable the residents to participate in the recent elections using postal votes and evidence of this was seen in the case files. The home has robust procedures for responding to any suggestion of abuse and training is given to staff in adult protection procedures. Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 - 26 The home provides a good standard of décor, furnishings and managed services providing a safe environment and an attractive, and homely place to live. The home is clean, free from odours and hygienic. The external grounds do not provide for a safe, comfortable or pleasant place for service users use. The home provides sufficient washing facilities and lavatories suitable and well dispensed to meet service users needs. Bedrooms are furnished to suit service users needs and provide for personal possessions to be displayed. Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 17 EVIDENCE: The home is well presented with a good standard of decoration and carpeting and is furnished comfortably, is clean and hygienic with no unpleasant smells. The premises are set in extensive grounds and these are showing sign of neglect and overgrowth and is distracting from an otherwise well maintained home and requires urgent attention. Garden furniture is poorly maintained and cigarette ends were on the ground outside the back door. The home has a variety of communal rooms with suitable and sufficient dining facilities. The space within the lounges is adequate to enable different activities to take place. Lighting is domestic in character and furnishings are of a good quality. The 46 single and 1 double bedroom have either wash hand basins or have ensuite facilities. The bedrooms have good quality furnishings and a proportion have nursing beds. Many of those seen have been personalised with pictures and ornaments. Ventilation is natural from windows that are fitted with restrictors. Heating is by low surface temperature radiators, electric supply is from 3 double electric sockets, each room has a staff call bell, overhead and bedside lighting. An appropriate door lock is fitted and each room has a lockable facility in the furniture. The hot water supply at service user outlets are all controlled and subject to regular monitoring. Sufficient assisted bathing facilities are available and disbursed throughout the home. On the day of inspection all bathrooms and toilets were clean and extractor fans working. In the main house a lift provides access between floors with staff accompanying service users as required. A new platform lift has been installed in the Dementia Care Unit. The home has met the requirement to have an assessment of the premises and facilities by an occupational therapist. The occupational therapist report identified that the home offers good access and that appropriate moving and handling aids are available. The home has a well-equipped laundry with washing machine capable of sluicing and disinfection of linen. It was observed that the ambient temperature in the laundry was uncomfortably high and natural ventilation was not available due to the inaccessibility of the windows to opening. There are sluice disinfectors fitted around the home. Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 18 Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 19 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 & 29 The home has a good mix of staff in sufficient numbers to provide consistency of care that meets service users needs. The home continues to make progress in developing a skilled staff group with understanding of service users needs. Recruitment and selection processes are to a good standard protecting vulnerable people. EVIDENCE: The home allocates staff to each of its identified areas to provide consistency and in such numbers that reflect the dependency needs of the service users. Usual allocations are one nurse and 3 carers on both the general nursing and the EMI unit during the day with 1 nurse and 2 carers on each overnight. These numbers are appropriate for the dependency levels of the current service users. Three of the seven comment cards said there were not enough staff on occasion. The manager should identify ways to ensure that staff are visible to visitors at peak activity periods. Care staff with NVQ qualification at level 2 or above exceeds the 50 requirement of the standard. A sample of staff files were inspected and show that recruitment procedures are completed to a good standard with appropriate checks in place. Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 20 In meeting with staff there was a good deal of satisfaction in working at Holbeche. In response to questions of what improvements they would like to see they identified an activities co-ordinator in post as soon as possible, an extra hoist would be useful on the general side and there was considerable anxiety about the reliability of the lift. Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 21 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36 & 38 Leadership of this home is good and staff demonstrate an awareness of their roles and responsibilities. Staff receive supervision and direction to ensure that the service users receive consistent quality care. Environment management and staff training in respect of health and safety ensures service users safety and welfare are protected. EVIDENCE: The new in post manager is well experienced and is progressing an application for registration. All levels of staff consider themselves to be valued and respected for their input into the team as a whole. On the day of the inspection it was apparent that there was a very good atmosphere amongst the staff. The manager holds frequent staff meetings and maintains a record of actions taken in response to staff inputs. Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 22 Supervision is well established and the records show these to be up to date and the content of sessions relevant to the activities of work. Maintenance monitoring at the home is good and wide ranging ensuring a safe environment. Monitoring and testing includes fire safety, emergency lighting, water temperatures and these were seen to be good with 43°c achieved consistently and the record shows actual temperatures and adjustments undertaken. Other regular checks include bed rails, staff call, window restrictors and wheelchair safety checks. Staff receive training in health and safety at induction with ongoing updates at appropriate intervals. During the tour of the building it was observed that all corridors were clear of obstructions and the premises are kept in a safe condition. Appropriate arrangements are in place for the monitoring, recording and reporting of accidents. Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 23 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 4 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 3 x x x 3 x 3 Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 24 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. 1. Standard op9 Regulation 13(3) Timescale for action The registered must implement a 31.10.05 programme of staff training and practice that demonstrates the danger of re-sheathing used hypodermic needles to eradicate this practice. The registered person must 31.12.05 provide accommodation that visitors can be received other than in service users own private rooms. The responsible person must 31.10.05 maintain the grounds and garden funishings in good condition and well tended. The manager must complete the 31.12.05 registration process Requirement 2. op13 23(2)(i) 3. op19 23(2)(h) 4. op31 9 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard op7 op12 Good Practice Recommendations The contingency plans included in the care plan should be expanded to provide staff with specific direction on how to respond to complications in service users health. The manager is recommended to seek service user views E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 25 Holbeche House Nursing Home 3. 4. 5. 6. op15 op26 op16 op27 of what activities they consider to be suitable for them. The manager is recommended to seek service users views about the inclusion of favourite foods in the menus. The responsible person should implement a means of controlling the ambient temperature within the laundry. The manager is recommended to further promote the availability of the complaints procedure. The manager is recommended to find means of ensuring the visibility of staff to visitors at peak activity periods. Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 26 Commission for Social Care Inspection Halesowen Office, West Point, Ground floor Mucklow Office Park Mucklow Hill, Halesowen West Midlands 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 Holbeche House Nursing Home E55_v241373_Holbeche House NH_s58391_Stg4.doc Version 1.40 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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