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Inspection on 13/12/05 for Hurst Manor Nursing and Residential Home

Also see our care home review for Hurst Manor Nursing and Residential Home for more information

This inspection was carried out on 13th December 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Hurst Manor is managed well with a welcoming and friendly staff team. Staff care for residents sensitively. There is good commitment to staff training. Activities continue to be thought out, presented well and documented with an evaluation of how each resident participated and enjoyed the session. Meals are good; the variety of meals is maintained. The accommodation for residents is of a high standard.

What has improved since the last inspection?

Three recommendations were made as a result of the last inspection. They were in relation to resident contracts, care plans and staff interview equal opportunity documentation. All the recommendations made have been taken on board by the management and implemented. The proprietor continues to invest into further improving the environment at the home by enlarging bedrooms and providing en-suite facilities, upgrading staff facilities and routinely redecorating the home to provide a high standard of accommodation at the home. The home was awarded the Investors In People status in 2005. The home continues to benefit from the support and training of a management consultant.

What the care home could do better:

No requirements or recommendations have been made as a result of this inspection. However, the home management needs to keep stressing the message to nursing staff on the importance of ensuring that medication records are always complete where medicines for residents are prescribed with a variable dose.

CARE HOMES FOR OLDER PEOPLE Hurst Manor Nursing & Residential Home Hurst Martock Somerset TA12 6JU Lead Inspector Judith Roper Announced Inspection 10:00 13 and 14 December 2005 th th 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 Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 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. Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hurst Manor Nursing & Residential Home Address Hurst Martock Somerset TA12 6JU 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) 01935 823467 01935 825728 info@hurstmanor.co.uk www.hurstmanor.co.uk Hurst Manor Limited Mrs Ada Susan Aldworth Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Elderly persons of either sex, not less than 60 years, who require general nursing care Up to fifteen places for personal care. Date of last inspection 6th July 2005 Brief Description of the Service: Hurst Manor is a three storey Grade II listed Georgian House situated in the centre of the village of Martock. The home is set in grounds, laid to lawn and flowerbeds. The home currently provides up to 30 places for nursing care and 15 places out of the total 36 registered places can be for personal care. Day care is provided for service users requiring nursing care within the registered numbers. The home added the garden wing extension in 2005. The quality of the garden wing is exceptionally high, offering en-suite bedrooms, a shared bathroom, communal and office space, landscaped gardens and parking spaces. Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over two days starting at 10am each day. 32 residents were at the home. The service is registered for 36 persons but there is currently some building improvement works taking place at the home meaning that the home is deliberately not at full admission capacity until all rooms are ready. The inspector was able to see and to speak with many residents. Three relatives were available to talk to the inspector during the inspection. The inspector also received feedback cards from 9 residents, 3 relatives and 2 visiting health care professionals prior to the inspection. The comments were in the vast majority of cases positive and complimentary about the service. All responses were discussed with the home’s management. Staff on duty were able to give time to speak with the inspector. The proprietor Mr. Lawson and the manager Mrs. Aldworth were available for comment during the inspection. The inspector would like to thank Mr. Lawson and his staff for their time and hospitality shown to the inspector during her visit. The home was being decorated for the Christmas festivities and the atmosphere was welcoming and friendly. This inspection focused on revisiting recommendations made at the previous unannounced visit in July 2005, inspecting any Standards not inspected at that visit as well as assessing some key Standards in the Care Homes Regulations. Records examined were three resident care plans, activity records, preadmission assessments, and medication records. The home also provided the CSCI with a pre-inspection questionnaire and requested copies of staffing rosters, menus and activity schedules. During the inspection the proprietor also supplied the inspector with copies of results of recent staff and quality assurance surveys. This inspection has found that the home continues to demonstrate its commitment to providing high quality care and accommodation for residents. What the service does well: What has improved since the last inspection? Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 Page 6 Three recommendations were made as a result of the last inspection. They were in relation to resident contracts, care plans and staff interview equal opportunity documentation. All the recommendations made have been taken on board by the management and implemented. The proprietor continues to invest into further improving the environment at the home by enlarging bedrooms and providing en-suite facilities, upgrading staff facilities and routinely redecorating the home to provide a high standard of accommodation at the home. The home was awarded the Investors In People status in 2005. The home continues to benefit from the support and training of a management consultant. 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. Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 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 Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 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): 1, 2, 3, 4 The home provides a range of easy to read, well presented information about the home for enquiries and new admissions in order for people to make an informed choice to continue with the application process or trial period following admission. Contracts are in place for residents and contain clear instruction regarding the terms and conditions of the stay at the home. Pre-admission processes are robust to ensure that the placement is appropriate. The home meets the needs of current residents and via regular reassessment of need is able to determine the continuing suitability of placement at the home. EVIDENCE: The home has a Statement of Purpose and Service User’s Guide. The home is also preparing welcome packs for new residents that includes information about the home and some complimentary welcome gifts, akin to a stay in a superior hotel. Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 Page 9 Resident contracts now contain as well as the room to be occupied reasons why the home may discuss with the resident a necessary room change. This information was recommended in the previous inspection report. Two care plans of recently admitted residents were admitted and the inspector discussed an admission procedure with one resident. The home is able to demonstrate that it follows its own policies and procedures for assessing the suitability of a referred resident. Care plans demonstrated good pre-admission assessments by the home and the home had obtained assessments of a new resident’s need from a placement officer’s community assessment report. The staff team are established and have appropriate training in order to meet the needs of current residents. Pre-admission processes are documented and the decision to whether the home can meet the need of a resident being referred to the home is made only following an assessment by the home. Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Care plans inspected were reviewed regularly and reflected current needs. Residents receive appropriate care and attention from the home’s staff and community health care professionals. This means that an extended professional network of care provider’s meets residents care needs. Medication management is satisfactory and nursing staff have had medication training updates in 2005 in order to ensure that the systems of administering medications in the home is safe. Residents are spoken to and treated with dignity and respect. This maintains resident’s self-esteem and sense of worth. EVIDENCE: Three care plans were inspected in detail and one care plan was inspected briefly. Care plans reflect individual current needs. Risk assessment tools are completed for both environmental and clinical issues, plans are reviewed monthly and residents or family members are consulted regarding their written plan of care. Social histories and activity plans are very well maintained. There was good written evidence of staff identifying changes in health and Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 Page 11 following through appropriate action in addressing the health changes in cooperation with community health care professionals. Care records demonstrated that residents receive health monitoring visits and access to chiropody, dentistry or opticians where appropriate. Pressure area care risk assessments were completed and appropriate care and equipment provided. The home has sensibly addressed the threat of a pandemic of Avian flu by producing an Avian flu policy and this has included consulting staff and writing to residents and relatives explaining what precautions the home has taken to date and will take should Avian flu spread to the UK. Two residents seen who need assistance with nail care did not have a good enough standard of nail hygiene. This was brought to the attention of the Matron and this was addressed immediately. Medications management was inspected. The home received a community pharmacist inspection recently and the pharmacist made several recommendations to the home in order to improve medication record management at the home. It was reassuring that the vast majority of the pharmacists recommendations appeared to have been heeded with out of the pharmacist’s identified recommendations only a minority of variable dose records not always completed. The variable dose recording was not always present in relation to Paracetamol and antacid tablets. This was discussed with the Matron and the inspector stressed the point that registered nurses should be reminded of the professional accountability for their actions in administration and record keeping of medicines. Residents spoken with confirmed that the staff in the home speak to them with grace and respect. A visiting relative echoed this finding. The inspector observed staff interacting with residents in a polite and friendly manner during the inspection visit. Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 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, 15. Social activities provided at the home are imaginative, varied, documented well and assessed for positive or negative result to whether similar sessions are planned. Both residents and visitors spoken with and in feedback card responses said that the activities in the home were good and had improved this year. At the inspection visitors said they are made to feel welcome. Meal times are relaxed and sociable. By swapping the functions of the dining room and lounge in the original building recently, this has added to the social ambience during meals, as the room now used as a dining room is larger, allowing more residents to be seated at one time. Choices of dishes are good and varied. EVIDENCE: The home’s activity coordinator works 32 ½ hours per week. Activities are planned weekly and a schedule is provided for residents. Activities take place every day and include group and individual activities in the home and outside trips. Residents said that they enjoyed the activities offered and the enthusiasm of the activity coordinator. Resident’s activity profiles and records of activities undertaken are very well documented and evaluated to plan for future age appropriate and meaningful individual activities. There is a good sensory equipped space in the home’s quiet lounge that is frequently in use. The inspector has a useful discussion with the activity organiser and the management about the Year of the Volunteer to think through ideas if Hurst Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 Page 13 Manor could attract further volunteers into the home to assist with resident activities. The home welcomes visitors and families and provides good private space for families to meet with relatives. The home is preparing for a Christmas evening at the home later in the week for relatives and friends of residents to attend too. Resident meetings are held and placement reviews are held for residents to discuss their care. Lunch was observed on both inspection days. The dining spaces are congenial to a relaxed and social mealtime. Residents needing assistance at mealtimes were observed to be cared for sensitively and professionally by individual staff members. Residents have a choice of main meal. The kitchen was briefly inspected. The proprietor has plans set out to extend the kitchen at the home. The home had recently received and EHO inspection and some advisory comments were made in the report. The progress in addressing the advisory comments was discussed with the home’s chef. Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 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): 17. Residents asked during the inspection confirmed being given the opportunity to take part in the civil process, thus the home is protecting fundamental voting rights for residents. EVIDENCE: Residents asked said that they were supported by the home to freely vote in the summer local/general elections Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 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, 20, 21, 22, 23, 24, 26. Hurst Manor provides a high standard of accommodation. The elegant listed building is furnished in keeping with the stylish exterior. Residents and visitors appreciate this. Building work continues to further enhance the environment at the home. EVIDENCE: The garden wing at Hurst Manor was officially opened on the 5th of July 2005 after being registered with the CSCI. The 11 single en-suite bedrooms and communal spaces in this wing of the home provide a very high quality living and working space for the home. The wing had been built to exceed National Minimum Standards and it includes pleasing landscaped accessible gardens and an inner courtyard. The wing is now occupied and bedrooms have been personalised to reflect individual tastes. The proprietor is also currently upgrading facilities in the main home. Four bedrooms are being improved and a larger new staff room is being provided. The fixtures and furniture in the home are of good quality. One over-bed table was identified by the inspector as being too tatty for use. The matron agreed and made arrangements for its replacement. The proprietor suggested in the Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 Page 16 feedback session at the end of the inspection introducing a regular formal audit of the condition of equipment in the home additional to staff reporting faults to the maintenance or management team to address. Medical equipment is provided appropriately to meet nursing care needs. Bathrooms and toilets are provided in sufficient numbers to meet needs. There are several lounges in the home offering communal or more private spaces. The laundry is sufficiently equipped to meet the needs of the additional registered rooms. Infection control practices in the home are clear and adhered to by staff. The home is clean without malodours and the environment looks fresh. The home was festively decorated at the inspection visit. Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 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, 30. The staffing levels at the home are sufficient to meet the needs of current residents. There is a high proportion of care staff holding the NVQ qualification in care. This provides a layer of care staff with a professional qualification. Staff employment practices are sufficiently robust to protect residents. Staff training is organised annually and takes due consideration of individual staff training needs so that there is a competent staff team at the home. EVIDENCE: The staffing levels for the home following the registration of the additional rooms had been agreed between the home owner and the CSCI. The home is complying with this staffing notice. The home admits a maximum of 30 nursing residents. There is at least one registered nurse on duty at all times in the home. The number of ancillary staff in addition to care and nursing staff are sufficient to ensure that the home is managed well. Staffing levels have increased beyond the minimum staffing notice where there has been a fluctuating higher dependency level of residents in the home. Several staff during the inspection had been affected by staff sickness over the last few weeks that has negatively impacted upon staffing levels at times due to staff being unavoidably ill because of a virus locally. The effect on the staff was that many were tired coping with additional shifts and covering for unwell colleagues. This was discussed with the management who acknowledged the staffing difficulties recently. Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 Page 18 There is a strong commitment to continuing staff training in the home. Most care staff hold the NVQ qualification in care at level 2. Several others are training to level 3. Team leader care staff are employed to supervise junior care staff. Staff recruitment records were inspected and details of staff employed and dates of when CRBs were obtained were submitted to the CSCI in the preinspection questionnaire. The inspected information held on staff files was in accordance of Schedule 2 of the National Minimum Standards. The administrator was able to demonstrate both verbally and by documentary evidence a good understanding of adult protection vetting procedures for the employment of new staff. Since the last inspection, as recommended, the home has produced and introduced the use of a pro-forma sheet for staff interviews. This aids the demonstration of transparency in equal opportunities in the home’s employment procedures. The home submitted details of staff training in the pre-inspection questionnaire. A good range of clinical, supervisory, managerial and statutory training has taken place at the home in 2005. Nursing staff have received syringe driver management, wound care and medication training. The care and nursing team have also attended training events in managing challenging behaviour, effectively communicating with people with a degree of hearing loss, disability awareness, palliative/terminal care and infection control. Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 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): 33, 34, 35, 38. Management at the home is competent and fosters an open but professional ethos at the home. Quality assurance processes are formal as well as informal. The home is able to demonstrate that it seeks the views of people both using the services at the home and working in the home. These views are responded to in order to improve upon services. Resident monies handed in for safekeeping is managed robustly and safely. Health and safety issues are managed competently. Residents live in a safe environment. EVIDENCE: The home has formal quality assurance processes in annual quality questionnaires to regular staff and resident meetings and staff supervision sessions. The results of questionnaire surveys are published in the home. All Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 Page 20 comments whether positive or negative are published and include acknowledgement and an action plan to address any negative feedback. The management of resident monies was inspected with the home’s administrator. This included the inspector randomly picking the account of one resident and checking that the money held in the home tallied exactly with the record maintained. It did. The Matron informs the CSCI of serious or notifiable accidents in the home. Appropriate records are maintained for accidents in the home and reporting to RIDDOR, if appropriate. The inspector observed staff assisting residents to move position. Staff followed best practice handling techniques. Details of equipment servicing records were submitted in the pre-inspection questionnaire. Some records were checked against this record by reading servicing labels on actual equipment in the home. Those checked were an accurate record of the details provided to the CSCI by the home. Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X 3 3 3 3 4 4 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 3 3 X X 3 Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? N/A 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 Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hurst Manor Nursing & Residential Home DS0000003267.V261633.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!