CARE HOMES FOR OLDER PEOPLE
Hurst Manor Nursing and Residential Home Hurst Martock Somerset TA12 6JU Lead Inspector
Shelagh Laver Unannounced Inspection 21st April 2008 10:00 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 and Residential Home DS0000003267.V362487.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. Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hurst Manor Nursing and 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 sue@hurstmanor.co.uk www.hurstmanor.co.uk Hurst Manor Ltd 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 and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Old age, not falling within any other category (36) The maximum number of service users who can be accommodated is 36. 27th September 2006 Date of last inspection Brief Description of the Service: Hurst Manor is a three storey Grade II listed Georgian House situated in the centre of the village of Hurst. The home is set in its own landscaped ground with lawn and flowerbeds. Hurst Manor is a care home providing nursing for up to 36 elderly persons of either sex, not less than 60 years, who require general nursing care. Day care is provided for service users requiring nursing care within the registered numbers. There has been a recent registration change to provide care for 11 people whose primary need relate to dementia although no admissions have been made at the time of this report. The accommodation is mainly in the large Georgian House and the garden wing that has en-suite bedrooms with patio doors onto the gardens. There is a large car park to the side of the care home. In 2007 a major extension and refurbishment had resulted in 35 rooms of which 33 are en-suite. There is a choice of communal rooms and attractive outdoor spaces. Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. This key inspection was carried out over two days by one inspector. At the first visit CSCI concentrated on the recording of care and records related to staffing and maintenance. At the second visit all people who lived in the home were seen and whenever possible spoken to. Staff on duty were spoken with and a complete tour of the building was made. The home had submitted a detailed an Annual Quality Assurance Assessment (AQAA) that provided a summary of the homes’ achievements and progress over the previous year. Since the last key inspection on 27th September 2006 the home has undergone accommodation and registration changes. A random inspection was made on 24th May 2007 to review progress on the building. An inspector visited the home as part of the process to register the home to provide care for people with dementia on 7th April 2008. There has been a substantial amount of building and refurbishment. An attractive atrium has been created where visitors are welcomed and people can sit and enjoy their newspapers or coffee. Rooms have been renovated and a new kitchen has been installed. The home has made two changes to its registration. In May 2007 the home made a variation enabling all the beds to be used by people with nursing needs. In April 2008 an application to provide care for 11 people with dementia was approved. There are no plans at the moment to begin admitting people with dementia until the training programme is complete. Overall people in the home are well cared for and the standard of service is good. People we met were positive about life at Hurst Manor and felt “well cared for.” However at this inspection there was evidence that improvement is needed in the documentation and implementation of the nursing care for people in a vulnerable and unstable condition. Attention must be paid to the prevention of pressure damage, maintenance of diet and fluids and the documentation of wound care of frail people. The ways in which staff are instructed supported and supervised must be reviewed to ensure that these fundamental nursing functions are undertaken to the same high standard as other aspects of provision in the home. Evidence for these concerns was from care documents for three frail people studied in depth.
Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 Page 6 What the service does well:
This is a friendly home where people said they were well looked after. All people spoken to said staff were “polite and kind.” There were several comments that people were “happy” and “well suited.” One person who said he didn’t want to be in any care home added “but this is probably as good as it gets.” People are able to choose how they spend their days. During the inspection people were observed in their rooms or communal areas. People who were unwell were seen to be resting quietly and comfortably. One person said, “I have my own interests” and went on to talk about trips out with family. Staff spoken to said that they enjoyed working at Hurst Manor and were offered good training opportunities. The “hotel services” at Hurst Manor appeared to be very well organised and effective. The home was clean and well presented. There is a good choice of food at meal times and the lunch seen was well presented. People said food was “excellent” and “very good.” During the inspection a member of the staff was observed “taking orders” for lunch whilst serving teas and coffees. The interaction between people and all staff seen was friendly and respectful. Personal choice is respected. At lunch time one person was heard to have requested “a glass of wine and a bowl of ice cream!” Care is taken so that people can maintain their appearance. A hairdresser visits regularly and the laundry service produces clothes that look very well cared for including hand ironing. The management and staff in the home consult with people who live there in a number of ways to try and ensure satisfaction. There is an annual survey that in 2007 resulted in 34 responses from relatives and people who live in the home. There have been changes to the delivery of beverages, cleaning routines and lighting as a result. The survey is comprehensive and asks open and closed questions, encouraging people to give full and frank opinions. One comment was “I feel that all the staff put the needs of the elderly first, even when the bells are constantly being pressed! I acknowledge their hard work.” There are clear records of social activities. People spoke of trips to the coast or garden centres. There are also plenty of daily activities advertised in the newsletter such as “coffee and crafts in the Atrium.” There are plenty of “brain stretchers” as one person called them. One person has a collection of plants in a sheltered courtyard. There are some examples of thoughtful ideas. People find in their rooms a comprehensive “Welcome Pack” that includes a collection of post cards to send to family and friends with their new address. There is a Customer Services Manager. The AQAA states that the “brief” of this person is to “ensure that residents and relatives receive an excellent service.”
Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. People are able to review information to assist them in making a choice to move to the home. People are assessed prior to arriving at the home using a range of information. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information about the care home and the services available is contained in the statement of purpose and service user guide which are available in the home, on display near the front entrance along with the last inspection report and other related information. People are welcome to visit the home prior to admission. Some people are not able to visit the home due to them being in hospital. Relatives made the choice following visits to the home. One person said they had local knowledge of the home that enabled them to choose.
Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 Page 10 Contracts were reviewed. The terms and conditions were set out clearly stating the fees, liabilities and responsibilities of each party. This includes the fact that the fees will be adjusted should additional equipment be required at a later stage. The matron / deputy matron visits all prospective residents to carryout a needs based assessment using the activities of daily living model of care. The matron then discusses the assessment with her staff to clearly determine that care needs can be met. In the files inspected there was evidence of full assessments by the home and other professionals. Hospital discharge letters and SAP reviews were seen. The fees for the home range from £520-£837. People can be re-assessed in the home and progress to nursing care when needed. Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is adequate. Most people are well cared for but there is a need to improve the planning and recording of nursing care for some frail people. Medication systems are safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care planning system is based on the Sharps system using the activities of living model. All people have a care plan that is reviewed at appropriate intervals. Overall people in the home confirmed that they received good personal care and that their health needs were met. All people seen looked comfortable and well presented. Frail people were seen resting comfortably. Five care plans were examined in detail. The plans indicated that assessments of risk of pressure damage were made on admission. In two the action to be taken to prevent further damage was not sufficiently detailed and did not give care staff clear guidance of the action to be taken. Plans had not been revised and up-dated as peoples’ needs changed.
Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 Page 12 Recordings made by care staff indicated that for one person there was a deterioration without evidence of clear preventative action by nurses. There was a belief that the routine of the home ensured that people were moved sufficiently but this is not a robust approach to pressure damage prevention. The therapeutic role of diet did not seem to be clearly understood or implemented effectively in two cases. When a wound had developed the recording by staff of the progress of that wound was erratic and in one case action was not sufficiently prompt. Records indicated that the home ran out of prescribed dressings and in two cases it was not clear that the wounds were checked regularly. Full names of people completing these records should be used not initials. The recording of assessments of nutrition was not seen in two files and evidence of good practice was inconsistent. One person’s plan stated that a carer had been allocated at each shift to ensure that sufficient diet was taken. Food supplements were obtained but there was no robust system to ensure that they were received regularly. The monitoring of weights of some people was not undertaken with sufficient diligence. Immediate action was taken by staff during the inspection to weigh one person who appeared thin and action was taken to ensure dietary supplements were received. Fluid balance charts were available for some people but were not always fully completed. There must be clearer guidance and monitoring by nursing staff to ensure people receive sufficient fluids and that action is taken when they are not drinking well. There was evidence that people could receive subcutaneous fluids when required. When people are suffering from pain there should be a clear plan to prevent it. People were seen to have been prescribed pain relief but there was no overall plan that included all measures required to make the person comfortable. In one file the hospice nurse was supporting a person in the home but there were no records to indicate the advice or support provided to the person. There are regular planned visits from GPs in addition to access to a range of outside health professionals. Arrangements for residents to attend appointments outside the home are in place. People are encouraged to be independent and are involved in their personal care. The medication system and procedure was checked and found to be satisfactory. Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is good. People are encouraged to make choices about how they spend their day. There is a programme of activities available. Food is plentiful and wholesome. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People enjoy a varied lifestyle at the home. During the visit to the home people were observed pursuing a number of options. Some people said they joined in the activities and entertainment others said they preferred their own company. All people were aware of the activities programme and entertainment planned. There is a monthly newsletter that details all events. In May this included music and people giving “A talk on bees.” One person said “Some activities are just like being with friends. We talk or play games.” The registered provider sends out an annual resident satisfaction survey and includes the comments and suggestions from residents to improve the life style in the home. Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 Page 14 Food is of a good standard. People spoken to during the inspection spoke positively about the meals. People are encouraged to eat in the attractive refurbished dining room but can also chose to eat in their rooms. The dining room is large with round tables fully laid with cutlery and condiments. Hot and cold drinks were available along with wine. The menus are well balanced and people requiring soft or special diets are provided for. Every day there is a salad available and fresh fruit salad is available daily. The dietician is consulted if any special diets are required. Comments relating to the provision of food and drink to people needing nursing support are included in the personal care section. Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. People are protected by up to date policies and procedures. There is a complaints policy and procedure that is used by people in the home and their relatives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is robust, residents and relatives are aware of who they can make any concerns known. Responses to complaints are recorded. The recruitment procedure and processes are robust. Three recently employed staff files were checked to ensure the process is carried out. The homes quality assurance system also ensures safe practices in the home. Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 Quality in this outcome area is good. People live in an attractive comfortable environment that is safe and adapted to their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has undertaken substantial development and the new environment has been built to a high standard. New rooms are 12square metres or larger. Fixtures and fittings are appropriate and of a good quality. Rooms are colour co-ordinated and people have been able to personalise them. There are attractive gardens and courtyard areas. Most ground floor rooms open onto a garden or courtyard. The furnishings throughout the home are comfortable although the sitting room in the main house needs attention to make it more welcoming. Maintenance is planned and carried out regularly. 33 rooms have en-suite facilities. 25 have showers in the en-suites.
Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 Page 17 The home was clean and tidy. A couple of the bathrooms were being used as storerooms. The communal areas are comfortable with adequate easy chairs for all residents. There is adequate equipment for moving and handling. The home expects people to rent or purchase their own electric pressure relieving equipment should this become necessary. Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is adequate. People can be assured that the care staffing level is maintained to meet their needs. There is a requirement for nursing staff to update their knowledge and vigilance with regard to key areas of care. Recruitment policies and procedures protect people in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three staff recruitment files were seen. They contained evidence of appropriate pre-employment checks. There is evidence of induction programmes and staff spoken to confirmed regular training is provided. All staff are undergoing the ‘Yesterday, Today and Tomorrow’ training which is provided by the Alzheimer’s Society. This includes care and ancillary staff. Two senior staff have completed the follow up training called ‘Making the most of Yesterday, Today and Tomorrow.’ The training manager is undertaking a Diploma in Dementia Studies with Bradford University. The provider confirmed that he will not admit people with dementia until all staff have received the training first. The training manager provides the common induction standards for all staff and is adding on the standards for good dementia care practice. As a nursing home there is always at least one Registered Nurse on duty. There are plans to ensure that RMNs are on duty should the home begin to
Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 Page 19 admit people with dementia. A review of the duty sheets indicate that there are sufficient staff on duty including trained staff. The home must therefore review the way the nursing and care teams work together to ensure that when necessary the nursing care in the home becomes more focused and effective. The AQAA states that 45 of care staff are qualified to NVQ level 2 or above. All catering staff have received Food Safety training. Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 Quality in this outcome area is adequate. The management of the home is competent and has many years of experience in caring for older persons however there is a need to address some areas of care delivery. The management team use a quality assurance system to monitor service delivery. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a detailed and comprehensive annual survey. The results of questionnaire surveys are published in the home. All comments whether positive or negative are published and include acknowledgement and an action plan to address any negative feedback. Quality assurance processes are formal
Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 Page 21 as well as informal. The registered person is able to demonstrate that he 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. The latest survey was carried out in July 2007 and indicated a great deal of satisfaction and a small number of concerns that were addressed. Records of peoples’ finances are kept and there is a robust system of checks. There is a thorough maintenance programme with organised record keeping. The manager and senior staff at the home must review the way in which staff teams are managed to ensure that the responsibility for the nursing care in the home is appropriate. Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 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 X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 X X 3 X X 3 Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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. 2. Standard OP7 OP8 Regulation 13(4) 17(1)a Requirement A plan of care must be produced that meets relevant clinical guidelines People who have been assessed as being at risk of developing pressure damage must receive planned and recorded effective preventative care that reflects current best clinical practice. Nutritional screening must be undertaken on admission and subsequently on a periodic basis for all people in the home. Records must be maintained and appropriate action reflecting best clinical practice must be taken in the event of excessive weight loss or gain. The home must ensure that having regard to the needs of the person adequate quantities of suitable wholesome and nutritious food and drink is available and that adequate records are kept. (This relates to people having poor appetite or unable to take fluids sufficiently themselves.) Staff in the home must receive
DS0000003267.V362487.R01.S.doc Timescale for action 01/06/08 01/06/08 3. OP8 12(1) 01/06/08 4. OP15 16(2) 01/06/08 5. OP30 18(1) 01/06/08
Page 24 Hurst Manor Nursing and Residential Home Version 5.2 6. OP31 12(1) up-dates on best practice concerning pressure damage prevention, care planning, wound care and maintenance of diet and nutrition. There must be clear lines of accountability within the home that ensure the delivery of nursing care that meets clinical best practice. 01/06/08 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. Refer to Standard OP11 Good Practice Recommendations The registered person is encouraged to introduce the gold Framework standards into care plans for persons needing palliative / end of life care. Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hurst Manor Nursing and Residential Home DS0000003267.V362487.R01.S.doc Version 5.2 Page 26 - 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!
