Inspection on 08/08/08 for Jackson House Nursing Home

This inspection was carried out on 8th August 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Jackson House Nursing Home 09/02/09

Jackson House Nursing Home 09/08/07

Jackson House Nursing Home 26/01/07

Jackson House Nursing Home 08/12/05

Jackson House Nursing Home 25/10/04

Jackson House Nursing Home 19/04/04

Jackson House Nursing Home 16/12/03

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

CARE HOME ADULTS 18-65 Jackson House Nursing Home 2 Lode Hill Cottages Styal Cheshire SK9 4LH Lead Inspector Ms Julie Porter Key Unannounced Inspection 8 August 2008 10:30 Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Jackson House Nursing Home Address 2 Lode Hill Cottages Styal Cheshire SK9 4LH 01625 525443 01625 525443 jacksonhouse2@hotmail.co.uk 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) Mr Clifford Slack Manager post vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 4 Date of last inspection 9 August 2007 Brief Description of the Service: Jackson House provides accommodation and nursing care for up to four adults with a learning disability. The people who live there each have their own room and there are shared lounge and dining areas, plus kitchen and bathroom. People who live at Jackson House are generally physically independent, and the home does not have any aids or adaptations such as a passenger lift or mechanical hoists. The home is close to Styal National Trust village, and a small convenience store/post office and pub are within easy walking distance. The weekly fee payable at the home depends on the needs of the individual. Information is available from the acting manager. Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is 0 stars. This means that the people who use the service experience poor quality outcomes. This visit took place on 8 August 2008 and a second visit was made on 11 August 2008, as some records were unavailable the first time. A total of six and a half hours was spent at the home. The visits were carried out by one inspector of the Commission. During our visits, we spoke with people living in the home, the acting manager and staff on duty. We had a look around the premises and checked various records held by the home. The visit was just one part of the inspection. Before the visit the home manager was asked to complete a questionnaire to provide up to date information about the home. This was not returned on time and a second request had to be made. CSCI questionnaires for people living in the home and staff to complete were sent to the manager for distribution so they could tell us what they think of the home. What the service does well: The home has thorough processes in place to assess and introduce possible new people to the house before they move there so they can get to know the home and staff know what their needs are before they move in. People are encouraged to maintain contact with family, so that they continue to be part of family life. People living in the home are encouraged to pursue activities of their choice so that they can maintain and develop new skills and friends. The people living in the home are well known in and are encouraged to be part of the community. Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 6 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. Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. People’s needs are assessed before they move to the home so that they know their needs can be met there. EVIDENCE: One person had moved to the home since the last inspection. Evidence was seen that some staff from the home had met the person before he moved there. Records showed that he had visited the home five times to have a meal with the people already living there and had stayed overnight once. We spoke with him about his move to the home and he said that it was okay. He remembered visiting and said that he had wanted to move in. He told us he found the home better than where he was living before. Staff told us that it would be more usual to have many more overnight stays before moving to the home but because of this person’s condition it was felt appropriate to move more quickly. The decision had involved the service user, staff from the home and a multi disciplinary team involved with the person’s care. Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 9 Information about the person’s health and information regarding any recent appointments had been transferred from where he had lived previously. The assessment document used for the home covers daily living, health, social and emotional needs and includes a life history of the person. Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use services experience poor care in this outcome area. We have made this judgement using available evidence, including a visit to the service. There have been incidents of people who live at the home being restrained, with no behaviour management programme in place to back this up. This poor practice may leave people who live at risk of not having their rights upheld and being restrained inappropriately. EVIDENCE: Three people’s plans were looked at during our visit. In one, we looked at assessments in particular. The other two plans were looked at in relation to recent incidents in the home. One care plan contained an assessment of the persons’ needs relating to their health and behaviour. The care plan identified specific needs, the outcomes they wanted to achieve and the actions necessary to get there. A number of risk assessments were seen relating to the person’s behaviour and actions. The home has a process to update and review care plans regularly. Evidence Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 11 was seen that other health care professionals are involved with their care such as psychiatrists, psychologists and speech and language therapists. The daily records and other related documents were inspected regarding two incidents in the home. Records showed that two people had been restrained during separate incidents. Information was not been recorded sufficiently to demonstrate this was part of an agreed plan and a strategy for managing people’s behaviour. The records did not identify who restrained, how they were restrained and for how long was the person was restrained. One of the incidents of restraint was completely contrary to the persons agreed care plan of not using physical touch. Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. People are encouraged to pursue interests and activities of their choice so that they maintain their interests and develop new skills. EVIDENCE: People living in the home told us of a variety of activities they are involved in going to see live bands and tribute bands, steam trains and planes, going to the pub and eating out. One person walks to the local shop daily for the newspaper and chats with neighbours on the way there and back. During our second visit, people were involved with going shopping to do the household weekly “big” shop. One person said that they were looking forward to starting voluntary work soon, working with sick animals. Records showed that people living in the home are encouraged to maintain contact with family and friends. Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 13 During both our visits people living in the home were having lunch. They told us they liked the food and more or less could choose when and what they ate. Staff cook most of the meals. Meal times appeared relaxed and sociable occasions. Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. The physical and mental health of people living in the home is monitored by the staff and other health professionals so they get the care they need. EVIDENCE: CSCI questionnaires returned from three people living in the home say that they feel they can do what they want and that they can make decisions about what they do each day. Routines in the house appear to be flexible Care plans show that people living in the home are registered with the local doctor and a healthcare specialist based at Rosemount monitors their mental health. The home has policies and procedures relating to medication and medication administration. Only qualified nurses administer medication in the home. Medication is provided from the pharmacy in blister packs. For some medication this is not appropriate and this is therefore supplied in the original foil wrappers. Medicine administration record (MAR) sheets were looked at and records had been maintained appropriately. Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 15 Guidance and protocols for administering “as required” medication were available. Although these are informative, they could be improved to describe specific behaviour/actions so that administration of these medicines is not just left to staff interpretation of the guidance . Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use services experience poor care in this outcome area. We have made this judgement using available evidence, including a visit to the service. People’s concerns are not recorded, staff have not done updated training on safeguarding adults and people’s rights are not adequately protected by staff actions relating to restraint so people who live at the home are at risk of poor practice, harm and possible abuse. EVIDENCE: Three questionnaires returned from people living in the home say that they know who to complaint to should they be unhappy with any aspect of the service. No complaints have been recorded in the homes log. This was discussed with staff who said that they tend not to record any matter unless it was serious. Staff have not received refresher training in relation to protection of vulnerable adults. Staff attended a training event “Proactive approach to conflict” in July 2008. We saw daily records and care plans for two people in relation to two incidents of restraint. The first incident involved verbal aggression, resulting in the person being put into their room. The person then tried to prise the window open to jump out and the daily record states that staff restrained the person “for quite a lengthy time.” In the second incident, the person had been verbally and physically aggressive when staff prevented him from making a second cup of coffee for himself. His Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 17 care plan, dated 01 April 2008, in relation to verbal and physical aggression states, “if the situation is escalating redirect to another area do this by talking and not using physical touch.” Despite this guidance, the person was physically restrained and moved from the room to the house porch. This incident happened after staff had attended training on ‘Proactive approach to conflict’ in July 2008. The document “How to move towards restraint free care” was left with the manager for guidance on current practice and record keeping. The manager told us that no referrals have been made to the local authority under the local authority’s safeguarding adults procedures. Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 and 30 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. On the whole the home was clean, tidy and well maintained so that the people living there do so in comfortable surroundings. EVIDENCE: The home is in Styal conservation village and is in keeping with other homes in the area. We had a look around the communal areas of the home and since the last visit some improvements have been made. The upstairs bathroom and the downstairs shower room were clean and tidy; downstairs has benefited from new shower. On two occasions, we found there were no hand towels available in the downstairs toilet. A “star lock” is the only means of locking the room to give any privacy and people living in the home have to ask for the key if they want to use that toilet. Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 19 The kitchen worktops are showing signs of wear and tear and in some places heat damage had removed the surface so the chipboard was showing through. We were invited to see one person’s room; it was nicely decorated and he had lots of things he was interested in on show. The home was clean and tidy on both days of the visit. Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People who use services experience poor care in this outcome area. We have made this judgement using available evidence, including a visit to the service. In the absence of thorough recruitment processes, records and regular mandatory training for staff, the home cannot adequately demonstrate that the people living there are safeguarded from poor practice or harm. EVIDENCE: We were unable to access the staff records on the first day of the visit and so they were inspected on 11 August. Information provided by the acting manager on 28 July 2008 states that 13 nursing/care staff are employed in the home, and ten have an NVQ in care at Level 2 or above. The manager provided us with a training chart but this showed that with the exception of two courses, all other dates were in the future. No evidence could be provided that these courses had been booked and when asked, the manager confirmed that staff have not received any mandatory training. Six staff recruitment files were inspected and we found the following; all six files identified that that criminal record bureau (CRB) clearance had been Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 21 obtained, three files did not have two written references, two files contained only one written reference. One file did not have an application form. Information regarding the selection process i.e. the interview and decision to appoint varied in quality and content. Records were not available to show how decisions had been made in respect of employing people with CRB checks that were not clear and monitoring of their performance. We were unable to confirm the start dates of employees as contracts were not available in every case. We were told by the acting manager that rotas stored on the computer did not always reflect the shifts actually worked. Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 and 43 People who use services experience poor care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Health and safety matters, recruitment and training are not appropriately managed which means that people staying at the home are not suitably safeguarded. EVIDENCE: The home has been without a registered manager since 30 November 2007. Since then two requests have been made to the owner of the home for information regarding the appointment of a manager. To date, no application has been made by the person who is acting as manager for registration with the Commission for Social Care Inspection, as required by the Care Standards Act 2000. Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 23 The Annual Quality Assurance Assessment (AQAA) was not returned on time and a reminder was needed. Questionnaires regarding the quality of the service are given to people living in the home annually. Those seen were on the whole positive. No evidence was available to say that advocates were involved with the people living in the home apart from their own relatives. Some records were unavailable for inspection during the first inspection visit and at the second visit staff records were found to be incomplete. Rotas stored on the computer are not being maintained to show changes. During the visit on 8 August, the fire safety records showed that staff training had taken place in 2006, the last fire drill was 06 January 08, the emergency lighting had been tested monthly until March 2008, and fire alarm tests had been recorded until April 2008. At our second visit, further records were produced to show that the alarms had been tested weekly and emergency lighting monthly. The training chart showed that staff had received fire safety training on 02/06/08. The manager was asked and confirmed that these records were accurate. The acting manager could not provide evidence that thorough and satisfactory recruitment processes had been adopted in recruiting staff since he has been in post. Staff have not received up dated mandatory training. Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 2 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X 2 2 2 Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 25 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 Standard YA23 Regulation 13(7) Requirement Appropriate steps must be taken to make sure that no person living in the home is subject to unnecessary restraint, so that their rights are respected and they are not subjected to harm or abuse. A record must be maintained of any circumstances surrounding any restraint used on a person who lives at the home, the nature of the restraint and the length of time it was used. This is to make sure that any restraint used is part of a behaviour management plan, is used appropriately and in the best interests of the person concerned. All staff must receive regular updates in protection of vulnerable adults training so that people are protected from harm and abuse. All staff must receive regular mandatory training relating to moving and handling so that DS0000018802.V366210.R03.S.doc Timescale for action 12/08/08 2 YA23 13(8) 12/08/08 3 YA23 13(6) 30/11/08 4 YA32 13(5) 31/12/08 Jackson House Nursing Home Version 5.2 Page 26 people are moved safely. 5 YA34 19 Schedule 2 Thorough and consistent recruitment processes must be developed so that people living in the home are protected from possible harm or poor practice. The person who is identified as the manager of the home must apply to the Commission for Social Care Inspection to be registered, as managing an establishment without being registered in respect of it is an offence under the Care Standards Act 2000. 30/09/08 6 YA37 Care Standards Act Part II Section 11(1) 31/10/08 7 YA41 17(3) Staff records must be maintained 30/09/08 and contain information as specified in Schedule 4, to protect people living in the home. The manager must ensure that 30/09/08 procedures are in place to enable access to be given to records necessary for inspection. 8 YA41 17(3)(b) 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 YA22 Good Practice Recommendations A log should be maintained of all verbal complaints made/concerns raised by residents including the outcome, to show that residents are listened to and their concerns are acted upon. Information describing specific behaviours should be included in the protocol for administering “as required “ medication so that all staff clear and follow this DS0000018802.V366210.R03.S.doc Version 5.2 Page 27 2 YA23 Jackson House Nursing Home consistently. 3 4 YA24 YA23 The damaged kitchen worktops must be replaced so that hygiene standards are not compromised. All new staff should receive training relating to adult protection within 6 months of employment and every 2 years The lock on the downstairs shower room should be changed so that people living in the home can have privacy without having to ask for the key. 5 YA24 Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North West Region Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries.northwest@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 Jackson House Nursing Home DS0000018802.V366210.R03.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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