Inspection on 02/05/06 for Lyme Regis Nursing Home

This inspection was carried out on 2nd May 2006.

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

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

Other inspections for this house

Lyme Regis Nursing Home 29/04/08

Lyme Regis Nursing Home 09/07/07

Lyme Regis Nursing Home 17/11/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Lyme Regis Nursing Home Pound Road Lyme Regis Dorset DT7 3HX Lead Inspector Gloria Ashwell Unannounced Inspection 2nd May 2006 12:00 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 Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 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. Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lyme Regis Nursing Home Address Pound Road Lyme Regis Dorset DT7 3HX 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) 01297 442322 01297 444851 Magna Care Centre Limited Mrs Melanie Jane Boyd Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one service user, as known to the Commission for Social Care Inspection, under the age of 65 years. 17th November 2005 Date of last inspection Brief Description of the Service: Lyme Regis Care Home is established in premises originally built as a cottage hospital. The home is on a hill above Lyme Regis and thereby parts of the ground and lower ground floors have direct and level access to the gardens and car park. During early 2005 the home became owned by Magna Care Centre Limited and managed by BML. It is registered to provide nursing care for a maximum of 27 service users requiring nursing care in a total of 23 single and 2 double bedrooms. The home has a locally contracted agreement to provide two Lyme Community PMS (Primary Medical Service) nursing beds. There is a communal lounge on the first floor and a smaller lounge/dining room at lower ground level. A passenger lift enables level access throughout the home. There is a level car park to the front of the home and an additional parking area at one side of the building. There is a large paved area and a landscaped garden to the rear of the house. The home is close to a bus route, with a bus route to other nearby towns. Fees are charged weekly; at present fees range between £487 and £700 per person. Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was one of the two statutory inspections required in accordance with the Care Standards Act 2000. Since the last inspection no formal complaints against the home have been received or investigated by the Commission. The inspection was unannounced. The inspector was assisted throughout the inspection by registered manager Mrs Boyd, observed staff interaction with residents, the carrying out of routine tasks and spoke to 8 residents and a visiting health care professional. The duration of the inspection was 4 hours. Additional information used to inform the inspection process included the monthly reports regularly sent to the Commission by the provider and Comment Cards completed by health and social care professionals, residents and their representatives. What the service does well: The home provides good standards of nursing and social care to residents who are frequently very frail and highly dependent on staff for assistance. Despite their frailty residents are assisted to maintain as much independence as possible and are encouraged to maintain contact with the local community. A Comment Card completed by a social care professional states “Much improved with new manager in place…. improved communication and general care…particularly good at picking up on relatives needs/concerns as well as resident needs”, and one from a local doctor states “Very caring home – seems well run”. Meals are appetising and of good quantity and quality. The premises are comfortable with car parking spaces at the front of the house and a well maintained small garden and terrace at the rear. Staff are kind and helpful to residents. Residents are treated with respect, their privacy is protected and staff understand and meet their needs. Residents feel safe and well cared for. Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 Page 6 Medicines prescribed by doctors are safely stored and carefully administered to residents by trained nurses thereby protecting residents from risks of medicine errors. Residents wishing to do so may store and administer their own prescribed medicines. 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. Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 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 Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 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): 3&6 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Prior to admission, the needs of each proposed resident are assessed to ensure the home will be able to properly meet them. The home does not provide intermediate care. EVIDENCE: The records of a recently admitted resident included details of pre-admission assessment which had been carried out by the manager in communication with the hospital where the resident was at the time accommodated. The inspector spoke to the resident who confirmed satisfaction with the home and said “It’s very good…. I’m very comfortable”. Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The standard of care is very good and in accordance with a written plan of care for each resident ensuring that staff have sufficient information upon which to base their care practice. Residents health needs are fully met but periodic audit of accidents should be recorded to minimise risks of recurrence. Medicines prescribed by doctors are safely stored and carefully administered to residents by trained nurses, thereby protecting residents from medicine errors. Residents receive prescribed medicines at the correct times and in correct amounts. Residents wishing to do so can manage their own medicines. Residents are treated with respect and their privacy and dignity is protected at all times. Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 Page 10 EVIDENCE: A visiting health care professional expressed satisfaction with the home saying it had ”a friendly atmosphere” and provided a good standard of care. Residents were similarly pleased; one observed that the manager and staff “have been more than helpful…you can’t speak highly enough of them…they’re always willing to help…”. The inspector examined care records of 4 residents and found that each contained risk assessments forming the basis for care plans and daily records describing the care of each resident. To ensure correct identification of residents records contain a recent photograph of each resident; it is recommended that the home develops and implements a policy/procedure for obtaining consent to personal photography. Records are kept of all accidents but although the ‘falls pathway’ system is used and most include evidence of investigation and consequent action taken to minimise the risks of recurrence it is recommended that periodic audit be recorded to identify any trends or aspects of risk, to ensure that these can be properly managed and thereby reduced. Medication administration records were properly kept indicating that residents receive prescribed medicines at the correct times and in correct amounts those wishing to do so can manage their own medicines in accord with a risk assessment process; none of the currently accommodated residents manage their own medicines. Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The quality of daily life in the home is good with residents assisted to maintain as much independence as possible. Social and leisure activities are suited to the preference and ability of each resident. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. Meals are appetising and of good quantity and quality. Most of the very frail residents take meals in the ground floor lounge; others receive them in their bedrooms. There are intentions for improvement of the dining room facility. EVIDENCE: The inspector spoke to a number of residents; all those able to express an opinion indicated satisfaction with the home, including the range of activities, meal provision, staff and premises. Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 Page 12 The home employs an Activities Organiser who arranges local excursions, oneto-one and small group social and recreational activities. Visitors are welcome at any time and those the inspector spoke to said they are always made to feel welcome and placed at ease by the staff. Residents said they were very satisfied with the quality, choice and quantity of food provided; one resident said that ”the food is excellent…they insist on getting the flavours right”. Since the previous inspection and in accord with a recommendation of the associated report, the home has introduced advance menus and increased menu choice. The inspector observed the serving of lunch to a number of highly dependent residents who require pureed food and recommended that it be presented in a more appetising way, with separated constituent parts (e.g. green vegetables, potatoes, meat) rather than as on the day of inspection, all being pureed together. As noted during the previous inspection, at the time of inspection only frail and minimally communicative residents were using the lounge (on the ground floor) and the (lower ground floor) dining room was not being used. The narrow shape of the dining room reduces its usefulness. It is again recommended that dining room provision be improved. Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The complaints procedure provides information on the procedure to follow to persons wishing to make complaint; all complaints are recorded and properly investigated. The home adheres to a policy/procedure for the prevention of abuse and staff have received training in this subject to ensure that they remain vigilant to protect vulnerable residents from risks of abuse. EVIDENCE: Residents feel they are safe, and well cared for; comments included “It’s a lovely place…(the staff) are very good”. Residents feel confident that if they had concerns or complaints they will be listened to and taken seriously. The home keeps records of all complaints received and investigated. Since the last inspection 3 complaints have been received; 2 related to aspects of care, and one to the temperature of the premises not upheld. Both complaints about care standards were investigated by the manager; one was partly upheld and the other was not upheld. Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 Page 14 The complaint about the room temperature was investigated and not upheld, but aspects of modernisation were nonetheless introduced and a thermometer was displayed in the room. Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 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 & 26 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Recent improvements to the premises have resulted in the provision of a generally well-appointed and comfortable home; the programme of improvement remains ongoing. On the day of inspection the home was clean, pleasant and hygienic and there was evidence indicating that this is the usual standard of provision. EVIDENCE: During recent months, the registered provider has improved many parts of the premises; there is an ongoing programme of refurbishment and redecoration, including carpet replacement as necessary. In accord with requirements included in the report of the last inspection, extractor fans have been installed to areas without other ventilation, and Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 Page 16 ‘privacy locks’ have been installed to en suite hygiene facilities in residents bedrooms. During the tour of the premises the inspector noted that one bedroom contained a carpet with unsightly stains, a neighbouring bedroom had a carpet loosened and creased presenting a tripping hazard and the vinyl floor covering of the lower ground floor sluice room was damaged and unsuited to effective cleaning. This report contains requirements for these floor coverings to be improved. The inspector toured the premises and found the home to be clean and pleasant, despite the currently vacant post of one cleaner which has resulted in no cleaner being on duty during alternate weekends. The manager explained that the home is at present seeking to employ a replacement cleaner and that she herself empties bins on the days when no cleaner is at work. Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 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 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The home employs enough staff to meet the needs of residents and to ensure their safety and comfort and the good condition of the premises. Recruitment practices ensure the protection of residents from potentially unsuitable staff. Staff receive appropriate training and are competent to carry out their jobs. EVIDENCE: Trained nurses lead the care team and at all times the home is in the charge of a trained and competent nurse. Staffing levels are provided in accordance with the assessed needs of residents to ensure that at all times sufficient staff are available to properly meet their needs. The inspector spoke to a number of staff, including registered nurses, care workers and household staff. All were enthusiastic about their work and felt that they provided a good standard of care to residents. The records of 2 recently employed staff members were examined and found to contain all essential information including two written references, an Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 Page 18 interview assessment, health details, evidence of identity and of induction training. The records of one of these persons, who was previously known to the manager, did not provide full dates of previous employment (i.e. only the years of starting and leaving were written) although the manager was personally aware of this information; it is recommended that this information be always recorded. There is an enthusiastic approach to staff training; trained nurses and care staff are supported and encouraged to undertake training in relevant subjects. Recent topics for care staff have included ‘promoting continence’ and moving and handling. Of the 11 care staff currently employed, 2 are trained nurses from overseas (not undertaking adaptation training for registration in the UK), 3 hold a National Vocational Qualification in care and one is nearing completion in training for this award. In consequence, the home is nearing the compliance target of 50 of care staff trained to NVQ in care. All new staff undertake a programme of induction, including clinical work supported by use of video films and questionnaires. Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is generally adequate. This judgment has been made using available evidence including a visit to the service. The home is well managed and staff understand their work and receive training appropriate to their needs. Residents and their representatives are satisfied with the home and feel staff care for them well and put them at their ease. The home has implemented a quality assurance system to ensure that residents remain satisfied with all aspects of the home. With the exception of the personal allowances of some residents, the home does not manage the finances of residents. The premises and equipment are properly maintained in good condition and subject to ongoing improvements but there remains opportunity for greater safety of specified aspects. Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 Page 20 EVIDENCE: Since the previous inspection Mrs Melanie Boyd has become the registered manager of Lyme Regis Nursing Home. Mrs Boyd is an experienced nurse and manager and demonstrated high degrees of competency in both aspects throughout the inspection. The home has ongoing systems for quality assurance; a satisfaction survey has been prepared and is to be issued during coming weeks. During March of this year Mrs Boyd published the first issue of a newsletter describing planned social events for residents and introducing her intention to hold periodic meetings for residents and their relatives. There is a selection of clear and appropriate policy and procedure documents, including those for care provision, management and the premises. Records of fire alarm tests, staff training and drills were in order. With the exception of the personal allowances of some residents (for which all transactions are confirmed by receipt), the home does not manage the finances of residents. Staff trained in First Aid and health care are on duty in the home at all times. All staff are supervised and each has a personal profile containing records of appraisal. Records of maintenance include the following: - passenger lift: routine service 24 March 2006. - a certificate of safety for the electrical installation dated 27 February 2001 bearing the instruction that the installation should be re-inspected after five years. The manager stated that arrangements have been commenced for this work. - a certificate confirming the safety of the gas installation dated 5 December 2006. During the tour of the premises it was noted that some residents bedrooms contained large television sets brought from their private addresses; at least 2 of these sets appeared to be precariously standing on small cabinets not designed for this purpose. The home has recorded a health and safety risk assessment for the premises; it is required that this be extended to include assessment of the suitability/safety of all personal property brought into the home by residents. Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 Page 21 A ground floor bedroom was observed to have only one double electric socket and in consequence a series of extension leads were trailed about the room, to enable use of the television set; it is required that at all times the safety of the premises is maintained and recommended that at the earliest opportunity an additional socket be installed in this room, and any other similarly disadvantaged rooms. Individual service user risk assessment has been recorded for risks associated with hot surfaces presented by the often very hot water supplied to wash-hand basins and warning notices have accordingly been displayed above the basins. However, there remains opportunity for accidental scalding and in particular, residents may be unable to read/comprehend the notices so it is recommended that the home implement more reliable systems of control, e.g. install thermostatic devices to each hand basin. Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 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 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 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. Standard OP19 Regulation 16 Requirement Timescale for action 01/07/06 2. OP38 13 3. OP38 13 The floor coverings of the lower ground floor sluice room and 2 lower ground floor bedrooms (identified to the manager during the inspection) must be improved to ensure safety and fitness for purpose. The home must develop and 04/06/06 implement a process of assessment of the suitability/safety of all personal property brought into the home by residents. At all times the safety of the 04/06/06 premises must be maintained; the use of extension leads must be avoided. Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard OP7 OP8 OP15 OP29 OP38 OP38 Good Practice Recommendations The home should develop and implement a policy/procedure for obtaining consent to personal photography. Periodic audit of all accidents should be recorded to identify any trends or aspects of risk. Dining room provision should be improved. Full dates of previous employment should be recorded for all applicants. At the earliest opportunity an additional electrical socket should be installed in all bedrooms with only one double socket. The home should implement reliable systems to control the maximum temperature of hot water supplied to hand basins e.g. install thermostatic devices. Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Lyme Regis Nursing Home DS0000063737.V292253.R02.S.doc Version 5.1 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. 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