Inspection on 09/03/07 for Manor Cottage Hotel

This inspection was carried out on 9th March 2007.

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

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

Other inspections for this house

Manor Cottage Hotel 07/03/06

Manor Cottage Hotel 09/08/05

Manor Cottage Hotel 16/02/05

Manor Cottage Hotel 05/05/04

Manor Cottage Hotel 23/09/03

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

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 Manor Cottage Hotel Manor Cottage Hotel 1-3 Manor Crescent Preston Paignton Devon TQ3 2TN Lead Inspector Susan Samways Unannounced Inspection 9th March 2007 10:30 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 Manor Cottage Hotel DS0000034029.V320398.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. Manor Cottage Hotel DS0000034029.V320398.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor Cottage Hotel Address Manor Cottage Hotel 1-3 Manor Crescent Preston Paignton Devon TQ3 2TN 01803 550363 01803 526546 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 Kenneth Peek Mrs Hazel Susan Weaver Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Manor Cottage Hotel DS0000034029.V320398.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One Service User (named elsewhere) in the category `Dementia` Date of last inspection 07/03/06 Brief Description of the Service: Manor Cottage provides care for up to eighteen service users who fall within the category of old age. It is a large, detached property situated on the level, close to all local amenities. The home benefits from a level garden. The accommodation is arranged over two floors with some bedrooms on the ground floor. There is a stair lift to assist service users to access the upper floor, however, it is still necessary for service users to manage a few steps at the top of the staircase. Current fees are £340 – 380. Manor Cottage Hotel DS0000034029.V320398.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection which lasted for 7.5 hours. The registered manager was available throughout the inspection. Six residents were spoken to as a group in the lounge and three others were seen individually in the privacy of their own rooms. Four members of staff were interviewed during the inspection. Various documents, including care plans and staff files, were examined. Prior to the inspection completed surveys were received from nine residents, three relatives, two visiting professionals and four staff. What the service does well: What has improved since the last inspection? Manor Cottage Hotel DS0000034029.V320398.R01.S.doc Version 5.2 Page 6 All radiators are now fitted with guards. 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. Manor Cottage Hotel DS0000034029.V320398.R01.S.doc Version 5.2 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 Manor Cottage Hotel DS0000034029.V320398.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have a comprehensive assessment made which provides all those concerned with sufficient information to make the decision whether Manor Cottage is an appropriate home for them. EVIDENCE: Residents who completed surveys and those who were spoken to during the inspection confirmed that either they or their relatives were given sufficient information about the home in order for them to make a decision as to whether it could meet their needs. Four residents said that they had spent periods of respite care at Manor Cottage prior to making the decision to move in permanently. The files for three residents were examined. Each had a comprehensive assessment which clearly identified their needs. These had been completed by Manor Cottage Hotel DS0000034029.V320398.R01.S.doc Version 5.2 Page 9 the registered manager or her deputy. It is their practice to visit all prospective residents and gather information from all relevant sources. Evidence of this was seen in the files. Manor Cottage Hotel DS0000034029.V320398.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Care plans are based on a comprehensive assessment and involve the resident or their representative in their development. Residents’ health and social care needs are well met and regularly reviewed with staff, resident and, where relevant, their relatives. Adherence to medication policies and procedures safeguards residents. Care for those coming to the end of their lives is provided in a caring and sensitive way. EVIDENCE: The records for three of the residents were examined. They contained detailed care plans based on comprehensive assessments. Information included the name the resident wished to be known by and any food preferences. Consent Manor Cottage Hotel DS0000034029.V320398.R01.S.doc Version 5.2 Page 11 to medication forms and risk assessments were also on file. Most but not all of these documents had been signed by the resident or their representative which would indicate their involvement in the process. The daily records were found to be complete. The records showed that care plan reviews are carried out each month. Each resident has a key worker and staff spoken to confirmed that it is their responsibility to organise and chair the monthly care plan reviews and record and, where appropriate, action the decisions made. It is the resident’s responsibility to invite their relatives to the review if they wish them to be present. Residents spoken to and those who had completed surveys all spoke highly of the staff who care for them as did several relatives. They described the staff as conscientious, caring, friendly and supportive. One resident said that the staff are kind and have a joke with them. They also said that staff provide help with things they cannot do but give encouragement to continue to do the things that they can. Staff were observed to treat residents with respect. The health care needs of the residents were seen to be met and were documented in the care plans. An optician, a chiropodist and a dentist visit the home on a regular basis. Nutritional screening is undertaken for each new resident and residents’ weights are regularly monitored and were seen to be recorded in the care plans. The manager stated that the dietician is involved when required and the cook is invited to care plan meetings. The home has good relationships with the district nursing service especially with regard to pressure care. Visiting professionals said that residents are provided with good supportive care, that the home endeavours to accommodate residents with very specific needs and that the staff work well with other professionals thus ensuring continuity of care. There is a good medication policy and procedure in place. Residents were seen to have given signed consent to medication. All medication records, including receipts and returns of medication, were seen to have been signed. The registered manager stated that when medication is received from the pharmacy it is checked immediately and any discrepancies reported to the pharmacist. Patient information leaflets for each form of medication used are kept for reference. Only named staff who have received basic training from a pharmacist may take responsibility for administering medication. However, the registered manager and her deputy have now attended an advanced medication course which enables them to train the staff in the safe administration of medication. Those residents who were asked all said that they receive their medication on time and that they are happy for the staff to take that responsibility. The home has a policy on dealing with the death of a resident. The manager, while recognising that not everyone wishes to discuss the subject, has been Manor Cottage Hotel DS0000034029.V320398.R01.S.doc Version 5.2 Page 12 able to ask all residents how they would like to be cared for if terminally ill and what arrangements should be made following death. Their comments have been included in their care plans. Where appropriate relatives have also been included in this. The manager has stated that the home’s intention is to care for residents who are coming to the end of their lives for as long as they are able to provide adequate care and this is included in the home’s training programme. When a resident is close to death they try to keep to the same staff providing the care and the manager will, if required, remain on duty during the night to ensure a good level of care is provided. They endeavour to maintain good communication with the GP and district nurses to ensure as far as possible that the resident is comfortable, pain-free and that their dignity is maintained. The family’s wishes regarding being contacted are ascertained. If they wish to stay overnight they can be accommodated. Manor Cottage Hotel DS0000034029.V320398.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. This judgement has been made using available evidence including a visit to this service. Residents are provided with a range of activities and social events. Residents’ contact with friends and relatives is positively encouraged. The home enables residents to maintain control over their day-to-day lives by promoting choice. The dietary needs and preferences of the residents are met with the provision of nutritious and varied meals. EVIDENCE: During the inspection a group of six residents were spoken to. They were appreciative of the flexible approach taken to the routines of daily life, for example being able to have breakfast in their rooms if they chose and getting up and going to bed at the time of their choice. They also said that there is a good range of activities which they can participate in or not as they choose. Information about forthcoming events is displayed on the notice board. The Manor Cottage Hotel DS0000034029.V320398.R01.S.doc Version 5.2 Page 14 home has an activities organiser twice a week and staff encourage residents to participate in table games, quizzes, crafts and simple cooking. The manager regularly organises social events and parties and visits are made to the home by donkeys and PAT dogs which are very popular. The Bridge-a-gap group, which is associated with the local GP surgery, hold regular coffee morning at the home which are well attended by both residents and members of the local community. Members of local churches visit the home to hold services. Residents said that if they do not wish to participate in any of the activities or social gatherings there is another room that they can use or they retire to their own rooms. Trips out are also organised to places like the theatre, garden centres or somewhere for a cream tea. Residents said that they appreciated the time taken to enable them to go out. Comments about the home were received from eight relatives. All said that they were happy with the care provided and that they are made welcome whenever they visit the home. They also said that they are included in any special events. One commented that “the staff and manager go that little bit extra in support for us too”. Residents said that they liked the fact that visiting times are not restricted which meant that their visitors could come when they were able. There is a room available for visitors to stay overnight which they felt was particularly important if one of the residents was very unwell. Relatives also said that they are kept informed about important issues and are involved in decision making when appropriate. Residents are encouraged to personalise their rooms and records were seen to be kept of all furniture and other items the residents bring to the home. Information regarding advocacy services was seen to be on the notice board. Residents, or their relatives, manage their financial affairs for as long as they are able or is practicable. Meticulous records are kept by the manager of any financial transactions undertaken on behalf of a resident. All the residents spoken to during the inspection said that the meals provided were very good, that they appreciated the range of choice they are given and the fact that they are involved in planning the menus. They appreciate the fact that their dietary requirements and food preferences are taken into consideration by the cook who has been observed ensuring that each resident gets the right meal. Meals are cooked using primarily fresh ingredients. A comment was made that there should be more fresh fruit available. The manager stated that residents are encouraged to eat fresh fruit, which is always available on request, but she would ensure that all residents are aware of this. Residents said that they can have a drink at any time including during the night if they can’t sleep. All staff have undertaken food hygiene training. Manor Cottage Hotel DS0000034029.V320398.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. This judgement has been made using available evidence including a visit to this service. Residents’ rights are protected and they are safeguarded from abuse by staff being made aware of adult protection procedures. EVIDENCE: A policy regarding the protection of vulnerable adults, including whistleblowing, is in place. The manager has set up an in-house training programme regarding this which all staff, including the cook and the housekeeper, have undertaken. The home’s policy on accepting gifts and legacies has been given to all staff and a copy is included with every resident’s contract as is a copy of the home’s complaints procedure. The complaints procedure is included in the Statement of Purpose and the Service Users’ Guide and a copy is on the notice board. Residents who completed surveys said that they knew who to speak to if they were not happy and how to make a complaint if they needed to. Relatives also said that they were aware of the complaints procedure. No formal complaints have been received by the Commission for Social Care Inspection about Manor Cottage during the last three years. Manor Cottage Hotel DS0000034029.V320398.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): 19,20,21,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Manor Cottage provides a homely and comfortably furnished environment which is clean and hygienic with well laid out communal space. EVIDENCE: The home is suitable for its stated purpose. It was seen to be well maintained, providing a homely and comfortable environment. New chairs have been purchased for the lounge and the manager stated that a new carpet for the lounge was on order. The home has a pleasant garden which residents said they enjoyed when the weather permitted. One resident said that they had been for a walk round the garden with a member of staff that morning. Although several rooms have en-suite facilities and there are communal bathrooms, there is currently only one bath that can be safely used by the Manor Cottage Hotel DS0000034029.V320398.R01.S.doc Version 5.2 Page 17 residents with the assistance of the staff. This bathroom has been extended in size but space is still limited. All the required radiator guards have now been fitted. Where there are no guards because residents have requested not to have one, the manager has completed risk assessments. The premises were seen to be clean, hygienic and free from offensive odours. A housekeeper is employed who has responsibility for ensuring the cleanliness of the home. The laundry room is used for residents’ personal items only. All other laundry is contracted out which includes special bags for foul laundry. Mops and buckets were seen to be colour coded according to use. Information obtained from the Health Protection Agency was seen to be available for staff and has been incorporated into the home’s infection control policy. Records showed that most of the staff have received training in infection control and that three of the night staff were due to undertake it. Manor Cottage Hotel DS0000034029.V320398.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 good. This judgement has been made using available evidence including a visit to this service. Staff recruitment procedures and training programmes safeguard residents and provide consistent good levels of care. EVIDENCE: Since the last inspection the staff team has been re-structured to include two team leaders. One of them, who was spoken to during the inspection, said that they were enjoying the challenge of the additional responsibility. The staff rotas seen showed that there are sufficient staff on duty during the day and at night to meet residents’ needs. Ancillary staff, including two cooks, a housekeeper and a handyman, are also employed. The files for two new staff were examined. These showed that a thorough recruitment process had been followed which included verifying the applicant’s identity, taking up references and carrying out police checks. The recruitment process was confirmed by staff interviewed during the inspection. The manager is committed to staff training. New staff are now expected to complete the Skills for Care induction. There is also a comprehensive on-going training plan for all staff, some of which is in-house and some arranged through external agencies. Examples of recent training include Parkinson’s Manor Cottage Hotel DS0000034029.V320398.R01.S.doc Version 5.2 Page 19 disease, catheter care, care of the dying, dementia care and religious beliefs. There is always a member of staff trained in first aid on duty. Three staff have NVQ Level 2 in Care or above with others working towards it. Manor Cottage Hotel DS0000034029.V320398.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): 31,32,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management style is open and receptive to the views of the residents and others involved with the home. Staff are well supervised which ensures a good standard of care for residents. Safe working practices provide protection for both residents and staff. EVIDENCE: The registered manager is well qualified and experienced. She has NVQ Level 4 in Care and Management and the home is well run. In discussion the manager was able to demonstrate a detailed knowledge of the running of the Manor Cottage Hotel DS0000034029.V320398.R01.S.doc Version 5.2 Page 21 home and of all the residents, their needs and how they should be met. During the inspection it was observed that staff and residents approached the manager with confidence. Residents spoken to said that they could raise any concerns with her or make suggestions and know that they would be well received. Staff interviewed said that they felt well supported by the manager. Relatives who completed surveys made very positive comments about how well the home is run. Meetings for residents are held to which relatives are also invited. The meetings are used to inform residents of any changes and forthcoming events, to seek residents views regarding the running of the home and as an opportunity for residents to bring up any issues, concerns or ideas. These take place approximately monthly before an entertainment or social event when residents would be gathering anyway. Holding meetings at that time results in residents being more relaxed and therefore more likely to contribute to any discussion. The manager has developed a good system of quality assurance and quality monitoring. Satisfaction surveys have been done with both residents and visitors, a summary of the results of which is available in the reception area. There is a book for anyone to make suggestions at reception where survey forms for visiting professionals and relatives are also available. In addition to this there is a rolling plan for reviewing other aspects of the running of the home. These reviews are done during staff meetings. Examples of these reviews are medication policy and procedure every two months, social activities every six months, staff training annually and a health and safety checklist completed monthly. The manager writes an annual report for the owner covering topics such as policies and procedures, meals and menus, support services, activities, maintenance and refurbishment and complaints and incidents. The manager requests a response from the owner to the issues raised in the report so that a development plan can be devised. Systems are in place for dealing with residents’ money when required with detailed records being kept, but wherever possible residents are encouraged to manage their own affairs. Staff supervision is well established. Both the registered manager and her deputy carry out staff supervision the frequency of which is determined by how experienced the member of staff is. This ranges from weekly to every two months. This was confirmed by staff spoken to. Safe working practices are encouraged by the manager who ensures that staff are trained in manual handling, infection control and food hygiene. Fire safety is also a priority with all staff having done fire drills and having had training in fire fighting and the use of fire equipment. Fire safety checks are carried out at the required intervals. Environmental risk assessments are in place and any accidents are appropriately recorded. Manor Cottage Hotel DS0000034029.V320398.R01.S.doc Version 5.2 Page 22 Manor Cottage Hotel DS0000034029.V320398.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 4 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 x x x 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 x 3 Manor Cottage Hotel DS0000034029.V320398.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The registered manager should ensure that staff carrying out care plan reviews encourage residents or their representatives to sign the reviews to demonstrate their involvement in the process. The registered manager should ensure that residents know that fresh fruit is always available. 2 OP15 Manor Cottage Hotel DS0000034029.V320398.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Manor Cottage Hotel DS0000034029.V320398.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. 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