Inspection on 05/04/07 for Manor House Nursing & Residential Home

This inspection was carried out on 5th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 House Nursing &... 15/08/06

Manor House Nursing &... 14/02/06

Manor House Nursing &... 10/10/05

Manor House Nursing &... 17/02/05

Manor House Nursing &... 06/08/04

Manor House Nursing &... 02/12/03

Manor House Nursing &... 04/08/03

Manor House Nursing &... 13/09/02

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

CARE HOMES FOR OLDER PEOPLE Manor House Nursing & Residential Home Moreton Road Upton Wirral CH49 4NZ Lead Inspector Jeanette Fielding Key Unannounced Inspection 5th April 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Manor House Nursing & Residential Home DS0000020925.V332257.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 House Nursing & Residential Home DS0000020925.V332257.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor House Nursing & Residential Home Address Moreton Road Upton Wirral CH49 4NZ 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) 0151 677 0099 0151 604 0328 www.bupa.com BUPA Care Homes (BNH) Limited Mrs Christine Varty Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Manor House Nursing & Residential Home DS0000020925.V332257.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 40 beds nursing care / 20 beds personal care in an overall total of 60 To admit one named service user aged 57 years of age for the category of (TI) 15th August 2006 Date of last inspection Brief Description of the Service: The Manor House is a large care home providing nursing and personal care for up to 60 residents over the age of 65 years. It is situated in extensive and well-maintained grounds that are fully accessible. Accommodation is provided on three floors with stair and passenger lift access to the first floor. Some rooms on the second floor are reached by a set of stairs and residents occupying these rooms need to be mobile. There are 59 single rooms of which 58 have full en-suite facilities. Communal areas are located around the home. Information provided by the manager identifies that the fees are currently set at £720 - £820 per week. Individual residents requiring these services meet the costs of chiropody, hairdressing, physiotherapy and newspapers. Manor House Nursing & Residential Home DS0000020925.V332257.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted in one day, over a period of six hours. It involved the examination of records relating to the care required by and afforded to residents and of staff personnel records. Records relating to the safety of equipment used in the home were also inspected. The manager, staff and residents were spoken to during the day. The registered manager had completed a pre-inspection questionnaire that gave information about the current status of the home. A tour of the premises was undertaken and vacant bedrooms were inspected. No requirements or recommendations are made following this inspection. What the service does well: What has improved since the last inspection? What they could do better: The home should continue to provide a high standard of care. Manor House Nursing & Residential Home DS0000020925.V332257.R01.S.doc Version 5.2 Page 6 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 House Nursing & Residential Home DS0000020925.V332257.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 House Nursing & Residential Home DS0000020925.V332257.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 and 3. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective residents have full information about the home to enable them to make an informed choice about the home’s ability to meet their needs. Detailed pre-admission assessments are undertaken on all prospective residents to ensure that the home can meet their individual health, care and social needs. EVIDENCE: The home has a detailed statement of purpose and service user guide that provide full information about the home and the services provided. Both documents comply with the National Minimum Standards and are available for viewing in the reception area of the Manor House. Copies of these documents are available from the home on request. Manor House Nursing & Residential Home DS0000020925.V332257.R01.S.doc Version 5.2 Page 9 The inspector examined the care files for residents who had recently been admitted to the home. New assessment forms are now used to record the information gathered at the time of the assessment. These are now used in all BUPA homes and are extremely informative. Information is gathered regarding the residents’ medical history, current care needs and social preferences. The information gathered at the assessment is used to prepare a plan of care for the service user. The Manor House has developed a reputation for providing a high quality environment, hotel services and good standards of care. The home is not contracted to provide Intermediate Care. Manor House Nursing & Residential Home DS0000020925.V332257.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. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The records relating to the care afforded to residents are clear and provide evidence that each service user is given the level of care necessary in line with their assessed needs and their individual preferences. Medications are administered in accordance with the home’s policy and procedure to ensure the protection of residents. EVIDENCE: The care files for five residents were inspected. The files contained detailed care plans which gave full information regarding the residents’ health care and social needs, together with information on how these needs are to be met. Risk assessments were in place together with full information on how the risks will be reduced or eliminated. Separate assessments recorded the moving and handling, nutritional, continence and tissue viability need of the residents and Manor House Nursing & Residential Home DS0000020925.V332257.R01.S.doc Version 5.2 Page 11 there were documents to support the use of bed rails or profiling beds and the ability of residents to administer their own medications. The care plans include information regarding the residents’ individual preferences and choices to enable staff to meet the resident’s specific requests. The home has good links with local GP’s, District Nurses, Community Psychiatric Nurses (CPN’s), the Continence Advisor and the Tissue Viability Nurse. A dentist and optician are available as necessary and the home has links with a chiropodist who provides a service for which there is an additional charge. The home has a contract with a Physiotherapist to provide rehabilitative support. Residents are free to choose to use the services of their own therapists or one provided by the hospitals. Wound plans are created if residents have pressure sores, although no sores have developed whilst residents have been accommodated within the home. Wound plans are created if service uses have pressure sores or any other wound/skin damage and photographs are used to monitor the healing processes. The home has a comprehensive policy and procedure for the handling of medications. Examination of the medications and the associated records show that staff follow the procedure to ensure that residents are administered their medications as prescribed. The disposal procedure is currently being reviewed to ensure greater security for those medications that are no longer required to be held in the home. Appropriate security measures are in place for all medications. Personal care is provided in resident’s own rooms or in one of the bathrooms around the home. Locks are fitted to bathroom and toilet doors to assist privacy. All of the resident’s rooms have a door lock and residents can choose whether they use them or not. Residents can meet with their visitors in their own room or in one of the communal lounges. Most of the residents in The Manor House are self-funding and expect high standards of care. The manager expects that her staff will provide care and support in privacy and will maintain the dignity of the residents at all times. Manor House Nursing & Residential Home DS0000020925.V332257.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A high number of activities is available to offer social stimulation to residents and enhance their recreational opportunities. A selection of meals is offered to residents to provide them with a well balanced and nutritious diet. EVIDENCE: Records are held on residents’ personal files of their individual preferences regarding activities, religious and recreational interests. The manager and staff strive to enable residents to maintain their interests and offer new opportunities in which they can participate. Daily routines are flexible and offer choices to residents to spend their days as they wish. Manor House Nursing & Residential Home DS0000020925.V332257.R01.S.doc Version 5.2 Page 13 The home employs an Activities Organiser to arrange individual and group events. A programme of activities is prepared each week and issued to all residents, together with being displayed on notice boards throughout the home. The Activities Organiser spends her mornings in one-to-one contact time with individual residents and coffee is served in the lounge (though this doesn’t preclude residents taking the morning drink in their own room). Afternoons are usually spent engaged with group activities or with outside entertainers. Bingo, exercise sessions, Art classes and Sewing classes are all available. The home celebrates birthdays and other national events with parties and themed meals. Records are held in daily reports of all the activities that residents participate in or if they have chosen not to participate. One residents spoken to was busy knitting toy animals to raise money for her churches’ charity event. The hairdresser was in the home on the day of the inspection and the atmosphere in the salon was bright and cheerful with residents laughing and chatting. Ministers of religion visit the home to support individuals or to hold services for those residents who choose to attend. Breakfast trays are made up and taken to resident’s bedrooms. Lunch and dinner are served in one of two restaurants with waitress service. Care staff assist residents who are unable to manage on their own. Tables in the restaurants are attractively laid out with tablecloths and napkins. A menu listing a choice of foods is available on each table and residents decide what they wish to eat. Alternatives to the main menu options are provided where special dietary requirements are in place or where residents do not wish to take one of the meals on offer. The home provides a choice of sandwiches at suppertime. The inspector spoke with a number of residents who were all complimentary about the meals provided at the Manor House. Manor House Nursing & Residential Home DS0000020925.V332257.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and the policies and procedures are followed to ensure that residents are protected from abuse. EVIDENCE: The home has policies and procedures in place to deal with complaints and these are included in the statement of purpose and service users guide. Compliment/Complaints forms are available in the entrance hallway to the Manor House. Records inspected showed that the manager had dealt with three complaints since the last inspection and these had been fully investigated with appropriate action being taken where necessary. All were dealt with in the required timescale. All residents are listed on the Electoral Register and are given the opportunity to vote in local and national elections. Manor House Nursing & Residential Home DS0000020925.V332257.R01.S.doc Version 5.2 Page 15 The home has policies and procedures to deal with suspected incidents of abuse and “whistle blowing” arrangements in are place to support staff in raising any concerns. All staff are provided with training in the recognition of abuse and the actions to be taken if abuse is suspected. The home has a copy of Wirral’s Adult Protection Procedures. Manor House Nursing & Residential Home DS0000020925.V332257.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 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents live in an extremely pleasant, safe and well maintained environment that has the specialist equipment necessary to support their care needs and maximise their independence. EVIDENCE: The home was originally a manor house that has been modernised and extended to provide accommodation for up to 60 older people. All areas of the home are decorated and furnished to a high standard. The home is set in extensive grounds that are well maintained. Supported living flats owned and managed by a separate company are located on the same site. Manor House Nursing & Residential Home DS0000020925.V332257.R01.S.doc Version 5.2 Page 17 Communal space in the home is well set out with small sitting areas or larger communal spaces. A reading room is provide with library books and talking books that are changed regularly. Two restaurants are located in the old manor house and have high, ornately patterned ceilings. The newer areas of the home have much lower ceilings, are more modern in design and can more easily accommodate the movement of residents and the use of specialist equipment. A programme of improvement continues with a number of bedrooms and communal areas having been redecorated since the last inspection. Plans are in place to redecorate and refurbish additional areas of the home to further improve the environment for the residents. The home has 59 bedrooms all of which are for single occupancy. However, one can be used to accommodate a married couple or friends who choose to share, thereby taking the home to its ceiling of 60 residents. All of the bedrooms, except for one, have their own WC wash hand-basin and bath. Bedrooms are extremely well presented and have a good level of wardrobe and drawer space. Residents are encouraged to bring small items of furniture (fire precautions permitting) and treasured items to personalise their room. It is evident that residents, staff and relatives strive to provide an extremely homely environment within bedrooms. The home has some communal bathrooms that are fitted with specialist bathing equipment to aid residents. A range of handrails, grab rails and hoists are provided around the home and specialist beds, mattresses and other equipment are provided as necessary. With the exception of a small number of bedrooms in the residential area, the home is accessible to wheelchairs and outside space has been developed to provide level access. Discussion took place with the manager regarding access to the residential area and potential alterations and facilities that could be considered to improve access. Windows around the home provide natural light and ventilation. The home was found to be warm and well lit. Thermostatic valves control the temperature of hot water delivered to residents’ rooms and bathrooms to ensure that residents are not placed at risk. The temperature of the hot water is tested on a regular basis and records of these tests are held. The home was found to be clean and well maintained throughout and no offensive odours were present. Policies and procedures are in place for the control of infections and for the disposal of general and clinical waste. Manor House Nursing & Residential Home DS0000020925.V332257.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. The home has a robust recruitment policy and procedure to ensure that residents are protected. Staff are well trained to safeguard the residents and to meet their individual care needs. EVIDENCE: The home employs a team of 16 qualified nurses and 35 care staff to ensure that the needs of residents are met. 3 trained nurses and 8 care staff are employed between 8:00am and 2:00pm, 2 trained nurses and 5 care staff are employed to work between 2:00pm and 8:00pm and 2 trained nurses and 4 care staff work through the night. The home’s manager is able to increase staffing levels for short periods of time if the needs of residents require higher levels of support. The home also employs chefs, kitchen assistants, housekeeping, laundry and maintenance staff and all staff were seen to work together to form a strong and effective team. Training continues for all staff at the home. Recent training includes fire lectures, moving and handling, tissue viability and adult protection. Specific Manor House Nursing & Residential Home DS0000020925.V332257.R01.S.doc Version 5.2 Page 19 and relevant training is provided according to the role and responsibility of individual staff and provides the opportunity for career development. BUPA also promotes ‘personal best’ to enable staff to identify with specific subjects and to further identify training needs. NVQ training continues at both level 2 and level 3. At present, 54 of the care staff hold NVQ qualifications and other care staff are currently working towards this award. BUPA Care Homes is an equal opportunities employer and has strict procedures for the recruitment and appointment of staff. The care files of three staff who had recently been appointed to the home were inspected. All files contained evidence that POVA and CRB clearances had been obtained together with satisfactory references. All new staff are required to complete a comprehensive induction training programme which is evidenced and the inspection of the files of two staff who had been employed at the home for some time provided evidence of on going training and development. Trained nurses are identified as “link” nurses for tissue viability, pain relief and other topics and cascade knowledge and training to colleagues. Basic training in moving and handling, fire safety, health and safety and food hygiene are provided at induction and updated on a regular basis. Specialist training is identified in supervision and is provided when required. All staff are give regular supervision and annual appraisals are held. Manor House Nursing & Residential Home DS0000020925.V332257.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The views of residents, relatives and other healthcare professionals are sought on a regular basis to enable improvements to continue. The home is management to a high standard to ensure the protection and best interests of the residents. EVIDENCE: The registered manager of the Manor House is a qualified nurse who holds a recognised care management qualification. She has many years experience of Manor House Nursing & Residential Home DS0000020925.V332257.R01.S.doc Version 5.2 Page 21 managing care homes for older people and was able to evidence on going training and personal development. During the course of the inspection it was clear that the manager had a good understanding of the needs of each of the residents in the home and was fully up to date with their care arrangements and individual expectations. Residents spoke highly of the manager and were complimentary about her style of management and her commitment to their care. They were also complimentary about the staff within the home and of how helpful they were. BUPA requires its managers to provide monthly returns of quality audits undertaken in the home. These range from reviews of care plans to sickness absence returns and checks on the management of medicines. Additionally the home organises an annual quality assurance questionnaire that is given to all residents and their relatives. Quarterly resident and relative meetings are held at which the manager and her staff discuss matters affecting the current and future care arrangements at the Manor House. She also presents feedback from the most recent resident/relative survey and the outcome form any CSCI report. A senior manager from BUPA visits the home on a monthly basis to complete the required Regulation 26 visits following which a report is prepared. Records relating to the financial accounting of the company are held at their head office and are available to CSCI. The Commission is not aware of any financial matters that would affect the continued operation of this home. The home does not manage the financial affairs of any of the residents. Expenditure for hairdressing or chiropody is billed to the resident or their family for payment. Staff will manage small amounts of money for those residents who request them to do so and detailed accounts of deposits and expenditure are maintained. All of the company’s polices and procedures for the management of a care home are available in The Manor House. Records are held in the home of the required checks made on electrical equipment and mechanical devices in the home. Fire safety equipment and hot water temperatures are tested routinely and appropriate certificates confirm the safety of gas and electrical appliances. The home’s lifts are checked and waste disposal arrangements are in place through contracts. Records relating to the care and support of residents and the employment of staff are kept locked in the home when not in use. Medicines are stored safely and appropriate records kept of their receipt and disposal. Manor House Nursing & Residential Home DS0000020925.V332257.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 4 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 4 X X 4 Manor House Nursing & Residential Home DS0000020925.V332257.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Manor House Nursing & Residential Home DS0000020925.V332257.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 House Nursing & Residential Home DS0000020925.V332257.R01.S.doc Version 5.2 Page 25 - 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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