Inspection on 08/05/06 for Marston Court

This inspection was carried out on 8th May 2006.

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

The inspector 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

Marston Court 08/10/07

Marston Court 24/01/06

Marston Court 24/08/05

Marston Court 28/02/05

Marston Court 19/08/04

Marston Court 18/02/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Marston Court Marston Road Oxford Oxfordshire OX1 1ND Lead Inspector Jane Handscombe Unannounced Inspection 5th & 8th May 2006 07:15 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 Marston Court DS0000013159.V292959.R01.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. Marston Court DS0000013159.V292959.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Marston Court Address Marston Road Oxford Oxfordshire OX1 1ND 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) 01865 241526 01865 722290 manager.marstoncourt@osjctoxon.co.uk The Orders Of St John Care Trust Mrs Theresa Jean Whitford Care Home 39 Category(ies) of Past or present alcohol dependence over 65 registration, with number years of age (3), Dementia - over 65 years of of places age (20), Learning disability over 65 years of age (3), Old age, not falling within any other category (39), Physical disability over 65 years of age (20) Marston Court DS0000013159.V292959.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of persons that may be accommodated at any one time must not exceed 39. 24th January 2006 Date of last inspection Brief Description of the Service: Marston Court is a care home providing personal care and accommodation for 39 older people and Day care facilities for 10 from the local community. There is provision for 6 service users who need help with rehabilitation (intermediate care). The care home is managed by The Orders of St John Care Trust who are responsible for many care homes throughout the county of Oxfordshire. Marston Court is located in a residential area of Oxford approximately a mile from the city centre. Local shops, churches, pubs and other amenities are accessible to service users. Marston Court is a two storey building served by a lift. With the exception of one double room, all rooms are single with shared bathroom facilities. The care home is divided into four wings, each having a lounge and dining area. The grounds are shared with the county office of The Orders of St John Care Trust providing some lawn and a secluded patio area with a water feature. Prices range from £484.00 - £680.00 per week. Marston Court DS0000013159.V292959.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’ involving two inspectors, which took place over two days. The inspectors arrived at the service on 5th May 2006 and were in the service for 8 hours and the second day involved one inspector spending a further 3 hours in the service. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the services and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Comments received from residents during the inspection included: ‘I don’t think you’ll find anyone fault this place’ ‘I am very happy’ ‘Very nice and comfortable, the carers are lovely and very kind’ ‘I would recommend this home highly’ Comments from General Practitioners included: ‘Excellent home – very good and caring staff’ ‘Very well run home. High standard of care/cleanliness’ The inspector would like to thank the residents, their families, staff members and other health professionals for their assistance during this inspection Marston Court DS0000013159.V292959.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There are a number of areas in which the home could improve upon for which one requirement has been made and a number of recommendations. Whilst the home provides staff with relevant training, to ensure that they have the skills and knowledge to undertake their roles competently, a requirement has been made to ensure that all staffs’ mandatory refresher training is up to date. It was noted that there is very limited choice in daily activities since the home does not presently employ an activities co ordinator, staff undertake to work with residents in small groups and in one to one situations where time allows. A limited number of places have been made available for residents to join the day centre clients and engage in their activities, however this is not ideal and does not serve to include everyone. Marston Court DS0000013159.V292959.R01.S.doc Version 5.1 Page 7 Residents mentioned the lack of activities within the home and the wish for more mental stimulation, therefore it is strongly recommended that the manager makes it a priority to seek to employ an activities coordinator in order that everyone can be included in daily activities if they so wish. There are a number of areas around health and personal care which could be improved upon, namely that of reviewing the procedures taking place around medication, ensuring that nutritional assessments are undertaken shortly after admission and reviewing the procedure for planning care for intermediate care residents to ensure that carers are kept informed of the content of care plans and the actions required are carried out. Further recommendations have been made to obtain formal feedback from residents, relatives and social and health care professionals, at least annually to assess the standards of services provided at the home. 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. Marston Court DS0000013159.V292959.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Marston Court DS0000013159.V292959.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has good pre admission procedures in place. In one instance, the admission procedures were not adequately followed. In general, the intermediate care assessments are adequate. EVIDENCE: The manager carries out pre-admission assessments to determine whether or not the home can meet the care needs of prospective residents. Where possible, the assessment is carried out in the individual’s home, or in hospital if that is their current situation. This enables the manager to find out more detail about the person and their background, meet the family and for the individual to meet a member of staff. The home’s pre-admission assessment form is clear and comprehensive, and forms the basis of the resident’s care plan. Marston Court DS0000013159.V292959.R01.S.doc Version 5.1 Page 10 A recent incident was brought to the attention of the commission which was investigated and involved all relevant parties; the result being that the resident has since been placed in a more appropriate setting which can address the complex needs. This incidence highlighted the importance of remaining within the categories of care and the importance of gaining a comprehensive assessment of needs to ensure that prospective clients are placed appropriately. The home has six intermediate care beds for residents who need to regain independent living skills prior to returning home. This care usually involves up to six weeks’ intensive rehabilitation provided by NHS staff from the Oxfordshire intermediate care team. Members of this team assess prospective residents and forward the assessment to the manager for her to decide if the home can meet the person’s care needs. The manager does not routinely visit prospective intermediate care residents, but discusses any queries with the members of the intermediate care team before she makes a final decision. An intermediate care resident spoke highly of the care he received. Marston Court DS0000013159.V292959.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are adequate systems and procedures in place to ensure service users’ health and personal care needs are met. Staff do not follow medication procedures robustly. Nutritional assessments are not always undertaken. EVIDENCE: Four care plans were randomly selected for inspection, to include a resident admitted for intermediate care. The care plans for the permanent residents set out in detail the action that staff needed to take to meet the individual’s care needs, and were drawn up with the involvement of the resident. A number of risk assessments relevant to the residents’ care had been completed and all care plans were found to be reviewed on a monthly basis and updated where necessary, however, nutritional assessments were not always being undertaken. Marston Court DS0000013159.V292959.R01.S.doc Version 5.1 Page 12 The care plans for intermediate care residents are written by members of the intermediate care team, but with minimal input from the home’s carers. The inspector noted that a care plan contained an instruction to staff to encourage a resident to drink a specific amount of fluid each day, but there was no evidence that this was being carried out. The manager should ensure that carers are aware of the content of care plans and that appropriate action is taken regarding the required care. All residents have a medication chart showing the medication they are taking. A number of charts were examined and these showed that medication had been given as prescribed. The inspector noted that some charts contained handwritten instructions made by staff. However, there was no indication that these had been checked by a second person. It is strongly recommended that all handwritten entries are checked for accuracy. Information regarding this can be found in the document: The Administration and Control of Medicines in Care Homes and Children’s Services, published by the Royal Pharmaceutical Society of Great Britain. Upon viewing a medication round, a further recommendation was made, to ensure that medication be signed for after the client has received the medication and not before, therefore allowing for correct recording initially as opposed to having to correct the MAR sheet if the resident chooses to refuse the medication. Residents are able to take responsibility for their own medication, if they so desire, within a risk management framework. Good facilities are provided to store medication safely, including controlled drugs. Medication charts containing reference to controlled drugs were checked against the controlled drug register and all entries were found to be correct. For safety reasons, it is recommended that oxygen cylinders are kept in oxygen cylinder stands and not left freestanding. Residents who spoke with the inspectors felt that they experience a sense of privacy and dignity at all times and are very happy with the care they receive. One female resident informed the inspector that “the male carers are very caring and I’ve no worries or concerns about them giving personal care’’. Staff were observed to knock on bedroom and bathroom doors at all times before entering and to offer assistance sensitively and in an unhurried manner. Marston Court DS0000013159.V292959.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is limited choice for residents to undertake daily activities. There is good provision for meals and mealtimes and residents welcome the choices available. Visitors are welcomed to the home at any time Residents are enabled to exercise choice and control over their lives. EVIDENCE: Residents spoken to were complimentary regarding the food and welcomed the choices available. The cook showed the inspector menus for the coming weeks and those observed were found to be well balanced, wholesome and offered choice. Residents informed the inspector that they are able to receive visitors and friends at any reasonable time, and are able to entertain them in the communal lounges or their own bedrooms. Marston Court DS0000013159.V292959.R01.S.doc Version 5.1 Page 14 It is recommended that recruitment for an activities co-ordinator should be of high priority in order to allow the residents more choice in following their recreational interests. Plans are in place for a cheese and wine party and a family barbeque is to be held in June to which family and friends are invited. Marston Court DS0000013159.V292959.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good policies and procedures in place to ensure that service users are protected from any form of abuse and are enabled to voice any concerns, allegations or complaints should the need arise. EVIDENCE: Speaking with residents on the day, it was apparent that they were aware of the complaints procedure and were confident that any concerns they may have would be acted upon appropriately. All residents spoken to were aware of who to take any concerns to if the need should arise. There are regular residents meetings held in the home to which all residents are invited. These meetings are an open discussion in which residents can voice any concerns and make any suggestions and the management can address their issues and discuss points of interest relating to the home. The meetings are minuted and displayed within the home to keep all residents informed. Marston Court DS0000013159.V292959.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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. The standard of the environment within this home is good providing residents with an attractive and homely place to live, which is maintained to a clean and hygienic level. EVIDENCE: On the day of inspection the home was clean and tidy with a homely atmosphere. The communal areas of the home are spacious and comfortable and provide good quality furnishings that are domestic in character. Redecoration is carried out as part of an ongoing programme of maintenance and this ensures that the company’s high standards are maintained. Gardens are available and provide pleasant outdoor facilities, which a number of residents were enjoying on the day of inspection during a spell of warm weather. Marston Court DS0000013159.V292959.R01.S.doc Version 5.1 Page 17 Cleanliness within the home was extremely good and there were no unpleasant smells. The home’s on-site laundry is spacious and has the necessary equipment to provide a good laundry service. Marston Court DS0000013159.V292959.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures around the recruitment, training and numbers and skill mix of staff are good, all of which serve to support and protect service users. EVIDENCE: The staffing levels on the day of inspection were sufficient to meet the needs of the residents. The recruitment systems in place are of a good quality; 4 staff files were sampled for inspection all of which contained the relevant pre employment checks, references and their relevant qualifications. The manager informed the inspector that six members of staff are presently undertaking their NVQ level 2 in care and one at NVQ level 3 with a further three waiting to be registered in August. Recent training for staff has included Fire training, safe handling of medication and COSSH with further training planned for moving and handling, food hygiene and dementia training. It was noted that one member of staff had not undertaken a refresher course in food hygiene since 2004; upon discussion with the manager, she informed the inspector that food hygiene training is planned and that this member of staff would be placed on the training course so as to update the carer’s skills appropriately. Marston Court DS0000013159.V292959.R01.S.doc Version 5.1 Page 19 Staff spoken to during the inspection informed the inspector that they undergo an appraisal once a year and regular supervision takes place both formally and informally. It was noted that one member of staffs’ contract, held on file, was not signed by the manager on behalf of the trust. Upon enquiry the manager informed the inspector that all staff are provided with a contract signed by both parties and that this omission would be dealt with immediately. Marston Court DS0000013159.V292959.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is supported well by the senior staff and provides good clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. The home is run in the best interests of residents and their finances are adequately safeguarded. Health and safety is promoted for the residents’ and staff benefit. EVIDENCE: The manager demonstrated a good understanding of management procedures and appeared to be an effective leader. Marston Court DS0000013159.V292959.R01.S.doc Version 5.1 Page 21 One carer whilst speaking with the inspector, said she thought the manager had ‘turned the home around’ since coming into post. Two further carers informed the inspectors that they found the manager to be very approachable. The manager updates her skills and knowledge and has attended a number of training courses during the past year to include first aid, health and safety assessments, infection control, customer care and manual handling and is awaiting to be registered for the Registered Managers Award and NVQ level 4 in care, which she has not yet completed and therefore a score of 2 in the scoring section of this report. The manager obtains feedback from residents and visitors when talking to them in the home, and has an ‘open-door’ policy that encourages people to see her without the need to make an appointment. Residents meetings are also held. However, there are no procedures in place to obtain formal feedback, such as through anonymous user satisfaction questionnaires sent out to residents, relatives and social and health care professionals. This is recommended. Residents are encouraged to control their finances for as long as possible, but when no longer able to do so, a representative or Social Services Money Management scheme is involved. The inspector discussed health and safety issues with the manager and saw maintenance records relating to maintaining a safe environment for residents, and was satisfied that the home has good procedures in place. Fire safety training is regularly arranged and was last provided by Oxfordshire Fire Service in January 2006. The home has nine fire marshals responsible for monitoring fire safety within the home and for carrying out routine fire safety checks. They also provide fire safety updates to all grades of staff on a regular basis. It was noted that a number of kitchen appliances were in need of repair; the springs on the pedal bins in the kitchen were broken which results in them not serving the purpose for which they are designed, the glass door seals on the combi oven need addressing in order that it retains heat and the dishwasher was not in working order. Upon speaking to the manager, it was reported that the parts for the combi oven had been ordered and that the dishwasher has been budgeted for and will be replaced. Recommendations have been made to address these health and safety issues. It was further noted when inspecting the larder, that new windows have been installed. It is recommended that fly screens be installed to protect foodstuffs from contamination and to allow for adequate ventilation. Marston Court DS0000013159.V292959.R01.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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Marston Court DS0000013159.V292959.R01.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 OP30 Regulation 18 Requirement The registered manager must ensure that all staffs’ mandatory refresher training is up to date. Timescale for action 30/06/06 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 Review the procedure for planning care for intermediate care residents to ensure that carers are kept informed of the content of care plans, and that action which is required is carried out. Nutritional assessments for all individuals admitted to the home should be carried out shortly after admission. Handwritten entries made by carers on medication charts should be checked by a second carer with reference to the original prescription. Oxygen cylinders should be stored in oxygen stands. Medication should be signed for after the client has received the medication. DS0000013159.V292959.R01.S.doc Version 5.1 Page 24 2 3 4 5 OP8 OP9 OP9 OP9 Marston Court 6 OP12 7 8 OP38 OP33 It is strongly recommended that the seeking of an activities co-ordinator is of priority in order that residents are enabled to partake within an increased activity programme. It is recommended that the kitchen equipment, highlighted in this report, be addressed and fly nets be installed in the larder. Obtain formal feedback from residents, relatives and social and health care professionals, at least annually, about the standard of services provided at the home. Marston Court DS0000013159.V292959.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South, Cowley Oxford OX4 2SU 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 Marston Court DS0000013159.V292959.R01.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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