Inspection on 05/12/06 for Meadow Cottage Nursing Home

This inspection was carried out on 5th December 2006.

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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meadow Cottage Nursing Home 07/02/06

Meadow Cottage Nursing Home 26/09/05

Meadow Cottage Nursing Home 27/01/05

Meadow Cottage Nursing Home 10/08/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Meadow Cottage Nursing Home 14 High Street Overstrand Norfolk NR27 OAB Lead Inspector Mrs Lella Andrews Unannounced Inspection 5th December 2006 10:45 Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Meadow Cottage Nursing Home DS0000015659.V323904.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadow Cottage Nursing Home Address 14 High Street Overstrand Norfolk NR27 OAB 01263 579221 01263 579315 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) www.efitzroy.org.uk Elizabeth Fitzroy Support Mr Edwin Clements Care Home 15 Category(ies) of Learning disability (15), Physical disability (15) registration, with number of places Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 15 people, of either sex, who have a Learning Disability or Physical Disability, may be accommodated. 7th February 2006 Date of last inspection Brief Description of the Service: Meadow Cottage is located in the village of Overstrand and provides accommodation for up to 15 service users with learning and physical disabilities. All accommodation and communal areas are on the ground floor, with administrative offices located on the first floor. The home is situated close to local amenities and has views across to the sea. The gardens are easily accessible to all service users. Limited car parking is available to the front of the building and there is ample on-road parking outside of the home. Specialised aids and adaptations have been fitted in service users bedrooms and all communal areas as necessary. Assisted bathing facilities are located throughout the building and offer choice for service users. Communal areas provide a choice of seating as appropriate. Each of the communal rooms are spacious, allowing easy access for wheelchair users. Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. CSCI are trying to improve the way we engage with people who use services so we gain a real understanding of their views and experiences of social care services. We are currently testing a method of working where ‘experts by experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term ‘experts by experience’ used in this report describes people whose knowledge about social care services comes directly from using them. The Inspector was joined for part of the visit to the Home by an expert by experience and their support worker. The Manager of the Home was very supportive of this initiative and the Inspector would like to thank him and the staff team for their support. This report contains information about the Home that has been gathered since the last Inspection which includes an unannounced visit to the Home on the 5th December 2006. During the visit the Inspector and the expert by experience spent some time talking to staff, observed medication administration, looked at records and discussed issues with the Manager as well as observing staff supporting clients. It is not easy to obtain information from the clients due to their communication needs and the Inspector and Expert by Experience were reliant on staff to assist with communication. The Commission received seven completed comment cards from relatives, all of which contained positive responses with additional comments such as: “…is looked after by people who are very good at their job and who also care.” “we visit every month and made very welcome” “…the care provided to the service users is excellent” “the care and attention that …receives is 100 ” The Manager had not returned the Pre Inspection Questionnaire and so therefore it was not possible for the Commission to gather the views of visiting health/social care professionals. What the service does well: The staff are enthusiastic and work hard to support the clients to make as many of their own decisions as possible. Staff receive training with regard to communication and use a range of different ways to communicate with the clients. Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 6 The clients personal and healthcare needs are met to a high standard. The staff and manager liase well with relatives. A lot of effort is taken to ensure that the clients are able to have the correct nutrition and that mealtimes are enjoyable. The clients are supported to take part in a range of activities. The Home is well managed and run in the best interests of the clients. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are no intentions to admit further clients but the organisation does have appropriate procedures for admissions if necessary. EVIDENCE: This standard was met during the last inspection and there have been no further admissions since then. Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The care plans provide good information for staff about how to meet the clients needs and are used as a working document. Staff work very hard to ensure effective communication to enable the clients to make as many choices as possible. Risks are recognised and assessed effectively. EVIDENCE: Two of the care plans were seen and these contain extensive information about the needs of the clients. The Manager said that the format of the care plans is being reviewed to ensure that the information is easy for staff to access. Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 10 The care plans are written in the first person and provide very clear information to staff about each persons individual needs and how they prefer these to be met. These include details about seemingly minor aspects of a persons life but which are actually very important details which can make a big difference to each individual. The communication difficulties that the clients have mean that it is extremely important for the care plans to be of a high quality. The clients also have a brief version of their care plans which are kept in their bags which accompany them at all times. The staff who spoke to the Inspector are aware of the content of the care plans and are involved in reviewing these on a regular basis. The staff are part of “key teams” for each client and they meet with the client regularly to review their care plans. The staff team work particularly hard to improve communication between themselves and the clients. All staff receive training with regard to communication and one of the staff has completed the Communication Coordinators training so that she can undertake more detailed work with individual clients. Communication is discussed regularly at staff meetings and new signs are learnt on a monthly basis. The staff have a good understanding of the different ways in which each of the clients communicate and were seen to spend considerable time ascertaining individual choices in a variety of different ways. Both the Inspector and the Expert by Experience observed examples of positive communication between staff and clients. The care plans included detailed risk assessments which cover a wide range of issues. These are also reviewed on a regular basis and the staff are aware of their content. It is recognised within the team that the clients have many limitations placed upon them due to their disabilities but the staff work hard to overcome some of these to ensure that the clients are able to take part in enjoyable activities in a safe way. Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Clients are supported to take part in a range of leisure activities both within the local community and farther afield. Clients are supported to maintain contact with friends and relatives. Relatives are made to feel welcome and have confidence in the staff team. The whole staff team work particularly hard to ensure that the nutritional needs of the clients are met whilst offering choices EVIDENCE: There is a Community Resource centre next door to the Home which is owned and managed by the same organisation and at which clients spend time during the day. Recently there have been changes to the way in which staff work resulting in more flexibility with staff from both settings supporting clients together. This has meant that there are additional staff within the Home at Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 12 key times such as breakfast time. It also means that clients are able to access more facilities within the community as staff from the Home provide additional support. The staff gave examples of the range of activities that the clients take part in which include going to clubs, swimming, ten pin bowling, cinema, football matches. The Home have also arranged “themed” days, for example, an Italian day with Italian food and music. The clients are supported to use the facilities within the village and had recently hosted a Christmas fayre which the community had been invited. The staffing levels at the Home have recently improved and there is less use of agency staff. Staff said that over the previous few months with reduced staffing levels the clients had still accessed organised activities but it had been the more spontaneous activities that had not taken place, such as going for a walk round the village. A musical instrument session took place during the visit to the Home and other clients were listening to music or watching television/dvds in their rooms. Clients are encouraged to make their own choices about where they wish to spend time and whether they wish to have company or not. Staff gave examples of how clients make choices about where they would like to go on holiday. Several of the clients have taken part in activity holidays this year. One of the clients has been supported to attend religious ceremonies with their family. All seven of the comment cards received from relatives contained positive responses with the majority having additional positive comments such as: “we visit every month and are made very welcome. The care provided to ….is excellent” “Meadow Cottage is a lovely place….the care has been wonderful” “we are extremely happy with the genuine hard work and care that…receives” The care plans contain details of the arrangements in place for enabling clients to maintain contact with friends and relatives. The staff recognise the importance of relationships in the lives of the clients. The majority of the clients have particular needs with regard to eating/drinking and the care plans contain detailed information about these. The staff, including the cook, are knowledgeable about individual needs and how these should be met. All of the staff work particularly hard to ensure that the clients needs are met and that mealtimes are as enjoyable as possible for the clients, particularly those for whom this can be a difficult time. Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 13 Professionals such as the dietician and the speech and language therapists are involved and the care plans show evidence of advice being incorporated into the way in which staff assist clients with meals. The cook has a good understanding of the individual needs as well as the clients particular choices with regard to food and drink. She is enthusiastic about providing meals that the clients will enjoy. The menus are on display in the dining room and these reflect the choices available as well as individual dietary needs. Wherever possible fresh, local produce is used with all meals being home cooked. The staff understand the need to respect the rights and responsibilities of the clients. These issues are covered within the staffs induction. Staff gave examples of how this is achieved and examples were seen in the observed interactions between staff and clients. For example, all clients have their own front door key and staff were seen to knock on doors prior to entering bedrooms/bathrooms. Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The staff work very hard to ensure that the personal and healthcare needs of the clients are met. Medication is managed appropriately although there is a need to ensure that the administration record is consistently completed. EVIDENCE: As previously mentioned in the report, staff work hard to improve communication between themselves and the clients so that they are able to support the clients to make as many choices about their lifestyles as they can. Staff gave examples of how they find out the clients choices of when they like to get up, go to bed and other daily routines. These details are also included within the care plans. The clients have complex health needs and the care plans contain details about how these should be met and have evidence of a range of healthcare professionals being involved in the clients care. The Inspector saw and heard Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 15 examples of how staff have identified health problems and ensured that appropriate healthcare has been provided. This can be particularly difficult with clients who have communication difficulties. There is always a qualified nurse on duty at the Home who works as part of the staff team but takes on additional responsibilities with regard to medication and health/nursing care issues. The nurses meet together regularly with the Manager to discuss the plans of care for the clients. Medication is managed by the qualified nurses. Medication is administered in a variety of ways depending on the needs of the individual clients. Medication is stored appropriately and the administration was seen to be carried out in a way which was safe and which involved the client in the process. It was noted that there were some gaps in the administration record and a requirement is made about this. Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff are aware of the importance of effective communication to enable the clients to raise any concerns Staff receive appropriate training with regard to Safeguarding Adults EVIDENCE: The CSCI have not received any complaints about the Home and the Manager confirmed that he has not received any either. The Home has a complaints procedure but it would be difficult for the clients to make a complaint on their own behalf. The Manager and staff are aware of this and recognise the importance of other people, such as relatives, advocates and staff from other services, being involved in the clients life. Staff attend training about Safeguarding Adults during their induction and the Manager said that additional training has been provided to those staff who had not attended for some time. Staff who spoke to the Inspector were aware of the procedure and have confidence that the Management team would deal with any allegations appropriately. The Manager is aware of the correct procedure with regard to adult protection and the organisations own disciplinary procedures. Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 17 Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The Home adequately meets the needs of the clients but the organisation has recognised that the clients will benefit from living in smaller groups and so plans are in place for this to happen. EVIDENCE: The Home is an old building which has been converted and modernised over the years. It has been recognised by the organisation that it no longer completely meets the needs of the clients and so there are plans in place for clients to move sometime within the next two years. The clients have their own bedrooms and these are attractively decorated and furnished with the clients own possessions. The dining room has recently been Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 19 decorated and the Manager said that urgent decoration and maintenance will continue to be completed until the clients move. The Home has a separate laundry room. Additional domestic staff have recently been appointed and the Home was clean and free from offensive odours on the day of the Inspection. Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Appropriate recruitment procedures are followed. Staff receive training and support to carry out their roles effectively. Staff are enthusiastic about their roles and were seen to be kind and caring. EVIDENCE: The staff team were observed by the Inspector and the expert by experience to communicate well with the clients and to be kind and caring. Staff who spoke to the Inspector were enthusiastic about supporting the clients and are keen to provide a good standard of care. The staff all receive effective induction which consists of two weeks formal induction at the regional office and a period of induction within the Home. There is also an ongoing training programme for staff to access throughout the year. The training department at the regional office maintain an overview of Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 21 the training required by each member of staff and reminders are sent to them when training is due. Regular staff meetings take place and the qualified nurses also meet on a regular basis. Staff said that the staffing levels had been reduced over the previous months but that recently they have been increased again which ensures that the clients needs are more easily met. Appropriate recruitment procedures are followed and the necessary records kept for new members of staff. Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The Home is well managed in an open and inclusive way The health and safety needs of the clients and staff are met The Home has various ways in which the quality of the service is measured. EVIDENCE: The Manager of the Home is a qualified nurse and has worked at and managed the Home for several years. He has undertaken a range of additional training Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 23 and continues to do so. The assistant manager also has many years experience of working with the clients. Staff spoke highly of the support that they receive from the management team and said that they are approachable and listen to what staff have to say. The Inspector saw a selection of records relating to health and safety. These show that equipment is regularly serviced and that regular checks are carried out with action taken to address any concerns. The Home follows the organisations internal monthly quality assurance process, known as REACH standards. These are carried out jointly by the keyworkers with the clients. The organisation has a forum for clients at which various issues affecting their lives can be discussed. The Home has a range of processes which measure the quality of the service provided and work hard to continually improve the service provided to the clients. There is a need to bring all of the processes together into an annual quality assurance report and a requirement is made about this. Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 2 X 3 X 2 X X 3 x Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 25 no Are there any outstanding requirements from the last inspection? 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 2 Standard YA20 YA39 Regulation 13 (2) 24 Requirement It is required that the medication administration records are accurate It is required that an annual quality assurance report is produced Timescale for action 05/12/06 31/03/07 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 Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Meadow Cottage Nursing Home DS0000015659.V323904.R01.S.doc Version 5.2 Page 27 - 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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