Inspection on 22/01/07 for Merafield View Nursing Home

This inspection was carried out on 22nd January 2007.

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

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

Other inspections for this house

Merafield View Nursing Home 08/12/05

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Merafield View Nursing Home Underlane Plympton Plymouth Devon PL7 1ZB Lead Inspector Mandy Norton Unannounced Inspection 22nd January 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 Merafield View Nursing Home DS0000065522.V310292.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. Merafield View Nursing Home DS0000065522.V310292.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Merafield View Nursing Home Address Underlane Plympton Plymouth Devon PL7 1ZB 01752 348070 01752 346414 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) Stagecare Limited Mrs Sally Philipson Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (6), Physical disability over 65 years of age (40) of places Merafield View Nursing Home DS0000065522.V310292.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Old age, Not falling within any other category (6) Physical disability over 65 years of age (40) Date of last inspection 8th December 2005 Brief Description of the Service: Merafield View is a purpose built Home situated in Plympton St Mary, on the outskirts of Plymouth Devon. The Home is registered to care for a maximum of 40 service users of either gender over the age of 65 years of age with physical disability/frailty or illness requiring nursing and/or personal care. The Home is arranged on 3 floors. Most accommodation is on the lower ground or first floors and the main communal areas are at ground floor level - all floors can be accessed by a passenger lift. There is a lounge and dining room and a sun lounge/conservatory on the lower ground floor. The home is owned and administered by Stagecare Ltd. There is access to the local shops and amenities. The fees charged range from £438 to £600 (information taken from the pre inspection questionnaire dated 14.09.06). The latest inspection report will be displayed in the foyer and the manager was advised that the Statement of Purpose should be updated to include information about where people can access the latest report if they do not have access to the internet. The contracts issued include name and date of admission and who pays the fee, how the fee is broken down and the total fee. It states that the terms and conditions provided on entry to the home should be read before signing the contract and says that the standard complaints policy, provided to the Service User (or their representative) on entry to the home, can be referred to if necessary. Merafield View Nursing Home DS0000065522.V310292.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place from 10 am until 3.10 pm and was conducted with the manager. A tour of the home was carried out. The report contains views from the completed staff surveys returned (13) reflected throughout, information taken from the completed pre inspection questionnaire (received September 2006) and views of Service Users spoken on the day of the inspection. The pre inspection questionnaire states that there has been 1 complaint made since the last inspection, which was substantiated. It was responded to within timescales laid out in the homes complaints procedure. What the service does well: Merafield View is homely, comfortable and welcoming. The staff are trained and competent in their jobs and there was a nice atmosphere during the inspection with staff interacting well with the Service Users and a number of visitors in the home. Service Users spoken with said that the staff are ‘kind and helpful’ The information about the home given to prospective Service Users and or their representatives has sufficient detail to allow an informed decision to be made about moving into the home. When possible, prior to admission, the manager or her deputy visit the person in their current setting to perform a full needs assessment in addition to receiving care plans from other social and health care professionals. Once admitted to the home Service Users needs are set out in a care plan, the plans provide sufficient information for care staff to be able to meet the individuals’ health, social and psychological needs. The processes in place to protect the health and welfare of the Service Users such as the complaints procedure, health and safety procedures and regular training for the staff help to assure the people living in the home that they are well looked after. Service Users are able to maintain contact with family and friends and exercise choice and control over their lives. Service Users receive a wholesome appealing diet. Service Users are asked on the day of the meal what they would like to eat, with alternatives to the menu always being available. Merafield View Nursing Home DS0000065522.V310292.R01.S.doc Version 5.2 Page 6 The home is pleasantly decorated and furnished and presented as clean, bright and hygienic. 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. Merafield View Nursing Home DS0000065522.V310292.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 Merafield View Nursing Home DS0000065522.V310292.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service or are prospective Service Users have good information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that people’s diverse needs are identified and planned for before they move to the home. This home does not provide intermediate care. EVIDENCE: The manager showed the inspector pre admission documentation that is completed prior to a decision being made about whether the home can meet a persons needs or not. She said that all prospective Service Users or their Merafield View Nursing Home DS0000065522.V310292.R01.S.doc Version 5.2 Page 9 representatives receive information about the home and its facilities (Statement of Purpose) and can come and look around at any time. The manager said that if a prospective Service User is local to the area she herself or her deputy goes to visit the person in their current setting to make an assessment. One completed assessment carried out in this way was examined. It included information about their current abilities, medication, next of kin and equipment required. The manager said that the contracts for Service Users are managed by the group’s head office in Dorset. A copy of a contract was examined and contracts included name and date of admission and who pays the fee, how the fee is broken down and the total fee. It states that the terms and conditions provided on entry to the home should be read before signing the contract and says that the standard complaints policy, provided to the Service User (or their representative) on entry to the home, can be referred to if necessary. Merafield View Nursing Home DS0000065522.V310292.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 good. This judgement has been made using available evidence including a visit to this service. The manager promotes and maintains Service Users health and ensures access to health care services to meet assessed needs. The homes medication systems protect the welfare of residents. Service Users are treated with respect and their right to privacy is upheld. EVIDENCE: Care plans were examined contained assessments which provided information about skin integrity, moving and handling, safety - including risk of falls and use of bed rails. The information generates the plans of care, which provide the basis for the care to be delivered. The care plans were clear and easy to understand A new system of care planning is being used in the home. Not all care plans have been transferred to the new documentation, but the manager said this exercise will soon be completed. The care plans are kept in the main office. Merafield View Nursing Home DS0000065522.V310292.R01.S.doc Version 5.2 Page 11 The medication system is well managed; A second drugs trolley has just been purchased to allow medicines to be given out by trained staff on different floors at the same time. The clinical co-ordinator is responsible for ordering, checking in and disposal of medicines. he manager was advised to ensure the homes medicines policies include procedures for transcribing medicines for example when a surgery rings the home to change the dose of warfarin. They already have a form for documenting INR (blood) results and subsequent warfarin doses to be given. The information is put straight onto the form during the telephone call from the surgery. This was noted as good practice. Disposal of unused/ out of date medication is safe, well recorded and removed by a licensed contractor. A tour of the home showed that in a number of rooms there were unlabelled pots of cream with no opening date written on them. It was recommended that the labels are kept on pots /tubes of cream to show they are being used for the person for whom they are prescribed and they have a date of opening clearly marked on them. During a tour of the home staff were overheard interacting with Service Users appropriately. Joining them into conversations and talking with them individually. Doors were closed when personal care was being delivered. Staff were seen knocking on doors before entering Service users rooms. Service User’s spoken to said that the staff kind and caring and nothing was to much trouble. The Statement of Purpose includes a short piece about maintaining Service User’s privacy and dignity. Merafield View Nursing Home DS0000065522.V310292.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 good. This judgement has been made using available evidence including a visit to this service. Effort is made by the home to provide an activities programme and social interaction/stimulation for Service Users. Service Users are able to maintain contact with family and friends and exercise choice and control over their lives. Service Users receive a wholesome appealing diet and are not rushed, encouraging the mealtime to be a social event. EVIDENCE: The activity co-ordinator is involved in a variety of activities with Service User’s. The Statement of Purpose describes therapeutic activities that Service User’s can expect to be offered including – cards, scrabble, bingo, armchair exercises, manicures, music and sing-a-longs and help with lifelong interests such as crosswords. It states that ‘the home offers a wide range of activities designed to encourage the client to keep mobile and, most importantly take an interest in life’. Service User’s spoken to said that staff take them out to the Merafield View Nursing Home DS0000065522.V310292.R01.S.doc Version 5.2 Page 13 shop almost on demand and activities are offered regularly. Service Users can have their own TV, radio and telephone (they are responsible for the individual bill). A tour of the home showed some Service Users in their rooms watching appropriate TV programmes, reading newspapers and magazines and chatting with visitors. Others were in one of the 2 lounges with their visitors or chatting to other Service Users. The menus (provided with the Pre inspection questionnaire) are on a rolling 2 week system. The menus state that fresh fruit is provided. Service User’s are asked after lunch what they would like for tea. A carer was doing this during the inspection. Alternatives are always available. Service Users spoken to said the meals were good and well presented. Although one comment was that more seasoning could be put in during cooking. The Statement of Purpose states that menus will be varied and favourite dishes and special diets can be catered for. ‘Tea, coffee and other hot drinks are served and available 24 hours a day, visitors are also catered for’. Service Users can eat in their rooms or in the dining room. Catering staff spoken to were approachable and well organised and were deep cleaning the cooker following lunch on the day of the inspection. The cook said the kitchen staff grow some of their own herbs that are used in the cooking. An environmental health officer report form June 2006 only had comments about the need to implement new recording systems (Better Business: Safer Food) recently introduced by the Food Standards Agency. Merafield View Nursing Home DS0000065522.V310292.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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users and their relatives/friends know how to make a formal complaint. People are safe living in this home. No formal meetings take place for staff or Service Users but there are good strategies in place for bringing concerns or complaints to the managers attention. EVIDENCE: The complaints procedure was seen displayed within the home and is in the Statement of Purpose, given to all Service Users and /or their representatives on admission. The manager and the clinical co-ordinators (deputy) role includes discussing concerns /complaints with Service User’s and /or their relatives. The manager is involved with any subsequent investigations. The PIQ stated that there has been 1 complaint since the last inspection, which was substantiated. Through discussion during the inspection the manager demonstrated an awareness of safeguarding (adult protection) issues and what immediate action to take and when and who to refer any incident on to. 12 of the 13 completed staff surveys indicated they were aware of adult protection procedures. Merafield View Nursing Home DS0000065522.V310292.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is safe and adequately maintained and clean and hygienic ensuring the Service Users live in a satisfactory environment. EVIDENCE: A tour of the home showed that Service Users rooms contain personal items including furniture, ornaments and pictures. There has been a programme of redecoration and procurement of equipment ongoing since the home was purchased by the current owners approx 2 years ago. The home appeared well equipped to meet the needs of Service Users identified with moving and handling risks and disabilities that affect their capability to bathe (hoists, stand aids, showers and assisted baths and toilets). Specialist mattresses and adjustable beds were seen in place for those Service Merafield View Nursing Home DS0000065522.V310292.R01.S.doc Version 5.2 Page 16 Users requiring them. The manager said that nearly all beds are now adjustable and suitable for the Service User’s needs. There is call bell system throughout the home, Service Users seen in their rooms all had the bell placed within their reach. There were a variety of toilet facilities for use by Service Users throughout the home. There is a shaft lift to all floors. There is some outdoor space for the Service User’s to use. There is 1 lounge / diner on the ground floor and a further lounge/conservatory on the lower ground floor. Both lounges were tastefully decorated and looked comfortable. Although the lower ground floor one was a little cold but the manager said it is rarely used by Service User’s as they prefer the lounge on the ground floor which is nearer to the main activity in the building. Visitors were seen with their relatives in the lounge and in the privacy of their own rooms. Hand washing facilities were seen throughout the home as were protective gloves and aprons. The kitchen appeared well equipped and large enough to manage the number of Service Users living in the home. There is a full time and part time handy man who carry out the ongoing decoration, portable electrical testing and any other maintenance jobs that need attention on a day to day basis. All faults/ jobs are written in a maintenance book for the attention of the handymen. This is checked daily. Merafield View Nursing Home DS0000065522.V310292.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. 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. There are sufficient numbers of staff with appropriate skills and knowledge to meet the needs of Service Users in this home. The homes recruitment procedures protect Service Users from being placed at risk of harm or abuse EVIDENCE: Duty rotas supplied with the pre inspection questionnaire indicate that the manager works full time and is on call alternate weekends with the clinical coordinator who acts as her deputy. The manager said that since the beginning of January the home is fully staffed and she is now having time to spend on duties such as supervision, appraisals and quality assurance. The pre inspection questionnaire (September 06) states that there are 8 Registered Nurses (RGN’s) employed in the home, they are assisted by 27 care assistants, 10 of whom have achieved a National Vocational Qualification (NVQ), level 2 or above, in care. There are also 14 ancillary staff (catering, laundry, domestic, activities and maintenance) employed in the home. The inspector saw training sessions available advertised in the office. Merafield View Nursing Home DS0000065522.V310292.R01.S.doc Version 5.2 Page 18 10 of the 13 completed surveys confirmed that funding and time are provided to receive relevant training, 3 did not know. The manager volunteered the information that she was behind on supervision and appraisals, but now the clinical co-ordinator is ‘up and running’ she will be able to start these properly. A number of the completed staff surveys stated that staff meetings are held and that they were supervised during their probation period. The inspector looked at 2 staff files of overseas staff employed at the home – they had all of the required documents including home office information and work permits. Merafield View Nursing Home DS0000065522.V310292.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed by an experienced Registered Nurse. There is a formal quality assurance system in place. Personal money held in the home on behalf of Service Users is managed appropriately (assessed during previous inspections). The registered provider shows a responsible attitude toward promoting and protecting the health, safety and welfare of Service Users and staff. Merafield View Nursing Home DS0000065522.V310292.R01.S.doc Version 5.2 Page 20 EVIDENCE: The manager has recently been able to employ a clinical co-ordinator /deputy. This has given her the opportunity to start to concentrate on staff supervision and appraisals, which by her own admission she has fallen behind on. The current manager has several years experience of managing the home and has achieved a Registered Managers Award. She finds the company that took over approx 2 years ago very supportive. She has been able to meet up with managers from the companies (BML) other homes and share experiences. The manager is regarded highly by other professionals. Staff have had training in health and safety and any issues are reported to the manager and/or the maintenance team who deal with the issues in a timely fashion. A tour of the home confirmed that there were no urgent health and safety issues outstanding. Management of Service User money was not examined at this inspection but has been found to be satisfactory in the past. The manager said that bed rails are fitted by maintenance personnel or a trained nurse. The manager is to ask the GP’s to also sign the consent form currently in use when bed rails are fitted. The accident book examined was completed appropriately. The manager checks all entries as part of the internal audit process. Their is a formal quality assurance system in use by BML, results and required actions are discussed with the manager. There are also in house satisfaction surveys circulated periodically. The outcomes are documented and actions taken written on the completed surveys. Some results of the in house questionnaire are included in the Statement of Purpose. The manager holds trained staff meetings, the last one being 03.01.07, and general staff meetings periodically. Regulation 26 reports (monthly unannounced visit to the home by the provider or his representative from which a report is required to be written)are sent to the commission regularly and are always informative. The fire log- book examined did not have up to date weekly fire alarm checks documented. Therefore it could not be confirmed that regular checks take place. However all other records seen were of a good standard and regularly completed. Merafield View Nursing Home DS0000065522.V310292.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 3 3 X X 2 Merafield View Nursing Home DS0000065522.V310292.R01.S.doc Version 5.2 Page 22 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 Standard OP38 Regulation 23 (4) (c) (iv) Requirement The fire alarm must be tested weekly in accordance with fire service regulations. The fire log - book must be completed following all alarm tests as evidence that the alarm has been tested at least weekly. Timescale for action 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended that all pots of creams should have a pharmacy label with the Service Users name on them and a date of opening clearly written on them. Merafield View Nursing Home DS0000065522.V310292.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Merafield View Nursing Home DS0000065522.V310292.R01.S.doc Version 5.2 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!