Inspection on 09/08/07 for Meresbeck Care Home

This inspection was carried out on 9th August 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

Meresbeck Care Home 16/06/09

Meresbeck Care Home 24/10/06

Meresbeck Care Home 03/02/06

Meresbeck Care Home 16/08/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Meresbeck Care Home 125 North Road Carnforth Lancashire LA5 9LU Lead Inspector Ajam Auckburally Unannounced Inspection 9th August 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 Meresbeck Care Home DS0000063658.V342105.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. Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meresbeck Care Home Address 125 North Road Carnforth Lancashire LA5 9LU 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) 01524 734176 SKR Limited Mrs Emma Stephenson Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The service is registered to accommodate a maximum of 20 service users in the category OP (older persons 65 and over) 24th October 2006 Date of last inspection Brief Description of the Service: Meresbeck is situated in Carnforth fairly close to the town centre but not too easy for frail elderly residents to reach. Meresbeck is registered with The Commission for Social Care Inspection (CSCI) to provide personal care for up to 20 residents of either sex aged 65 years and above. Resident’s private accommodation is provided in twelve single rooms, four of which have ensuite facilities, and four double rooms two of which have ensuite facilities. There are 2 lounges and 2 dining rooms, which are adequately fitted and decorated for the residents to choose from. The furniture in the dining rooms has recently been replaced. Residents are encouraged to retain their links in the community and every effort is made to ensure, hobbies and interests are pursued. Relatives, friends and visitors are made welcome at the home and can visit at any reasonable time. Activities are arranged both inside and outside the home for residents who wish to take part. There were 17 residents residing at the home at the time of the inspection. They all said that they are well cared for and that all the staff are kind and considerate. Current weekly fees are between £342 and £384 and additional extras like toiletries, transport, hairdressing, private chiropody and newspapers are paid for by the residents. Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Under IBL (Inspecting for Better Lives) Meresbeck was assessed as requiring a statutory key visit (inspection) between April 2007 and March 2008. An unannounced key site visit was carried out on 9th August 2007. The inspection lasted 5.5 hours. The inspection was carried out against the National Minimum Standards for Older People. The inspection despite being an unannounced one was carried out in a friendly atmosphere and with the full cooperation of the staff and the residents. During the inspection, some records were looked at and all the residents and the staff were spoken to. The residents were very positive about the care they receive and the way the staff treat them. Evidence about the inspection was gathered firstly by sending out a questionnaire, AQAA (Annual Quality Assurance Assessment) for the manager of the home to complete and return. The completed questionnaire gave information about several areas such as staffing, checks that the home has made about the safety and maintenance of the building, information about residents and other useful information. The AQAA also requests information about good practices and developments. Questionnaires were also sent to residents, the families and other professionals such as district nurses and doctors. By the time the inspection was carried out, 2 residents and 3 relatives had returned their completed forms. When they were analysed, they showed that no adverse comments were made about the home or the staff. One relative made this comment “They are all very caring.” There were 17 residents living at the home at the time of the inspection and there were 3 care staff, and a cook on duty. The manager who was off duty came to assist with the inspection. The number of staff on duty was sufficient to look after the well being of all the residents. The staff were observed to be polite and attentive when talking and dealing with the residents. Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Several areas of the home have been decorated and some carpets have been replaced. The tables and chairs in the dining room have been replaced with new ones. Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 Page 7 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. Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 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 Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There are very good practices to assess the needs of people coming to stay at the home. Resident’s benefit from having all their needs assessed and met. EVIDENCE: The records of admission of the last resident admitted to the home were examined. This resident was admitted as an emergency with minimal information but the records show that a full assessment was carried as soon as possible and a care plan devised. A member of the management team always visits prospective residents who are unable to visit the home, either in their own home or in hospital before Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 Page 10 admission. The manager said this helps with introduction as well giving and gaining information. The service user guide contains information about the care provided, the facilities, the staffing, the complaint procedure and other useful information. A copy of the last inspection report is given to all new residents. Prospective residents or their families are encouraged to visit the home and spend as much time as they need before making a decision. A written pre admission assessment is done to ensure that the staff of the home can meet the assessed needs. The staff said that they are given as much information about the new residents as possible so that they can provide tailor-made care. Several residents spoken to said that their families have chosen well for them and that they liked living at Meresbeck. They said that they can do what they want and that the staff provide assistance and help when required. The residents said that the staff are very good and that nothing is too much trouble for them. The home does not provide intermediate care. Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 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. 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 practices to meet the health and personal care needs of the residents are good. The residents have their needs assessed and met by a team of dedicated staff. EVIDENCE: Two residents, one of whom being the last one admitted to the home were case tracked. This meant that two residents were selected by the inspector and the care they receive examined closely. Their assessments and care plans were examined and they were spoken to. Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 Page 12 The records show that detailed written information about the residents has been recorded. These include an assessment to identify the needs of the residents and also a care plan which shows how the needs were being met. The physical assessment covers; personal hygiene, mobility, hearing, vision and other areas. The care plans give details of how the assessed needs are met. For example, if someone needed help with personal hygiene, the record will show that this person needs staff to wash and dress her. The care plans are reviewed monthly or as required to meet their changing needs. The residents and their families can be involved in this exercise. The residents said that they are very well looked after by the staff. They were very positive about the staff and the management of the home. They described the home as being very good. The inspector observed a very relaxed and friendly atmosphere in the home. There were good interactions between the staff and the residents. A stair lift is available to access the first floor. A bath hoist is available to assist residents with getting in and out of the bath. All the residents are white British, but the manager said if a resident from a minority group was to be admitted to the home, she will obtain as much information as possible by researching this group to meet care, cultural and dietary needs. Resident’s health care needs are met by involving health care professionals. GP’s, district nurses and chiropodist visit when required. The medications records were examined and they were found to be accurate. The medications of 2 residents were audit trailed and were found to be correct. Medications are only dispensed by senior staff who have had training on medications.. The home is sensitive to the needs of all the residents and does everything to help them remain as independent as possible. The staff were observed talking and helping the residents with respect and dignity. Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good range of activities to help stimulate and keep the residents active. Residents are encouraged to participate in activities and are helped to remain independent and active. EVIDENCE: The manager said that residents are encouraged to remain as independent as they want and able to. Residents were observed doing their own things. Some were in the lounges and others were in their rooms. They said that they are able to remain as independent as they want or able to. They said that staff are helpful and will provide assistance when required. Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 Page 14 Three residents were in their rooms after having had their breakfast there. They said that they like to relax by watching television or reading their newspapers after breakfast. The inspector spoke to most of the residents and they said that they are very happy living at Meresbeck and that everyone is nice and caring. They said that they can do what they like and do not have to join in activities if they do not want to. Activities in the home include Bingo, board games, entertainers etc. Occasional trips are organised for residents to go out. On a personal basis, staff will take residents to the shops or do their shopping for them. Most of the residents said that the shops are too far for them to get to. The residents said that there is enough to do if you like to join in communal activities. Several of them said they like to do their own things and join the activities they like. They said that no one is forced to do anything. The staff said that they try and meet residents’ individual needs. They said that if residents wanted to go for a walk or do something, they would try to oblige. Families and friends of residents are encouraged to visit when they want. Two relatives were present during the inspection and they said that they were very satisfied with the care provided and that the staff are good and helpful. Some of the residents said that their relatives take them out regularly. The residents said that the food is very good and that they are offered plenty to eat and drink. A choice of food is provided at lunchtime when the main meal of the day is served. On the day of the inspection, the choices for lunch were Gammon or Turkey. Meals are served in the dining rooms which have recently been furnished and decorated. Residents may eat in the lounge or in their rooms if they prefer. There is a good choice of food to choose from at breakfast and teatime. A cooked breakfast is available for those who want it. Records of meal served examined show that a good variety of meals are offered to the residents. The manager said that within reasons, the home could cater for every taste. She said that food to suit ethnic and cultural preferences would be offered to residents if required. Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 Page 15 Residents are offered hot drinks at regular intervals during the day. They said that they find that the regular drink rounds are adequate for their needs, but would ask the staff for a drink if they wanted one at other times. Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 Page 16 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. There are robust policies and procedures to safeguard and keep residents safe. Residents live in a home where they are not afraid to speak up. EVIDENCE: The manager has produced policies and procedures for dealing with complaints and abuse. The complaint procedure is included in the Service User Guide. It is available to residents and their families. The manager said that she speaks to residents and staff on a daily basis and this allows for problems and concerns to be sorted out as they occur. The residents said that if they had any complaints, they would speak to the manager and have every confidence that their concerns would be dealt with. The manager said that when the owner visits the home, he always speak to the residents to ensure that that if they had any concerns, he would sort them out. There are systems in place for staff to report any incident of abuse either by staff themselves or by others. Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 Page 17 All the residents appeared to be safe and free from harm, neglect and abuse. Staff were observed treating the residents with respect and dignity. The staff spoken to were aware of different types of abuse. One member of staff spoken to was able to describe abuse as being physical, emotional and financial. Several staff have attended a course on abuse awareness. Residents said that they are well looked after and that all the staff are kind and helpful. There were no visible signs of abuse or neglect. Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 Page 18 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 & 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 kept to a good hygienic standard and is well maintained. Residents live in a clean and well kept home. EVIDENCE: Meresbeck is situated in a residential area in Carnforth. The home is situated about half a mile from the town centre. During a tour of the building, the home was found to be clean and in good hygienic order. The home was found to be free from hazards and the residents were observed getting around the home safely. Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 Page 19 Some residents were in their rooms and they said that they like to stay in their rooms to read or watch television. There are two lounges and two dining rooms, which are adequately fitted and decorated for the residents to choose from. Residents are able to use these communal facilities when they want. Resident’s private accommodation is provided in twelve single rooms, four of which have ensuite facilities, and four double rooms two of which have ensuite facilities. The bedrooms vary in sizes, but are of good proportions. The home is well maintained and the colours are light and pleasant. The manager said that there is a rolling a programme of maintenance and carpets are changed when necessary. There is small car park at the front of the home. There is a garden area at the rear of the home. The residents’ general comments were that the home is clean and homely. There are grab rails fitted to some of the toilets to help residents who are disabled. A bath hoist is available to help residents getting in and out of the bath. A chair lift to access the first floor is available for the residents to use independently if they wish. Recommendations were made during the previous inspection for the owner to have handrails fitted along the main corridors. This work has not been carried out yet and the manager said that she would pursue it. The fitting of handrails would help residents with mobility difficulties walk safely and maintain their independence. Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 Page 20 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 excellent. This judgement has been made using available evidence including a visit to this service. There is a robust recruiting and training procedures to ensure that staff employed are fit to care for the residents. Residents are cared for by a team of well-motivated staff. EVIDENCE: The number of staff on duty has been maintained to a good level to meet the needs of the residents. At the time of the inspection, there were 3 care staff and a cook on duty. The manager who was off duty came to assist with the inspection. Staff rotas examined show that the staffing level is well within the recommended level for the number of residents at the home. The manager demonstrated a good understanding of the procedures to be followed when selecting and recruiting staff. The staff files examined show that appropriate checks have been carried out before offers of employment were made. Such checks included CRB (Criminal Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 Page 21 Records Bureau), POVA (Protection Of Vulnerable Adults) and 2 satisfactory references. Once a new member of staff starts work at the home, she undertakes an induction training programme involving orientation of the home, meeting residents and staff. Training also includes Fire Procedures, Moving and Handling and many other relevant courses. There is a clear commitment to the training and development of all staff at the home and they are all expected to go on the NVQ training programme once they have completed their induction training. Training records show that the staff at the home have attended several courses. These include: Abuse, Moving and Handling, First Aid, Dementia, Medications, etc. CSCI (Commission for Social Care Inspection) recommends that at least 50 of care staff achieved NVQ (National Vocational Qualification) level 2. The percentage of care staff at Meresbeck with this qualification is 81 and is commendable. The staff spoken to said that they enjoy working at the home very much. They said that the management is very supportive and listens to what they have to say. The residents said that the staff are marvellous and will do anything for them. There were good interactions between the residents and the staff. They all appeared to be happy and content Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 Page 22 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. There is a good management team running the home. The residents and staff benefit from living and working in a well managed home EVIDENCE: Meresbeck is owned by the Rai family under the name of SKR Limited. The registered manager is Emma Stephenson and she has worked at the home for several years. She is supported by a deputy and other staff. The inspector found that the home is being well managed and that the residents are well looked after. Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 Page 23 As the registered providers do not work in the home on a day to day basis. One of them visits the home on a regular basis to talk to the manager, staff and residents. Once a month, he completes a Regulation 26 form. This form is completed to ensure that owners who do not work at the home on a daily basis either himself or a representative looks at all areas of the home and leaves a written report. A copy of the report is also sent to CSCI. The Regulation 26 report of July 2007 states that the owner spoke to several residents and relatives and that they were all satisfied with the service provided and the way staff care for the residents. The staff said that the owner is approachable and that he talks to them when he visits. The home has a written health and safety policy in place, which is supported by a number of associated procedures such as COSHH (Control Of Substances Hazardous to Health) and infection control. The home has been awarded Investors in People and ISO (International Standards Organisation); both of these involve an annual assessment of the operation of the home. The ISO assessment was being done the day after this inspection. Residents and or their families are encouraged to deal with their own finances. Most of the fees due to the home are paid for by direct debit arrangements. Where the home, keeps money on behalf of residents, appropriate records are kept. The inspection was carried out in a friendly environment and residents and staff said that Meresbeck is a very good home. Meresbeck Care Home DS0000063658.V342105.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 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 4 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 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP22 Good Practice Recommendations The owner should consider fitting handrails alongside the corridors to help residents with poor mobility walk safely and maintain a greater degree of independence. Meresbeck Care Home DS0000063658.V342105.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Meresbeck Care Home DS0000063658.V342105.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. 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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