Inspection on 25/04/06 for Nazareth House

This inspection was carried out on 25th April 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 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

Nazareth House 08/02/10

Nazareth House 30/10/09

Nazareth House 10/09/09

Nazareth House 06/04/09

Nazareth House 14/04/08

Nazareth House 07/02/06

Nazareth House 27/07/05

Nazareth House 08/02/05

Nazareth House 01/07/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Nazareth House 118 Harlestone Road Northampton Northants NN5 6AD Lead Inspector Mrs Sarah Smart Unannounced Inspection 25th April 2006 10:30 X10029.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 Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and 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. Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Nazareth House Address 118 Harlestone Road Northampton Northants NN5 6AD 01604 751385 01604 580435 debi@naznptn.plus.com 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) The Congregation of the Sisters of Nazareth Mrs Deborah Elizabeth Miller Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (52) of places Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the home limits its services to the following service user categories: Care Home personal care only - up to 52 service users within the OP over 65 years category Between the dates of 23.04.05 to 03.05.05 no one falling within the category of OP may be admitted into the home where there are 53 service users who fall within the category of OP already accommodated within the home Between the dates of 23.04.05 to 03.05.05 a named service user can be accommodated in Room 6 of Zone 3 of the home. Between the dates of 23.04.05 to 03.05.05 - 53 service users within the category OP can be accommodated within the home 07.02.2006 2. 3. 4. Date of last inspection Brief Description of the Service: Nazareth house is a large home located on the outskirts of Northampton providing personal care for to up to 52 persons within the category of old age. Nursing care is not provided by the staff but by health care professionals that visit the home. Nazareth House is convenient to a bus service to the town centre which is approximately 2 miles away. The home has been established for many years and is run by The Congregation of the Sisters of Nazareth who also offer a comprehensive range of spiritual support and guidance to meet the individual religious needs and preferences of each resident. Daily mass is celebrated in the convent chapel, which is located within the home. The sisters publish a Charter of Residents Rights and Responsibilities in their brochure, which demonstrates the homes committed to individual rights and choice. The home consists of two wings, the St Margaret Clitherow unit and Thomas Moore unit. There is no difference in the levels of care given to the residents living in either of the units. Residents rooms are on two floors and a lift is available for the residents to use. Ten of the fifty rooms have en-suite facilities. Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was undertaken between the hours of 10.30am and 4pm. Preparation for the inspection included: review of the previous inspection report, requirements and recommendations, and took approximately 5 hours. The primary method of inspection used was ‘case tracking’. This involves selecting a number of service users and tracking their care and experiences through review of their records, discussion with them, the care staff and observation of care practices. The following areas were covered during the inspection: case tracking, medication, sample of policy review, staff rota, staff files, quality assurance, staff supervision, accident records, complaints records, tour of the premises, previous requirements made, and staff and service user interviews. Four service users were case tracked, two of whom were selected during the tour of the premises, and two selected at random. Two staff members, plus the manager, were interviewed at length, and several others briefly, whilst four service users, and two relatives were spoken to in detail. What the service does well: Needs assessments are recorded to a high standard, and service users stated that their needs are met. A relative gave very positive feedback to the inspector. Service users and a relative said that the food is acceptable, and choices available. Service users were involved in the writing of their care plans, which gave adequate information to the reader. Medication was managed to a high standard. Service users stated that their privacy and dignity is respected, and they are afforded choices. Social histories of service users had been ascertained, and the provision of activities was acceptable. All areas of the home, including the kitchen, were clean and tidy at the time of the inspection. Complaints and protection of service users is managed appropriately, and staff demonstrated a good knowledge of the processes surrounding this. The facilities offered by the home were acceptable, and pleasant, with beautiful grounds. The home is currently undergoing substantial renovation, which is managed to cause the least disruption to service users. Staffing levels were satisfactory, as was staff training. Recruitment of paid staff was satisfactory. Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 6 Service users stated that the staff are friendly, and pleasant communication was observed. The home is managed to a satisfactory standard. Quality monitoring is carried out to an acceptable standard. Service users money is handled appropriately. Records pertaining to health and safety were satisfactory. 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. Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are adequately informed, apart from some who do not have contracts of residency, and their needs are met. EVIDENCE: All the service users case tracked had very thorough needs assessments, which also identified the associated risks. The home does not provide intermediate care. Service users spoken to stated that their needs were met, and that they are happy with the care which they receive. None of the service users files viewed contained contracts of residency. Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 9 The relative of a poorly service user took time to express her positive opinions about the home to the inspector. She stated that she is kept informed by the staff, but not worried unnecessarily, that the staff are on the ball, and acknowledge her requests. She feels able to mention if she has any problems. The relative added that the meals are good. Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users health and personal care needs are met, although documentation should be kept more up to date. EVIDENCE: Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 11 A sample of care plans were viewed. In three instances these documents had not been reviewed for several months. There was evidence of service users involvement in their writing. The content of the care plans was appropriate, and gave adequate instruction to the reader to meet the service users needs. None of the service users case tracked had nutritional assessments carried out, and only one of the four had their weight recorded. The manager stated that a nutritional score is due to be introduced in the coming months, and staff were currently being trained in its use. She added that service users are only weighed regularly if a problem is identified. All of the service users had pressure sore risk assessments completed, however one was not scored correctly when compared with her medical history. In all but one instance these assessments had not been reviewed, giving cause for concern particularly as one of the service users had since developed a pressure sore when her condition deteriorated. Service users identified as being at high risk had the appropriate pressure relieving devices in place. A sample of medication was viewed. The home operates a homely remedy policy. In one instance the variable dose of a service users medication was not recorded, but otherwise the management of medication was maintained to a high standard. The medication policy contained all of the required information. Service users spoken to during the inspection stated that their privacy and dignity is respected by staff and care practices observed reinforced this. Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users social needs are met. EVIDENCE: Service users files contained a social history, including family and employment history. The inspector observed that activities were underway during the inspection. A programme of activities is written. Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 13 Service users spoken to stated that there are activities and entertainment in the home, and beautiful gardens which are accessible to them. One service user who declines to join in activities said that she does feel bored and lonely at times. Staff stated that this service user often goes into the garden with other service users. Service users stated that their visitors are welcomed into the home, and the relatives in the home during the inspection were very relaxed and gave totally positive feedback. They also stated that they are afforded choices about their daily lives. The home have a minibus which is used for outings etc. Service users were generally happy with the food offered, and a board displayed in the dining room offered a choice. The kitchen was visited, and whilst two pieces of equipment were currently broken, and the freezer requiring repair, the kitchen was clean and tidy and well organised. Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Service users are protected, and complaints are handled appropriately. EVIDENCE: The complaints policy contained all of the required information. Complaints were well documented, but did not state the complainants satisfaction with the outcome. Staff spoken to demonstrated an acceptable knowledge of the complaints procedure. The home have a copy of the Northamptonshire interagency policy on abuse, and again staff were aware of the action to be taken in the event of an allegation of abuse. A relative stated that any comments were promptly and appropriately addressed. Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The facilities offered by the home are satisfactory. EVIDENCE: A sample tour of the premises was undertaken. Service users rooms were noted to be personalised by the individual occupying the area. Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 16 All areas of the home were accessible to the service users, including the landscaped grounds. The home has several lounge and dining areas, with kitchenettes. In two of these kitchenettes food was not stored appropriately, and the fridge temperatures were not being recorded daily. The home has a computer for the service users use, with internet access, and a dedicated hairdressing room, and a chiropody room. Service users stated that they are happy with their rooms, and all areas of the home were noted to be clean and tidy. The home is currently undergoing renovation in all areas. The inspector was satisfied that this is being appropriately managed to cause the least disruption to the service users. Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Staffing was adequate, however recruitment of volunteers could be more robust. EVIDENCE: The duty rota was viewed. The home is staffed with 9 carers during the morning including three senior carers, 6 including two senior carers on a late shift, and two senior carers on duty over night. None of the staff were noted to be working excessive hours. In addition to the rotered staff, there are 6 nuns who work voluntarily in the home, who are on call at night. The voluntary staff are not recorded on the duty rota, and it is recommended that such a record is held. The manager advised the inspector that all statutory training is up to date, and staff files reinforced this. Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 18 A sample of staff files were viewed. The files for contracted staff contained appropriate information. The file viewed belonging to the voluntary staff member contained a Criminal Records Bureau check but little else. It is recommended that the full recruitment procedure should be introduced for all staff. Service users stated that the staff are friendly, and pleasant communication was observed at all times by staff. Staff spoken to advised that they felt the staffing levels adequate. Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Management of the home is generally satisfactory. EVIDENCE: Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 20 The manager has undertaken a variety of training, and is a registered nurse. The manager stated that the home has a quality pack, however service users are not currently sent questionnaires. She added that regular service user or relative meetings are held which are chaired by an external person, and a suggestions box is also available. The manager also allocates a two hour period on Fridays when relatives and service users can meet with her. A sample of service users money was inspected. This was all appropriately managed. Accident records were viewed. The manager advised that she regularly assesses the accidents to observe for trends. Fire records were all satisfactory. Portable Appliance testing had not been carried out since April 2004. Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 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 X 2 3 3 3 4 X 5 X 6 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 ENVIRONMENT Standard No Score 19 3 20 3 21 3 22 3 23 3 24 3 25 3 26 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 X 37 X 38 2 Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 22 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. 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 6 Refer to Standard OP2 OP29 Good Practice Recommendations Service users should be issued with a contract of residency, and a signed copy retained on their file, to protect both the home and the service user. All staff, including volunteers, should undergo the full and robust recruitment procedure. Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Nazareth House DS0000012866.V289727.R01.S.doc Version 5.1 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. 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