Inspection on 14/12/06 for Newstead Nursing Home

This inspection was carried out on 14th December 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Newstead Nursing Home 27/05/09

Newstead Nursing Home 28/08/08

Newstead Nursing Home 16/08/07

Newstead Nursing Home 20/04/06

Newstead Nursing Home 16/12/05

Newstead Nursing Home 16/08/05

Similar services:

Ashlong House

Norbury Crescent (30)

Henry Nihill House

Birchwood

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

The Infirmary

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

CARE HOMES FOR OLDER PEOPLE Newstead Nursing Home Denewood Road Highgate London N6 4AL Lead Inspector Stephen Boyd Key Unannounced Inspection 14th December 2006 11.15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Newstead Nursing Home DS0000064195.V318325.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. Newstead Nursing Home DS0000064195.V318325.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newstead Nursing Home Address Denewood Road Highgate London N6 4AL 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) 020 8348 4611 020 8341 7459 www.goldcarehomes.com GCH (Heath Lodge) Limited Care Home 36 Category(ies) of Dementia - over 65 years of age (0), Learning registration, with number disability over 65 years of age (0), Old age, not of places falling within any other category (0), Physical disability over 65 years of age (0), Terminally ill over 65 years of age (0) Newstead Nursing Home DS0000064195.V318325.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One specified service user who is under 65 years of age may be accommodated in the home. The home must advise the registering authority at such times as the specified service user attains 65 years of age or vacates the home. 20th April 2006 Date of last inspection Brief Description of the Service: Newstead Nursing home has since the 1 August 2005 been owned by a private company called Gold Care. Newstead can provide residential accommodation and nursing care for up to thirty-six older people. There are nursing staff available both during the daytime and awake throughout the night. There are 5 double bedrooms and 26 single bedrooms. There is a large staffed kitchen and there are facilities for service users and their relatives to make drinks in the garden room. There is a large open reception area that has tables and chairs so that visitors can sit and chat and a large open lounge and dining area. There are four bathrooms providing four assisted baths and one shower. The home is situated in a residential area of Highgate. The areas used by service users are arranged over the ground floor and are wheelchair accessible. There is an area that is used solely by the staff and this is on the first floor. There are two wings, Thompson and Goldsmiths. Thompson wing was converted for service users about 12 years ago. The home is supported by a number of volunteers and a visiting clergyman. The stated aim of the home is to provide long-term nursing care for elderly people with complex needs who require 24-hour supervision, a homely environment which reflects the service users rights of personal choice, dignity and privacy and to implement individualised care plans in-conjunction with service users needs and wishes. There are display shelves in the reception area accessible to service users, relatives and staff, which hold information such as previous inspection reports The current weekly fees for accommodation in the home range from £ 528 to £ 850. A copy of this Inspection report can be requested directly from the home or via the CSCI website (web address can be found on page 2 of this report.) Newstead Nursing Home DS0000064195.V318325.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place in one day in December 2006. The inspection was scheduled after the outcome of an inspection in October 2006 which had been carried out to follow up requirements from the last key inspection of April 2006. The Inspection visit in October had raised a number of concerns regarding the quality of care which determined the need for this further key inspection. The inspector met with the homes’ acting manager and spoke with five service users, two visitors and three staff as part of the inspection process. A tour of the premises was undertaken and various records, policies and procedures were reviewed. What the service does well: What has improved since the last inspection? The inspection in October 2006 identified thirteen requirements to be met, two of which were immediate requirements relating to the availability of drinks at all times and adherence to agreed staffing levels. The requirement for the provision of drinks had been met but the staffing issue was still of some concern. Of the other eleven requirements, five had been met at the time of this inspection. These were regarding an annual development plan having been produced, staff being aware of service users plans of care and following these at all times, ensuring records are kept when service users have been assisted to bath or shower, assessing and meeting the dietary requirements and cultural preferences of service users from an ethnic minority and reviewing practice at mealtimes to ensure a more pleasant and comfortable experience for service users. All the above improvements have contributed to a better care level for service users being available, although other improvements need to be made to raise this level further. Newstead Nursing Home DS0000064195.V318325.R01.S.doc Version 5.2 Page 6 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. Newstead Nursing Home DS0000064195.V318325.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 Newstead Nursing Home DS0000064195.V318325.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): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs are assessed prior to moving to the home and the home does not admit people without assuring service users their needs can be met. EVIDENCE: Service users files sampled during the inspection contained holistic assessments. These were either undertaken by the placing authority or by the manager if the placement was privately funded. The homes newest service user was seen to have an assessment completed. The home does not offer an intermediate care service and therefore standard six is not applicable. Newstead Nursing Home DS0000064195.V318325.R01.S.doc Version 5.2 Page 9 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have individual plans of care; though they need to be improved in respect of the activity care plans. Service users health care needs are met. The medication system was generally in good order though some gaps in signing medication when given were apparent. Service users are treated with respect and privacy is given good priority. EVIDENCE: Service users sampled were found to have care plans which were based on their assessments. They were reviewed on a monthly basis and staff spoken with were able to demonstrate knowledge of the care plans. The observable needs of one service user were seen in respect of their care plan and found to be met during this inspection. The activity care plans for two of the sampled service users were not completed and this needs to be done. Newstead Nursing Home DS0000064195.V318325.R01.S.doc Version 5.2 Page 10 The home supports a range of service users with differing health needs such as diabetes, mobility issues and feeding requirements. Care notes and records of appointments with health professionals were seen and showed good support being provided. Risk assessments sampled at this visit showed identified risks and strategies as to how these could be minimised. Precautions to minimise the possibility of infection were seen such as paper towels and soap dispensers in rooms. There was also anti bacterial gel for use by staff and visitors. The home operates a monitored dosage system of medicine administration which was working well in most respects. There were some gaps in record signing noted and these were pointed out to the senior nurse on duty and the manager. An air conditioning unit purchased to keep down the temperature of the medicine room in hot weather appeared to have worked and fridge temperatures were also being recorded appropriately. Controlled drugs are kept and recorded appropriately. Observation during the inspection and discussion with service users and visitors indicated that service users are treated in a respectful manner and their rights to privacy upheld. An issue in respect of service users dignity being compromised by the use of plastic cups raised at the last visit had been addressed. Newstead Nursing Home DS0000064195.V318325.R01.S.doc Version 5.2 Page 11 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 and 15 Quality in this outcome area is adequate This Judgement has been made using available evidence including a visit to this service. Service users would benefit from a greater level of activities being available in the home. Service users have contact with family and friends as they wish. Service users exercise choice over their lives. Changes to the menu would offer service users a greater level of satisfaction regarding food provision. EVIDENCE: It was disappointing to note that the home had been without an activities coordinator for the previous two months, although it is acknowledged that steps to recruit a new one were taking place. On the day of inspection no activities were being undertaken by staff with service users. Also, as stated earlier there was evidence that activity plans for service users were not being completed or pursued. The issue of providing suitable activities on a regular basis has been highlighted in previous reports and needs to be remedied again if service users are to have a good quality of life in this respect. It was clear that service users can have contact as they wish with family, friends and others. In discussion with service users and visitors they praised staff for having a welcoming attitude. One visitor stated “ they always have Newstead Nursing Home DS0000064195.V318325.R01.S.doc Version 5.2 Page 12 time for her and her friend” There are places within the home as well as service users bedrooms where visits can be undertaken in private. Service users can make decisions about their lifestyles with support from staff as necessary. Service users were able to spend time alone or in company, could use their bedrooms at any time, dress as they wished and go to bed and get up at times of their choosing. As identified in the summary section of this report, areas relating to food provision and mealtimes raised at the last inspection had been addressed such as ensuring service users have access to a range of drinks at all times including with meals and ensuring that mealtimes are more pleasant experiences, for example with everyone comfortably seated. This inspection highlighted that there are still some issues that need to be dealt with. There was a lack of fresh vegetables seen to be available and service users commented on this as an area they wanted to see improved. The inspector acknowledged that more fresh fruit was available than had been seen at the previous visit. Service users also made negative comments about the number of times mashed potato was served, which was backed up by menus seen during the inspection. Apart from the above, comments on food quality and quantity were generally positive in nature. Newstead Nursing Home DS0000064195.V318325.R01.S.doc Version 5.2 Page 13 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 and 18 Quality in this outcome area is adequate. This Judgement has been made using available evidence including a visit to this service. Service users and their relatives and friends can be confident that their complaints are listened to and acted upon Service users are protected from abuse, however the unavailability of the homes policy could compromise this always being the case. EVIDENCE: A policy and procedure in respect of complaints was seen to be available. Service users and visitors indicated they knew how to make a complaint if necessary. Four complaints had been received and investigated by the home since the previous inspection. At the time of the inspection the homes policy on protecting vulnerable adults from abuse was not available. The manager felt this had been taken out of the policy file for review. (A copy was sent to the inspector the day after the inspection) Relevant policies and procedures in respect of POVA were available for the London Boroughs covering the home. Staff have received training in the protection of adults from abuse. Newstead Nursing Home DS0000064195.V318325.R01.S.doc Version 5.2 Page 14 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): 19,22 and 26 Quality in this outcome area is adequate. This Judgement has been made using available evidence including a visit to this service. Service users generally live in a safe and well-maintained environment. There is a need to create additional appropriate storage space and to ensure that bathroom and shower facilities meet the needs of all service users. The home was clean and pleasant in appearance. EVIDENCE: The premises including individual bedrooms were seen to be well decorated and maintained. There are plans to continue refurbishments including the carpeting of corridors in Thorpe wing. Service users and visitors felt the home was in good order including their own accommodation. Rooms were personalised to include items such as ornaments, pictures, photographs and televisions. The issue which is most pressing at the home is to have suitable storage space. For example, a hoist was seen to be stored outside a sluice and bathroom area preventing or making access difficult. The previous inspection Newstead Nursing Home DS0000064195.V318325.R01.S.doc Version 5.2 Page 15 highlighted similar issues. The inspector understands some plans to make changes to the building are in progress. These need to address the storage issues for the future. The home was found to be clean and tidy during the inspection. Service users and visitors commented that this was their usual experience of the home. Newstead Nursing Home DS0000064195.V318325.R01.S.doc Version 5.2 Page 16 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 and 30 Quality in this outcome area is adequate. This Judgement has been made using available evidence including a visit to this service. Service users needs are met by the skill mix of staff but not consistently by the numbers of staff on duty. Staff are recruited in an appropriate manner and have the necessary training to make them competent to carry out their roles. EVIDENCE: On the day of the inspection there were thirty service users in the home from the registration capacity of thirty-six. At the time of the visit there were two RGN’s and four care staff on duty as well as the manager. There were separate cooking, domestic, maintenance and administration staff on duty. The last inspection highlighted a requirement to maintain previously agreed staffing levels in line with the homes’ own policy which would mean a need for five care staff to be on duty as opposed to the four available at the time of inspection. A review of staffing levels was said by the manager to have been sent to the CSCI, however this was unavailable in the home. Staff spoken with during the inspection said levels of care staff had been reduced the week prior to the inspection and they had noted some greater pressure on their workload. The inspector acknowledges that the day after the inspection, the manager informed the CSCI that five carers had been reinstated on morning and afternoon shifts whilst an activities co-ordinator is actively recruited. Newstead Nursing Home DS0000064195.V318325.R01.S.doc Version 5.2 Page 17 Each staff member has an individual training file and a training matrix shows an “at a glance” view of what training staff have carried out and when. Training undertaken by staff has included protection of vulnerable adults, fire safety, first aid, food and hygiene, manual handling and infection control. Twelve of the current care staff have obtained National vocational qualifications at level two or above. Staff felt there were good training opportunities available within the home. Three staff files were viewed during the inspection and these showed that appropriate recruitment procedures were in place. Staff spoken with confirmed that they had undergone interviews, had references taken up on them, had Criminal records bureau checks pursued, made a declaration of medical fitness and made photo identity available. Newstead Nursing Home DS0000064195.V318325.R01.S.doc Version 5.2 Page 18 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): 31,33,35,36 and 38 Quality in this outcome area is adequate. This Judgement has been made using available evidence including a visit to this service. The home appears to be run by a professional manager, though her competence needs to be fully ascertained by undergoing a process of registration. Service users financial interests are safeguarded. Staff are more regularly supervised than they have been in the past. The health, welfare and safety of service users and staff are generally well promoted, though some issues need to be addressed. EVIDENCE: The homes’ manager informed the inspector that she had recently resubmitted an application for registration, as her previous application had not been received by the CSCI registration team. The manager is a trained nurse and is Newstead Nursing Home DS0000064195.V318325.R01.S.doc Version 5.2 Page 19 awaiting the result of the Registered manager’s award which she has undertaken. Staff and service users spoke positively about her during the inspection. Since the last inspection visit the home had submitted a draft annual development plan which shows how the views of service users and others will inform planning. Surveys are carried out to help this process as well as meetings with service users and relatives. Monies held on behalf of service users were randomly checked and found to be in order with appropriate records and receipts. Monies are held in a secure manner. The home has up to date insurance cover. Supervision of staff although being carried out more regularly since the last inspection visits, still needs to be improved to show a consistent level of six supervisions for each staff member throughout a calendar year. Staff spoken with said they valued the sessions they did have with their supervisors and found them supportive. The home was found to have up to date certificates of safety for electrical, fire and other equipment A new gas safety certificate needs to be made available. Fire records showed that weekly fire alarm tests were not recorded up to date and this needs to be addressed. COSSH policies and procedures were in place as well as risk assessments for the environment. Newstead Nursing Home DS0000064195.V318325.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X 2 X X X 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Newstead Nursing Home DS0000064195.V318325.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP27 Regulation 18(1) Requirement The registered persons must ensure that staffing levels, including nursing, care and domestic staff levels, are reviewed and staffing always maintained at documented levels. A copy of the review should be sent to CSCI. Previous timescale of 28/02/06, 30/06/06 and15/11/06 not fully met. The registered persons must ensure that all staff receive individual documented supervision at least six times per year. Previous timescales of 28/02/06, 30/05/06 and 15/11/06 not fully met. The Manager must submit her application for registration to the Commission for Social Care Inspection as a matter of urgency. Previous timescale of 30/05/06 and 30/10/06 not met. The registered providers must ensure service users activity DS0000064195.V318325.R01.S.doc Timescale for action 22/01/07 2. OP36 18 (2) 28/02/07 3. OP31 9 22/01/07 4. OP7 15(1) 31/01/07 Newstead Nursing Home Version 5.2 Page 22 5. OP9 13(2) 6. OP12 16(2) (m) 7. OP18 12(a) 8. OP22 23(2)(l)( m) 9. OP22 23(2)(j)(n ) 10. OP38 17(2) 11. OP15 16(2)(i) plans are completed. The registered providers must ensure that medication is always signed as given at the time of administration so that gaps in signing do not occur. The registered providers must ensure that service users are able to participate in a range of social activities throughout the week. The registered providers must ensure that the homes’ own policies and procedures with respect to the protection of vulnerable adults are always available in the home. The registered persons must provide a designated area for storage of large items which does not restrict access to facilities within the home. The registered persons must undertake a review of the home’s bath and shower facilities to assess whether these are adequate to meet service users’ needs. An Occupational Therapist should be consulted for assistance in this review. The outcome of this assessment must be sent to the CSCI. This a repeat requirement, previous timescale of 30/11/06 not met The registered providers must ensure that an up to date gas safety certificate is available and that fire alarm tests are carried out and recorded weekly. The registered persons must review the current menu, in consultation with service users, and amend it according to their wishes and nutritional needs. In particular, fresh vegetables and a greater choice of cooked potato options must be included in the daily diet. DS0000064195.V318325.R01.S.doc 31/01/07 28/02/07 22/01/07 30/04/07 28/02/07 31/01/07 31/01/07 Newstead Nursing Home Version 5.2 Page 23 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 OP12 Good Practice Recommendations It is recommended that the training on appropriate activities undertaken by staff on activities for people with dementia be built on by a formal programme involving care staff and nursing staff in the provision of an activities programme when the activities co-ordinators are not available. This recommendation is restated. Newstead Nursing Home DS0000064195.V318325.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Newstead Nursing Home DS0000064195.V318325.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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