Inspection on 04/09/06 for Nightingale House

This inspection was carried out on 4th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Nightingale House 02/07/07

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

CARE HOMES FOR OLDER PEOPLE Nightingale House 57 Main Road Gidea Park Romford Essex RM2 5EH Lead Inspector Julie Legg Key Unannounced Inspection 4th September 2006 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 Nightingale House DS0000066621.V310681.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. Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingale House Address 57 Main Road Gidea Park Romford Essex RM2 5EH TBC TBC 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) Nightingale Residential Care Home Ltd Care Home 37 Category(ies) of Dementia - over 65 years of age (37) registration, with number of places Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 28th November 2005 Brief Description of the Service: Nightingale House is a registered care home for 37 people aged 65 and over. The home is situated in a residential area of Romford. It is on several bus routes and approximately ten minutes walk from a main line station. The home is a large two storey detached house with extensions, the house is set back from the main road and surrounded by well - maintained gardens. There are a total of 22 bedrooms, providing shared and single accommodation and two of the single rooms have an en-suite. All of the other bedrooms have a vanity unit and there are ample communal toilets on both floors. There are five bathrooms, three of which have medic baths, which are a special walk- in and sit down type of bath. There is also a shower room and a further domestic bath. Personal care is provided on a 24- hour basis, with health care needs being provided by health professionals such as GPs and community nurses. The Statement of Purpose and the Service User Guide are issued to every prospective resident and both of these documents are displayed in the entrance hall of the home. A copy of the most recent inspection report is also available. A resident or relative/representative could ask for his or her own copy, which the manager would make available. The fees for the home are £430-£500 a week. The manager made this information available on 13th September 2006. Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a day and lasted seven hours. The inspector spoke to seven residents about their experience of living at the home and to two relatives whilst visiting the home. Discussions took place with the registered provider, the acting manager and four care staff. Staff were spoken to about care practices and their employment at the home. They were also observed directly and indirectly providing care to residents. A tour of the home took place and a number of staff and resident’s records were examined What the service does well: What has improved since the last inspection? The registered provider has owned the home for less than six months and already there has been many improvements in the fabric of the building, a new central heating boiler, dishwasher, washing machine and alarm system have been installed. The front garden has been improved with the addition of new benches and some remedial decorating inside the home has taken place. Staff Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 6 have been provided with new uniforms and a keyworker system has been introduced. Two of the previous requirements have been met. The Statement of Purpose has been reviewed and now contains all the relevant information. The registered person now provides wheelchairs for use within the home. Staff commented that ‘the new owners are brilliant, we are working as a team’, ‘the owners are very supportive, they have given me more responsibility’. Residents stated that ‘they are very nice, nothing is too much trouble’. Relatives also spoke positively ‘the home has improved since the new owners have taken over’. 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. Nightingale House DS0000066621.V310681.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 Nightingale House DS0000066621.V310681.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Prospective residents and their relatives have detailed information on the hoe to enable them to make an informed choice about moving into the home. A detailed pre-admission assessment is undertaken of all prospective residents, this will ensure that their identified needs can be appropriately met by the home. Prospective residents and their relatives are able to visit the home prior to their admission and obtain a copy of the service user guide. EVIDENCE: The Statement of Purpose has been revised and further developed. It now clearly sets out the objectives and philosophy of the service and clearly states the number of single and double bedrooms. This was a previous requirement that is now met. The service user guide is informative and written in plain English, a copy of this documents is given to all residents. Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 9 The file of a fairly new resident was looked at. A pre-admission assessment by the home and an assessment from the local authority had been undertaken, there was also an occupational therapist report, as well as information from the family. During the first week of admission a further detailed assessment takes place that leads to a comprehensive care plan. (See standard 7). Residents and relatives are able to visit the prior to a resident moving in. residents that were spoken to had not been able to visit the home prior to them moving. All of the residents thought their relatives had made the right choice and stated that they ‘were happy and settled’. Relatives that were spoken to stated that they ‘had visited other homes, but this one had a nicer atmosphere’. The home does not provide intermediate care. Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Work on the care plans is still ongoing and this means that not all plans accurately reflect the current needs of the residents. Residents are treated with respect and the arrangements fro their personal care ensures that their right to privacy is upheld. EVIDENCE: Some of the new care plans were examined and compared with the daily log, communication book and the care being provided. These care plans are detailed and comprehensive, identifying the residents’ personal social and health needs and how these needs should be met. The new registered providers have revisited and amended the new care plans to include more comprehensive and person centred, such as ‘X likes to read the newspaper in the morning after breakfast’, ‘Y likes to sit by the door and open the door for visitors’ (his previous occupation was as a doorman). Therefore this piece of Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 11 work is still ongoing. This was a previous Requirement that has been set with a new timescale. This is Requirement 1. Further work is still being carried out in auditing the care recording system and the training of staff to make sure that important information is recorded in the most appropriate place, to ensure that the care plans are working documents. This was a previous Requirement that has been set with a new timescale. This is Requirement 2. Care plans are being reviewed through short- term observations, monthly reviews are being undertaken by the key worker; these were very informative and the manager then undertakes three monthly reviews. Residents’ health needs are clearly identified as part of their care plan and how these needs are to be met. Records indicate that health professionals such as, chiropodists, dentists, GPs, community nurses and hospital out patient appointments have seen residents. Other written evidence includes residents being weighed monthly. One resident confirmed that the chiropodist and the optician had recently seen them. Staff were seen to treat residents in a respectful and sensitive manner. Staff understood the need to respect resident’s dignity and were seen to knock on bedroom and bathroom doors before entering. Residents spoken to said that care staff were respectful when attending to their personal care needs. A relative stated that ‘they treat my Mum very respectfully, I wouldn’t have it any other way’. Risk assessments were examined. The risk assessments were detailed and covered areas such as use of a hoist and a wheelchair, nutritional needs and continence. Residents were possible and relatives have been consulted in formulating of these assessments. Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. 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 the service. There is an activities programme available, but more consideration needs to be given to planning activities which are suitable for all residents including those with specialists needs such as dementia. Visiting times are flexible and people are made to feel welcome, this ensures that residents are able to maintain contact with relatives and friends. Residents would have more choice and control over their lives if resident and relative’s meetings took place. The meals in the home are well presented and nutritionally balanced. They offer both choice and variety to residents. EVIDENCE: There is a general programme of activities and the new registered providers have gone some way to offer a more variety of activities, such as some of the residents are cooking on a Friday morning, which has proved to be very popular, pampering afternoons and armchair exercises, and local entertainers Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 13 also put on shows. However the registered providers need to ensure that on planning a future activities programme, the social needs of all the residents particularly those with dementia are met. This is Requirement 3. Visiting times within the home are flexible and visitors commented ‘staff make us feel welcome and offer us a cup of tea/coffee and biscuits’. Visitors were seen at various times during the inspection. Residents are able to receive visitors in one of the lounges or their own bedrooms. Relatives are encouraged to attend any of the social activities that are arranged within the home. The registered providers are aware that resident and relative’s meetings are not taking place; this was discussed during the inspection. These meetings need to be arranged in the near future, to enable the new providers to introduce themselves and discuss their vision of the future of the home and find out what the residents and relatives want provided. A residents’ survey would also assist the providers in establishing the level of satisfaction on the services provided and where residents’ choice/rights being observed. This is Requirement 4. Meals are served in the dining room and on the day of the inspection, meals were seen to be balanced in nutrition and of generous portions. There is a choice of meals and residents and relatives spoke highly of the food and one resident sated that ‘at times the meals were too big’. Some of the residents require assistance with feeding and staff were seen to carry out this task appropriately, talking to residents and not rushing them. The home has to cater for a range of diets including diabetic and soft diets as well as residents’ likes and dislikes. Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using that available evidence including a visit to the service. Residents and their relatives can be confident that their complaints will be listened to and acted upon. The home has a policy and procedure regarding allegations of abuse. The staff have undertaken training in adult protection/abuse awareness to ensure that there is an appropriate response to any allegations of abuse. EVIDENCE: The records of complaints and compliments were examined. There has been some improvement in the way complaints are now logged. Complaints clearly indicate details of the complainant, the nature of the complaint, the outcome and whether the complainant was satisfied with the outcome. Five residents were asked ‘if you were unhappy about anything in the home, who would you talk to’? Three of the residents said they would talk to a senior or the manager, the other two residents said they would speak to their family. The Commission has only received one Regulation 37 notice since April 2006. The inspector discussed these notices, which requires all registered providers to notify the Commission about significent events that may adversely affect the well-being or safety of any residents, including hospital admissions. This is Requirement 5. There is a written policy and procedure for dealing with allegations of abuse and whistle blowing. The home also has a copy of the local authority Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 15 (Havering) documentation on abuse. Training on adult protection/abuse awareness is an ongoing programme that is attended by all staff. The inspector spoke to staff who confirmed that they had attended training and were able to inform the inspector of action to be taken if there were any concerns about the welfare and safety of residents. Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21, 23,24 and26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is clean, pleasant and spacious with access to indoor and outdoor facilities, which adequately meet the needs of the residents. There are sufficient and suitable toilets and bathrooms for the number of residents. Residents’ bedrooms mostly suit their needs, however the registered provider must ensure that all of the furniture, flooring and décor are fit for the purpose. EVIDENCE: The registered provider has owned the home for less that six months, but he has already commenced an ongoing programme of renewal of the equipment, fabric and decoration of the premises. He has installed a new central heating boiler, dishwasher and washing machine, as well as a new alarm system. Work Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 17 has been carried out in the front garden, with more benches being provided and some remedial decoration within the home has taken place. New televisions have also been provided. A rolling maintenance programme is undertaken to ensure that the residents live in a safe and comfortable home. There are two comfortable communal lounges, which also double up, as dining areas both rooms wee very clean. There are sufficient toilets and bathrooms on each floor, three of the bathrooms have Medic baths, which are a special walk-in and sit down type bath. All of the facilities were very clean and free from any offensive odour. The bedrooms vary in size, shape and facilities. Two have en-suite toilets and the remaining rooms have a vanity unit, in the double rooms there are curtains around the vanity unit and the beds, which afford the residents some privacy. Most of the bedrooms are appropriately furnished and have photographs, pictures, radios and televisions that residents have bought from their own homes; one resident’s bedroom is a testament to West Ham Football Club. Some of the bedrooms are in need of a makeover; redecorating, new bedroom furniture and the replacing of vinyl cushion floor for carpet. This is Requirement 6. The home is cleaned on a daily basis and throughout the inspection all areas of the home were found to be very clean and tidy. Additional cleaning time has been made available one day a week to ensure that the standard of cleanliness is maintained. There are adequate control systems in place to ensure that there are no offensive odours. Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to the service. The home’s staffing levels are satisfactory and there are sufficient staff on duty. However the registered provider must ensure that all staff have the appropriate training to meet the needs of the residents. The home has a clear recruitment policy and procedure and appropriate checks are undertaken, which ensures the protection of residents. EVIDENCE: Staff rotas were examined and the rota correlated with the number of staff on duty. During the day there are four care staff on each shift, at least one of the care staff are a senior and two waking night staff, which is sufficient to meet the needs of the residents. Four staff were spoken to and they all stated that they now have more time to sit and talk to the residents. Three staff files that were examined showed that all the relevant recruitment procedures are being followed. All files had a completed application form, two written references and all had Criminal Records Bureau (CRB) checks. Staff files showed that staff have undertaken training in area such as first aid, medication awareness, dementia awareness, adult protection, moving and handling and mental health awareness. Though it was not possible to see whether care staff had updated all of their mandatory training and where Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 19 further training was required. The registered provider needs to carry out a training audit of all the care staff to ensure that mandatory training has been updated and that staff have the necessary skills to meet the needs of the residents. This is requirement 7. Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 36 and38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. During the absence of a registered manager, an acting manager is currently managing the home. She is an experienced person and has demonstrated that she is managing the home well. Residents, relatives and staff need to be consulted to ensure the home is run in the best interests of the residents. Residents and staffs’ health, safety and welfare are promoted and protected. The registered provider needs to ensure that residents are supported by staff who are appropriately supervised. EVIDENCE: Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 21 The registered manager resigned from her post in June 2006. the acting manager has substantial residential experience, she has a good understanding of the needs of the residents and the areas in which the home needs to develop. She was observed carrying out her job, in which she had discussions with staff and was seen talking to residents. Residents commented that she was very kind and nothing was too much trouble for her. The registered provider is also involved with the running of the home. Comments from staff indicated that they appreciated the improvements carried out and felt very supported by the acting manager and the registered provider. Monthly visits are carried out by the registered provider under the requirements of Regulation 26 of the Care Home Regulations, and reports of these visits are available to the Commission. The registered provider needs to carry out a quality assurance survey involving residents, relatives, staff and visiting professionals and from the results develop an annual development plan, which reflects the aims and outcomes for the residents. The registered provider is looking at developing the home, he must be mindful to engage with residents and relatives on a regular basis, to ensure that they are fully informed of developments within the home. From discussions with staff and the acting manager it was evident that there are opportunities for ad hoc supervision and staff meetings. However, there was no evidence that care staff are receiving regular formal supervision or yearly appraisals. This is Requirement 8. The home has carried out all health and safety checks. Fire drills and alarm testing are regularly undertaken. Water, freezer and fridge temperatures are also recorded regularly. Manual handling training for staff has been discussed earlier in this report. Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 2 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 2 X 3 Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 14 Requirement All residents must have a comprehensive care plan, which details their needs and how staff are to meet these on a day-today basis. Previous timescale 31/12/05 not met The care recording system of health and personal care must dovetail with the new care planning system. Previous timescale 31/12/05 not met The activities programme must meet the needs of all the residents, particularly those with dementia. The registered provider must ensure that relatives and residents views are obtained through regular meetings. The registered provider must ensure that the Commission are notified of all events that fall within the remit of regulation 37. All of the residents’ bedroom furniture, floor covering and decor are fit for the purpose. An audit of the care staff’s training needs to be undertaken. The registered person must DS0000066621.V310681.R01.S.doc Timescale for action 31/01/07 2 OP7 14 31/01/07 3 OP12 16 31/12/06 4 OP14 16 31/12/06 5 OP18 37 30/09/06 6 7 8 OP24 OP30 OP36 23 13 18 31/12/06 30/11/06 30/11/06 Page 24 Nightingale House Version 5.2 ensure that all staff are appropriately supervised at least six times a year. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Nightingale House DS0000066621.V310681.R01.S.doc Version 5.2 Page 26 - 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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