Inspection on 07/06/05 for Old Vicarage Nursing Home

This inspection was carried out on 7th June 2005.

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

Old Vicarage Nursing Home 06/02/08

Old Vicarage Nursing Home 20/06/06

Old Vicarage Nursing Home 02/09/05

Old Vicarage Nursing Home 09/12/04

Old Vicarage Nursing Home 11/08/04

Old Vicarage Nursing Home 12/11/03

Old Vicarage Nursing Home 18/06/03

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

CARE HOMES FOR OLDER PEOPLE Old Vicarage Nursing Home Norwich Road Ludham Norfolk NR29 5QA Lead Inspector Ann Catterick Announced 07 June 2005 09:30 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 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. Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Old Vicarage Nursing Home Address Norwich Road Ludham Norfolk NR29 5QA 01692 678346 01692 678565 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Hewitt-Hill Limited Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. That appropriate care and accommodation is provided for three service users who are under 65 years of age. No further service users under the age of 65 should be admitted withuot agreement with NCSC. 2. Twenty-nine (29) Older People may be accommodated. Date of last inspection 09 December 2004 Brief Description of the Service: The Old Vicarage is a care home with nursing for older people, and is situated in the village of Ludham. Hewitt-Hill Limited owns the home. The majority of service users require nursing as well as personal care and the staffing ratios reflect this level of care, with a nurse on duty at all times. The 29 bedrooms are situated over two floors with access via a shaft lift. Some of the ground floor bedrooms open direct to the gardens. The communal areas consist of two lounges and one conservatory that doubles as a dining area. The grounds consist of surrounding lawns, shrubs, large trees and flowerbeds, with a small patio area and pond, all of which can be accessed by service users. There is ample car parking at the front of the premises. Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced and took place on the 7th of June and was over a period of 7hrs. The home has recently been bought by the Hewitt-Hill Limited Company, which is a company owned by Mr Ashley George. The home does not have a manager at the present time but the deputy, Irene Burchell, is Acting Manager in the interim period and seems to be managing the task well. On the day of inspection the inspector was able to meet with Ashley George, Irene Burchell, several service users, staff and relatives as well as tour the building and have a look at documents, care plans and files. All of those service users spoken to were satisfied with the care that they were receiving and spoke very positively about the staff saying they were caring and kind. The atmosphere in the home was very positive on the day of inspection and service users appeared to be happy and relaxed in their environment. What the service does well: All of those service users spoken to said that the staff were well trained, kind and good at their jobs. Comments made included, “staff very nice.” “Very pleasant,” “excellent,” “well trained,” “very helpful.” A relative said that she was “more than satisfied with the care.” Staff are offered the appropriate training to ensure that they have the knowledge and skills to care for service users in the correct way. Many of the staff that work in the home have worked there for a long time and the staff seemed to work well together. The staff have a good understanding of the needs of the service users and are able to meet their needs. They did acknowledge that some service users needs were significantly greater than others. The kitchen was clean and well managed and the home uses lots of fresh ingredients. Meat, vegetables and eggs are all bought locally and the kitchen staff offer good quality home cooking. All service users said that the food was good and plentiful. The inspector sat with some service users at lunchtime and people were able to eat their lunch in a relaxed unrushed way Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The new provider is aware that there are lots of opportunities to improve the environment in which the service users live. At the moment there is not enough lounges and dining areas to enable people to have a choice of where they sit and where they have their lunch. The new provider is going to look at this with a view to increasing the number of comfortable seating areas for service users. He is planning to provide an area with dining tables that service users can use all year round and is not dependent on the weather as is the case at present in the conservatory area. The baths in the home are all against the wall and this means that not all service users can have a bath if they choose to do so. The new provider is to consider a new bath in the centre of one of the bathrooms or the creation of a walk in shower that would be easy and safe to use. Some areas of the home would look much nicer if they were decorated and had different lighting. This is something that the provider is planning to look at. The inspector has asked for the provider to put all of his plans for improving the environment in writing so anybody who is interested can look at what plans he has for the future. This will also allow the inspector to make sure he is doing what he said he would. Some social activities take place in the home but there is the opportunity for much more to happen in this area. Some of these activities could be group activities and others could be on a one to one, such as a manicure or a member of staff reading the newspaper with a service user. Of course this would all be led by the service users and if someone preferred not to get involved in any activities that would be absolutely fine as well. It would be helpful for the home to include service users life experiences and what they enjoy doing on the plans of their care to assist staff when providing these services. The appointment of an activities person may be a way forward for the home. Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 Page 7 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. Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 4 and 6. The statement of terms and conditions and the service user guide provide prospective service users and their families with the information needed to enable them to make an informed choice about whether or not the home would meet their needs. All service users are issued with a statement of the terms and conditions that includes information about the accommodation and services that are provided to them within the home. The home is aware of its responsibility to provide needs for service users as stated within the statement of purpose and service users guide and adheres to these responsibilities thus ensuring service users know that their needs will be met. Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 Page 10 EVIDENCE: A copy of the service users guide is given to all service users and offered to prospective service users. This was seen and gives all information needed to enable service users and their families to be able to make an informed choice as to whether or not they would like to live a the Old Vicarage. Those service users that were asked confirmed that they had received a copy of the service users guide. A sample of the statements of terms and condition was seen. This is at present in two parts and includes most of the information required of this standard. It has been recommended that the manager review the statement of terms and condition to ensure that it provides all the information needed to meet the outcome of this standard. The home’s statement of terms and conditions identifies clearly the services provided within the home and staff are trained to meet these needs. The home does not provided intermediate care. Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8,and10. Those care plans seen identified the service user’s health and personal needs but did not, in all cases, include the social needs of service users. The information in the care plans gave staff enough information about individual needs to ensure that health care needs could be met. Service users felt that the staff within the home treated them with respect and promoted their dignity and respected their rights to privacy. EVIDENCE: Several care plans was seen and these included most of the information needed to enable staff to provide for all care needs. There was a lot of information relating to the health and personal needs of service users but it was felt that generally the information about social preferences and social histories was rather limited. Many of the service users have very specific health care needs and these appeared to be being met. Those visitors spoken to felt that the health needs of their loved ones were fully provided for. Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 Page 12 Staff were seen to engage with service users in a way that promoted their independence and respected their dignity. Several service users were spoken to about the way care was offered to them and all spoke very favourably about staff saying that staff cared for them in a way that was sensitive and caring and promoted their independence and respected their dignity. Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15. Overall it was felt that the lifestyle experiences within the home matched most service users lifestyle preferences. Service users were supported and enabled to maintain contact with friends and family by always making visitors welcomed within the home. The food served within the home is of good quality and well prepared. The choice, as to where, service users can eat their meals is limited by the environment and lack of communal space. . EVIDENCE: Most of the service users spoken to were very satisfied with the lifestyle experiences that they had within the nursing home. There was some acknowledgement that there was only limited opportunity for social activities and it is felt that this area of care needs to be further developed. Time could be spent in small group or individual activities. Several service users are cared for in bed and there may be opportunity to spend more social time with these service users. A recommendation is that the proprietor consider the appointment of an activities person to be specifically responsible for this area. Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 Page 14 Service users said that the local church has regular involvement in the home and this service is used by some of the service users. Other faith groups would always be accommodated. Three visitors were spoken to; they all visited on a very regular basis, and all felt that the home was welcoming encouraging them to feel at home. The manager said that she informs relatives that the nursing home should feel like an extension of their home and they should treat it as such. The head cook had recently resigned and the assistant cook was taking the lead role in the kitchen on the day of inspection. The kitchen was clean and well managed and there was evidence of home cooking and fresh ingredients, such as, vegetables, meat and local farm eggs. Although there was an alternative at meal times if the service users did not like the meal offered, it appeared that service users had to ask for an alternative, as it was not part of the menu. It is recommended that two choices be written on the daily menu sheets. On the day of inspection there were several choices for desert and these were offered to service users so that they could choose whatever they preferred. All food seen looked appetising and was presented well. All service users spoke positively about the food saying it was of good quality with lots of variety. The homes only designated dining area is in a large glass conservatory that is often too hot in summer and too cold in winter. The consequence of this is that service users have their meals in their bedrooms or at lap tables in the lounge. This is an area that the new proprietor plans to address. Those service users that were eating their lunch at small individual tables in the lounge said that they were happy to have their meals in this way, however the option to sit at a dining table should be available. Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 Page 15 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 standard(s) 16 The home has a clear complaints procedure that is included in the service users guide and evidence showed that when a complaint is made these procedures are followed. EVIDENCE: One complaint had been made since the last inspection and evidence was seen of how the complaint policy was followed. The correct procedures had been followed and the complainant was satisfied with the response. Those service users spoken to said that if they had a complaint they would go to the manager. Details of the CSCI were included in the service users guide. Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 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 standard(s) 19, 20, 21, 23, 24, 25 and 26. A new company has recently purchased the home and the new provider has not had the opportunity to address the environmental requirements that were made, prior to his purchasing the property. It has been agreed that the provider will provide the CSCI with a comprehensive maintenance plan to identify areas of improvement and refurbishment for the home. At the present time the outcomes for standards 19, 20, 21, 24 and 25 are not fully met. On the day of inspection the home was clean and tidy and free from any offensive odours. EVIDENCE: The previous provider did not meet the requirements from the last inspection. The new provider is aware that he needs to meet these requirements. Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 Page 17 No written maintenance plan is in place and the new provider is to create this and send a copy to the inspector. The home does not provide adequate communal space offering only 2.7 sq metres per person when the minimum required is 4.1 sq metres per person. This does not include the conservatory as the availability of this as communal space is dependent of the weather as this has a significant influence of the temperature, with the room often being too hot or too cold. On the day of inspection one of the lounge areas was being used as a hairdressers and this left only one lounge and the conservatory for people to use as communal space. The grounds offer large areas of lawn and patio area that offer further space in the summer months. A service user and their visitor were seen to be using a small summerhouse in the grounds. The home has four bathrooms although on the day of inspection one was being used as a storeroom. All of the baths are situated against the wall and offer a limited facility. At least one service user felt that they would like a bath but were not able to use the facilities. When looking at care plans several service users were offered a bed bath. It is recommended that at least one of the bathrooms offer an adapted facility that would enable more service users to have the choice of a bath. Another alternative would be the installation of a walk in showering facility. Most rooms are en suite and the home has adequate communal toilet facilities. The bedrooms vary in shape and size giving an individual appearance although some look to be rather small. It was noted that not all bedrooms had all of the facilities required in standard 24. It was noted that for two people to sit in a bedroom were the occupant spent most of their time in bed the second person had to sit on a wheelchair. No bedrooms are lockable and service user need to ask if they wish to have a lock on the door. It would be more empowering if all doors had a lockable facility and service users could then choose whether or not to use the facility. The home has a pre set valve at the water source that should ensure that water temperatures are as required, however this did not appear to be working correctly on the day of inspection as water from some bath outlets was above 50 degrees. The provider said that he would look into this and have the appliance serviced. Radiator covers are in place but these are of poor quality and would benefit from being replaced. Some of the corridor areas had poor lighting that did not add to the atheistic fell of the home. Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 28. The staffing notice was not available for inspection, however, there appeared to be enough staff on duty to meet the minimum requirements in this area and those service users spoken to felt that their needs were being met. This area will be looked at in more detail at the next inspection. Nursing staff and care workers have the appropriate training and skills to ensure that service users are in safe hands at all times. EVIDENCE: The rota was inspected and appears to have sufficient nurses and care staff on duty at any one time to meet need. Neither, the acting manager, or the new proprietor, could find the nursing notice provided by health and this will be looked at in some detail at the next inspection. However, some service users made comment that some service users are very dependent and take a considerable time for staff to care for and felt that their own needs, on occasion, had to be compromised because of this. It was felt that an activity person would be of great benefit to the home to encourage activities or interests. The home has a relatively stable staff group who know the service users very well. All of the service users spoken to spoke very favourably about staff saying that they were competent and well trained, doing there job very well. Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 Page 19 Twenty seven per cent of care staff have NVQ level 2 or above and further members of staff are hoping to complete NVQ in the near future. When speaking to a fairly new member of staff they said that they received induction training and support when they first started in post and continued to get good support as they were progressing within their role. Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36 and 37. The registered manager has recently left the home and the deputy manager is acting as manager at the present time. She has significant experience in the role of deputy and appears to managing the role of manager well. The acting manager offers both formal and informal supervision. Policies and procedures are in place but would benefit from being reviewed and in some cases revised. EVIDENCE: The acting manager has worked in the home for some time and has a clear understanding of the role of manager. She appeared to be enjoying her role and is considering applying for the position on a permanent basis. If this were the case she would need to complete the management components of the Registered Manager’s Award and make application to become registered manager. Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 Page 21 Evidence of formal supervision was seen but the format was rather clinical and there was opportunity for improvement. There was nothing recorded with relation to training or staff development and the format may need to be revised. A sample of the policies was looked at and it was clear that some policies had not been reviewed for some. The new proprietor is aware of this and plans to do some work in this area in the near future. Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 x 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 2 1 2 x x 2 2 3 STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 2 x x x x 2 2 x Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 19 Regulation 23.2 (b)(c) Requirement Timescale for action 01/08/05 2. 20 3. 21 The registered provider must ensure that service users live in a safe, well maintained environment and that a programme of routine maintenance and renewal of fabric and decoration is implemented with records of this kept. 23..2(g)(h The registered provider must )(i) ensure that the home provides adequate communal space for service users. 23(j) The registerd provider must ensure that all service users have access to a bathing facility that meets their needs. 01/12/05 01/12/05 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. 2. Refer to Standard 12 24 Good Practice Recommendations That the registered provider give consideration to the appointment of an activities person to offer social and recreational activities within the home. That all rooms arel lockable to give service users the I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 Page 24 Old Vicarage Nursing Home 3. 4. 5. 25 24 25 choice as to whether or not they wish to lock their bedroom doors. That the lighting in coridors be changed to offer more suitable lighting with a more pleasing astheisic feel. That all bedrooms have appropritate seating for visitors. That those radiator covers that are of poor quality be replaced. Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection 3rd Floor - Cavell House St Crispins Road Norwich NR3 1YF 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 Old Vicarage Nursing Home I55 s15669 Old Vicarage v222578 070605 Stage 4.doc Version 1.30 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!