Inspection on 15/05/06 for Pexton Grange

This inspection was carried out on 15th May 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

Pexton Grange 02/04/07

Pexton Grange 30/10/06

Pexton Grange 20/09/05

Pexton Grange 21/04/05

Pexton Grange 02/02/05

Pexton Grange 30/04/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Gleneagles Nursing Home Pexton Road Sheffield South Yorkshire S4 7DA Lead Inspector Janice Griffin Key Unannounced Inspection 15th May 2006 06:50 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 Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Gleneagles Nursing Home Address Pexton Road Sheffield South Yorkshire S4 7DA 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) 0114 244 1223 0114 244 1224 www.shefieldcare.co.uk Gleneagles (Yorkshire) Limited Mrs Maureen Parr Care Home 56 Category(ies) of Old age, not falling within any other category registration, with number (38), Physical disability (18) of places Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th September 2005 Brief Description of the Service: Gleneagles is a purpose built home providing accommodation on three floors; all floors are serviced by a lift. The home is sited in a residential area in the North of Sheffield, close to local shops and a bus route to the city centre. Parking is located at the front of the building. The garden which has level access is attractive, well maintained and is situated to the rear of the building. The previous inspection report was made available to service users and their families, details of this was on the homes notice board. The weekly fees are: £429 to £475 this information was provided on the 15th May 2006. The home charges extra for chiropody, toiletries, clothing, telephone, holidays and hairdressing. Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place from 06:50 am to 14:30 pm. As part of the inspection process the inspector spoke to ten service users, four relatives, five staff and the manager. The inspector would like to thank service users, the relatives, the staff and the manager for their openness and for their commitment to the inspection process. The inspector was pleased to note that all ten-service users spoke positively of the ongoing support provided by the staff. Observations confirmed that service users were extremely comfortable and at ease in the company of the manager and staff whom they said were approachable, supportive and sensitive to their needs and feelings. The relatives described the service as in the main excellent. A number of records were examined which included, the managers preinspection questionnaire, medication records, three service users care plans, and three weeks menus and three weeks staff rotas. Records relating to staff recruitment, service users finances, staff training and the homes quality assurance systems were also checked. Several areas of the building were also inspected. Since the last inspection one complaint has been made to the Commission For Social Care Inspection, the complaint was about the attitude of a staff member and issues relating the care provided. Feedback on the inspection was given to the manager. What the service does well: The environment is homely, friendly and welcoming. All ten-service users said they liked living at the home where they were well cared for by staff. They described the staff as being “very good” and very hard working. Service users were able to visit the home for trial periods. Service users were only admitted once it had been determined that the home could meet their needs and all service users spoken to were happy with the arrangements. All service users attended a wide variety of social and leisure activities and these were based very much on the personal preferences of each individual. The staff cater well for service users with disabilities needs. Feedback was being sought on a regular basis from service users and their families. Staff interacted well with each service user and it was obvious from discussions with service users and relatives that staff had developed positive and respectful relationships with them. Relatives described the service as “excellent”. Records were in the main well ordered and up to date and the manager was keen to ensure that any issues found were addressed. The manager and staff Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 Page 6 had completed a range of training courses and were committed to developing this further, this includes the providers aim to ensure that 50 of staff are trained to NVQ level 2 and the manager to NVQ level 4, in the near future. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 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 Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 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): 2,3 and 6. Quality in this outcome area is: adequate. This judgement has been made using available written evidence, discussion with ten service users, four relatives, and a visit to the home. Some service users have moved into the home without having his or her needs assessed this does not ensures that care needs can be met. Service users were able to have informal introductory visits to the home at the time of their admission. Service users confirmed that this helped them to get to know everyone at the home, which made them feel less anxious. Intermediate care is provided in a dedicated area of the building. EVIDENCE: Detailed full needs assessments had not been completed by the referring social worker for all service users admitted to the home. Families had been involved in the assessment process as appropriate. Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 Page 9 Service users spoken to said at the time of their admission they were able to have informal introductory visits to the home and they had been provided with a contract containing the relevant information. Records checked and discussion with four relatives confirmed that service users families had been involved in decisions regarding the arrangements. An up to date contract/statement of terms and conditions had been provided to service users and signed copies were retained on individual files. These clearly detailed the fees, including any extra charges, and the services and facilities provided by the home. Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 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): 7,8,9 and 10. Quality in this outcome area is: adequate. This judgement has been made using available written evidence, discussion with ten service users, four relatives, and a visit to the home. Service users were encouraged and supported by staff to make decisions and they were provided with formal and informal opportunities to participate in the day-to-day running of the home. This protects the rights and well being of service users. Information in care plans was not adequate, as it did not allow the staff to have full knowledge of the service users needs. There was little evidence in the care plans to show that the service users and their families are involved with the care planning production or the review. This does not allow the service users to have a say in how their care needs will be met. The procedures in place to ensure the safe management of medication need to be improved. The current practices do not protect the service users from harm. Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 Page 11 EVIDENCE: All the service users spoken to said that the staff promoted their privacy and dignity. Staff were observed knocking on bedroom doors and waited to be invited in before entering. Three service users plans of care were checked. Each set out some individual service users needs and the action required and taken by staff to ensure those needs were met. Discussion with ten service users and the staff identified that a range of health professionals visited the home to assist in maintaining health care needs. Service users weight was being checked on a regular basis. Ranges of aids to assist service users with mobility problems were provided; these included lifting hoists, assisted baths, walking frames and wheelchairs. Care plans detailed the gender of staff that they wished to support them with their personal care but one did not have any details of the service users religious or cultural needs. Service users and relatives had not been involved with production of the care plans or the reviews. Service users who were able could retain control of their own medication, a lockable facility was provided to store such items. Systems were in place to ensure the safe administration and recording of medication, however it was noted that one MAR sheet had not been signed on one occasion to show whether medication had been given or not. Records were kept of medication received, and disposed of. A pharmacist had checked the home’s medication systems in February 2006; no issues of concern were noted at that visit. Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 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: good. This judgement has been made using available written evidence, discussions with ten service users, four relatives, five staff and a visit to the home. Service users had access to a range of leisure activities based on their individual choices and preferences. Service users confirmed that the routines of daily living were flexible and suited their individual preferences. Service users were supported with maintaining and developing contact with their family and friends, and they also said that visitors were always welcome at the home. Which creates a home that people want to visit. A good choice of food was not offered to service users at teatime and two service users from an ethnic background said they were not being offered special diets on a regular basis. This does not promote the rights of service users. Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 Page 13 EVIDENCE: All service users spoken to confirmed that staff were extremely supportive and always encouraged them to become integrated into the local community, when they felt able to do this and with the appropriate staff support provided. Service users also confirmed that staff supported them with discovering how to enjoy social situations and activities. Service users said they could choose how they wished to spend their leisure time and generally this was based on the personal preferences of each individual. Service users, relatives and staff confirmed that the activities co-ordinator ensured that service users were regularly supported with their leisure and social needs. Service users confirmed that they had regular contact with representatives from the local churches and that they were able to visit them at the home if they wished. The inspector observed breakfast and lunch, the meals served looked appetising and plenty of choice of food was available. Two service users said they were not happy with the teatime meal, as it always seemed to be cheese or ham sandwiches. Two service users from an ethnic background said they would appreciate a choice of Afro-Caribbean food being offered. One member of the staff said when special diets were offered they were only offered for a short period then it went back to a traditional English diet being offered. Two service users were being offered a Muslim diet. Special cutlery and crockery was provided for those service users who had difficulty using knives and forks. Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 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 after discussion with ten service users, four relatives, four staff members and using available written evidence including a visit to the home. The homes complaints procedure was clear, accessible and contained the necessary information. Service users were protected from abuse by the awareness of staff through training and the homes procedures. EVIDENCE: The complaints procedure was available for service users, their relatives and staff. The manager confirmed that this would be available in alternative formats and languages should this be requested. All service users and relatives spoken to said that they knew that they could complain if they were not happy about anything and that they felt able to discuss any issues or concerns that they may have with the manager and staff. They also said that staff were always available and that they were encouraged to talk about anything that troubled them or caused them anxiety. Since the last inspection one complaint has been made to the CSCI about the attitude of a staff member and issues relating the care provided. This complaint had been investigated by the provider but was not upheld. Staff had received formal adult protection training. The manager was aware of the Sheffield City Councils adult abuse procedures. No allegations of abuse have been made at this home since the last inspection. Staff had been made aware of the action to take in dealing with third party information. Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 Page 15 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 and 26. Quality in this outcome area is: adequate. This judgement has been made after discussion with ten service users, four relatives and using available evidence including a visit to the home. On the day of the inspection the home was clean but some areas had damaged/stained decoration and carpets. This made the home look shabby in parts. One bathroom was being used to store equipment in; this could impose on the staff and service users safety. The bedroom doors were fitted with locks. This promotes the privacy of service users. Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 Page 16 EVIDENCE: Service users said they could choose where they wished to spend their time and that they had enough room to do the things they wanted. Service users said that the home was always clean; this they said made them feel safe because the home was well looked after by the staff group. Some areas had damaged decoration and stained carpets. The bedroom doors were fitted with suitable door locks and lockable facilities were provided in all the bedrooms. Some service users had been provided with a key to their room door, those who had not been provided with a key had been deemed incapable of using a key. Service users could smoke in a designated smoking area. The appropriate seating had been provided in the garden for those service users wishing to sit outdoors whenever the weather permitted. Each floor had a number of toilets and bathrooms, assisted baths and showers were provided for those service users with mobility problems. Toilets were easily accessible as they were close to lounge and dining areas. All the toilets had been adapted for service users with physical disabilities and a good supply of equipment was also available for those service users. Staff confirmed that they were provided with protective clothing if they needed it and that all the equipment was in good working order and that it had been serviced as required. Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 Page 17 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 Quality in this outcome area is: good. This judgement has been made after discussion with ten service users, four relatives, five staff and using available evidence including a visit to the home. Care staff had a range of skills and experience, which effectively supported the service users. This will ultimately benefit the health and welfare of the service users. The homes recruitment procedures were not adequate, as they do not protect the service users from harm. The home had a training and development plan and all staff had completed a range of training relevant to their role, but further training is required. Staff said that they had not had any training on caring for people with physical disabilities. This does not allow the staff to ensure they meet the individual assessed needs of service users. Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 Page 18 EVIDENCE: The service users and relatives said that there was always enough staff on duty. They added that staff worked very hard and described them as “very caring, kind and understanding” they added that staff treated them like human beings they were not intrusive and that you could have a joke with them. Staff were approachable and sensitive to the needs of service users and were able to communicate effectively with each person. Three staff files were checked; the files demonstrated that a thorough recruitment processes had not been followed as required by the Care Homes Regulations. Criminal Record checks had been done and two references obtained but gaps were noted in one staff’s employment history. Staff spoken to had an understanding of the home’s fire procedures; they had received training on moving and handling, fire, food safety and infection control. Staff files checked and discussions with four staff and the manager confirmed that all staff had completed detailed induction training. Staff had completed training on NVQ in care and this had ensured that more than 33 of the staff team were qualified to level 2. . Staff said that they had not had any training on caring for people with physical disabilities. Staff were being formally supervised at the frequency required to fully ensure individual staff development and the monitoring of care practices Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 Page 19 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): 31,33,35 and 38. Quality in these outcome areas is: good. This judgement has been made after discussion with the manager, five staff and using available written evidence including a visit to the home. Ten service users and five staff spoken to said the manager were approachable and very professional. The manager is currently undertaking NVQ level 4. This should enhance her management abilities. Service user surveys are completed six monthly, which ensures that the home is run in the best interest of service users. Records were in the main up to date and well ordered to ensure the best interests of service users. The manager reports most notifiable incidents, however one notifiable incident had not been reported to the CSCI. This is a breach of Regulation 37. The homes policies and procedures met the required standards. A safe environment was provided in all parts of the home. This protects the health and welfare of the service users. Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 Page 20 EVIDENCE: The manager had a job description that clearly defined her roles and responsibilities and staff were aware of her role. She said she was committed to ensuring that the home provides a high standards of care, she has started to complete regular internal audits on all aspects of the service provided by the home. She is currently undertaking her NVQ level 4 training. Staff spoken to had an understanding of the home’s fire procedures; they had received training on moving and handling, fire, food safety and infection control. There was a quality assurance system, which sought the views of service users. The responsible individual visit the home on a regular basis a report is written following the visits. A copy of the responsible individuals monthly report is always sent to the local office of the CSCI. The inspector noted that one service user had an accident, which resulted in him/her being sent to A/E for treatment, the CSCI had not been notified of the incident. No fire exits were blocked and hazardous substances were securely stored. The manager handles money on behalf of some service users, account sheets were kept, receipts were available for all transactions and all transactions were witnessed by a second individual. The accounts were audited this year. Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 Page 22 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. 2. 3. 4. Standard OP3 OP7 OP8 OP9 Regulation 14 15 15 13 Requirement Service users must only be admitted to the home on the basis of a full needs assessment. The service and their relatives must be involved with the care planning and reviewing process. The care plans must include details of the service users religious and cultural needs. Medication administration sheets must always be signed to show whether medication has been given or not. This has been outstanding since 20/09/2005. Timescale for action 01/06/06 01/06/06 01/06/06 15/05/06 5. OP15 16 6. OP19 OP26 16,23 Special cultural diets must be 22/05/06 provided at all times for all service users from an ethnic background. The meal at teatime must be reviewed after consultation with service users about their likes and dislikes. Areas around the home with 01/09/06 stained/damaged decoration must be redecorated. The stained carpets must be cleaned or replaced. This has been outstanding since 12/05/2004. Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 Page 23 7. OP22 16 Suitable provision must be made for the storage of aids and equipment. This has been outstanding since 12/05/2004. 01/10/06 8. 9. 10. OP28 OP29 OP30 18 19 18 At least 50 of the staff must be 01/12/06 trained to NVQ level 2. Gaps in staff’s employment 01/06/06 history must be explored. Staff must be provided with 01/09/06 training on caring for younger people with physical disabilities. This has been outstanding since 20/09/052005. The manager must be trained to NVQ level 4. The manager must notify the CSCI of all incidents notifiable under section 37 of the Regulations. 01/12/06 15/05/06 11. 12. OP31 OP33 9 37 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 Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Gleneagles Nursing Home DS0000021780.V291861.R01.S.doc Version 5.1 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. 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!