Inspection on 26/04/06 for Portland Nursing Home

This inspection was carried out on 26th April 2006.

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

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

Other inspections for this house

Portland Nursing Home 18/08/09

Portland Nursing Home 17/09/08

Portland Nursing Home 02/10/07

Portland Nursing Home 24/04/07

Portland Nursing Home 31/01/06

Portland Nursing Home 01/03/05

Portland Nursing Home 13/12/04

Portland Nursing Home 09/09/02

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Portland Nursing Home 8 Park Road Buxton Derbyshire SK17 6SG Lead Inspector Rose Veale Unannounced Inspection 26th April 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 Portland Nursing Home DS0000002071.V289804.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. Portland Nursing Home DS0000002071.V289804.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Portland Nursing Home Address 8 Park Road Buxton Derbyshire SK17 6SG 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) 01298 23040 01298 23040 Mr Joginder Singh Rai Mrs Mary B Rushe Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Portland Nursing Home DS0000002071.V289804.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. One place for a person aged 63 years and over with Nursing and Personal care needs. Application Variation number 56973/2071 31st January 2006 Date of last inspection Brief Description of the Service: Portland Nursing Home is situated near to the centre of Buxton where a wide range of amenities are available. This Victorian building has been extended to accommodate 40 beds on three floors, which are accessed via a lift or staircases. The home is registered to provide personal care with nursing for up to 40 older people, though only 29 beds are currently in use. There is a large number of shared rooms. None of the bedrooms have en-suite facilities. Three lounges, including dining facilities, are provided on the ground floor. A patio area is provided to the rear of the building, which can be accessed by residents from the larger lounge room. Fees at the home range from £470 - £490 per week, (this information was provided on 26/04/2006). Portland Nursing Home DS0000002071.V289804.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over 6 hours. There were 25 residents accommodated on the day of the inspection, 24 assessed as requiring nursing care. Residents, staff and visitors were spoken with and a tour of the building was carried out. Records were examined, including residents care records, staff records, maintenance and health and safety records. Some residents were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. The acting manager was available and very helpful throughout the inspection. The home had appointed an acting manager as the previous manager, Mary Rushe, had left. The previous inspection took place on 31/01/06 and some of the timescales of requirements made then had not expired at this inspection. Where necessary, these requirements have been repeated in this report. What the service does well: What has improved since the last inspection? Progress had been made with improving care plans and there was evidence that care plans had been reviewed monthly. Further improvements had been made to the environment, including the refurbishment of one bathroom, redecoration of some bedrooms, and provision of some new furniture. Work had been carried out to improve the staff records and the records seen were well organised and included all the required information. The staff training programme had been further developed and staff had attended training in the protection of vulnerable adults. Portland Nursing Home DS0000002071.V289804.R01.S.doc Version 5.1 Page 6 The acting manager had applied for registration with CSCI. 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. Portland Nursing Home DS0000002071.V289804.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 Portland Nursing Home DS0000002071.V289804.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 good. This judgement has been made using available evidence including a visit to the service. There was full assessment of residents’ needs to ensure that their needs could be met by the home. EVIDENCE: The care records of three residents were examined. Each included a contract / statement of terms and conditions of residence in the home. One of these was signed by the resident’s representative, the others were unsigned. None of the contracts included the room number to be occupied by the resident, or a specific breakdown of the fees to identify the nursing care element. This was a requirement from previous inspections and has been carried forward in this report. The home had produced a Service User’s Guide. This was not easily available to residents / their representatives as it was kept in the office. It did not include all the information required. Portland Nursing Home DS0000002071.V289804.R01.S.doc Version 5.1 Page 9 All the care records seen included detailed assessment information, including the home’s own assessment of the resident’s needs and the assessment from the hospital and / or care manager. A resident and visitor spoken with confirmed that assessment of the resident’s needs had taken place by the home prior to admission. Standard 6 does not apply to this home. Portland Nursing Home DS0000002071.V289804.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 good. This judgement has been made using available evidence including a visit to the service. Improvements had been made to care plans and residents’ personal and healthcare needs were generally well met. Further development of care plans was needed to ensure residents’ needs were fully met. EVIDENCE: The care records of three residents were examined and each included a care plan. Work had been carried out by the acting manager and deputy manager to improve care plans. The documentation now included review forms which showed that care plans were reviewed monthly. The care plans mostly included the assessed needs of residents. One plan did not include the specific nutritional needs of the resident. The care plans did not include sufficient detail of the action required by staff to meet the needs of residents. For example, one plan noted that the resident could become agitated but did not detail the action required by staff when this happened. The relative of a resident confirmed that they had been involved in care planning and reviews of care. Residents and a relative spoken with said their needs were met by the home. It was apparent from observation of care practices and discussion with Portland Nursing Home DS0000002071.V289804.R01.S.doc Version 5.1 Page 11 staff that the needs of residents were generally understood and met. There were several residents who had dementia and were unable to communicate effectively to express an opinion. The care records of a resident with dementia were examined and their care requirements were discussed with the manager and staff. It was clear that the resident’s primary care needs were for personal and nursing care, rather than related to the dementia, and so the resident was appropriately placed in the home. Staff in the home would benefit from dementia awareness training and the acting manager said that this was planned for later this year. Residents and visitor spoken with said the staff were aware of maintaining privacy and dignity for residents. For example, comments included that staff were “kind” and “nothing is too much trouble”, staff approach and communication with residents was said to be good. It was observed that staff knocked on doors before entering and consulted with residents before assisting them with mobility. The medication system and records were examined and were generally in good order. Improvements had been made since the last inspection and the requirement made regarding the medication system had been met. Portland Nursing Home DS0000002071.V289804.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 evidence including a visit to the service. Generally, residents were offered a suitable range of activities to meet their social needs. Some residents did not have access to an appropriate choice of activities. The meals provided were of a good standard and met the expectations and needs of residents. EVIDENCE: The care records included information about residents preferences regarding their daily routines and social activities. One resident spoken with said they could get up and go to bed when they chose, “more or less”, and another resident was pleased that staff respected their choice to remain in their room for much of the time. Records were kept of activities offered to residents. The home had recently started to include details of the residents’ family and social history in the care records. Residents, visitors and staff spoken with said the activities offered to residents had improved recently. Two residents spoken with particularly enjoyed the regular bingo sessions at the home. A small group of residents was observed playing a game of skittles with a member of staff and appeared to be enjoying this. Activities were organised by the acting Portland Nursing Home DS0000002071.V289804.R01.S.doc Version 5.1 Page 13 manager and care staff. No additional hours were provided for an activities coordinator. The choice of activities offered to residents who were more dependent because of dementia appeared limited. Staff spoken with were enthusiastic about providing activities for residents and had ideas and plans for future events and activities. A visitor spoken with said they were always made welcome by staff and that they were able to see the resident in private if they wished. Relatives and representatives of residents were invited to attend meetings at the home to air any views or concerns. A telephone had been provided for use by residents. Residents and visitors spoken with said the meals provided were good and that there was a choice if they did not like what was offered on the menu. Residents said that breakfast was mostly taken in their rooms and that lunch was eaten at small tables in the lounges. The acting manager said that there were plans to change the large lounge / dining room to make it more appealing for residents to enjoy meals in there. Portland Nursing Home DS0000002071.V289804.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 using available evidence including a visit to the service. The systems in place in the home, and staff attitudes and awareness, ensured that residents are protected. EVIDENCE: The complaints procedure was included in the Service User Guide for the home. There was a complaints book for minor complaints which had not been used. From discussion with staff and the acting manager, it was clear that minor complaints were brought to staff by residents and relatives, sometimes through the relatives meetings held in the home. Notes were seen of these meetings with the action to be taken. Residents and visitors spoken to were aware that they could complain and said they were happy to bring any concerns to the acting manager or the staff. Nearly all the care staff at the home had attended protection of vulnerable adults training. Staff spoken with said this training was interesting and useful. They were aware of the procedures to follow if they had any concerns. The acting manager and deputy manager had secured places on the Derbyshire County Council training course for September 2006. Portland Nursing Home DS0000002071.V289804.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 using available evidence including a visit to the service. The planned ongoing programme of maintenance and refurbishing, when completed, will ensure a safe and pleasant environment for residents. EVIDENCE: There was an ongoing programme of general upgrading and refurbishment which had resulted in improvements to the environment. Five bedrooms had been redecorated and new wardrobes and drawers provided. One bathroom had been completely refurbished and looked bright and clean. The work identified in the recent fire officer report had been carried out. It was discussed with the acting manager that residents should be offered the choice of a suitable lock to their bedroom door, following risk assessment. The new furniture seen did not provide lockable storage for residents. It was found at the last inspection that there was no evidence of systems for the control and prevention of Legionella in the home, and also that no current Portland Nursing Home DS0000002071.V289804.R01.S.doc Version 5.1 Page 16 gas safety or electrical safety certificates were available for inspection. The home had recently had an inspection and report by the local water authority which itemised the work required to meet health and safety standards, including the prevention and control of Legionella. The work required had not been carried out. The acting manager said this was being planned. An electrical safety certificate was seen at this inspection. The gas safety certificate had not been obtained, although it was noted that the work had been arranged for May 2006. There was a large patio area accessible from the large lounge/dining room. The patio was currently unsafe for residents to use as the slabs were cracked and uneven, there was a fence panel missing, the outlet pipe from the dryer in the laundry came out onto the patio, and the area was generally uninviting. The acting manager said that there were plans to make the area safe and pleasant for residents to use. There were three sluice rooms in the home, one on each floor. As required at the last inspection, two of these were manual sluices which had been repaired and were in working order. The third was a mechanical sluice/disinfector which was not working. The laundry was suitably equipped. Residents and visitors spoken with were generally pleased with the environment of the home, making comments such as “it’s homely”, “I like my bedroom”, “it’s sometimes a bit untidy”(in the lounge) and “it’s always clean”. Portland Nursing Home DS0000002071.V289804.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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents were generally well supported by the systems in place in the home. A robust induction programme was needed to ensure the protection of residents. EVIDENCE: The staff rota was seen and showed that staffing levels appeared suitable for the number and dependency of residents. Residents and staff spoken with said that staffing levels were satisfactory to meet the needs of residents. There were no additional hours provided for administrative support for the acting manager or for the organisation of activities for residents. Some progress had been made on staff training since the last inspection. Out of 20 care staff, 3 already had NVQs in care and 6 were to commence NVQs on 3rd May 2006. Training records seen showed that staff had received training in fire safety, moving and handling, and the protection of vulnerable adults. Some staff had received training about continence promotion and diabetes. Most staff were working towards achieving a basic food hygiene qualification. Staff spoken with were pleased with the training programme at the home and said they were encouraged and supported by the acting manager. Staff training needs were discussed and noted in supervision sessions. The home had started to develop a comprehensive induction programme for new staff. It Portland Nursing Home DS0000002071.V289804.R01.S.doc Version 5.1 Page 18 was not clear that the induction programme complied with the requirements and guidance of Skills For Care, (National Training Organisation specifications). The records of three members of staff were examined. The records seen were well organised and included all of the required information. Portland Nursing Home DS0000002071.V289804.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 this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The overall management of the home was satisfactory, ensuring the home was run in the best interests of residents. However, the health, safety and welfare of residents was compromised by the delay in action to previous requirements. EVIDENCE: The acting manager was in the process of applying to be registered with CSCI. Residents and staff spoken with were positive about the acting manager. Staff were pleased with the open and ‘hands on’ approach of the acting manager. There was a system of quality assurance in the home, including questionnaires for relatives, relatives meetings, and Regulation 26 visits by the provider. There was no formal system for wider consultation about satisfaction with the service and the production of an annual report. Portland Nursing Home DS0000002071.V289804.R01.S.doc Version 5.1 Page 20 There was a system in place for keeping residents’ personal money in the home. The money was kept securely in a safe with access only by the acting manager or deputy manager. Records were kept of all transactions. It was found at the last inspection that there was no evidence of systems for the control and prevention of Legionella in the home, and also that no current gas safety or electrical safety certificates were available for inspection. The home had recently had an inspection and report by the local water authority which itemised the work required to meet health and safety standards, including the prevention and control of Legionella. The work required had not been carried out. The acting manager said this was being planned. An electrical safety certificate was seen at this inspection. The gas safety certificate had not been obtained, although it was noted that the work had been arranged for May 2006. Records were examined including the accident book, fire log book and maintenance records and were generally satisfactory. The accident book had been completed as required, but individual accident reports had not been stored as required by the Data Protection Act. It was observed that wheelchairs were being used without the footplates in place when transferring residents. The acting manager said this was to prevent possible injury to residents’ legs. There were no risk assessments or assessment by physiotherapist seen in residents’ records regarding this practice. Portland Nursing Home DS0000002071.V289804.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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 1 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 1 Portland Nursing Home DS0000002071.V289804.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. Standard OP1 Regulation 5(1)(2) Requirement The Service User’s Guide must include all the required information and must be made available to all residents. The contract/statement of terms and conditions must include the free nursing element of the fee. Previous timescale 01/06/05 The registered person must prepare a written plan as to how the residents’ needs in respect of their health and welfare are to be met. (From inspection report 31/01/06) The upgrading programme must be implemented for all bathrooms including redecoration and provision of appropriate aids. (From inspection report 31/01/06) Suitable storage facilities must be provided in bathrooms. Previous timescale 01/07/05. (From inspection report 31/01/06) The registered person must ensure that the programme for DS0000002071.V289804.R01.S.doc Timescale for action 30/06/06 2. OP2 5(1)(c) 01/06/06 3. OP7 15(1) 01/06/06 4. OP21 23(2)(b) (d) 01/08/06 5. OP21 23(2)(m) 01/08/06 6. OP24 23(b)(d) 01/08/06 Portland Nursing Home Version 5.1 Page 23 7. OP25 23(2)(p) 13(4) 8. 9. OP26 OP28 23(2)(k) 18(1)(i) 10. OP30 18(1)(i) 11. OP38 13(4) 23(1) (2) the replacement of bedroom furniture and carpets is continued and completed to meet with national minimum standards. (From inspection report 31/01/06) The registered person must ensure that a system for the prevention and control of Legionella is implemented and a certificate of completion is sent to CSCI. Previous timescale 28/02/06 A sluicing disinfector in working order must be provided. The registered person must ensure that 50 of staff achieve NVQ Level 2. (From inspection report 31/01/06) The registered person must ensure that a structured induction programme is implemented for all new members of staff. Previous timescale 01/04/06. The registered person must ensure that remedial action is taken regarding the gas safety examination and a current Gas Safety Certificate must be sent to CSCI on completion. Previous timescale 28/02/06. 01/08/06 01/08/06 01/08/06 30/09/06 31/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations The activities programme should be expanded and consideration should be given to employing an activities DS0000002071.V289804.R01.S.doc Version 5.1 Page 24 Portland Nursing Home 2. 3. 4. OP27 OP29 OP30 coordinator. Consideration should be given to providing additional hours for administration support for the acting manager. Notes should be kept of interviews with applicants for staff vacancies. Dementia awareness training for staff would be of benefit to residents and staff. Portland Nursing Home DS0000002071.V289804.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Portland Nursing Home DS0000002071.V289804.R01.S.doc Version 5.1 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. 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