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Inspection on 31/01/06 for Portland Nursing Home

Also see our care home review for Portland Nursing Home for more information

This inspection was carried out on 31st January 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents said that they found the staff very caring and that they `cannot do enough for you`. Residents told the Inspector that `the food is good`, `the home is very clean` and `it is like my home`. Comments from relatives included `staff are kind and welcoming` and `there is an open door policy`. Residents and relatives reported that the new manager was approachable and staff were always available and came when they rang the buzzer. A generally well-decorated and comfortable environment is provided. The food provided is to a good standard and the menu is varied, offering home cooked and baked food.

What has improved since the last inspection?

Improvements have been made to the environment including the replacement of some of the furniture, the redecoration of bedrooms and lounges and the replacement of carpets. Residents and relatives spoke positively of these changes. A fax machine has been provided and a computer is expected in the near future. Residents` needs are fully assessed prior to their admission to the home.

What the care home could do better:

Further improvements to the environment are expected including the refurbishment of the bathrooms and the replacement of bedding and bedroom furniture. Care plans are expected to be improved to cover all aspects of the residents care needs and to be reviewed on a regular basis. Staff are expected to attend protection of vulnerable adults training and the manager to attend Derbyshire`s training. The home is required to ensure that its recruitment policies and procedures are rigorously adhered to with particular regard to CRB and POVA checks. The home is required to implement a thorough induction and foundation training programme and NVQ training. Systems are expected to be put in place to ensure that the health, safety and welfare of residents and staff are fully promoted and protected, namely gas, electrical, fire safety and hot water. The manager is expected to register with the CSCI.

CARE HOMES FOR OLDER PEOPLE Portland Nursing Home 8 Park Road Buxton Derbyshire SK17 6SG Lead Inspector Marie Bonynge Unannounced Inspection 31st January 2006 10:30 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.V280943.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.V280943.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.V280943.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 12th October 2005 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 for 40 Nursing beds for Older People but 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 via the larger lounge room, by service users. Portland Nursing Home DS0000002071.V280943.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 7 hours. The focus of this inspection was to follow up the requirements and recommendations made at the last inspection and to examine key standards and outcomes for residents. The Inspector spoke to a group of 3 residents, 2 individual residents, 3 relatives, 5 members of staff and the Deputy Manager. Several residents had difficulties in expressing themselves in words and were unable to contribute directly to the inspection, but they were observed during this visit as to how well their needs were being met by staff. Inspection methods used included case tracking 3 residents, examination of their care plans and associated records, maintenance records, medication systems and a brief tour of the building. The Registered Manager Mrs Rushe has left The Portland since the last inspection and a new manager has been appointed. Progress has been made regarding the implementation of some of the requirements that have been made on a number of occasions. A number of serious concerns were highlighted on this inspection including recruitment and employment checks, the maintenance of hot water, electrical and gas systems and the induction of staff. An immediate requirement was left in respect of these matters and a letter of serious concern was sent to the Provider for urgent action. An action plan has been received by the CSCI and these matters will continue to be monitored via the inspection process. What the service does well: What has improved since the last inspection? Improvements have been made to the environment including the replacement of some of the furniture, the redecoration of bedrooms and lounges and the Portland Nursing Home DS0000002071.V280943.R01.S.doc Version 5.1 Page 6 replacement of carpets. Residents and relatives spoke positively of these changes. A fax machine has been provided and a computer is expected in the near future. Residents’ needs are fully assessed prior to their admission to the home. 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.V280943.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.V280943.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 and 3 Residents can be assured that their needs are fully assessed prior to their admission to the home. EVIDENCE: Three residents care plans were examined as part of the case tracking process. These indicated that full assessment information had been provided for each of the residents including a nursing assessment and community care assessment where applicable. The Manager or Deputy Manager had also completed an assessment on behalf of the home, although the same assessment tool had not always been used and this assessment was not always kept in the same place. A sample of contracts was seen that indicated that both privately funded residents and those whose placements were assisted via the local authority had a contract in place. However the contracts did not identify the free nursing care element of the fee. This was a requirement from a previous inspection. Portland Nursing Home DS0000002071.V280943.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 Residents care needs are generally met, however the documentation does not clearly support this. Medication systems were generally in good order, however some improvements are needed to ensure that these are maintained. EVIDENCE: Three residents care plans were examined. These indicated that a variety of documentation had been introduced that was not consistent in all of the care plans seen. The Inspector was advised that new care plans had been introduced, however these took the form of a risk assessment process rather than identifying all of the elements of the residents’ health, personal and social care needs as indicated in the assessments provided. The action that staff needed to take to meet the residents’ needs was not identified, although in some of the old care plans this was clearly documented. Discussions with residents, relatives and staff indicated that residents felt they were well cared for and that their needs were being met. Communication systems were well established by way of handovers, detailed daily records and Portland Nursing Home DS0000002071.V280943.R01.S.doc Version 5.1 Page 10 discussions with staff supported the view that they were aware of the care needs of residents and how these were to be met. Residents and relatives also said that they felt involved in the planning and implementation of their care although this involvement was not formally recorded on the care plan. Risk assessments were in place including those for falls, nutrition, moving and handling and skin integrity. These had been reviewed, although the reviews were not always completed monthly. Records clearly showed that residents had access to other health care professionals for example the primary health care team, dentist, optician and chiropodist. Medication systems were examined, the home administers medication from the boxes and bottles dispensed. Systems, policies and procedures were generally in good order with the exception of the following: • • Storage space was adequate, however the treatment room was also being used for the storage of various items that were not related to medicines including slippers and clothing. A system for the receipt and disposal of medicines was in place. Medication Administration Records (MAR charts) were examined for the 3 residents who were case tracked, these were generally in good order, although there were some omissions in the recording of signatures. Where ‘O’ had been recorded when a medicine had not been taken there was no key to identify the reason why not. A Controlled Drugs register was in place, however this was almost full and a new register was not available. There was no lock on the medicines fridge door, however this was stored in the locked treatment room. The Maximum and minimum temperatures of the medicines fridge were not being recorded. Photographs of residents were not kept with the MAR charts. • • • • • Portland Nursing Home DS0000002071.V280943.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 and 15 The standard of food provided is generally good and residents feel that they have choice and are consulted about the food provided. EVIDENCE: Residents said that they felt they were consulted about the services and facilities at the home and that they were supported to maintain their interests. This was not formally recorded in the care plans or daily records, although the Manager had begun to implement this. A requirement from the previous inspection has been met in respect of this. Residents told the Inspector that they felt the food was good, there was plenty of it and they were offered alternatives to the menu if they so wished. Meals were generally taken in the large lounge / dining room although a couple of residents sometimes had their meals in their rooms. Residents’ choices were upheld in this matter. There were plenty of food stocks, both fresh and frozen and much of the baking was done in the home. The main meal of the day was at lunch-time and residents said that they had plenty of snacks and drinks throughout the day. Portland Nursing Home DS0000002071.V280943.R01.S.doc Version 5.1 Page 12 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): 18 Policies and procedures were in place to assist in protecting residents, further training for all staff is needed to underpin these policies and procedures. EVIDENCE: The Manager had instigated a programme of training that included protection of vulnerable adults training, some staff had completed this and others were due to attend the training. The Manager had not attended Derbyshire’s protection of vulnerable adults training. A requirement has been carried forward in respect of this. Portland Nursing Home DS0000002071.V280943.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 25 and 26 Significant improvements in the environment have led to the provision of a generally homely and comfortable setting. Deficits in the maintenance of heating, hot water and electrical systems cannot ensure that a safe environment is being provided. EVIDENCE: A generally well-maintained and comfortable environment was provided. A programme of general upgrading to the fabric and decoration of the building has commenced resulting in a much improved environment. Residents commented that they liked their home and their bedrooms, but the improvements were welcomed. The Inspector was advised that new bedding and furniture was on order, some of the furniture had already been replaced. Requirements made in previous inspection reports were met as follows: Portland Nursing Home DS0000002071.V280943.R01.S.doc Version 5.1 Page 14 • • • • • • • • • A written programme of routine maintenance and renewal of the fabric and decoration of the premises had been implemented. A plan and programme for achieving compliance to timescales set in relation to the physical environment of the home had been implemented. Areas of chipped and worn paintwork and woodwork had been repaired and made good. The water damage in the downstairs lounge had been repaired. A furniture replacement programme had been implemented. A programme had been introduced to replace bedroom furniture and carpets. The radiator guards had been painted. All areas of the home were free from offensive odours. Window restrictors had been replaced. A date had been set for the upgrading of the bathrooms to include storage, redecoration and the provision of appropriate aids. A recent inspection by the Fire Officer had identified a number of areas that needed attention. (See standard 38 for further comments regarding health and safety). There was no certificate or evidence to suggest that systems for the control and prevention of Legionella had been put in place. An immediate requirement was left in respect of this. The home was generally clean and free from offensive odours throughout. Three sluices were provided in the home, however none of these were working. This was a potential infection risk and a letter of serious concern was sent to the Provider regarding this matter. Portland Nursing Home DS0000002071.V280943.R01.S.doc Version 5.1 Page 15 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): 28, 29 and 30 Residents are not supported and protected by the home’s recruitment policy and practices. A training programme is in place, however the lack of a formal induction programme does not provide for staff to fulfil the aims of the home and always meet the changing needs of residents. EVIDENCE: A programme has been implemented for the achievement of level 2 NVQ, however there were few care staff who had this qualification. Policies and procedures were in place regarding the recruitment of staff. Two staff files were checked that indicated that these were not being adhered to and recent guidance regarding Criminal Record Bureau disclosures (CRB checks) was not available. A number of new staff had been appointed without having had CRB checks applied for or POVA checks, 2 written references had not been obtained for some of these members of staff. A letter of serious concern has been written to the Provider requiring urgent attention. Training records were examined. A training programme was in place and individual records were available for staff. An overall training plan had not been developed and a formal induction programme was not in place for staff. Portland Nursing Home DS0000002071.V280943.R01.S.doc Version 5.1 Page 16 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 Systems are not in place to ensure that the health, safety and welfare of residents and staff are fully promoted and protected. EVIDENCE: The Registered Manager has left since the last inspection and a new manager has been appointed who has worked in the home for a number of years. The new Manager has not yet applied for registration with the CSCI and an application is expected. Positive comments from residents, relatives and staff were made to the Inspector regarding the new manager and they felt the home was being run in an open manner that was beneficial to residents. A deputy manager has also been appointed. A system of quality assurance was in the process of being implemented to include residents’ questionnaires, residents meetings and relatives meetings. Portland Nursing Home DS0000002071.V280943.R01.S.doc Version 5.1 Page 17 Relatives said that they welcomed the opportunity to be consulted about the care of the person they had come to visit. Regulation 26 provider visits were being recorded. Systems were in place for the administration of residents’ personal allowances, although individual records were not examined on this occasion. The Deputy Manager advised that the home did not have responsibility for residents’ financial interests. Certificates of maintenance were examined including those for gas and electricity. Urgent matters had been identified for action following a gas safety inspection in August 2005. There was no Gas Safety Certificate or evidence to suggest that the matters had been rectified and that remedial action had been taken. A certificate was not available regarding the maintenance of electrical systems and electrical equipment. A certificate regarding systems for the prevention of Legionella was not available as identified in standard 26. A number of recommendations had yet to be carried out in respect of the Fire Officer as identified in standard 19. The lock to the front door was not working properly resulting in the door not being able to be opened. A side door was being used. A new security lock had been ordered but had not arrived. Advice had not been sought from the Fire Officer regarding any potential implications of this. The Deputy Manager contacted the Fire Authority during this visit. Temperatures for the fridges and freezers were not being recorded. Records were not being maintained as identified in the main body of the report. Portland Nursing Home DS0000002071.V280943.R01.S.doc Version 5.1 Page 18 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 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 3 2 X X 2 1 1 STAFFING Standard No Score 27 X 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 1 1 Portland Nursing Home DS0000002071.V280943.R01.S.doc Version 5.1 Page 19 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 OP2 Regulation 5 1) c) Requirement The contract and statement of terms and conditions must include the free nursing element of the fee. From inspection report 01/03/05. 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. The registered person must ensure that the care plan and risk assessments are reviewed monthly. The registered person must ensure that all of the identified issues in standard 9 are attended to. The Acting Manager must attend Derbyshire’s protection of vulnerable adults training. All members of staff must attend the relevant training regarding adult abuse. From inspection report 01/03/05. Previous timescale 01/07/05. The registered person must implement the recommendations DS0000002071.V280943.R01.S.doc Timescale for action 01/06/06 2. OP7 15 1) 01/06/06 3. OP7 15 2) b) 01/06/06 4. OP9 13 2) 01/06/06 5. 6. OP18 OP18 13 13 01/06/06 01/06/06 7. OP19 23 4) a) c) d) e) 01/03/06 Portland Nursing Home Version 5.1 Page 20 8. OP21 23 2) b) d) 9. OP21 23 2) m) 10. OP24 23 2) b) d) 11. OP25 23 2) p) 12. OP26 23 2) k) 13. 14. OP28 OP29 18 1) i) 19 1) a) b) Sch 2 15. OP29 19 1) a) b) Sch 2 16. OP30 18 1) i of the Fire Authority within the given timescales. The upgrading programme must be implemented for all bathrooms including redecoration and provision of appropriate aids. Suitable storage facilities must be provided in bathrooms. From previous inspection report 01/03/05. Previous timescale 01/07/05 The registered person must ensure that the programme for the replacement of bedroom furniture and carpets is continued and completed to meet with national minimum standards. 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 the CSCI. Immediate requirement left. The registered person must provide necessary sluicing facilities and ensure that the 3 sluices are in good working order. The registered person must ensure that 50 of staff achieve NVQ level 2. The registered person must obtain completed CRB and POVA checks prior to the commencement of employment of staff. The registered person must obtain 2 written references for new members of staff prior to the commencement of employment. The registered person must ensure that a structured induction programme is implemented for all new DS0000002071.V280943.R01.S.doc 01/08/06 01/08/06 01/08/06 28/02/06 28/02/06 01/08/06 01/04/06 01/04/06 01/04/06 Portland Nursing Home Version 5.1 Page 21 17. 18. OP31 OP38 19. OP38 20. OP38 21. OP37 members of staff. The manager must apply to the CSCI for registration. 13 4) 23 The registered person must 1) a) 2) c) ensure that remedial action is taken regarding the gas safety examination and a current Gas Safety Certificate must be sent to the CSCI on completion. Immediate requirement left. 13 4) 23 The registered person must 1) a) 2) c) provide a certificate to the CSCI regarding the maintenance of electrical systems and electrical equipment. Immediate requirement left. 13 The registered person must ensure that the temperatures of the fridges and freezers are recorded. 17 Sch 2 Records must be maintained, and 3 accurate and up to date in accordance with regulations as identified in the main body of the report. 8 1) 01/04/06 28/02/06 28/02/06 28/02/06 01/05/06 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. 2. Refer to Standard OP3 OP7 Good Practice Recommendations The homes’ own assessment should be recorded on the same assessment tool and kept in the residents care plan. Residents involvement should be formally recorded in the care plan. Portland Nursing Home DS0000002071.V280943.R01.S.doc Version 5.1 Page 22 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.V280943.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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