Inspection on 29/05/08 for Queen Alexandra Hospital Home

This inspection was carried out on 29th May 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Queen Alexandra Hospital Home 27/06/07

Queen Alexandra Hospital Home 23/01/06

Queen Alexandra Hospital Home 16/08/05

Queen Alexandra Hospital Home 06/01/05

Queen Alexandra Hospital Home 05/05/04

Similar services:

Thorndene

Sutton Lodge Nursing Home

Wingham Court

Bethany Lodge

17 John Street

Red Oaks

Clare House Nursing Home

Broad Oak Manor Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Queen Alexandra Hospital Home Gifford House Boundary Road Worthing West Sussex BN11 4LJ Lead Inspector Merle Blakeley Unannounced Inspection 29th May 2008 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 Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Queen Alexandra Hospital Home Address Gifford House Boundary Road Worthing West Sussex BN11 4LJ 01903 213458 01903 2194151 matron@qahh.org.uk 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) Queen Alexandra Hospital Home Limited Mrs Valerie Walker Care Home 60 Category(ies) of Physical disability (60), Physical disability over registration, with number 65 years of age (60) of places Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th June 2007 Brief Description of the Service: Queen Alexandra Hospital Home is situated in a residential area of Worthing with local shops and other amenities within walking distance. The seafront and beach are close by. The majority of residents living at the home are exservicemen or women who have chosen the home because of its connections with the armed forces. The home has recently completed a major new building project, which has increased the number of single bedrooms available at the home to 36 and provides a new occupational therapy, physiotherapy unit and further communal areas. The home has two separate wards Alexandra Ward and Norfolk Ward. Further major building works are currently being carried out in 2008 to the north end of Norfolk Ward and when complete will provide additional single and double en suite rooms. The fees for the home are per week and are based on assessed need and are banded on low £719.33, medium £822.83 and high needs £947.03. Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this service is 2 Star. This means the people who use this service experience Good quality outcomes. This unannounced inspection was carried out on May 29th 2008. As well as this site visit information was also gained from a returned Annual Quality Assurance Assessment (AQAA) and feedback surveys from sixteen residents and thirteen staff. During the visit we spoke to several residents individually and in groups and we also spoke to care staff, ancillary staff, the HR manager, the finance officer, ward managers and the chief executive officer. We also looked at several care plans and all supporting documentation such as risk assessments, daily records and healthcare information and a thorough check was carried out on how medications are being stored and administered within the home. Records of how complaints and safeguarding issues are dealt with were discussed. We also viewed staff records, which included recruitment procedures, qualifications and the types of training courses that are offered to staff. We also carried out a tour of the premises. The homes quality assurance system, how people’s finances are managed and health and safety procedures were also viewed and discussed. What the service does well: Queen Alexandra Hospital Home provides excellent facilities for people who have physical disabilities. The home produces comprehensive care plans and individual reviews are carried out regularly to ensure that the service can continue to meet people’s changing needs. The computerised special care programme ensures that staff are alerted to carry out certain health checks and screenings on residents. Both single and shared rooms are available and people have access to a very good range of healthcare professionals. The home provides dedicated areas for physiotherapy and occupational health and a variety of activities are offered. The service has its own coach and minibus for transporting wheelchair users. The home employs a large staff team and those staff that we spoke to on the day of the visit stated that they enjoyed working in the home and felt it provided a relaxed and caring environment for people. Records show that 50 of the staff team have obtained National Vocational Qualifications in Care and all the nursing staff are qualified. A good level of training courses are also offered to staff on an ongoing basis. The premises are kept very clean and tidy and maintained to a good standard. Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 Page 6 The home has multidisciplinary care reviews for resident’s, which include involvement from other healthcare professionals. 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. The summary of this inspection report can be made available in other formats on request. Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are assessed prior to moving into the home to make sure that the home can meet their individual needs. EVIDENCE: Once a person has made an initial enquiry to the service either the matron or one of the ward managers will assess their needs. The home uses a proforma pre-assessment record, which looks at the twelve activities of daily living such as hygiene and dressing, communication, eating & drinking, mobility, sleeping, health and mental health conditions etc. From this information staff will be able to make an informed judgement as to whether the home can meet this person’s particular needs. If the persons needs can be met then this pre-assessment will form part of the resident’s plan of care. Residents and their relatives and friends are involved in the care planning process, as they are able to provide valuable and personal Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 Page 9 information. People’s continuing care needs are assessed and reviewed on a regular basis. Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 &10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care planning system gives clear information about how each person care needs should be met. People’s current healthcare needs are being met and medication is being appropriately stored and administered. EVIDENCE: Care plans viewed during this visit had been developed from the initial preassessment form. Clear information is provided to staff to enable them to be able to meet the needs of the residents in all aspects of their health, personal and social care. Care plans are comprehensive and updated regularly on a special care computerised system, which also alerts the relevant named nurse to carry out certain health screens and checks. Copies of people’s care plans are kept in their rooms as well as on the computerised system. This is to ensure that all care staff have easy access to each person’s records, as only registered nurses have access to the computerised system. Risk assessments Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 Page 11 regarding skin viability, nutrition, falls and manual handling are carried out and reviewed on a regular basis. Records revealed that residents have access to a good level of healthcare professionals such as GP’s, dieticians, specialist nurses, chiropodists, dentists, opticians etc. The home employs two full time physiotherapists, a physiotherapy assistant plus a psychosexual therapist is employed for one day a week, as is a speech and language therapist. The vast majority of people living in the home receive one-to-one physiotherapy sessions during the week. Two local GP’s carry out a surgery at the home twice a week. Weekly multidisciplinary meetings are held to look at the individual care needs of residents. People who were spoken to during the day and feedback from service user surveys indicated that the home is continuing to meet the healthcare needs of residents. A thorough check of all medication records was carried out for both wards, as there had been some errors identified during the last inspection. We also checked any controlled drugs that the home was administering. We also observed medication being administered to residents during lunchtime. Records showed that medication is being correctly administered. Controlled drugs were also found to be in order. Any person who self medicates undergoes a risk assessment to ensure they are competent and this assessment is reviewed on a regularly. Residents who were spoken to during the day stated that overall they were very happy with the level of care they were receiving and no one raised any concerns. Some residents said they appreciated what the staff did for them and most of them were kind and helpful and they all worked very hard. Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with a flexible lifestyle that suits their needs and they are encouraged to exercise choice and control in their lives. EVIDENCE: The home provides a programme of activities for the residents who are able and wished to be involved. There is a dedicated occupational health room with two occupational therapy assistants. A full time occupational therapist has now been appointed. A number of activities and hobbies are provided and several residents were seen in the room painting and doing various different craftwork activities. One resident has his artwork on display in the home. Day trips are organised and the home has it’s own coach and minibus and a full time driver is employed. Some of the residents said they were looking forward to a trip to the Chichester Flower Festival that was being organised for the following day. Other outings that have been organised in May have included visits to Wisley Gardens and Runnymede. As well as crafts and hobbies people can also be involved in quizzes, darts practice, band practice, bingo, crosswords and skittles. From the information provided in the resident feedback questionnaires most people said they were happy with the level of activities that were being Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 Page 13 provided, some did say that it could become a bit boring at the weekends because there were no activities. This was discussed and the home is aware of this and it is their intention to provide a range of stimulating activities for people at the weekends. Visitors are made welcome in the home and people were seen coming in and out of the home throughout the day. We were able to speak to one relative who stated that staff were very welcoming and they had no concerns about the care their relative received. Several residents were spoken to regarding choices and control in their lives. They stated that this could be difficult at times because of their physical disabilities and they had to rely on staff a great deal. They said where they could they were able to make their own decisions and choices about certain aspects of their daily lives. The home appears to be providing a varied and healthy menu, although some people commented in the questionnaires that they did not always like the food. We were able to spend some time with residents during lunch in the dining room. The meal on the day looked well presented and appetising and all who were spoken to said they were enjoying it. There was evidence that people have several options available to them at mealtimes, as we saw omelettes, salads and fish dishes also being prepared. The Head Chef was spoken to briefly and she stated that the home catered for several different types of diets such as vegetarian, diabetic and low fat and she felt that individual needs were being catered for. Several people require assistance during meal times and staff were seen to be helping residents in a friendly and caring manner. Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has produced a complaints policy and procedure and a safeguarding adults procedure. EVIDENCE: The home has produced a complaints policy and procedure, which is made available to all residents. Comments received from feedback questionnaires indicated that people knew how to make a complaint if they needed to. The home holds regular residents meetings where any concerns or complaints can be raised. The home has not received any complaints however just prior to the inspection the CSCI received some concerns about practice issues within the home from a student nurse. A number of these concerns were discussed and the issues addressed on the day. The remaining three concerns have been left with the matron to investigate on her return from annual leave. The home has a safeguarding adults policy and procedure and all staff have undertaken this training during their induction period and refresher courses are provided on an annual basis to ensure staff remain up to date with their knowledge. All staff undergo CRB checks before commencing employment. No safeguarding referrals have been made. Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides excellent facilities and is maintained to a very good standard. EVIDENCE: A tour of the premises was carried out with one of the ward managers. The majority of the rooms are for single use but there are also several rooms, which are shared. The ward manager stated that people had made the decision to share a room, as they preferred not to be on their own. All residents have electric profile beds and overhead tracking hoists are used. A great deal of specialist equipment is available to residents and most use wheelchairs and walking aids. There are communal areas within the home which include a large dining room, a lounge with a bar area, a conservatory, occupational health room, physiotherapy room, quiet areas and various outdoor areas. The Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 Page 16 home also has its own dedicated chapel and chaplain and church services are held on Sunday mornings for residents and members of the public. In April 2008 a new sensory and cognitive therapy room was opened for residents who have an acquired brain injury (ABI) and currently the Phase 2 Upgrade of the north end of the Norfolk Wards is being carried out. When this work is completed there will be an additional three single and two double en suite bedrooms. The double rooms maybe used for either single use or for married couples. Some of the shared rooms may also be made into single rooms. Upgrading of bathrooms is being carried out plus a new nurses station is being built. The home will continue to retain its registration as a sixty bedded care home. On the day we found the home to be very clean and tidy and maintained to a very high standard. Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing numbers ensure that residents assessed needs are being met. Over 50 of staff hold an NVQ qualification and records show that staff receive a good level of training. EVIDENCE: Queen Alexandra Hospital Home currently employs a care staff team of approximately seventy staff and thirty-six ancillary staff. From the seventeen residents surveys that were returned three people felt that the home needed more staff and from the thirteen staff surveys returned four felt that more staff were needed. This was discussed with the ward manager who felt that when these surveys were completed in March 2008 the home was experiencing some staff shortages due to staff sickness and annual leave and agency staff were being used, however the home was now back to full strength and there was currently one vacancy for an RGN. There are normally four trained nurses and fourteen care assistants on duty in the morning and three trained nurses and nine care assistants for the afternoon shift. During the night there are three trained nurses and six care assistants. Three ward manager’s who are all registered nurses, are also employed and they work various shifts. There are currently fifty-six residents. Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 Page 18 Thirty care staff hold National Vocational Qualifications (NVQ) Levels 2 and 3 in Care and there are seventeen registered nurses. An NVQ Assessor is employed one day a week to assist staff in obtaining their NVQ qualifications. We looked at the training records for staff and they revealed that all staff have access to a good level of training which has included manual handling, health & safety, safeguarding adults, food hygiene, infection control and fire safety. Some staff have also attended courses in continence, counselling skills, challenging behaviour, dysphagia, first aid and dementia awareness. A range of staff recruitment files were viewed and they included all the required information, however the home needs to ensure that all staff have a recent photo included in their file, as this provides proof of identity. The HR Manager stated that he would carry this out as soon as possible. POVA First and CRB checks are applied for although there was some confusion about when POVA First checks should be used. This was discussed and clarified with the HR Manager, as a requirement had been made regarding POVA First checks during the last inspection. The staff that were spoken to on the day stated that overall they were happy working at Queen Alexandra Hospital Home and felt, as a staff team that they all got on well together and were supportive of one another. They also said that they received a good level of training and supervision Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run by a qualified and experienced registered manager. The home has produced a quality assurance system and people’s finances are being safeguarded. Health and safety checks are being carried out. EVIDENCE: The home is run and managed by an experienced manager who holds a nursing qualification and the Registered Managers Award (RMA). She has now been managing the home for eight years and staff who were spoken to felt she ran the home in a very professional and knowledgeable manner and continued to maintain high standards. They also said she was supportive and approachable. The registered manager was not available during this visit so Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 Page 20 one of the ward managers facilitated the inspection. The Chief Executive Officer stated that the home was creating a new post for a deputy manager and they were hoping to appoint someone very soon. The home has produced a quality assurance system and resident satisfaction surveys are sent out to residents twice a year. Relative surveys and stakeholder surveys are also carried out bi-annually. Monthly resident meeting are held where people are able to discuss any issues or concerns. Regulation 26 Visits are discussed at monthly board meetings and a board member is allocated to carry out a “walk around” inspection, however this inspection is not formally recorded only discussed at the next board meeting. The home will need to ensure that all Regulation 26 Visits are formally recorded and the records kept on file so that they can be viewed at future CSCI inspections. The home employs an Administrative Officer who is responsible for resident’s finances. We looked at the residents ledger account and computerised records are kept on all transactions made by residents. We checked some of these records randomly and they were found to be in order. Residents have their own interest bearing accounts. Health and Safety checks were discussed with the Chief Executive Officer who is also the Health & Safety Officer for the home. Fire drills are carried out three monthly and fire alarm checks are carried out weekly, fire training is provided every six months for the day staff and three monthly for the night staff. Emergency lighting is also checked weekly, as is the hot water temperatures. A Fire Risk Assessment was carried out in January 2008 and an emergency evacuation plan has been produced. There are several staff that are qualified first aiders and there are various first aid points throughout the home. Regular checks are carried out on all plant and equipment. Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X 4 X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Queen Alexandra Hospital Home DS0000024198.V363452.R01.S.doc Version 5.2 Page 24 - 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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