Inspection on 28/02/06 for Rottingdean Nursing And Care Home

This inspection was carried out on 28th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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

Rottingdean Nursing And Care Home 14/09/07

Rottingdean Nursing And Care Home 20/06/06

Rottingdean Nursing And Care Home 07/09/05

Rottingdean Nursing And Care Home 01/03/05

Rottingdean Nursing And Care Home 26/08/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Rottingdean Nursing And Care Home 30 - 32 Newlands Road Rottingdean Brighton East Sussex BN2 7GD Lead Inspector Jennie Williams Unannounced Inspection 28th February 2006 10:15 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 Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 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. Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Rottingdean Nursing And Care Home Address 30 - 32 Newlands Road Rottingdean Brighton East Sussex BN2 7GD 01273-308073 01273-300377 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) Mr Jon Breeds Mrs Carol Breeds Mrs Melanie Jane Barber Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That service users accommodated must be aged sixty five (65) years or over on admission. That a maximum of twelve (12) places can accommodate service users in receipt of personal care only at any given time. That the maximum number of service users to be accommodated is thirty four (34). 7th September 2005 Date of last inspection Brief Description of the Service: Rottingdean Nursing and Care Home is located in a quiet residential area in Rottingdean. There is limited car parking availabe at the home, but free parking is available on the adjacent street. Local amenities are available at the town centre a short walk down a hill. Rooms are located over three floors. Building works have been completed to make provisions for all residents to be able to access all areas of the home. There are twenty-eight (28) rooms for single occupancy and three (3) double rooms. There are suitable toilet and bathing facilities provided to meet the needs of residents. There is a passenger shaft lift available at the home to assist residents to access all floors. There is a dining room, a good sized lounge room and a garden at the rear of the building that residents are able to access. Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Rottingdean Nursing and Care Home will be referred to as ‘residents’. This unannounced inspection took place over five and three quarter hours on the 28 February 2006. Staff files, some policies and procedures, records, care plans and medication procedures were inspected. Fifteen residents and six staff were spoken with throughout the inspection process. The environment and some individual rooms were spot-checked. In order that a balanced and thorough view of the home is obtained, this inspection report should be read in conjunction with the previous inspection report of 7 September 2005. There were 33 residents living at the home on the day of inspection. Six were in receipt of personal care only and 27 in receipt of nursing care. What the service does well: What has improved since the last inspection? Care plans have improved and are more personalised to the individual. A quality assurance and quality monitoring system has been developed and implemented and an analysis undertaken of the results. The strip lighting within the home has commenced to be changed to be of domestic in character. The home is continuing to work towards the 50 ratio of NVQ level 2 qualified staff. Records of fire training and fire drills have improved. Building works have been completed which now allows residents access to all areas of the home. Residents previously had to be mobile to access some areas. There is a newly developed staff photo board near the entrance at the home that has photos of staff and their position within the home. Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 Page 6 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. Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 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 Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 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): 1, 3, 4 & 5 The home has suitable information available to prospective residents and their representatives to make an informed decision if the home is suitable for their needs. EVIDENCE: The Statement of Purpose and Service User Guide were found to be located at the entrance of the home and within individuals’ rooms. These documents contain information for prospective residents/representatives on the facilities and services provided at the home. The registered manager undertakes a pre assessment of all prospective residents. Relatives/representatives are involved in this process wherever possible. Information is obtained from other health professionals and copies of current care plans are taken, wherever applicable, as recommended from the last inspection. There had been seven new admissions since the last inspection. The pre assessments spot-checked was noted to be fully completed and signed, as required from the last inspection. Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 Page 9 Prospective residents/representatives are provided with an opportunity to visit the home prior to moving in if they wish. Overnight trial visits are available if required. The home does not take emergency admissions. Some residents spoken with confirmed that they had visited the home prior to moving in. The home does not have dedicated accommodation to provide intermediate care, however respite is available if there is a spare room. Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 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 & 10 Residents needs are being met with the clear information provided in the care plans on the assessed needs of residents. Residents’ privacy and dignity are respected. Residents are safeguarded by the medication procedures in place. EVIDENCE: A new care plan format has been developed and is due to be implemented for all residents. All new residents care plans are being drawn up on the new format and other residents’ plans are being changed as the needs of the individual changes. This new format is more personalised to the individual. There is a front page in the care plans that provide a quick clear overview of the resident’s needs. Eg. whether dentures, hearing aids, glasses are worn, food likes/dislikes, if plate guards are used to promote independence when eating, whether the resident smoke etc. There was evidence that care plans are being reviewed on a monthly basis. It was noted that turning charts were not being used effectively. (Turning charts - used for people who have limited movement and are at risk of developing pressure areas.) One chart inspected demonstrated that a resident had not been assisted in changing position for a period of over 15 hours. It Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 Page 11 was confirmed that this was not accurate. It is required that monitoring charts in use are accurately completed. Care plans spot checked had a plan of care form signed by the resident’s advocate to confirm that they agree with the plan of care and the home will notify them of any changes to the plan as soon as is reasonably practicable. Residents spoken with were complimentary about the care and services provided at the home. It was confirmed that staff discuss their care needs with them. There is pressure-relieving equipment at the home to promote tissue viability. There was evidence that input is obtained from a tissue viability nurse when the need arises. There is clear documentation regarding wound dressings and clear descriptions provided to demonstrate that the treatment for any wound is effective. There was evidence that continuity of care with wound dressings is promoted, with a regular nurse undertaking the dressing. Some residents observed to be wearing glasses all confirmed that they have had their eyes tested within the last six months or were due within the next month to have their eyes retested. Residents are seen by a GP of their own choice when the need arises. There was evidence that medication was being signed for at the time of administration. There were clear large photos of the residents for each MAR chart. Registered nurses are responsible for the administration of medication. There are clear accurate records being maintained for controlled drugs. It is recommended as good practice that hand written MAR charts are double signed by staff trained in medication procedures. One medication was noted to be prescribed twice per day; staff had not been administering this. It was confirmed that this medication is administered ‘as needed’ (PRN). It remains an outstanding recommendation that PRN medication be clearly identified. All residents spoken to were complementary about the staff working at the home and confirmed that they felt their privacy and dignity are respected. Staff were observed to address residents by their preferred term of address. Residents are provided with opportunities to have a private phone installed into their own room. Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 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 & 15 Residents’ lifestyle in the home is their own choice. Residents have opportunities to participate in activities that are of interest and within their capabilities. EVIDENCE: Residents spoken to confirmed that their lifestyle is their own choice and the routines of daily living are flexible. A new activities person has been employed at the home for 15 hours per week. It was confirmed that the home used to have a full time activities person, but residents found this too much. Residents spoken with confirmed that there are sufficient activities provided at the home should they choose to be involved. Visitors are welcomed at the home. There is a visitors’ book at the entrance of the home that all people must sign upon entering and leaving the home. Residents are able to choose whom who they see and do not see. Residents were very complimentary about the food at the home. Comments ranged from ‘quite nice’ to ‘plentiful and looks lovely’. One resident confirmed that they are a ‘fussy eater and an alternative is offered’. Residents choose where they wish to eat their meals. The Inspector enjoyed a tasty meal with a resident in the dining room. Other residents chose to remain in their rooms. Specialist nutritional advice is obtained when required. Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 Page 13 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 & 18 Staff are provided with sufficient information to inform them of the correct procedures if an allegation of abuse is made. EVIDENCE: There is a complaints procedure available at the home. This provides clear information on the steps to take should anyone wish to make a complaint. There has been no complaint made directly to the CSCI since the last inspection. One complaint has been made directly to the home. This is currently ongoing. Records are kept of complaints and copies are maintained of all related correspondence. There are suitable policies and procedures in place that provide staff with clear guidance on action to take if there is an allegation of abuse. There is a clear POVA flow chart on the front of the policies and procedures folder. There is whistle blowing policy that staff have access to. This includes the contact details of the CSCI as recommended at the last inspection. Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 Page 14 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, 21, 22, 25 & 26 Residents live in a home whose location and layout is suitable for its stated purpose. EVIDENCE: There are suitable toilet and assisted bathing facilities located throughout the home. Bathing facilities have been improved to ensure they meet the needs of the increasing numbers of residents in receipt of nursing care. Hoists, grab rails and other aids were seen to be located throughout the home to assist maintaining independence. Rooms were seen to be personalised to reflect the residents choice and taste. Two residents informed the Inspector that they were left in the lounge room without a call bell. There was a call point located directly behind one of the residents, although the individual was unable to reach this. It was discussed with the manager that a call bell extension be provided for the lounge room. The registered manager will discuss this with the residents concerned. Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 Page 15 Some areas contain strip lighting, which is not domestic in character. It has been an outstanding requirement for the last three inspections that strip lighting be changed to lighting that is domestic in character. This has commenced to be changed as rooms become free. A resident spoken to who had strip lighting in their room confirmed that they were not concerned about the strip lighting. This outstanding requirement has been lowered to a good practice recommendation. The home was found to be comfortably warm during the inspection. Hot water is being delivered around the recommended 43°C. It is required that hot and cold taps are clearly identifiable to reduce confusion for residents and staff. There is emergency lighting provided throughout the home. The home was found to be clean and free from offensive odours. The home has sluicing facilities appropriately placed throughout the home. There are suitable procedures in place for the safe laundering of clothes and bedding. Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 Page 16 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 Residents’ needs are being met with the number and skill mix of staff on duty at all times. Residents will be better safeguarded if staff only commence employment following suitable POVA and CRB checks. EVIDENCE: Residents spoken with were complimentary about the staff working at home. Most residents confirmed that there were sufficient numbers of staff on duty. Staff spoken with confirmed that there were always enough staff on duty. The rota provided to the Inspector demonstrates that there are seven staff working in the mornings, five in the afternoon and three staff at night. There is always a registered nurse on duty for every shift. Registered nurses are included in these numbers. Staff spoken with confirmed that they are provided with opportunities to undertake training relevant to their roles. A cleaning person was spoken to who confirmed that they have received manual handling training but have not received any infection control training. It is recommended that domestic staff be provided with infection control training and supervision. There was a staff member found to have commenced work without a POVA check and enhanced CRB. It was made an Immediate Requirement that staff must have a POVA First check undertaken before commencing work. Staff with a POVA First check must only work supervised until a full CRB disclosure is returned. Two other new care staff files inspected demonstrated no shortfalls in the documentation required to be kept on all staff. Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 Page 17 It is recommended that the application form regarding a prospective employees mental health be expanded. It currently only focuses on depression/anxiety. The home is continuing to work towards meeting the required 50 ratio of care staff being NVQ level 2 qualified or equivalent. There are currently four with NVQ level 3, four with NVQ level 2 and one staff member currently undertaking NVQ level 2 studies. An additional two staff have been signed up to commence their NVQ level 2 studies in the near future. This has not been reflected as an outstanding requirement as there is evidence that home is working towards the ratio of qualified staff. This will be reassess at the next inspection. Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 Page 18 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 & 38 Staff and residents benefit from a well run home. Residents’ personal allowances are safeguarded by the procedures in place and records kept. The health, safety and welfare of residents and staff are promoted and protected so far as is reasonably practicable. EVIDENCE: The registered manager has the relevant skills and experience to manager the home. She is registered with the CSCI. She has been working at the home since June 2005. She is a registered nurse with current registration with the Nursing and Midwifery Council (NMC). The registered manager confirmed that she has completed the Registered Manager Award (RMA) and is waiting for the certificate to be forwarded. It is recommended that a copy of this certificate be forwarded to CSCI upon receipt. Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 Page 19 Staff spoken to were complimentary about the registered manager. There are clear roles and responsibilities within the home. There is a commitment to equal opportunities in the home A quality assurance and quality monitoring system has been developed and implemented as required from the last inspection. A copy of the analysis was provided to the Inspector. 22 questionnaires were sent to residents/relatives and 17 were returned. GP feedback was also sought as part of the process. The home has addressed areas of shortfalls identified, wherever possible. The home proposes to undertake questionnaires on an annual basis in November. The home has implemented a questionnaire regarding the pre admission and arrival of any new resident to the home. This is given to the individual two weeks after admission. The financial viability of the home was not assessed on this occasion. There is suitable insurance in place. The home has been owned by the same providers for a period of time and has given no cause for concern regarding financial viability to date. Records inspected demonstrated that there are suitable procedures in place for the safe handling of residents’ monies. Receipts are kept of all financial records. Residents are aware that if they require their own personal allowance, this is available during the hours that the receptionist works. Some residents are encouraged and supported to maintain their own personal allowance. All monies are kept securely at the home. Suitable health and safety checks are undertaken to safeguard staff and residents within the home. Clearer records of fire training and fire drills are being maintained as required from the last inspection. It was confirmed that fire training took place the week prior to the inspection. The suitability of the person providing this training has improved as required form the last inspection. Any shortfalls that affect the health, safety and welfare of staff/residents have been highlighted in the relevant section of the report. Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 Page 20 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 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 2 X X 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 Page 21 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. 1. 2. 3. 4. Standard OP8 OP22 OP25 OP29 Regulation 15 16(2)(c) 13(4) 19 Schedule 2 Timescale for action That monitoring charts in use are 30/03/06 accurately completed. That a call bell extension is 30/03/06 provided in the lounge room. That hot and cold taps are 30/04/06 clearly identifiable. That staff have a POVA First 28/02/06 check undertaken before commencing employment and work supervised until a full enhanced CRB is returned. (Immediate requirement) That all domestic staff are 30/04/06 provided with infection control training and supervision. Requirement 5. OP30 18(1)(c) 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 OP9 OP9 Good Practice Recommendations That hand written MAR charts are double signed by staff trained in medication procedures. That PRN medication be clearly identified. (Outstanding DS0000014036.V267168.R01.S.doc Version 5.0 Page 22 Rottingdean Nursing And Care Home recommendation) 3. 5. 6. OP25 OP29 OP31 That the strip lighting is changed to lighting that is domestic in character. (Outstanding requirement from last three inspections, see content of report.) That the information obtained regarding a prospective employees mental health status be expanded. That a copy of the certificate for the RMA be forwarded to the CSCI upon receipt. Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Rottingdean Nursing And Care Home DS0000014036.V267168.R01.S.doc Version 5.0 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. 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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