Inspection on 17/02/06 for Somerset Nursing Home

This inspection was carried out on 17th February 2006.

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

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

Other inspections for this house

Somerset Nursing Home 22/05/07

Somerset Nursing Home 18/12/06

Somerset Nursing Home 24/05/06

Somerset Nursing Home 13/07/05

Somerset Nursing Home 09/03/05

Somerset Nursing Home 15/06/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE Somerset Nursing Home Somerset Nursing Home 1 Church Lane Wheldrake York North Yorkshire YO19 6AW Lead Inspector Denise Rouse 17th February 2006 10:20 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 Somerset Nursing Home DS0000045154.V281491.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. Somerset Nursing Home DS0000045154.V281491.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Somerset Nursing Home Address Somerset Nursing Home 1 Church Lane Wheldrake York North Yorkshire YO19 6AW 01904 448313 01904 448022 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) Roche Healthcare Limited Care Home 46 Category(ies) of Dementia (46), Dementia - over 65 years of age registration, with number (46), Old age, not falling within any other of places category (46), Physical disability (46), Physical disability over 65 years of age (46), Terminally ill (4) Somerset Nursing Home DS0000045154.V281491.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users in the category DE and PD must: (i) Be aged 50 and over and (ii) require nursing care 9th March 2005 Date of last inspection Brief Description of the Service: Somerset Nursing home is a care home for older people providing personal & nursing care for up to 46 service users. The home is situated in the village of Weldrake, approximately 8 miles from the centre of York, there are 14 elderly persons bungalows within the grounds of the home. The business is owned by Roche Healthcare Limited. The home provides both single and shared accommodation on two storeys and has a passenger lift. Somerset Nursing Home DS0000045154.V281491.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out over six hours, by one inspector, following a day’s preperation. The acting manager was available for part of the inspection. Service users and staff were spoken with. A tour of the building was undertaken which included communal areas, bedrooms, kitchen, laundry and the administration office. Records inspected included service users care profiles, personal allowance records, staff files and food preparation documentation. The service user guide, statement of purpose and brochure were also examined. A feedback session was held at the end of the inspection with the acting manager and regulatory inspector. What the service does well: What has improved since the last inspection? What they could do better: The Statement of Purpose must be updated, to allow service users to make an informed choice about if the home can meet their needs. Care plans and risk assessments need to be more detailed. They must be regularly updated and reviewed, to ensure service users needs are identified and can be met. More activities must be planned and provided to meet the preferred social needs of all service users, including those with dementia. Somerset Nursing Home DS0000045154.V281491.R01.S.doc Version 5.1 Page 6 The security of the building must be reviewed. An outer door left open posed a potential risk to service users, particularly those who were confused and may wander out of the building unobserved and unaccompanied. Staff were committed and worked hard to care for service users, however care staff numbers continue to be inadequate. This shortfall was identified at the previous inspection and has still not been addressed. There was a shortfall in training for staff, especially regarding dementia. Training must be provided to help staff give appropriate specialized care to these service users. Staff files were not all accessible within the home. Therefore there was a problem in checking that the correct written information was being received relating to new staff. The files must be available within the home for inspection. The managerial arrangements for the home are not adequate which means that problems identified were not being dealt with. The acting manager only works 3 days per week and no proper managerial cover is in place when she is absent. The proprietor must ensure that adequate managerial cover is provided each day of the week to ensure that the service is not adversely affected. Day to day management of the home was not effective in dealing with the problems the home was experiencing. Products within the Hair salon must be stored securely to prevent service users gaining access to substances, which could be hazardous to their health. 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. Somerset Nursing Home DS0000045154.V281491.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 Somerset Nursing Home DS0000045154.V281491.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): Standard 1 Service users do not have access to the correct information within the statement of purpose and service user guide to make an informed choice about this service. EVIDENCE: The statement of purpose and service user guide had relevant information missing. This included service users views about the home, the acting managers qualifications and experience, and that of the proprietor and staff. Some of this information was found within the homes brochure. There was no information available to suggest that service users with dementia resided within the home. The service user guide did not contain information relating to the last Commission for Social Care Inspection. Adequate up to date information must be available to service users, relatives and their families to allow individuals to make an informed choice about the service. Somerset Nursing Home DS0000045154.V281491.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): Standards 7 8 10 Staff treated service users with respect and upheld their privacy but health and social care needs were not fully met. EVIDENCE: Service users were addressed respectfully. Staff were seen to maintained privacy whilst personal care and toileting was being carried out. Visiting General Practitioners were taken to service users bedrooms for private consultations. Service users unopened received mail. A pay phone and mobile was available for service users, if they did not wish to have a private phone line fitted in their bedroom. Care profiles for all service users were in place but information was missing relating to social needs. Care plans and risk assessments had been implemented but were not reviewed and updated monthly or as service users needs changed. This had resulted in some service users who were losing weight not being adequately monitored. There was no indication that a dietician or General practitioner had been consulted, weekly weights had not been recorded and body mass index recordings were intermittent and inadequate. Nutritional care plans were not reviewed and updated. There was no documentation to suggest that the chef had been consulted to assist with Somerset Nursing Home DS0000045154.V281491.R01.S.doc Version 5.1 Page 10 providing an adequately nutritional diet for these service users. The poor standard of documentation, as well as the obvious lack of monthly review to the documentation places frail service users at unacceptable risk. Weight loss had occurred which was left unchecked and the staff had failed to notice or initiate adequate assessment and re-evaluation of this service user needs. There was no indication that relatives had been involved with any care plan reviews. Care profiles for service users with dementia were also of poor quality and shortfalls in identifying and recording how needs were to be met were apparent. The acting manager was informed of all the areas of concern at the time of the inspection. She agreed that detailed work was required by staff to ensure that service users were not placed at risk due to such inadequate review and poor documentation of needs and how they are to be met. Somerset Nursing Home DS0000045154.V281491.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): Standards 12 14 15 Service users were provided with a wholesome appealing and well balanced diet. There were shortfalls within the home relating to social needs and recreational interests. EVIDENCE: There was a poster displayed regarding an outing to a local pub. In summer bus trips are undertaken to the coast and local attractions. Aromatherapy and hairdressing was available within the home. A part time activities co-ordinator was available 4 days a week. A programme of activities was not displayed within the home. Service users social interests and hobbies were not adequately recorded. No individual care plans relating to their social needs or hobbies were evident. Documentation of the activities undertaken was poor, an example in one service users file stated “ singing”. There was no evidence that service users with dementia were having their social or cultural needs met with particular regard to their condition. This must be addressed. A service user stated “ The only problem is I have to wait to go to bed at night, as the doubles are put into bed first.” Service users must be able to receive the care they require on an individual basis. Care delivered within the home must Somerset Nursing Home DS0000045154.V281491.R01.S.doc Version 5.1 Page 12 not be institutionalized. Service users who require two members of staff to assist them must not be placed in bed first, if they do not wish to go to bed. Individualized care must be delivered at times suitable to meet the needs of all service users. The food served looked appetizing and well presented. The chef was aware of service users requiring diabetic, puree and gluten free diets. A choice of meals was available. Service users were asked daily what whey would like to eat. The kitchen was clean, tidy and well stocked. Records relating to fridge, freezer, and hot meat temperatures were recorded. Home baking was available for morning coffee, afternoon tea and supper. Service users who required assistance with feeding were given help by staff over an adequate period of time to ensure meals were unhurried. All meals were served on trays to service users who were sat within the lounge areas or in their bedroom. A service user stated, “ The food is fine”. In April following the refurbishment the dining room will contain 3 tables and service users will be encouraged to utilize this area. Somerset Nursing Home DS0000045154.V281491.R01.S.doc Version 5.1 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): Standard 16 Service users can be assured that their concerns would be listened to, taken seriously and acted upon. EVIDENCE: Records relating to complaints were examined. There was adequate evidence relating to the investigation process and outcome. Discussions had taken place with the person making the complaint. The complainant was satisfied with the investigation process and outcome of the investigation. The complaints policy was displayed within the home. The time scale for dealing with complaints was stated within the policy. All complaints were dealt within 28 days. Details were provided to ensure that service users could contact the Commission for Social Care Inspection if they wished. Somerset Nursing Home DS0000045154.V281491.R01.S.doc Version 5.1 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): Standard 19 24 25 Service users security was compromised by an unlocked outer door, décor within the communal lounges, conservatory and dining room was poor. Service users bedrooms were comfortable and they were able to bring in personal items from home. EVIDENCE: Service users bedrooms were personalize by bringing in items from home. Shared bedrooms contained screens to ensure privacy was maintained. At inspection it was noted that there was an open door leading onto the drive; this remained open for five minutes and continued to be open whilst the inspector went to the front door and gained access. The team leader was taken to the door, which had a notice on it “ please keep door shut at all times” the door was then closed. Inadequate door security places service users at risk from wandering or unauthorized persons being able to access the home. Access to the building by new visitors on an evening may be difficult, due to a doorknocker being utilized to alert staff that a visitor was waiting to gain entry. Door security systems require reviewing. Somerset Nursing Home DS0000045154.V281491.R01.S.doc Version 5.1 Page 15 The conservatory was unoccupied and contained extra chairs and stored items; it was not being used due it being inadequately heated. This will be addressed in the refurbishment. Access could be gained to this area by residents who may be placed at risk due to the storage of items. This must be addressed. Service users were seated around the perimeters of the lounges, this gave an institutionalized appearance. Décor was poor; one lounge carpet had silver masking tape over a tear in the carpet to prevent staff or service users tripping. The carpet will be replaced in the refurbishment programme. The Commercial Manager discussed the planned refurbishment project with the inspector. This will commence in April and will address the poor décor within the lounge areas. Seating will be arranged in small groups instead of around the perimeters of the lounges. Somerset Nursing Home DS0000045154.V281491.R01.S.doc Version 5.1 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): Standards 27 28 29 30 Service users basic care needs are met, but insufficient numbers of qualified and care staff, and inadequate training regarding the needs of service uses with dementia limit the level of care provided. EVIDENCE: Service users basic personal care needs were met. Service users stated, “ The staff are good”. Fifty percent of care staff hold the National Vocational Qualification in Care at Level two or three. Induction training occurs for new care staff. However qualified and care staff were not provided in adequate numbers to enable staff to provide anything other than basic care. It was obvious that they were working under pressure. The proprietors must address the staffing shortfalls, which were a requirement on the last inspection report and have still not been addressed. There was not enough care staff to allow for an agitated service user with dementia to receive one to one attention. A domestic was asked to clean within the area where this agitated service user was to observe them. Some shifts were covered by one qualified nurse for up to 46 service users, 18 of whom have dementia. The standard of care cannot be monitored appropriately and staff supervision cannot take place to an appropriate level. This places service users at risk. The acting manager was only available 3 days per week; there was inadequate managerial cover of the home in her absence. The proprietor must ensure that adequate cover is maintained 7 days per week to ensure that the standard of Somerset Nursing Home DS0000045154.V281491.R01.S.doc Version 5.1 Page 17 management and services provided within the home are conducted at an acceptable level. Training in dementia must be provided to all staff to ensure they understand the complex needs of these service users and can deliver appropriate care. Fire training should be increased to ensure that staff are able to react swiftly and effectively should the need arise. Two staff have undertaken the appointed persons first aid course, this does not provide adequate cover for the home. More staff must complete this course to ensure the health and safety of service users and staff is maintained. Roche are about to open a training centre within Yorkshire. The shortfalls regarding training must be addressed prior to this facility being opened it necessary. Somerset Nursing Home DS0000045154.V281491.R01.S.doc Version 5.1 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): Standards 31 33 35 38 Policies and procedures are in place to ensure service users financial interests are safeguarded. Service users and staff were placed at risk by inadequate managerial cover being provided over a 7-day period, and inadequate storage of hairdressing products. EVIDENCE: The acting manager had undertaken a Certificate in management in Health and Social Care at Leeds University. Adequate managerial cover must be provide over 7 days per week to ensure that the home can run efficiently and effectively. Internal monitoring by management of service users care profiles must be implemented to ensure management have an overview of the quality of the documentation and care being delivered to all service users. Any shortfalls must be addressed. Somerset Nursing Home DS0000045154.V281491.R01.S.doc Version 5.1 Page 19 No formal audit of the homes practices and procedures was undertaken by the acting manager to ensure that the home was running effectively. Residents and relatives meetings were not being undertaken and the acting manager intimated that these would be commenced shortly. Quality assurance questionnaires were sent out to service users and their families on a yearly basis. Feedback from this process was displayed upon notice boards throughout the home. Monthly staff meetings were undertaken. An annual development plan was in operation within the home. The acting manager was going to ask for the views of social workers and local general practitioners by questionnaire. This will be sent out shortly. Service users personal allowance accounts were audited and the balances checked were correct. Receipts were kept and held in a poly pocket with the balance statement and monies for each service user. The Acting manager does not act as an appointed person for any service user. One item held in a locked drawer within the office on behalf of a service user. The administrator pointed out there were a number of items of jewellery, which had been handed in as lost items found within the home a list of these items should be made. The acting manager should address this issue in line with the company policies and procedures. Access was gained to the hairdressing salon, which was not locked. Perm solutions and other hair products were not stored securely; this places service users at risk. Somerset Nursing Home DS0000045154.V281491.R01.S.doc Version 5.1 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 1 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 1 X X X X 3 3 X STAFFING Standard No Score 27 2 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 X X 2 X X 1 Somerset Nursing Home DS0000045154.V281491.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 456 Requirement The registered person must ensure must ensure the statement of purpose and service user guide contain sufficient information to enable potential service users to make an informed choice about where they wish to stay. The registered person must ensure that service users Care profiles are completed in enough detail to ensure adequate care can be provided. All entry’s must be signed and dated. Care plans and risk assessments must be reviewed and updated at least monthly or when the service users need change. OUTSTANDING REQUIREMENT FROM THE LAST INSPECTION. The registered person must ensure that nutritional screening is undertaken for all service users who have care needs in this area. This must be adequately reviewed DS0000045154.V281491.R01.S.doc Timescale for action 01/06/06 2 OP7 15 (1) (2) 17/02/06 3 OP8 12 30/03/06 Somerset Nursing Home Version 5.1 Page 22 4 OP12 16 (n) 5 OP19 13 (4) (a) 6 OP27 18 (1) (a) 7 OP29 19 8 OP30 12 (b) 9 OP31 12 (a) Records must be maintained of weight, and all appropriate action taken. The registered person must ensure that service users Social interests are recorded within their care plan. Activities must be provided which are suitable for individual service users assessed needs. The registered person must ensure that service users and staff are not placed at risk due to external doors being left open. The registered provider must ensure enough suitably qualified nurses are deployed within the home at all times. Care staff must also be present in sufficient numbers to be able to meet the needs of all the service users. These issues must be maintained from the date of this inspection. OUTSTANDING REQUIREMENT FROM THE LAST INSPECTION. The registered person must ensure that pre employment information relating to new staff commencing at the home is available for inspection. Including evidence of Criminal records Bureau Checks and Protection of vulnerable adults checks. Records unable to be checked must be faxed to the Commission for inspection. The registered person must ensure all care staff receive Training in dementia. Appointed persons first aid training must be provided to ensure that the home has adequate cover. The provider must ensure that there is adequate managerial DS0000045154.V281491.R01.S.doc 01/06/06 31/03/06 17/06/06 17/06/06 30/06/06 10/06/06 Page 23 Somerset Nursing Home Version 5.1 10 OP38 13 (4) (a) cover over a 7-day period. So that the quality of the service does not deteriorate in the acting managers absence. This must be maintained. The registered person must 17/02/06 ensure hairdressing products Within the salon are locked in a cupboard. 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 3 Refer to Standard 14 30 32 Good Practice Recommendations Service users should be able to request to go to bed at a time suitable to meet their needs. Fire training should be increased for all staff. Residents and relatives should be invited to attend regular meetings held within the home to make their views known regarding the services provided. Service users and relatives should be invited to be involved with care plan and risk assessment reviews. Items of jewellery stored in the office, that have been found within the home, and not claimed by service users or their families, should be listed. Company policy should be followed regarding these items. 4 35 Somerset Nursing Home DS0000045154.V281491.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Somerset Nursing Home DS0000045154.V281491.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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