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Inspection on 20/06/05 for St John`s Nursing Home Limited

Also see our care home review for St John`s Nursing Home Limited for more information

This inspection was carried out on 20th June 2005.

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

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

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

What the care home does well

The service users spoken with were all pleased with the service that they were receiving. All of the relatives who returned questionnaires said that they were satisfied with the care being provided (one relative complained directly to CSCI about the lack of activities and their concerns have been incorporated into this report).

What has improved since the last inspection?

The home has now fully met three more of the outstanding requirements from the last visit. Service user files have also improved, and the premises (the requirements in this report notwithstanding) continue to improve and have become more homely, which has helped to create a pleasant atmosphere. This clearly means that the service users have a much more attractive environment in which to live.

What the care home could do better:

Of most concern at this visit was the deterioration in the staff recruitment process. In spite of previous requirements, it was evident that major oversights were continuing, which puts service users at risk. For this reason, an enforcement notice has been served on the home. There are other areasthat also require improvement. Foremost of these is the staffing numbers, and the provision of suitable activities. There have been 20 new requirements made, however with the exception of those mentioned above they are relatively minor and should not be difficult to achieve.

CARE HOMES FOR OLDER PEOPLE St Johns Nursing Home Limited 129 Haling Park Road South Croydon Surrey CR2 6NN Lead Inspector Margaret Lynes Announced 20 & 21 June 2005, 09:40 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 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. St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service St Johns Nursing Home Limited Address St Johns Nursing Home, 129 Haling Park Road, South Croydon, Surrey, CR2 6NN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8688 3053 020 8688 3053 St Johns Nursing Home Limited Miss Jayanti Bhowanee Care Home 45 Category(ies) of Dementia - over 65 (23) registration, with number Old age (22) of places St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31.1.05 Brief Description of the Service: St Johns is a 45-bed nursing home set in South Croydon. It lies within easy reach of the centre of Croydon, and a selection of public transport links. The home is registered to cater for elderly clients who require general nursing care, (22 beds) and also clients with dementia who require nursing care (23 beds). The stated aim of the home is ‘to provide a safe and comfortable environment with a happy atmosphere’. St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced, and was conducted over the course of two days. During that time a number of records were examined, the premises were inspected and time was spent talking with service users and staff. Due to ongoing concerns regarding the number of unmet requirements, this home received an additional inspection last year. At that visit it was noted that of the fifteen outstanding requirements seven had finally been met, four were partially met while four remained outstanding. This visit showed that three of those unmet requirements were still unmet; while two of the partially met remained that way – indeed one had actually deteriorated. This inspection has resulted in a further twenty requirements being made. The majority of these requirements should not be difficult to meet, and in meeting them the home will improve the overall quality of the service being provided, and improve the well-being of the service users. What the service does well: What has improved since the last inspection? What they could do better: Of most concern at this visit was the deterioration in the staff recruitment process. In spite of previous requirements, it was evident that major oversights were continuing, which puts service users at risk. For this reason, an enforcement notice has been served on the home. There are other areas St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 Page 6 that also require improvement. Foremost of these is the staffing numbers, and the provision of suitable activities. There have been 20 new requirements made, however with the exception of those mentioned above they are relatively minor and should not be difficult to achieve. 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. St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 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 standard(s) 3 (6 is not applicable) Pre-admission assessments were being carried out, either by the home or by the Placing Authority, so that the needs of potential service users were identified. This means that the service user can be reassured that the home has taken into account their individual needs, and feels that it can meet them; and the staff in the home can be as familiar as possible with new service users, and have an understanding of what specific service they will need to provide. EVIDENCE: The files of nine service users were examined. While not all of them contained an in-house assessment, those without contained information from the placing authority or, in some cases, the home that the service user had transferred from. Some of the in-house assessments were better completed than others – in many instances just single word answers had been recorded. Now that staff are more accustomed to the need for thorough assessments, the manager should consider ways in which the assessments can be improved. St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 and 10 The service user plans seen adequately covered the health, personal and social care needs of the service users. This means that the staff team are aware of the differing needs of their residents, and know what specific care needs to be given. The manager must ensure, however that these plans are regularly reviewed so that any changing needs are identified and steps taken to meet them. Staff ensure that each resident is able to access community based health facilities as and when required which ensures that their healthcare needs continue to be responded to in a timely manner. Due to a number of errors being found in the medication administration records, the Inspector was not satisfied that the service users well being was adequately protected in this regard. Clearly any mistakes in giving out medication can have serious consequences for the service users. From observation and discussion, service users were treated with respect, and their right to privacy was upheld. St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 Page 10 EVIDENCE: The files of nine service users were inspected. There was good documentation in each of these. Supplementing the care plans were a number of assessments, including those for pressure areas, dependency, moving and handling and leisure activities. In discussion with one service user it was clear that the armchair provided was not suitable. For this reason the proprietor needs to obtain a reclining chair which should enable to the service user to sit out in comfort. Several gaps were found in mediation administration records, as were a number of instances were staff had clearly signed to say that they had given medication, but then had overwritten their signature to say that the drugs had not been given. This implies that staff are signing the records in advance, which is unacceptable. There was also one instance where staff had not given an explanation (as required) for the code used on the chart. From observing the interaction between the staff and the service users, and having also talked to a number of service users it was evident that they felt that they were being treated with respect and that their privacy was upheld as much as was possible. St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 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 standard(s) 12, 13, 14 and 15 Although the staff do provide a number of activities, the lack of a designated activities co-ordinator does mean that there is not always enough stimulation for service users. This can have a detrimental impact on the physical and mental well being of the service users. Service users maintain contact with their families and representatives who are encouraged to visit. Service users receive a wholesome and appealing diet at times convenient to them. However for those service users who require assistance with feeding it is important that staff endeavour to make their experience as positive and enjoyable as possible. EVIDENCE: Nine relatives and four residents kindly took the time to complete questionnaires prior to the inspection. They all expressed their satisfaction with the home. However although the staff do provide a number of activities, the lack of a designated activities co-ordinator does mean that there is not always enough stimulation for service users. This was a view shared by a number of relatives and residents. Staff endeavour to complete a form listing service users activity St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 Page 12 preferences, with assistance from both service user and relatives if possible, so that they can be aware of each individual’s wishes. The lunchtime meal was sampled and was well prepared and appetising. Service users said that they found the food to be good however it was disappointing to see one member of staff standing over a service user to feed them, rather than, (as good practice requires) sit down to assist them with their meal. St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 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 standard(s) 16 and 18 The home has a satisfactory complaints procedure in place, which is accessible to service users. There was an adult protection procedure in place which was incorrect, and would not offer sufficient protection to service users. This was compounded by the unsatisfactory recruitment procedures– see comments in Standard 27. EVIDENCE: The home had received one complaint since the last inspection visit. This was quickly and satisfactorily resolved. CSCI received one complaint from relatives regarding the lack of activities. This complaint is upheld and comment has been made in the previous section regarding this. Following previous requirements the home did update its POVA procedure however on this visit, for some reason, the procedure contained in the policy and procedure manual was an old version which stated that the proprietor would review and report of abuse, and investigate it. This is contrary to the Local Authority procedure and needs to be amended. It had also been previously required that the restraint procedure be amended. This has yet to be done. St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 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 standard(s) 19, 22, 24 and 26 The vast majority of the home was in a good state of repair, and once the minor issues have been dealt with, the home will fully meet the need to provide a safe and well-maintained environment which is clean, pleasant and hygienic. EVIDENCE: A tour was made of the communal areas and a number of the bedrooms. The environment of the home was pleasant, however it should be noted that two requirements made with regard to the premises at the time of the last two inspections have still not been met. Seven areas of repair were identified, the areas of repair are listed in the requirement section at the end of this report. None of the issues are major and it is expected that they will be dealt with promptly. With the exception of one shower room, the communal areas were clean, pleasant and hygienic, as were the bedrooms that were visited. A number of bedrooms are en-suite but there are a sufficient number of toilets in the St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 Page 15 communal areas. There are ample bathing facilities. While the home does have specialist equipment it was not felt that there was a sufficient supply of (service user) transfer slings, and the home would benefit from an additional hoist. Service users are able to bring in their own personal possessions, and it was nice to see rooms outfitted with furniture brought in by the residents. There is an ongoing need for the home to purchase hospital type beds, as the divans that are still widely used are not suitable if service users need to use to hoist to be lifted. All of the service users spoken with commented that they were comfortable in their rooms. St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 While there were usually enough staff on duty, there were occasions when the numbers fell below the minimum levels previously agreed. This means that the needs of service users cannot always be attended to promptly. In spite of previous requirements, the home had not improved its recruitment procedures, in fact they had notably deteriorated. This means that new staff are not properly vetted before being appointed, which places the service users at unnecessary risk. The home has employed a large number of new staff recently but not all had been inducted. This means that they will not be familiar with the home, or the standard of care they are expected to provide. This, in turn, will mean that the quality of the service provided to residents may be diminished. EVIDENCE: The rotas for two weeks were examined. On one occasion there was a shortfall of one qualified nurse on a morning shift, while on eight occasions there was a shortfall of one carer on duty. This is an issue which has been frequently raised with the proprietor, and it is disappointing to have to raise it again. Any further failure to meet the minimum levels could lead to enforcement action being taken. The quality of staff recruitment is another issue that has been raised on frequent occasions. It was of great concern to find on this visit that the standard had noticeably decreased. The files of 18 new staff were examined. St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 Page 17 Of these, nine had commenced work in the home prior to CRB/POVA checks being carried out, although they were now in place. A further six staff were working in the home without either of these checks. Eleven staff had failed to supply the required two references, while there was no clear evidence that all staff who needed a work permit had one. Additionally, a number of the new staff had failed to complete a health declaration, or supply a complete work history. Files for a further seven new staff could not be found. This is unacceptable and an enforcement notice has been served. There was evidence on some of the new staff files that the staff concerned had received an induction to the home however there were a number of files where there was no information to suggest an induction had been provided. Staff training undergone in the past year included first aid, dementia, continence, COSHH and moving and handling. Although requested, information regarding the number of carers who have achieved an NVQ level II award was not provided. St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 37 and 38 Regrettably the Registered Manager was unable to be present for this visit. The home was being ably managed by the deputy however. The Inspector was not satisfied that the rights and best interest of the service users were adequately safeguarded due to poor record keeping in some areas. The lack of up to date risk assessments for both individual service users and the premises in general, indicated that the home was not being maintained to an appropriate level of safety, thus putting service users at risk. EVIDENCE: While the deputy manager is more than competent to manage the home in the absence of her senior, it would be helpful to her, and indeed to all of the senior staff team, if the manager looked at ways to delegate more of her responsibilities. This would thus assist these staff when having to cover for the manager. St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 Page 19 It was not possible to assess either Standard 33 or 35, as the relevant documents were not available. Additionally, the Inspector was unable to find copies of all Regulation 26 visit reports. While the home does have comprehensive risk assessment documentation in place, this has not been thoroughly reviewed for over a year, in spite of previous requirements to this effect. The Inspector could not find any evidence that risk assessments had been carried out on service users. The home does not have a current electrical installation safety certificate in place. This must be rectified. St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 x x 2 x 2 x 2 STAFFING Standard No Score 27 2 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x 3 x x x x 2 1 St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? 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 9 Regulation 13 Requirement The manager must ensure that medication administration records are accurately completed at all times. The manager must ensure that an adequate number of activities are provided for service users. The POVA and restraint procedures must be amended. The previously set timescale has not been met. Staff must ensure that extractor fans are periodically cleaned. A number of fluorescent lights require diffusers. Staff must ensure that the inside of the microwave oven is regularly cleaned. Staff must ensure that emergency bell cord pulls are within reach at all times. Additional (service user) transfer slings must be purchased so that there are sufficient on each floor. Staff must ensure that all overbed light cords/switches are within reach of service users whilst they are in bed. The previously set timescale has not been met. The sink surround in bedroom S2 G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Timescale for action 21/6/05 2. 3. 12 18 16 13 31/7/05 31/7/05 4. 5. 6. 7. 8. 9. 19 19 19 19 22 24 23 23 16 13 23 23 21/6/05 31/7/05 21/6/05 21/6/05 31/7/05 31/7/05 10. 24 23 31/7/05 Page 22 St Johns Nursing Home Limited Version 1.30 11. 26 16 12. 13. 14. 26 27 29 23 18 19 15. 30 18 16. 37 17 17. 38 13 18. 38 13 19. 20. 38 38 13 13 must be repaired/replaced. The previously set timescale has not been met. Staff must ensure that clinical waste bags are regularly removed to the exterior waste bins so that they do not cause an odour within the home. The manager must ensure that staff have access to sufficient stocks of disposable gloves. The proprietor must ensure that minimum staffing levels are met at all times. The proprietor and manager must ensure that they obtain all of the required documentation for new staff prior to them commencing work at the home. The manager must ensure that all new staff receive a suitble induction and that this is recorded. The manager must ensure that the required records are maintained to a satisfactory standard, this includes the need to have a photograph of each service user. The manager must ensure that appropriate risk assessments are carried out, and regularly updated, for each service user. The manager must ensure that a risk assessment is carried out re the premises and that this is regularly reviewed. The proprietor must ensure that the home has a current electrical installation safety certificate. The manager must ensure that the bath hot water temperature does not exceed 43C (on this visit it was measured at 45C). 21/6/05 21/6/05 21/6/05 21/6/05 21/6/05 31/7/05 31/7/05 31/7/05 31/7/05 21/6/05 St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 Page 23 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. 4. 5. 6. 7. Refer to Standard 3 7 15 22 22 22 32 Good Practice Recommendations It would be good practice to review the pre-admission methodology to seek ways of making it more comprehensive. The manager should ensure that all care plans are regularly reviewed, and that this is recorded. It would be good practice for staff to sit with, rather than stand over, service users when assisting them at mealtimes. It would be helpful to service users if handrails could be fitted in all corridors. It would be beneficial to both service users and staff if the home purchased an additional hoist. There remains an onging need for more hospital type beds to be purchased. The manager should consider ways of delegating more responsibility to senior staff so that they have a better understanding of the complexities of the role of manager and can feel better prepared to deputise in the managers absence. The manager should ensure that she has a copy of the report of each Regulation 26 visit. The proprietor should obtain a reclining armchair so that a service user (identified to the care staff) can sit out of bed in comfort. 8. 9. 37 8 St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 8th Floor, Grosvenor House 125 High Street Croydon CR0 9XP 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 St Johns Nursing Home Limited G53-G53 S19041 stjohnsnh V178405 200605 stage 4.doc Version 1.30 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. 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