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Inspection on 06/03/07 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 6th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

During the inspection the opportunity was taken to talk briefly with several residents. In spite of the shortcomings in a number of areas, they said that they were happy with the service they received. They felt that the carers in particular were kind and gentle, and treated them with respect.

What has improved since the last inspection?

Over the course of the last ten months, since the first key inspection, progress has been made with the majority of the requirements that have been made. While the home continues to perform poorly in a number of key areas, it is acknowledged that it has improved in others. Particular praise must be given to the recruitment of an activities co-ordinator, who has made a tremendous difference to the home. It is to be hoped that one a Registered Manager is in post, the home will be able to achieve some stability, which will allow it to focus on further sustained improvement.

What the care home could do better:

It will be noted that while several of the Standards have been given low `scores` (see last section of this report), there are no corresponding requirements, as would perhaps be expected. This is because on this visit it was evident that action was being taken with regard to, for example, the hot water temperature and the recruitment of a manager, but the overall performance of the home with regard to some Standards has been poor. The registered person must make a concerted effort to both ensure that the requirements that have been made are actioned, and to ensure that improvements that have been made are sustained and built on. This report contains three new requirements and two outstanding. The former relate to the need to ensure that complainants can feel as though their concerns will be appropriately dealt with, without the perception that they will in some way be penalised for complaining; the need to ensure that the quality assurance system is completed and introduced as soon as possible; and the need to ensure that the accident book is fully completed at all times. The two outstanding requirements relate to medication recording and recruitment.

CARE HOMES FOR OLDER PEOPLE St John`s Nursing Home Limited St John`s Nursing Home 129 Haling Park Road South Croydon Surrey CR2 6NN Lead Inspector Margaret Lynes Key Unannounced Inspection 10:15 6th March 2007 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 St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St John`s Nursing Home Limited Address St John`s Nursing Home 129 Haling Park Road South Croydon Surrey CR2 6NN 020 8688 3053 020 8649 9611 primecare@hotmail.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) St John`s Nursing Home Limited Care Home 45 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (22) of places St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th November 2006 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. At the time of this inspection the home was without a registered manager. The home provides information about its services in a Service User Guide, which is made available to current and potential Service Users. Additional information can be found in the home’s Statement of Purpose. The home has an inspection report on display in the lobby (unfortunately it was over a year old and should be replaced by the most recent report). The current weekly fees (as provided at the time of this inspection) range from £525 - £675. St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was carried out by two Commission officers – Ms Lynes (Lead Inspector) and Mr Town (Regulation Manager), and consisted of examination of paperwork, discussion with service users and staff, and a tour of part of the premises. The focus of the visit was to inspect the key Standards where there have been repeated requirements - more specifically the Standards relating to staff recruitment, quality assurance, the environment, medication administration, and the day-to-day management of the home. This visit was the culmination of a number of inspection visits carried out over the past 10 months, since the key inspection in April 2006. A total of four random inspections have been carried out, plus a further two additional visits. This is a reflection of the ongoing concerns the Commission has regarding this home. Following the key inspection in April 2006, a total of eight requirements were found to be unmet from previous inspection visits, while some 9 new requirements were made. The follow up random inspection visit on 6th June found that eleven of these seventeen requirements were still unmet. This resulted in a further random visit on 3rd July. Of the eleven requirements that were found not to have been met at the aforementioned June visit, the timescale for compliance for five of them had now been reached. Of these five, progress had been made with regard to two, although they had not been fully met; one had been met, whilst two remained unmet. The failure to ensure all outstanding requirements had been met necessitated a third random visit on 5th October 2006. An improvement was noted on this visit, as action had been taken to meet eight of the outstanding ten requirements. The unmet requirement that was of most concern to the Commission was the ongoing failure of the proprietor to appoint a Manager for the home, following the resignation of the Registered Manager in January 2006. This October visit also led to eight new requirements being made. A fourth random visit was made to St Johns on 30th November Of the two outstanding and eight new requirements that were in the report of the inspection visit conducted on 5th October, it was noted that action had been taken to comply with three of them. The two regarding the premises, and one regarding staff recruitment were not inspected on this occasion. It was also found that the home was in the process of taking the necessary steps to comply with the requirement regarding the bedside lamps, and the registration of a new manager. Staff had also removed the portable electrical heaters from bedrooms as the central heating was now operating satisfactorily. Just one of the requirements inspected was not met, and this related to medication St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 6 administration. This requirement had yet again not been actioned, and it was evident that much more vigilance was required. Mention has been made of two additional visits that were also made to the home. These were as a result of complaints received by the Commission. A total of seven complaints have been received over the course of the current inspection year. The vast majority of these related to staffing issues, in particular substandard recruitment practice. One related to a number of concerns regarding to care issues. All of these complaints were, in part, substantiated, and requirements made where appropriate. Two Statutory Enforcement Notices have been served on the home in this current inspection year (and indeed two were also served in the previous inspection year). Both related to unacceptable recruitment practice. The Commission has also had to notify the proprietor that the behaviour of a number of his representatives towards Inspectors was unacceptable, and bordered on obstruction of the inspection process. If all of the issues raised in these aforementioned visits are considered collectively, there is clear reasoning why it was found necessary to conduct a second key inspection within one inspection year – hence this visit. The overall outcome is that while there has been further improvement in key areas, it is also clear that the home still must both improve and sustain the quality of its overall service. In doing so it will move closer to providing a service that meets the minimum Standards. A key inspection will be carried out within the first quarter of the forthcoming inspection year. It is to be hoped that further improvement will be noted at that stage. What the service does well: What has improved since the last inspection? Over the course of the last ten months, since the first key inspection, progress has been made with the majority of the requirements that have been made. While the home continues to perform poorly in a number of key areas, it is acknowledged that it has improved in others. Particular praise must be given to the recruitment of an activities co-ordinator, who has made a tremendous difference to the home. It is to be hoped that one a Registered Manager is in St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 7 post, the home will be able to achieve some stability, which will allow it to focus on further sustained improvement. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 8 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 St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (excellent, good, adequate or poor). This judgement has been made using available evidence including a visit to this service. EVIDENCE: These standards was not assessed on this visit. St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 9 and 10 standards 7 and 8 were not assessed on this visit Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Not all the residents can be assured that the home’s procedures for dealing with medication are sufficiently robust enough to protect them at all times Residents were confident that the staff would treat them with dignity and respect EVIDENCE: All of the medication administration charts were examined. The Inspectors raised a number of queries with one of the trained staff, as it was apparent that in some cases there was no clear or consistent methodology in place. For example, on one chart the medication was being given at a time different to that stated on the prescription. The nurse explained that this had been discussed and agreed with the GP and the morning; midday and evening times stated on the administration record had been crossed through. Unfortunately St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 11 this agreement with the GP had not been recorded anywhere. A similar query arose with another chart, where medication was not being given at the time stated. Although the nurse had previously explained that the procedure was for staff to cross through the times that were not needed, this procedure had not been followed in this instance. There was similar confusion regarding the codes used to indicate where medication had not been given. The administration records included, at the bottom of each sheet, the codes to be used. The home had also introduced its own coding system, which meant that staff were using different codes to indicate the same thing. Staff were advised to ensure that there was one, simple, easy to understand procedure that staff could consistently follow. The Inspectors were pleased to be able to talk with two service users. Both expressed their satisfaction with the care that they received. Staff were observed helping service users at lunchtime, and it was pleasing to note that they sat with the residents, and helped them to eat their meal at a pace to suit the resident and not the staff. Staff appeared aware of the need to treat residents with respect and with dignity. The home arranges for residents to enjoy the privacy of their own rooms and provides screens in shared rooms. St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (excellent, good, adequate or poor). This judgement has been made using available evidence including a visit to this service. Not assessed on this visit. EVIDENCE: St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate 16 and 18 This judgement has been made using available evidence including a visit to this service. Not all residents or their relatives are confident that their complaints will be listened to and taken seriously and acted on. Residents can generally be assured that the policies and procedures to protect them from abuse are in place. However this may be undermined if residents or their families do not feel confident to raise concerns or complaints with staff or management. EVIDENCE: While there had not been any recorded complaints at the home for several months, as mentioned in the summary at the start of this report, the Commission has received seven complaints regarding staffing issues (particularly recruitment) and general care practice. The views from residents and their relatives as to how well the home deals with complaints were mixed. At one extreme Inspectors were told that complaints were not made for fear of retribution, while at the other end of the scale it was commented that complaints never had to be made, but if they St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 14 were, the person commenting felt that the home would deal with them appropriately. The inconsistency in the responses received, indicates that the staff and management team need to communicate to residents, families and staff more effectively that they will deal with complaints in a quick, transparent and nonjudgemental way. Historically, there have been concerns with regard to staff awareness of adult protection policies and procedures, and also with the way possible abuse cases have been dealt with by senior staff. While there were no specific issues raised at this visit, it is advisable for the home to ensure that all staff receive regular protection of vulnerable adult training. The policies and procedures regarding protection of residents are satisfactory and are reviewed and updated in line with regulations and other external guidance. Within the policy it is clear when incidents need external input and who to refer the incident to within external agencies St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Residents cannot always be assured that they live in safe environment as there has been considerable potential risk to service users from excessively hot water from taps in their bedrooms and bathrooms. EVIDENCE: On this visit the general environment as such was not inspected, and these comments relate purely to the issue regarding the temperature of the hot water. As a result of a complaint, an additional visit was undertaken on 5th January 2007. The hot water temperature in the bathrooms, showers and bedroom St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 16 sinks was measured. It was of considerable concern to find that in a number of the outlets, the water temperature was in excess of 50˚C. This was the highest reading that the available thermometers could give. The senior staff were made aware of this risk to service users. It was investigated and identified that an emersion boiler heater had been switched on which had affected the temperatures of the water. Prior to leaving the home it was confirmed by the handyman that the water temperature had now reduced. On a subsequent visit to the home on 30th January, the water was tested again and in some of the outlets it was still in excess of 50˚C. While it is acknowledged that there were some teething problems with new boilers, the fact that the staff in the home did not react proactively to address this issue. Records of the water temperature were not consistently undertaken which resulted in the water remain overly hot for a number of weeks. It was noted on this visit that engineers were actually at work on the system installing mixer valves , and the water temperatures tested by the Inspectors was greatly reduced (indeed in some outlets it was now too cold). St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Generally residents can be assured that their needs will be met by the correct numbers and skill mix of staff. Residents cannot be confident that they will be protected by the home’s recruitment practice EVIDENCE: A number of rotas were provided for inspection. One of these indicated that on one shift, there was only one qualified nurse on duty, instead of the minimum two. As this pertains to the rota for the week after this inspection however, it is feasible that the necessary amendment will be made. While no requirement has been made therefore, the registered person is reminded of the absolute necessity of ensuring that minimum staffing levels are maintained at all times. Some ten staff files were inspected. Most were complete, however in some of them, parts of the documentation required by the regulations was missing. This included health declarations; photograph; reference, current residents visa (or evidence that a new one had been applied for); and full employment histories. St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 18 Whilst it may seem that these omissions are relatively minor, they are indicative of an ongoing failing by the registered person to ensure that the recruitment procedure in the home is satisfactory. That having been said, in spite of these omissions there was evidence of improvement . However improvements in recruitment practice in the past have not been sustained. The service has consistently failed to meet minimum recruitment standards, with shortfalls in recording and process being evident. This is not helped by low retention of staff which results in a continuous recruitment programme. Unfortunately, on one of the additional visits to the home it was identified that one new member of staff had been allowed to start work before the home had obtained appropriate police check clearance.(a POVA 1st ).This failure to ensure adequate vetting of new staff places service users at a risk and is entirely avoidable. As this is not the first occasion that this has occurred it may result in enforcement action being taken against the home. St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The residents cannot be assured that they will benefit from a well managed home, as the home has been without a registered manager for over 12 months. Residents cannot be totally confident that their health and safety will be adequately protected. EVIDENCE: St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 20 It is acknowledged that the registered person has now submitted an application for the registration of his nominated manager. What was of concern to the Commission was the length of time this took to occur, in spite of a number of reminders. The repeated requirements and ongoing failure regarding recruitment, for example, are indicative of a service that has not been able to benefit from consistent leadership. After much discussion with senior staff on previous visits regarding quality assurance systems, some improvement was noted on this visit. Further advice was given regarding the importance of triangulating the information that is collected, and using it to further improve the service being provided. The manager-designate was also advised to make better use of the Regulation 26 visits, and it was suggested that each visit could be used to examine a particular quality ‘theme’. The accident book was examined and a query raised regarding one entry where there was no record of the action taken or the outcome. The senior staff were reminded that this is a record required under the Regulations and as such it must be fully and accurately maintained. St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X X STAFFING Standard No Score 27 3 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X X X 2 St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 22 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 OP9 Regulation 13 Requirement The registered person must ensure that all medication administration records are accurately completed at all times. Previous timescale not met. The registered person must ensure that all recruitment documentation is obtained and available for inspection. Previous timescale not met. The registered person must ensure that complainants are confident that any issues they raise will be appropriately investigated, without the perception of possible repercussions. The registered person must continue to develop the quality assurance systems so that accurate monitoring of performance against the home’s stated aims and objectives can be achieved. The registered person must ensure that the accident book is accurately completed at all times. DS0000019041.V331560.R01.S.doc Timescale for action 06/03/07 4. OP29 19 06/03/07 1. OP16 22 06/03/07 2. OP33 24 28/03/07 3. OP38 17 06/03/07 St John`s Nursing Home Limited Version 5.2 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. Refer to Standard Good Practice Recommendations St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St John`s Nursing Home Limited DS0000019041.V331560.R01.S.doc Version 5.2 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!