Inspection on 19/09/05 for St Mary`s Nursing Home

This inspection was carried out on 19th September 2005.

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

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

Other inspections for this house

St Mary`s Nursing Home 11/03/09

St Mary`s Nursing Home 12/03/07

St Mary`s Nursing Home 21/01/06

St Mary`s Nursing Home 20/12/04

St Mary`s Nursing Home 26/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE St Mary`s Nursing Home Montilo Lane Harborough Magna Rugby Warwickshire CV23 0HF Lead Inspector Mrs Suzette Farrelly Unannounced Inspection 19th September 2005 09:30 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 Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Mary`s Nursing Home Address Montilo Lane Harborough Magna Rugby Warwickshire CV23 0HF 01788 832589 01788 832216 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Simon Northover Mrs Beatrice Gooch Francine Parry Care Home 77 Category(ies) of Dementia - over 65 years of age (28), Old age, registration, with number not falling within any other category (49) of places St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The Registered Manager must undertake and complete the Registered Managers Award by January 31st 2007. The Registered Manager must attend some accredited dementia training by December 31st 2005. 20th December 2004 Date of last inspection Brief Description of the Service: St Mary’s care home is set in its own grounds near to the village of Harborough Magna, 5 miles from Rugby. The care home has been developed from the old maternity hospital, and retains some of the character. St Mary’s care home is registered for frail elderly, and older people with dementia. The accommodation is over two floors with all rooms being single en-suite. The home offers all services where possible to meet the needs of the service users. Care is provided by qualified nurses and care staff that have received trained in dementia care. There is a small terrace from the dining room, where service users can sit out, looking across open land. Due to the rural situation the nearest village is approximately 1 mile away. Public transport to the home is limited. St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place from 07:45 hours until 16:30 hours. During this time the inspector spent time on the both units in the home reading records, talking to residents, staff and a visiting GP. Toward the end of the inspection discussion with the registered manager and owner of the home took place. The home was found to be welcoming and apart from an unpleasant smell when entering the Dementia Care Unit the home was found to be clean, free from unpleasant odours and well maintained. No relatives were seen during this inspection. What the service does well: The home has a good pre assessment process and ongoing assessments that enable the staff to determine the needs of the residents. Staff have good communication skills and it was noted that there is a demonstration of warmth and care when interacting with residents and each other. The home manages the care of immobile residents very well and there are no residents with pressure damage. Equipment, risk assessment and preventative care plans were available. Residents spoken to stated that they felt safe and cared for in the home, and that the staff were always kind and available to assist them. The relationship between the home staff and the GP services is very good, where new ways of communicating and ensuring that the residents receive good professional care has been implemented. The home informs and includes residents and their representatives in the decision on how to meet assessed needs of the resident. There is sufficient evidence to show that residents at the home maintain their admission weight and where weight loss occurs the GP, dietician and staff work together to determine the cause and to devise good working practices to encourage weight gain. St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed and a full assessment will take place at the next inspection. EVIDENCE: St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 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): 7, 8 ,9 The residents’ health, personal and social care needs are fully met however the care needs are not fully set out in the individual care plans which might result in inconsistent in the care is given. The residents are protected by the home’s policies and procedures for managing medication. EVIDENCE: Five care profiles were examined in depth, three from the Elderly Frail Unit and two from the Dementia Care Unit. There were pre-assessment in all profiles seen that had been completed prior to admission to ensure that the assessed care needs could be met. A letter was sent to the prospective resident with the Contract of Residency and information related to admission and the care that can be provided. Assessment continues after admission where risk assessments and ongoing evaluation of the effectiveness of care given is carried out. St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 10 All profiles seen had care plans available, these were to the point and written in plain English. All care plans are evaluated monthly and there was evidence that the resident and/or their representative were involved in developing the initial care after admission. It was discussed with the registered manager that changes in residents’ care are discussed with the resident and/or their representative and evidence that this has occurred is available. All residents have a full functional assessment, which is checked each month, there are, however a lack of care plans to deal with issues arising from this assessment. In one case a resident who has anxiety, shouts out, and swears has no suitable care plan to guide the behaviour of staff toward this situation. This could result in inconsistency in approach, which may cause further frustration and anxiety to the resident. It was also found that a resident who is artificially feed had been seen by the dietician and the regime of feeding had been altered, the care plan did not reflect this change and the information in the residents room was also different. It was found that the staff were aware of the new regime, however, this relies on verbal communication and good memory and mistakes could result. Discussion took place with a visiting GP who stated that the home are very good at communicating with his surgery and that between them they have developed a communication sheet which is completed by both the nurse and the GP. This enables the home and the GP to track changes in residents’ health status and treatment that has been given including tests and referrals. Daily records seen were concise and gave information about the residents’ day and their general health. Records showed that residents have access to other health professionals and are assisted to access care from the National Health Service. The home has suitable policies and procedures for the management of medication and the registered manager audits medication administration on a monthly basis giving feedback to the qualified staff on areas that require improvement. There were some creams seen in residents’ rooms that are administered by the care staff during daily hygiene routines. There were no locked facilities seen for these to be stored. The home does not have a procedure for administering over the counter medication to the residents; this was discussed with the registered manager. St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 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): 12 & 13 Residents find that the lifestyle experienced in the home does not always match their expectations and preferences, and does not always satisfy their recreational interests and needs. Residents maintain contact with family, friends and representatives and the local community if they wish. EVIDENCE: An activity profile of all the residents in the Dementia Care Unit was examined and this showed that there are a variety of activities involving small groups and individuals. It was found that the activity organiser for this area works three days a week, at other times there are few activities. This was discussed with the registered manager and the owner of the home. During the inspection no activities were seen. It was also noted that the communal areas in the Dementia Care Unit lacked a homely feel, there were no books, magazines, dolls for doll therapy. There was also a lack of pictures and ornaments. The rooms felt institutional and bear. This was discussed with the registered manager and the owner who stated that this would be looked into. St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 12 The activity organiser for the Elderly Frail Unit has been absent and there was no evidence that any activities have been carried out in this area. Residents were seen sitting in their rooms, in bed or in the communal areas with little if nothing to do. One resident was seen in their bedroom reading a newspaper and watching television, and stated that they were quite happy to entertain themselves. Another resident was seen alone in a lounge area, which had two birds in a cage. The resident stated that they were very noisy and that they did not like them. There were no books or magazines seen and the television was very low making it difficult to hear it. The residents are assisted to receive visitors at any reasonable time, and there was evidence in the profiles of visits and discussion between staff, residents and their visitors. Staff spoken to stated that the residents may receive visitors in the communal areas, the small conservatory or their own rooms. One carer spoken to described taking a resident out shopping, it was noted that staff do take residents either individually or in small groups out to the shops, the local pub and to various local beauty spots. It was discussed that records of this must be maintained. St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 & 18 The residents’ legal rights are protected and they are protected from abuse through the training, policies and procedures and practices in the home. EVIDENCE: Through discussion and records it was noted that the residents are given the opportunity to vote in local and general elections through postal voting or visiting the local polling station. All residents are registered with the local electoral register and the home ensures that those residents who are interested can be involved in the political process. The home acts as the representative for two residents; both have lived at the home for a number of years and have no known relatives. The process of handling their money was discussed and found to be appropriate. There are suitable policies and procedures related to the recognition of abuse and the role of staff in reporting suspicions or actual abuse. The home is presently investigating an allegation of abuse and it was found that they have acted appropriately and in accordance with national and local guidance. The home has a policy and procedure in relation to restraint of residents in certain circumstances. This needs to be evaluated and up dated. The policy discusses forms of restraint such as using a small table and recliners to prevent residents from rising from their chair. This practice is out dated and could be potentially cause accidents. The registered manager assured the inspector that these practices do not take place, and it was not observed red during the inspection. St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 14 The home demonstrated good practices when dealing with other forms of restraint such as the use of bed rails. A full assessment is carried out on the resident and appropriate forms are completed and signed by the home and the resident and/or their representative. St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 & 26 Residents live in a safe, reasonably maintained environment with comfortable indoor and outdoor communal facilities. Resident bedrooms are comfortable, personalised and reasonably maintained. The home is clean, pleasant and most areas are free from odours. EVIDENCE: St Mary’s is situated in the green belt just outside Harbour Magna the nearest town is Rugby. There is no local bus service and residents are taken out using the homes transport. The home has two floors containing single bedrooms with en-suite bathrooms containing toilet, hand washbasin and shower. Nine bedrooms were seen during the inspection and they were found to be in a reasonable state of décor, clean, free from odours and in most cases personalised. St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 16 One room appeared very bare, however, it was noted that the resident tends to hide their personal belongings. It was noted that there are no locked facilities in the residents’ bedrooms for the storage of creams and personal belongings; this was discussed with the registered manager who stated that this would be addressed. It was also noted that there are no locks to bedroom doors, this areas requires attention. There are extensive grounds and the views over the surrounding countryside are far reaching. The gardens are fenced to provide safety for the residents. The smaller area to the rear of the home contains a patio with seating and tables surrounded by raised flowerbeds. There is also a large garden area in the centre of the building, the residents can get into this area through a variety of patio doors leading onto an area where they can sit. The gardens are reasonably maintained, it was noted that the grass was rather long and there was a lack of flowers and character to the larger garden area. There is a dining area and two lounge areas on each unit in the home. A small kitchen area is available off the dining room on both floors. It was noted that the door to this area is wedged open while staff serve meals and drinks. It was also wedged open when no staff were present. This is poor practice and could result in an injury or accident and contravenes the fire regulations. Doors that need to be open must be fitted with a door release that is considered safe and the doors must be closed when staff are not in the immediate vicinity. The home has a full time maintenance person who carries out minor repairs and decorating. The home also has contracts with a variety of suppliers for equipment used in the home. One washing machine has broken and the home now has only one washing machine and one drier, the registered manager and owner must assess that there is sufficient equipment to ensure that the laundry person can deal with all the washing requirements within her working day. St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 & 30 Residents are in safe hands at all times and supported and protected by the home’s recruitment policies and procedures. Staff are trained and competent to do their job. EVIDENCE: The home has a positive view to training staff and 46 of care staff have completed their National Vocational Training at level II or III. There are also four overseas qualified nurses who are working as carers, due to their training they are classed as qualified carer. The home therefore has 61.5 trained care staff. There is also a qualified nurse registered with the Nursing and Midwifery Council on duty in each unit at all times. Five staff records were examined and it was found that all the checks that are required to ensure that staff who are fit to care for vulnerable people are employed had been carried out. Some files were missing copies of identity checks made and did not have a current photograph of the member of staff. Full induction of all new staff is carried out and the completed records of these are kept on file. St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 36 The residents live in a home, which is run and managed well by the present manager ensuring that the home is run in the best interest of the residents and that they are protected through supervision and appropriate policies and procedures. EVIDENCE: The registered manager has been in post since July 2005, she is a qualified nurse with a number of years experience working within the community. Despite not having run a care home before she demonstrated her knowledge of the National Minimum Standards for Older People. Since commencing as the manager she has completed training in Abuse, Adult Protection and Protection of Vulnerable Adults; Dementia care Matters run by St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 19 David Sheard and is due to commence her national Vocational Qualification at level IV in Care Management. She has also recommenced supervision of all care staff, through discussion and records seen it was confirmed that all areas related to philosophy of care, practices and training are covered during these sessions. Relatives and residents have completed a survey of the home’s services earlier this year and the analysis of the replies was seen. Discussion took place on how the information can be used to improve standards in the home and the registered manager was interested in the use of these to encourage changes in practice and delivery of the service. Other areas of residents care are audited monthly such as medication, accidents and incidents and any damage to skin. Audits and monitoring of other areas of the service were discussed and the manager verbally committed to developing this area. The home manages the personal monies of only a small number of residents who do not have any relatives or representatives. Records of all transactions are maintained with corresponding receipts. Most residents and/or their representatives are invoiced at the end of each month for their fees and any other monies spent. St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 2 2 2 X X X 2 X 2 STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 3 3 X St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 21 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 OP7 Regulation Requirement Timescale for action 15/10/05 15(2)(b)(c The registered manager must ) ensure that changes in care are S.3(1)(b) clearly marked in the care plans to ensure that all staff are aware of the care to be given. 15(1) 16(2)(m)( n) 4(1)(c) S. 1(9) The registered manager must ensure that there are suitable activities available for residents and that these occur daily. 2 OP12 31/10/05 3 OP12 A programme of events and 31/10/05 activities must be made available to the residents and or their representatives. The registered manager must evaluate the policy and procedure for the restraint of residents to ensure that all practices are appropriate. 31/10/05 4 OP18 13(6)(7) (8) S. 3(p) St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 22 5 OP19 16(2)(k) 23(2)(d) The registered provider and 30/11/05 registered manager must assess the unpleasant odour in the corridors on the Dementia Care Unit and eliminate this through deep cleaning or replacement of the carpets. An action plan with time scales must be forwarded to the Commission within four weeks. The registered provider and registered manager must ensure that the door to the kitchenette areas on each unit is fitted with appropriate door closure that will react when the fire alarm sounds. This door must also be closed when not in use. The registered provider and registered manager must ensure that there are locked facilities in each room for the storage of creams and residents valuables. There are no locks to the residents’ bedroom doors, the registered provider must consider how this can be rectified and furnish the Commission with a time scale to complete this. The registered provider and registered manager must ensure that there are adequate washing and drying facilities in the home to ensure that the quantity of washing can be completed in the allocated time. 30/11/05 6 OP20 23(4)(a) 7 OP24 16(2)(j) 15/10/05 8 OP24 12(4)(a) 31/12/05 9 OP26 16(2)(e) 13(3)(4)( a) 15/10/05 St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 23 10 OP29 S. 1 7 9 19 The registered manager must ensure that there are up to date photographs and copies of the evidence to establish the individual workers identity in each staff file. The registered provider and registered manager must develop the quality assurance and monitoring systems to ensure that all areas of the service are included. 30/11/05 11 OP33 24 31/12/05 St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP12 Good Practice Recommendations It is recommended that the home develop a policy and procedure for the administration of over the counter medications for residents. It is recommended that the staff record events such as outings and shopping trips in the activities profile to demonstrate that this had taken place. St Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Mary`s Nursing Home DS0000004410.V250927.R01.S.doc Version 5.0 Page 26 - 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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