Inspection on 03/04/07 for St Stephens Nursing And Residential Home

This inspection was carried out on 3rd April 2007.

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 Stephens Nursing And... 21/04/09

St Stephens Nursing And... 21/01/09

St Stephens Nursing And... 01/11/05

St Stephens Nursing And... 31/05/05

St Stephens Nursing And... 02/11/04

St Stephens Nursing And... 27/05/04

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

CARE HOMES FOR OLDER PEOPLE St Stephens Nursing And Residential Home St Stephens Nursing And Residential Home 4 St Stephens Avenue Bispham Blackpool Lancashire FY2 9RG Lead Inspector Mrs Jackie Riley Unannounced Inspection 3rd April 2007 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 Stephens Nursing And Residential Home DS0000006087.V331309.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 Stephens Nursing And Residential Home DS0000006087.V331309.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Stephens Nursing And Residential Home Address St Stephens Nursing And Residential Home 4 St Stephens Avenue Bispham Blackpool Lancashire FY2 9RG 01253 352625 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_stephens@btconnect.com Mr Keith Bell Mrs Brenda Christine Bell Mrs Annette Parkinson Care Home 31 Category(ies) of Dementia (31) registration, with number of places St Stephens Nursing And Residential Home DS0000006087.V331309.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st November 2005 Brief Description of the Service: St Stephens Nursing Home is registered to care for up to 31 people with dementia. The home is a detached 3-storey house with a purpose built 2storey extension to the rear. The home is situated in the residential North shore area of Blackpool, close to the seafront, and approximately 10 minutes by car to the town centre. There is good access to local transport networks. There are a full range of appropriate aids and adaptations in place to meet the needs of residents who are frail and immobile. The home has 27 single rooms, 14 with on suite facilities, and 2 double rooms. St Stephens Nursing And Residential Home DS0000006087.V331309.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit for the inspection was undertaken to look at Key Inspection issues. The site visit commenced at 9.30am and took place over a 6 hour period. The Inspector spoke to five staff members, a number of residents and the manager of the home. It should be noted residents living at the home have communication difficulties due to dementia, and physical constraints therefore their comments were limited, however the inspector made direct observations of the interaction between residents and staff throughout the inspection process. The inspection included discussion with five visitors during the site visit and telephone discussion with two relatives whilst preparing for and following the site visit. Comment cards had been received from eight relatives prior to the site visit providing their views about the home. Staff, care, maintenance and financial records were also examined as part of the inspection process. In general comments were positive about how the home is run, and the quality of care, which is provided. A full tour of the premises was undertaken with the manager and maintenance manager. What the service does well: The manager and staff endeavour to make sure residents receive a good quality of life to meet their individual needs. Relatives commented positively about the care their relatives receive, they included, “They provide a good level of emotional support for people in their care”, “Care for my mother when she has been ill has been excellent”, “The staff are very friendly and work hard and have a lot of patience with my dad who can be quite stubborn”. The home encourages residents to live a life, which is flexible, to meet their individual needs and where possible to identify and meet their individual choices. A staff member said, “The residents are so good to work with, they can be challenging but they all have their own personalities, and we try and make sure we know what they like and don’t like so they can enjoy certain things they used to like doing”. Individual residents go out with staff members at times, as many of them used to like going out for walks before they came into residential nursing care. One staff member spoken to said “ we like to take some residents out for a walk if the weather is O.K. they really get some enjoyment out of that”. Observation of care plans confirmed equality and diversity is promoted, so that nobody is disadvantaged. The staff team supporting residents on an individual basis were achieving this by recognising individual cultural and religious needs. Residents living at the home display a challenging mixture of need, due to the range of dementia levels within the home. One staff member St Stephens Nursing And Residential Home DS0000006087.V331309.R01.S.doc Version 5.2 Page 6 commented “ We’ve had training on challenging behaviour and feel well supported in how we manage situations when they happen”. 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. The summary of this inspection report can be made available in other formats on request. St Stephens Nursing And Residential Home DS0000006087.V331309.R01.S.doc Version 5.2 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 Stephens Nursing And Residential Home DS0000006087.V331309.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission and assessment procedures were clear to ensure the care needs of residents are met EVIDENCE: There have been a number of new admissions to the home since the previous key inspection. Three records examined confirmed the home has implemented a new system, which covers all areas of need and review. The records seen showed they were fully completed, with evidence of social work assessments being in place for people living in the home. Staff could describe in detail individual care needs and how they are being met. Staff spoken to said “Its important we get to know all the information so that we can provide the right level of care”. St Stephens Nursing And Residential Home DS0000006087.V331309.R01.S.doc Version 5.2 Page 9 Relatives spoken to commented on how they are informed about the care their relative receives at the home, saying, “ We are told about what my husband needs, and if there are any changes, so I know he is being cared for”, “The staff are very friendly and work hard and have a lot of patience with my dad who can be quite stubborn”. The home does not provide intermediate care. St Stephens Nursing And Residential Home DS0000006087.V331309.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): 7,8,9,10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The promotion of health and personal care is taken seriously so that residents received the right level of care they need. EVIDENCE: Individual records are kept for each resident with a plan of care setting out in detail the action that needs to be taken by staff to ensure all aspects of health, personal and social care needs of the residents are met. Significant events had been recorded and daily entries made setting out the care given, so that there is a clear audit trail of incidents or issues relating to individual residents. The level of dementia is such that it is difficult for the home to work with individual residents in the planning and input into the care plan, however this is not seen to disadvantage the resident as staff endeavour to gain information from relatives and friends to form a personal plan of interests, which can be used in relating events and experiences for the benefit of the resident. St Stephens Nursing And Residential Home DS0000006087.V331309.R01.S.doc Version 5.2 Page 11 Comments received included “we get to know about residents from their relatives, some have had some really interesting lives, and we can help them to remember things about those times”. The records of three residents were looked at. They have been reviewed and clearly described individual healthcare needs so that they can be met by the home. Discussion with staff members confirmed they were fully aware of the healthcare needs of residents and the importance of keeping records under review so that any changes can be identified and responded to. Entries made on care plans show there is good communication between the home and healthcare professionals. The records of one resident showed a need for specialist help for a speech problem and hearing difficulty resulting in a reduced quality of life, this problem had been identified and appropriate action had been taken by the home to make sure the appropriate care and treatment was being received for the benefit of the resident. Observations made demonstrated the staff team respect residents privacy and dignity in all aspects of their care. Some residents choose to stay on their own in lounge areas and their own rooms. A number of visitors were happy to discuss how the home meets their relatives needs and all commented positively about how the staff are so helpful. There was evidence that relatives are informed of any changes that may occur and affect their well being, such as GP appointments or visits and hospital admission, as well as any changes to their level of care.” We are told about what my husband needs, and if there are any changes, so I know he is being cared for”. Medication practices observed were safe and good records had been maintained ensuring residents receive their medication as prescribed for them. St Stephens Nursing And Residential Home DS0000006087.V331309.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): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are helped to exercise choice in their day-to-day lives and meals are wholesome and provide daily variation and interest for people living in the home. EVIDENCE: A three-hour period was spent in the lounge area, where general observation took place between residents and the interaction of staff. It was confirmed the staff team responded positively to residents on an individual basis and treated residents in a dignified manner at all times, and there was evidence residents were comfortable with individual staff members, with some of them enjoying a chat, or a walk around the room, or just held hands with a member of staff which was seen to be providing some comfort to the resident, by way of facial expression and the calmness seen. Staff were seen to have the time to do this, which was a positive outcome for residents. A staff member spoken to stated, “ Residents are so good to work with, they are challenging but they all have their own personalities, and we try and make sure we know what they like and don’t like so they can enjoy certain things they used to like doing” St Stephens Nursing And Residential Home DS0000006087.V331309.R01.S.doc Version 5.2 Page 13 “we get to know about residents from their relatives, some have had some really interesting lives, and we can help them to remember things about those times” There is recognition in care plans of individual cultural references to religious, and dietary needs so that no resident is disadvantaged in a way, if they have a personal cultural preference. This information is clearly recorded on personal plans and staff spoken to are aware of the need to recognise personal choice without being judgemental in any way. One staff member said “ this is covered in induction training when we start work here”. There is a social activity programme based upon daily group activities with staff and entertainment on a monthly basis. There is a flexible approach to this area as residents living at the home have very limited concentration limits, therefore the staff do not want to be rigid in any specific programme. Observations made confirmed the staff encourage residents to move around, have a ‘little dance’, if they wish. This is in addition to some of the organised programmes they use. Staff spoken to say, “ we like to take some residents out for a walk if the weather is O.K. they really get some enjoyment out of that”, “ we spend a lot of time with residents and know what sort of activities they like and don’t like, so we can give them what they need”. “Relatives like to tell us what their relative liked to do socially so we try and cover some of those areas”. The dietary needs of residents are taken seriously. There is a dedicated cook who prepares all meals on the premises and uses fresh produce wherever possible so that meals are nutritionally balanced and meet the medical and cultural needs of people living at the home. Observation took place of residents enjoying a lunchtime meal. This was seen to be pleasantly presented, by staff who took time with individual residents who needed help. There was no evidence of people being rushed and help was only provided if staff thought there was a need. Residents were assisted in a dignified way at all times. The homes laundry programme might benefit from a review in that some comments received included, “Clothes sometimes get lost”, “On occasions there have been times when teeth have gone missing and clothes missing”. This has the potential to cause some anxiety to relatives and attention to detail would reduce this. St Stephens Nursing And Residential Home DS0000006087.V331309.R01.S.doc Version 5.2 Page 14 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for complaints are handled well and taken seriously ensuring people feel listened to. Procedures for dealing with and reporting abuse were satisfactory ensuring people are adequately protected. EVIDENCE: The home has a complaints procedure, which is contained in the homes information literature available to residents and their representatives at the time of the admission process. All comments included in surveys about making complaints were positive. One visitor spoken to said, “I tell the staff or manager if I’m not happy about things”. The home has a record of any concerns and complaints made, how they were investigated and the outcome. There has been one complaint made to the Commission, which was investigated by the care home with written evidence of the outcome, since the previous inspection. The home has a procedure in place for dealing with allegations of abuse. The manager spoken to had a good understanding of the procedures to be followed in the event of any allegations or suspicion of abuse or neglect. There was evidence staff are going to receive further training in this area, when external training is available, however the home does have adequate local authority St Stephens Nursing And Residential Home DS0000006087.V331309.R01.S.doc Version 5.2 Page 15 procedures and guidance in place which is being used as a training tool, so that staff have the knowledge to make sure residents are safeguarded. St Stephens Nursing And Residential Home DS0000006087.V331309.R01.S.doc Version 5.2 Page 16 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): 19,21,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes environment is well maintained and safe for the comfort and benefit of residents living there. EVIDENCE: The home has a dedicated maintenance team, who make sure all areas of the home are maintained to a high standard. At the time of the inspection new windows were being put in place, which replace older and less energy effective ones. One comment received from a relative said, “they are always working on the home to make sure it’s a nice place to live, they can’t do enough”. A full tour of the home was undertaken with the maintenance manager. Resident’s rooms are individual in that personal items of furniture and personal artefacts are encouraged to make the room more homely. Personal features St Stephens Nursing And Residential Home DS0000006087.V331309.R01.S.doc Version 5.2 Page 17 were in place in most rooms thereby helping the resident to feel as comfortable as possible with items from home, which they could relate to. New beds are in place in some rooms and are being replaced on a rolling programme so that they are more suitable to meet the needs of the residents living at the home. Aids and adaptations are in place to meet the needs of the less mobile. Toilets and bathrooms are suitable to meet the needs of residents living at the home, however one comment received suggested, “The home might improve with another disabled toilet for wheelchairs”. There is a toilet off the lounge area, which is used, and it would benefit from another toilet specifically for wheelchair access. This was discussed with the manager of the home at the time and will be fed back to the larger management team for consideration. The home has in place policies and procedures for control of infection, and staff spoke to said they are made aware of the importance of infection control and this is part of the initial induction training programme with further training available so that the staff team work within publicised guidelines. The home was clean and hygienic throughout, as observed throughout the visit. A comment received through the surveys received was, “Dads room is always kept very clean and tidy”. St Stephens Nursing And Residential Home DS0000006087.V331309.R01.S.doc Version 5.2 Page 18 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All areas of staffing procedures are safe and good in order to meet the needs of the residents living at the care home. EVIDENCE: Staffing levels in the home are based upon making sure the needs of the residents are being met at all times. This is organised by the manager of the home, with staff being informed by staffing rota of their working hours. Staff spoken to said “ we can always talk to the manager about our working times and changes can be made whenever possible. Staffing levels seen at the time of the site visit were good, with staff having the time to spend with individual residents, without compromising the needs of others. Recruitment procedures are taken seriously by the home and three staff files seen had in place all recruitment checks so that users of the service are protected. It is recommended staff who have had criminal record checks for more than three years undergo a renewal, for the protection of people using the service. Staff training is seen by the management team as essential in making sure staff have the knowledge and skills to carry out their roles for the benefit of St Stephens Nursing And Residential Home DS0000006087.V331309.R01.S.doc Version 5.2 Page 19 people who live there. Staff spoken to said, “ Training is good here, they make sure we can get on a course if there’s one going”. Staff files contained evidence staff members have attended accredited training in the specialist areas of caring for people with dementia and with challenging behaviour. Staff who have not attended this training know they will be attending the training within a twelve month period. St Stephens Nursing And Residential Home DS0000006087.V331309.R01.S.doc Version 5.2 Page 20 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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed in a way in which it benefits the people who live there and has systems in place for the protection of all users of the service. EVIDENCE: The homes manager demonstrates complete competence in all aspects of the day to day management of the home. Comments received included, “ The manager is always there for you when you need any advice”. Members of the staff team spoke of how well supported they are by the management team, and how an open door policy helps the staff to feel comfortable about discussing anything they feel they need to. St Stephens Nursing And Residential Home DS0000006087.V331309.R01.S.doc Version 5.2 Page 21 The home has an annual development plan in place in order to continue to develop the home to ensure the safety and comfort of the residents. Regular staff and resident meetings are held and recorded and suggestions are carried out if agreed by both parties. One resident spoken to said, “The staff are always willing to listen”. There is a requirement to make sure all monthly inspections by the registered providers are recorded and a copy of the report is kept at the home and is available for inspection, so that there is evidence the home is being overseen by the registered providers. There was evidence all maintenance work and appliance checks were up to date. Recent recommendations made following a fire brigade inspection had been addressed within the specified timescales. Examination of policies, records and information received from the home prior to the inspection confirmed regular tests to emergency lighting, fire procedures and extinguishers had been carried out ensuring the safety and protection of residents and staff is maintained. All records seen were up to date, and whilst there is some transition of records to the new system there were no gaps in any of the essential information, which is required. St Stephens Nursing And Residential Home DS0000006087.V331309.R01.S.doc Version 5.2 Page 22 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 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 St Stephens Nursing And Residential Home DS0000006087.V331309.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP33 Regulation 26 Requirement There must be evidence monthly visits by the registered provider are recorded and a copy is available for inspection so that there is evidence of the providers knowledge about the general running of the care home for the benefit of all users of the service. Timescale for action 30/06/07 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 Refer to Standard OP12 Good Practice Recommendations The home should consider reviewing its laundry procedures to make sure all residents have their own clothes returned from the laundry and reduce to anxiety caused to relatives. The home should consider including an additional ground floor toilet with specific wheelchair access for the benefit of residents with mobility problems. Staff should have renewed ‘fitness’ checks after three years in post for the protection of all users of the service. 2 3 OP21 OP29 St Stephens Nursing And Residential Home DS0000006087.V331309.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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 Stephens Nursing And Residential Home DS0000006087.V331309.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. 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