Inspection on 21/06/05 for Sutton Veny House Nursing Home

This inspection was carried out on 21st June 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Sutton Veny House Nursing Home 11/03/08

Sutton Veny House Nursing Home 20/04/06

Sutton Veny House Nursing Home 19/12/05

Sutton Veny House Nursing Home 24/02/05

Sutton Veny House Nursing Home 27/09/04

Sutton Veny House Nursing Home 26/01/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Sutton Veny House Nursing Home Sutton Veny Nr Warminster Wiltshire BA12 7BJ Lead Inspector Susie Stratton Unannounced 21st June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sutton Veny House Nursing Home Version 1.30 D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Page 3 SERVICE INFORMATION Name of service Sutton Veny House Nursing Home Address Sutton Veny Nr Warminster Wiltshire BA12 7BJ 01985 840224 01985 840627 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Barry Lambert Sutton Veny House Limited Mrs Patricia Gronow Care Home with Nursing 28 Category(ies) of OP Old Age (28) registration, with number TI Terminally ill (2) of places TI(E) Terminally ill - over 65 (2) Sutton Veny House Nursing Home Version 1.30 D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Page 4 SERVICE INFORMATION Conditions of registration: 1 The maximum number of service users who may be accommodated at any one time is 28 of which one person only may be in the age range 60 - 64 years 2 No more than 2 service users with a terminal illness may be accommodated at any one time 3 The staffing levels set out in the Notice of Decision dated 12 September 2003 shall be met at all times Date of last inspection 24th February 2005 Brief Description of the Service: Sutton Veny House is a period house set in its own substantial grounds, providing pleasant surroundings for the residents to enjoy during the better weather. The home provides care with nursing for up to 28 people, in a mixture of single and double rooms over a range of different floors. On the day of the inspection, there were 25 persons resident in the home and the one empty bed was booked for a new admission. The manager of the home is Mrs Patricia Gronow, she leads a team of nursing, care and ancillary staff. The home is privately owned by Sutton Veny House Ltd. The Responsible Individual is Mr Barry Lambert of BML Healthcare Ltd. Their main office is in Poole in Dorset. The home is visited at least once a month by an area manager from BML Healthcare. There is ample parking on site. The home is situated on the outskirts of the village of Sutton Veny, close to the Wiltshire town of Warminster, which also has a range of shops, and a railway station. Sutton Veny is about 10 minutes drive from the A303, which links with the M3. Sutton Veny House Nursing Home Version 1.30 D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place between 1.25pm and 5.40 on a Tuesday afternoon, in the presence of Mrs Susan Nicholls, deputy manager. During the inspection, the Inspector spoke with one other registered nurse, five care staff and a domestic. The Inspector met and spoke with 14 residents, three relatives and observed care for nine residents who were too frail to talk. The Inspector reviewed the care records of four residents whom she had met with, in detail. The Inspector toured the building, reviewed systems and records for administration of medicines, inspected activities records and staff supervision files. Prior to this inspection, the Inspector had met with Mr Lambert, the responsible individual, on 14th June 2005, to discuss proposed improvements to the building. What the service does well: What has improved since the last inspection? The home now ensures that a copy of the summary of the latest inspection report is included in the service users guide, to inform all relevant persons of the home’s response to the National Minimum Standards. All hot surfaces in residents’ rooms which could present a risk have now been covered. A system to ensure that the kitchen is secure is in place. The care planning system continues to be developed and improved. Full social assessments and care plans are now in place for all residents. The owners are considering improvements to the building, including provision of a separate dining room and moving the laundry. Three requirements were identified at the previous inspection, all have been addressed. Eleven recommendations were made, eight have been addressed and the other three could not be assessed as relevant personnel were not on duty during the inspection. These will be reviewed at the next inspection. Sutton Veny House Nursing Home Version 1.30 D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Page 6 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. Sutton Veny House Nursing Home Version 1.30 D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Sutton Veny House Nursing Home D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 4 & 6. Sutton Veny does not provide intermediate care, so this standard is not applicable. Information about the service offered at Sutton Veny is available to all residents. Pre-admission visits are encouraged and full assessments of nursing and care needs are made prior to admission, to ensure that the home can meet the needs of residents admitted to the home. EVIDENCE: A service users’ guide is freely available in the front entrance hall and copies of the guide were observed in some residents’ rooms, it complies in full with standards and regulations. All prospective residents have a full assessment performed prior to admission. One pre-admission assessment had been completed in full by Mrs Gronow, the manager. Assessments from other relevant professionals had also been obtained. One newly admitted resident said that they had visited the home with a family member prior to admission and had been given the choice of two rooms. Another resident said that they had been too unwell to visit the home but that a family member had done so on their behalf. Discussions with residents, staff, observations of care and reviews of documentation showed that the home were able to meet the needs of residents admitted to the home. Sutton Veny House Nursing Home D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 & 11 Residents are supported by an effective assessment and care planning system, however some residents with a high risk of developing pressure damage may be put at risk by a lack of appropriate pressure relieving equipment for chairs. Staff demonstrated that they knew residents well and individual needs for privacy and dignity were met, including residents who are frail and dying. Most systems for safe administration of medicines are in place, but some residents may be put at risk as the home cannot demonstrate that certain residents have been administered their prescribed medicines and one resident’s emergency prescribed drugs and equipment was not securely stored. EVIDENCE: All residents have full assessments and care plans in place, which direct staff on how to meet residents’ individual needs. Care plans are written in approachable English and direct care. Care plans were evaluated regularly and there was evidence of resident and/or relative involvement in care planning. Where residents had complex care needs, detailed records of changes of position and fluids offered and given were maintained. Staff spoken with showed a detailed knowledge of residents’ individual care needs. Residents are all assessed for risk of pressure damage. Where risk is identified, a care plan is in place to reduce risk. All residents assessed as Sutton Veny House Nursing Home D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Version 1.30 Page 10 being at high risk of pressure damage have low airloss mattresses. However such residents generally had cushions on their chairs which were consistent with a medium degree of risk, the reasons for this was not documented in their records. On discussion with staff it appeared that the home only had one low airloss chair cushion in the home. This is of concern as one of the resident’s notes indicated that they had sustained some pressure damage but a low airloss chair cushion had not been considered for them. One resident had clear care plans, which had been regularly evaluated, however a review of their daily records indicated that one of their nursing care needs had changed very recently. Staff were aware of their changed care needs, but their care plan had not been up-dated. The part of the care plan relating to this need was not written in measurable terminology and would benefit from more precise directions on actions to be taken if the residents’ medical condition varied. Records showed that the home worked closely with the local GP service and that other professionals were consulted when needed, for example a physiotherapist had been asked to provide advice relating to one resident recently. One of the residents considered in detail had a wound, there were very clear records relating to the management of this wound and response to treatment. All medicines were securely stored, this included Controlled Drugs. All limited life drugs were dated on opening, so that they were not used after their expiry dates. A total of 20 individual medicines administration records had not been completed, one of these related to Temazepam, a schedule 2 drug. Nearly all of these related to two particular shifts and therefore are likely to relate to one member of staff. If medicines’ administration records are not completed, the home cannot demonstrate that the resident has taken their drugs and if not, why not. One resident had a plastic container left in their room which had testing equipment, including sharps and a prescribed emergency medication. All prescribed medication must be securely stored, in this case if it is needed in an emergency, a locked cupboard in the resident’s room is acceptable. Staff were observed to knock on residents’ bedroom doors prior to entry and called them by their own preferred names. Staff spoken with clearly knew residents’ individual needs and preferences and showed an enthusiasm for ensuring that these needs were met. Sutton Veny is registered to care for residents who have terminal care needs and also cares for some very frail persons. Where residents needed to be cared for mainly in bed, they looked comfortable, with well brushed hair, clean fingernails and hands. On a very hot day, they all appeared to be well hydrated with clean mouths and eyes. Staff responded very promptly to one resident when they said they were in pain. Sutton Veny House Nursing Home Version 1.30 Page 11 D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 A range of recreational activities are offered to residents and clear records are maintained. Visitors are encouraged. Service users could choose how they spent their days. EVIDENCE: An activities coordinator is in post. Her file showed a range of different activities offered to residents. She maintains individual records of assessments for residents’ social care needs, which reflected what the residents said. Records of activities engaged in were also maintained. On the day of the inspection, many of the residents were watching Wimbledon, either on the large screen television in the drawing room or in their own rooms. Some residents said that, now the good weather had come, they liked sitting on the terrace, enjoying the garden. The Inspector met with several relatives who said that they could come and go as they liked. Two said that they appreciated being able to bring the family dog in to visit with them, as it helped their relative. Several residents said that they went out with family members. Residents all confirmed that it was up to them when they got up and went to bed. One resident had rung her bell just before the Inspector came, as they had decided they wanted to be taken out onto the terrace, the said that they knew that staff would take them out, as that was what they wanted to do at Sutton Veny House Nursing Home D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Version 1.30 Page 12 that time. One resident said that they knew that if they wanted to go to bed early, all they had to do was to ring their bell and staff would come and help them. Another resident said “Carers do just what I want”. Many residents have brought items of their own into the home and their rooms were highly personal, reflecting their likes and preferences. Sutton Veny House Nursing Home D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The home has a complaints procedure, which residents reported works in practice. Practice supports an atmosphere to protect vulnerable adults from abuse. EVIDENCE: The complaints procedure is displayed in the main entrance area. Residents spoken with were all confident that if they brought matters up, that they would be addressed. One resident said that they had one carer who they particularly trusted and if they were not happy about something, they waited until they were back on duty and brought the matter up with them. Two residents said that they could tell any of the staff and that they would take action. One said “You can talk to anyone here, they’re so helpful”. Most residents said that they would speak to Matron and that she would make sure that their concerns were met. One said “If I’m not happy about anything, I always tell Matron” and another said “She always sorts things out”. Where residents needed restraints such as safety rails, there were clear individualised care plans in place, these were regularly reviewed. Staff spoken with showed an appreciation of abuse awareness and upholding of individual rights. Sutton Veny House Nursing Home D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 23, 24 & 26 Sutton Veny is well maintained and the owners are seeking to further develop the environment. All rooms are clean, attractive and fully furnished. EVIDENCE: Sutton Veny presented a well-maintained environment. There was only one domestic on duty on the day of the inspection and it was much to the credit of the domestic team that, despite this, all parts of the home were maintained at high standards of cleanliness. One large drawing room is provided, this gives access to a terrace, which overlooks the extensive grounds, which are attractive and well-maintained. Some residents like to sit in the entrance hall, which is provided with seating and chairs. There is a wide range of bathing and toileting facilities, to meet the needs of disabled residents. As Sutton Veny is an older building, all rooms are different from each other in shape and size, some rooms are very large. Where residents share rooms, screening was in use and residents who wished to rest after lunch were doing so in privacy. The owners are investing in new electrically operated profiling beds and all frail residents were nursed in such beds. One resident said how comfortable their Sutton Veny House Nursing Home D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Version 1.30 Page 15 new bed was. All residents had been left with access to the call bell system. One resident used their call bell just before the Inspector visited and it was noted that staff responded promptly. The kitchen can be secured when it is not staffed, however at the time of the inspection, it was not. It is advised that as Sutton Veny can admit persons with dual diagnosis, that staff should always secure the kitchen when it is empty, not only when risk to a resident may occur. The owners have met with the Commission to discuss developments and further improvements to the home, including increasing day space and modernising en-suite facilities for residents. Sutton Veny House Nursing Home D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Sutton Veny are staffing the home as required by the Commission, however full continuity of care cannot be ensured until reliance on agency care assistant staff has been reduced. EVIDENCE: Sutton Veny is required to staff the home in accordance with a Condition of Registration set out by the Commission. They were meeting the requirements of this Condition. A review of the off-duty and staffing records showed that the home continue to use some agency staff, mainly care assistants. The agency record book did show that generally the same staff were booked, this will help to ensure that agency staff are aware of individual resident’s needs and the home’s policies and procedures. Mrs Nichols reported that some new staff had recently been appointed, so she hoped that reliance on agency staff would be reduced in the future. The home does has a stable team of ancillary staff. Sutton Veny House Nursing Home D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 & 37 Sutton Veny has an established system to ensure that staff, including new employees are fully supported in their roles. Policies and procedures are in place to support practice, however residents could be even further supported by review of two specific polices. EVIDENCE: A review of files showed that all staff are regularly supervised. Records were individualised, providing evidence of a range of matters considered by the supervisor and supervisee. One carer said how supported they felt by the manager and that their work was appreciated. Records showed that new members of staff receive formal supervision six weeks after commencing employment. One member of staff was working her first day of employment on the day of the inspection. This person was not in uniform, to make sure that they were not asked by residents to perform any work unsupervised. It was observed that the person worked with at least one senior carer all the time that they were in the home. Sutton Veny House Nursing Home D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Version 1.30 Page 18 All records required by regulation are in place and the home has an extensive policies and procedures folder, which is available to staff. A specific policy on cross-gender care is not in place and as the home does employ male members of staff, this is needed. The home does have a policy on staff uniforms but it should be reviewed to ensure that it conforms to current Health Protection guidelines. It was noted as good practice that the home had put procedures in place to meet a recent hazard warning notice about administration of injection by insulin pens. Sutton Veny House Nursing Home D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION 3 3 3 x 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x 3 3 x Sutton Veny House Nursing Home D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Version 1.30 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 8 Regulation 12(1)(a) 13(4)(c) 15(1) 23(2)(n) Requirement If a service user is assessed as being at high risk of developing pressure damage, pressure relieving equipment which is consistent with the assessed degree of risk must be provided to them. Where such equipment is not indicated for any reason, the reasons for this must be documented in their care plan. Medicines adminstration records must always be fully completed at the time of administration. Prescribed medicines and devices/equipment must always be stored securely. Timescale for action 30 September 2005 2. 3. 9 9 13(2) 13(2) 30 September 2005 30 July 2005 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 2 Good Practice Recommendations The persons registered should include reference to the home’s categories of care in relevant parts of the service user contract. (This was identified at the previous inspection but could not be reviewed as the adminstrator was not on duty) D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Version 1.30 Page 21 Sutton Veny House Nursing Home 2. 3. 4. 7 8 14 5. 6. 19 29 7. 8. 37 37 Care plans should be revised as soon as care needs change. Care plans should be written in measurable terminology and actions to be taken should be written in clear, precise terms. The persons registered should ensure that written evidence of the choices offered to service users at mealtimes is made generally available. (This was identified at the previous inspection but could not reviewed as the catering manager was not on duty) The kitchen door should always be secured when the kitchen is unstaffed. The persons registered should ensure that copies of staff photographs and their letters of appointment are held on individual staff files. (This was identified at the previous inspection but could not reviewed as the adminstrator was not on duty) A policy and procedure on cross-gender care should be developed. The policy on staff uniforms should be reviewed to conform to the current Health Protection guidelines. Sutton Veny House Nursing Home D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Version 1.30 Page 22 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB 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 Sutton Veny House Nursing Home D51_D01_S43651_SuttonVeny_V233667_220605_Stage4.doc Version 1.30 Page 23 - 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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