Inspection on 02/08/05 for The Conifers Nursing Home

This inspection was carried out on 2nd August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

The Conifers Nursing Home 11/12/06

The Conifers Nursing Home 24/01/06

The Conifers Nursing Home 11/11/04

The Conifers Nursing Home 28/04/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE The Conifers Nursing Home 18 Johns Lane Great Wyrley Walsall West Midlands WS6 6BY Lead Inspector Lynne Gammon Unannounced 2 August 2005 - 11.30am 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. The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Conifers Nursing Home Address 18 Johns Lane Great Wyrley Walsall West Midlands WS6 6BY 01922 415473 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) Sovereign Health Care Associates Ltd Fabienne Harris CRH 34 Category(ies) of OP - 34 registration, with number PD(E) - 34 of places The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11 November 2004 Brief Description of the Service: The Conifers is currently registered to admit 34 elderly persons, and elderly with physical disabilities. A 34-bedded nursing home situated in Great Wyrley, close to Cannock and Walsall, all major road and rail networks, and a regular bus service, making access easy for visitors and staff. The home is a twostorey building, purpose-built in 1986 and located in a built-up housing estate with adjacent parking. Work is currently taking place to convert and extend the home to increase beds to 40. The provider and care manager have been working with the CSCI in implementing the building and commissioning process. The current proprietor Mrs Kandola has run the home since April 2003. The home currently has 30 bedrooms of which 26 are singles and four are doubles, the majority having en-suite facilities. The conversion is planned to provide 36 single and two double bedrooms. There are two lounges and two dining areas. Other services include a hairdressing area, and garden/patio facilities. All areas of the home have access via stairs, passenger lift and chair lift. There is also an annex housing a training and office suite, extensively used as a nationally accredited staff training school. All staff receive formal training and are qualified to, or training towards NMC or BTEC standards. The Conifers is a member of the Investors In People Award. The management of the Conifers Nursing Home is committed to maintaining quality systems that support the care of the service users. Teams of trained staff led by Registered Nurses deliver care. The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit was made on the 1st August 2005 at 10.30am. The inspection was carried out by one inspector who used the National Minimum Standards for Older People as the basis for the inspection. The total time spent for the inspection, including pre and fieldwork, amounted to 7 hours. The registered care manager, an RGN, was in charge of the home on the day of the inspection, plus 1 trained staff and 6 care assistants in the morning, 1 trained staff and between 4 and 5 care assistants in the afternoon and 1 trained staff and 2 care assistants on night duty. Other ancillary staff on duty that day included: 2 office administrators – 1 full-time and 1 part-time, an activities co-ordinator, a training manager, a cook, an assistant cook, 2 domestics, a laundry assistant and a maintenance person. There were 32 residents living in the home at the time of the inspection and these staffing levels were satisfactory to meet their needs. The inspection included a tour of the building, inspection of records, observation, and discussions with residents, staff and the registered provider. Since the last inspection on 11th November 2004, there had not been any complaints or incidents of alleged abuse received by the home or the Commission for Social Care Inspection. No requirements were raised at the previous inspection and no recommendations against the minimum standards, were outstanding from the last inspection report. Service users had been able to make a decision about the home following an assessment and invitation to visit prior to moving in. Care plans had been well written and health, personal and social care needs had been met and well documented. All aspects of service user privacy, dignity and choice were supported and endorsed. Service users confirmed that they were treated with dignity and respect and they and their relatives spoke highly of the quality of care provided by the staff. At the time of the inspection, the home was in the middle of a major conversion and refurbishment programme and some disruption was observed, but every effort had been made to keep this to a minimum as much as possible. A safe and happy environment had been maintained for the service users throughout the on-going building work and service users and their relatives had been consulted throughout the building programme. Service users confirmed that they were looking forward to newly refurbished bedrooms and communal areas. The standard of the conversion and redecoration that had already been completed at the time of the inspection was very good and once the programme is finished, the service users will benefit from a bright, The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 Page 6 beautifully decorated home with a high standard of quality furnishings and fittings. The condition of the existing bedrooms and communal areas were satisfactory but, as would be expected, were overshadowed by the newly decorated areas. The kitchen was also due to be completely refurbished and was therefore not inspected on this occasion but menus were seen to be varied and nutritionally balanced, with choices available to meet a range of needs. The home was well managed and organised, and service users were able to make their own choices and decisions about the day-to-day activities within the home. Good robust systems were in place to obtain service user feedback about the services provided within the home and records showed that this feedback was taken into account and actioned accordingly. What the service does well: What has improved since the last inspection? What they could do better: Two requirements have been raised as part of this inspection. Staff must ensure that administered medicines are recorded at all times and photographs of each staff member and proofs of their identity should be obtained to ensure the continuing protection of the service users. The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 Page 7 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 Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 5 Initial assessments were carried out for prospective service users who received confirmation that their needs would be met. They were also invited for a trial visit to enable them to make an informed choice about the home. EVIDENCE: Documentation evidenced that the registered care manager or her deputy carried out in depth pre-admission assessments providing a comprehensive understanding of the needs of the individual. Trial visits were available to all potential service users who were invited to visit the home, have a look around with their relatives, to have lunch and/or stay for a few hours. Some service users who were spoken to confirmed that they had been able to visit the home before choosing to stay. A trial period of 6 weeks also enabled service users to decide if the home was right for them. The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 The care planning processes within the home were clear and concise providing adequate information for staff to meet the needs of the service users. The administration and handling of drugs was overall well managed and documented to protect the service users but needed to be more stringent in the recording of drugs administered. Service users were treated with dignity and respect and their requests for privacy supported. EVIDENCE: Two service user care plans were examined and were well documented, meaningful and reviewed at least monthly. Risk assessments were completed and reviewed regularly. The health, personal and social care needs of the service users were well documented and up to date. There was extensive evidence to show that service users had access to a wide range of health professionals such as the dentist, clinical nurse specialists e.g. continence nurse, diabetic nurse, tissue viability nurse, and also the speech therapist, chiropodist, GP, etc. Daily diary records detailed future appointments with health professionals, dressing information, blood samples, prescription changes etc. The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 Page 11 Overall, on inspection, there was a well-organised system for the receipt, storage and administration of medicines. All documentation was checked, however a few gaps were identified in regard to the recording of administered medicines. It is a requirement of this report that the correct recording of administered drugs is maintained at all times to ensure the on-going protection of service users. The inspector discussed the issue of the disposal of medicines with the registered manager following the termination of the service previously carried out by the local community pharmacy. A contract had been set up with a waste disposal company to remove the medicines from the Conifers and the registered manager agreed to gain copies of their waste disposal licence and transfer notes to ensure that the medication from the home was being disposed in compliance with the Controlled Waste Regulations. No controlled drugs were prescribed at the time of the inspection and the controlled drugs register confirmed nil quantities. No service users were selfmedicating, but locked drawer facilities were available in each room for the safe storage of medication if needed. Staff were observed addressing service users in a respectful manner and knocking on doors before entering service user’s rooms. One relative spoken to said ‘the décor needs doing, but the care is lovely – no complaints at all. The staff are wonderful’. The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 There were a range of social, religious and recreational opportunities available to meet the expectations of the service users within the home. Visitors were welcomed in an open and friendly manner and service users were supported and encouraged to maintain contact with family and friends. Service users were able to exercise their rights to have control over their own lives and to fulfill their individual wishes and choices. Dietary needs of service users were catered for to meet a variety of individual needs. EVIDENCE: The home employed an activities co-ordinator five days per week who organised a range of activities to take place for the benefit of the service users. These included manicures, chair exercises, entertainers, barbeques and cream teas in the garden, dancing, handbag and clothes parties, visits to the local garden centre etc. A theatre group from London put on a pantomime in the home over the New Year and this year staff were preparing to do the pantomime in house for the benefit of the service users. Religious needs were also accommodated and included a monthly Holy Communion service for those service users who wished to attend. A local vicar made weekly visits to the home and the Salvation Army also attended the home every three months which one service user confirmed she enjoyed very much. The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 Page 13 There was an open visiting policy for relatives and other visitors at the home. Service users were able to see their visitors in the privacy of their own room if they so wished and some went out regularly for lunch or the day with friends or relatives. Service users confirmed that they could get up and go to bed when they wished to. They could also choose to participate in activities but were not pressurised to do so if they did not want to join in. The kitchen and the food were not inspected on this occasion but the home had an 8 weekly menu which had just been reviewed by the cook. The registered manager informed the inspector that service users had been asked to make comments on the proposed changes to the menu plans and the feedback would be discussed at the residents meeting. The inspector was extremely pleased to hear that staff were involving service users in this way. The registered manager also confirmed that those service users who have soft diets have their food items pureed individually and presented in a manner that was as attractive and appealing as possible to maintain appetite and nutrition. The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Complaints were listened to and resolved to the satisfaction of the complainant. The home’s policies, procedures and induction training protected service users from aspects of abuse. EVIDENCE: The Commission had received no formal complaints since the last inspection and none had been received by the home over the last 12 months. The complaints procedure was observed in the hallway of the home for the benefit of service users and visitors alike. Minor complaints were received by the registered care manager and resolved to the satisfaction of the service users. The home had an Adult Protection procedure, and abuse training for all staff carried out by the home’s training manager, was almost complete at the time of the inspection. New members of staff also received abuse training as part of their induction. The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 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 standard(s) 19, 20 and 24 A major refurbishment was taking place, which once completed, would provide a beautiful home for the service users and complement the high standard of care provided within the home. Some disruption to service users, but overall a comfortable, safe and clean environment with pleasant outdoor facilities at the rear of the property. EVIDENCE: The home was in the process of a major refurbishment programme at the time of the inspection in which the Commission had been involved throughout. One part of the home had recently been converted into 3 new bedrooms with ensuites, all of which were a good size, bright, warm and decorated to a high standard. The quality, colour and styling of the tiling, carpets and curtains were also of a high standard. A new office, foyer and disabled toilet had been created and a new dining room was almost finished. The rest of the home was due to be completely refurbished and the quality of the recent work above, exaggerated the need for this, particularly in the communal areas. The refurbishment was planned to include all of the existing bedrooms, the kitchen and the dining rooms and lounges. Additional building The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 Page 16 work was also planned to create more new bedrooms bringing the total number of places in the home to 40. Outside at the front of the property, there was a large car park area. At the rear of the property were attractive gardens with a range of shrubs and flowers and also a water feature. There were flat, paved surfaces around the garden and places for service users to sit. The new building work had created a new access to the gardens for the service users. The home had two lounges, one of which was being used as a dining room at lunchtime during the refurbishment. The service user’s bedrooms were satisfactory and each room contained a range of personal items belonging to the service user, a locked drawer facility, smoke alarm and guarded radiators. Service users confirmed that they had chosen the colour scheme that they wanted for their bedrooms when refurbished and were looking forward to having the work completed. All areas of the home were comfortable, clean and warm. At the time of the inspection, there was considerable building work taking place and it was clear that staff had worked hard to maintain the safety of the service users and to keep the disruption to a minimum as much as possible. Service users and their families had been kept informed and consulted on the proposed and agreed building work throughout the process and copies of the plans were observed hanging on the wall of a corridor within the home to ensure both service users and relatives were kept informed. The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 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 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, 28 and 29 The assessed needs of service users had been met by an adequate number of suitably trained staff. Staff files and recruitment procedures needed to be audited to ensure the protection of service users. Staff training had been given a high priority. EVIDENCE: On the day of the inspection, there were 32 service users living in the home. The daily staff coverage showed an adequate mix of qualifications, skills and numbers to meet the needs of the service users as follows: 07.30 – 14.00 14.00 – 20.30 20.30 – 07.30 2 registered nurses 2 registered nurses 1registered nurse 6 care assistants 4 care assistants ( 1 additional care assistant on duty at 17.30 – 20.30) 2 care assistants Other ancillary staff on duty that day included: 2 office administrators – 1 fulltime and 1 part-time, an activities co-ordinator, a training manager, a cook, an assistant cook, 2 domestics, a laundry assistant and a maintenance person. All senior care staff had achieved NVQ Level 3 in care and at the time of the inspection, five care staff were undertaking NVQ Level 2, with one care assistant in the process of completing NVQ Level 3. The commitment to training within the home was evident and a full-time training manager was employed to provide a continuous development programme for all staff. The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 Page 18 Two staff files were examined and each contained an application form, CRB clearances, two references and details of qualifications and some training. Appraisal sessions were also documented. However, they were lacking some of the required elements as set out in Schedule 2 of the Care Homes Regulations 2001 e.g. a recent photograph of the member of staff and proof of identity. It is a requirement of this report that the recruitment and selection procedures within the home are updated to prevent future omissions in staff files for any new staff and for all existing staff files to be audited and any gaps identified and corrected. The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 and 33 The ethos and leadership of the home was committed to meeting the needs of the service users. The home was clearly run in the best interests of the service users whose views were sought about the services provided within the home. EVIDENCE: The registered manager was an experienced and qualified nurse, a competent, and professional person entirely committed to providing a high standard of quality care for the service users in the home. Staff were encouraged to contribute to and affect service delivery within the home via a number of staff meetings, including trained nurse meetings every 2 months, general staff meetings every 2 to 3 months and various client group meetings. Minutes from these meetings were seen recorded and action taken. The service users benefited from the registered manager’s open and transparent style of leadership and management. Feedback was sought from The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 Page 20 both service users and relatives throughout the recent building planning process and comments were taken into account. Residents meetings were held every 3 months and minutes from those meetings were seen to include action taken and were well documented. An annual survey for service users and relatives also took place. Feedback from this survey was summarised, an action plan developed and then discussed at the resident’s meeting. The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 4 x 4 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION 3 3 x x x 3 x x STAFFING Standard No Score 27 3 28 4 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 4 x 4 x 4 4 x x x x x The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 Page 22 NO 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 OP 9 Regulation 13 (2) Requirement Timescale for action Immediate 2. OP 29 19 (1) (b) (i) To ensure that all administered medicines is recorded at all times in the appropriated records for each individual service user. All recruitment procedures to be Immediate updated and staff files to be reviewed and audited to ensure all staff have the appropriate checks prior to employment. 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 NONE Good Practice Recommendations The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 The Conifers Nursing Home E51-E09 S38253 Conifers V236010 04.07.05 Stage 4.doc Version 1.40 Page 24 - 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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