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Inspection on 22/06/08 for The Elizabeth Anne Nursing Home

Also see our care home review for The Elizabeth Anne Nursing Home for more information

This inspection was carried out on 22nd June 2008.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff members are multi skilled, and staff communication is good with daily handovers and regular staff meetings. The staff team work very hard towards providing best practice in relation to all aspects of their duties. Adaptations and equipment at the home suit the needs of the residents. The home is well run by a competent registered manager and senior team. Residents confirmed they liked the food at the home, and a varied and nutritious diet is provided with alternatives available.

What has improved since the last inspection?

What the care home could do better:

Maintain appropriate staffing levels in relation to nursing staff to meet the needs of the current group of residents. Ensure appropriate moving and handling procedures are followed. Maintain comprehensive food records.

CARE HOMES FOR OLDER PEOPLE The Elizabeth Anne Nursing Home 64 Edgar Road Cliftonville Margate Kent CT9 2EQ Lead Inspector Sandra Crosby Unannounced Inspection 09:30 22nd July 2008 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 The Elizabeth Anne Nursing Home DS0000026092.V367756.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. The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Elizabeth Anne Nursing Home Address 64 Edgar Road Cliftonville Margate Kent CT9 2EQ 01843 221375 01843 225054 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) Cliftonville Nursing Homes Ltd Mr John Moffatt Care Home 30 Category(ies) of Dementia (0), Mental disorder, excluding registration, with number learning disability or dementia (0) of places The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 2. Mental disorder, excluding learning disability or dementia (MD) The maximum number of service users to be accommodated is 30. Date of last inspection 21 August 2006 Brief Description of the Service: The Elizabeth Anne Nursing Home is a large detached premises, with 24 single and 3 double bedrooms. One of the double and ten of the single bedrooms have en-suite facilities and most have television points. Accommodation is on three floors and there are two shaft lifts. There is a call bell system in operation at the home. The home aims to ‘provide an environment and programme of care to residents which will reinforce normal acceptable behaviour, aiming to diminish confusion and encourage residents to move from dependency to independence through clear guidelines for their care’. The home is located close to the seafront, local shops and bus route in Cliftonville. There is an external grassed area to one side of the property where residents may sit out in the warmer weather. The registered manager stated during a telephone call following the visit to the home that the current range of fees range from £237.00 to 867.00 per week. The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use this service experience good, quality outcomes. This report contains the findings of the home’s key inspection and takes account of information obtained from various sources since the last inspection of 21 August 2006, including an Annual Service Review dated 31 January 2008 and a visit to the home. The key inspection visit was unannounced and carried out on Tuesday 22 August 2008 between 09.30 and 10.15 hours and on Wednesday 23 August 2008 between 09.30 and 15.30. During the inspection the inspector spoke with several residents, the registered manager, the care co-ordinator and staff on duty. Various records were seen and an accompanied tour of some areas of the home was made. The manager was registered with the Commission in June this year. Before taking up the post of manager, he was the deputy manager at the home. He is a registered Level 1 nurse with many years experience working with this client group. Information contained in the completed Annual Quality Assurance Assessment (AQAA), was comprehensive and information and observations made at the time of the inspection visit has been used when completing this report. Six of twelve service user surveys were returned, two completed by relatives and all providing positive comments about life at the home for example ‘good medical support’, ‘very good food’, ‘well looked after’, ‘extremely grateful to all staff’, ‘happy with treatment and care afforded to my mother’. The findings of this inspection were discussed with the registered manager and the care co-ordinator at the end of the visit, and overall indicate that this home provides good quality outcomes provision for the residents and in line with CSCI ratings agenda this service has achieved a good 2* rating. The registered manager confirmed that issues raised in relation to nurse staffing levels and moving and handling practice would be addressed. The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Maintain appropriate staffing levels in relation to nursing staff to meet the needs of the current group of residents. Ensure appropriate moving and handling procedures are followed. Maintain comprehensive food records. The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 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 summary of this inspection report can be made available in other formats on request. The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,3 and 6 were inspected at this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes Statement of Purpose and Service User Guide provide residents and prospective residents with the information they need to make a decision about moving into the home. The assessment process is thorough and prospective residents move into the home knowing that their needs can be met and that their independence will be maximised and promoted. It is not the general policy of the home to admit Service Users on a short-term basis, and this standard was judged as not applicable at this inspection visit. The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 10 EVIDENCE: The Statement of Purpose and Service User Guide have been seen at previous inspection visits. Both documents are well presented and suitable for purpose. The registered manager agreed to update these documents and make any necessary changes in relation to the management structure and staffing at the home. A pre-assessment documentation was seen that had recently been completed by the registered manager. The information seen was sufficient, as further information could not be obtained at the time of the visit. The home also obtains care management assessments, and other professional assessments where appropriate. All information collected is used to inform the initial care plan. It is not the general policy of the home to admit people on a short-term basis, and the manager confirmed that short-term care was only provided occasionally. The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 11 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): Standards 7,8,9 and 10 were inspected at this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from care plans that show that person centred care is promoted, and that health needs are being met. Personal care is offered in a way to protect resident’s privacy and dignity. The systems for medication administration are robust; and there are clear and comprehensive policies and procedures in place to ensure residents medication needs are met. EVIDENCE: Four care plans were examined and indicated that comprehensive records are being maintained. The care plans contained all information as required by the standards and regulations for example plan of care, daily records and regular reviews. The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 12 From information contained within the care plans, it is indicated that resident’s health care needs are met, and other professionals are contacted as appropriate in order to meet resident’s needs. The home is using pressure area care documentation that is used by the local Primary Care Trust. This format is an improvement on previous documentation used by the home and recorded evidence was seen showing improvement in a pressure area being treated by the nursing staff at the home. The medication records were seen to be appropriately signed for and up to date. The medications storage has been seen at previous visits, and found to be satisfactory. It was observed at this inspection visit that resident’s privacy and dignity are respected for example staff knock on bedroom doors and wait before entering, and staff were observed speaking to residents in an appropriate friendly manner. The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 13 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): Standards 12,13,14,15 and 16 were inspected at this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident they will have satisfactory opportunities regarding lifestyle choices. Residents are supported to maintain contacts with families and friends and enjoy a balanced and healthy diet. EVIDENCE: Residents said that the pace of daily life in the home is relaxed and unhurried. People said that they could choose when to get up, when to go to bed and how to spend their day in between. Written evidence to support this was also seen in the care plans. The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 14 A person is employed to undertake diversional therapy sessions, and is currently actively carrying out a programme of activities. As this person currently works twelve hours a week, the care staff at the home also assist with occupational therapies as and when they are able. The home also provides for outside entertainers, and has the usual party functions for example Halloween Party. Going to the races is an event planned in the near future. Comments in surveys supported this for example ‘love music and trips out’ and ‘various activities’. Links with family and friends are maintained. Visitors are welcome at all reasonable times. Residents who are able go out and about independently. The weekly menus were seen, and indicated that a varied and nutritious diet is available to residents. The daily food records being were not always recorded daily, and this issue was discussed with the cook and later with the registered manager. Residents confirmed that alternatives are available and spoke positively about the food provided at the home. Comments received in surveys supported this for example ‘very good food’. A professional heated trolley has been purchased and is now used at mealtimes. This provides residents with the opportunity to view what is being provided and to choose what they would like to have. The cook said that it also ensures that the food does not lose heat whilst waiting to be served. The dining area has recently been re-decorated and the residents chose the colours used. It was well presented with colour co-ordinated tablecloths and appropriate cutlery. Meals are taken in the main dining room or in the resident’s bedroom if preferred. People feel their rights as citizens are recognised and promoted, including fairness, equality, dignity, respect, and autonomy over their chosen way of life. The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 15 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): Standards 16 and 18 were inspected at this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and visitors know their complaints will be listened to and acted upon. Staff have good knowledge and understanding of adult protection issues, which protects the residents from abuse. EVIDENCE: The home has a complaints procedure, and the registered manager confirmed that there had been no formal complaints made since the last inspection. The AQQA documentation completed by the registered manager supports this statement. One anonymous complaint was received at the Commission Office in March 2007. The registered provider dealt appropriately with the complaint and it was closed. The complaints book for the home was seen, and the registered manager was asked to collate any information in relation to complaints in an individual format, and this he agreed to do. The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 16 There is a policy document in the home that commits everyone to do with the running of the Elizabeth Anne Nursing Home, to guard against any incident in which a resident might experience abuse. The AQAA documentation indicates that NVQ training is ongoing at the home and includes safeguarding of vulnerable adults. The staff training matrix indicated that seventeen members of staff had undertaken adult protection training and staff spoken to supported this. The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 17 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): Standards 19,20,21,22,23,24,25 and 26 were inspected at this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and comfortable home that is continually improved by an ongoing programme of refurbishment and redecoration. EVIDENCE: In general the premises are presented to a good standard. On the outside the fabric of the property looks mainly to be in good order although there has been problems with the roof leaking that have now hopefully been addressed. The outside garden area is well maintained and provides a pleasant area for residents to make use of if they so wish. A gazebo has been provided for when the weather may be to hot or for those that prefer to sit in the shade. On the inside most areas are well decorated, comfortably furnished and clean. There is ongoing redecoration and refurbishment. The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 18 Adequate toilet, washing and bathing facilities are provided to meet the needs of residents. The home has a Parker Bath and two well designed walk in shower facilities. The AQAA documentation states that the lounge and conservatory areas have been refurbished, an aquarium being provided in the conservatory, and a large screen television having been purchased for the lounge. Residents commented that they liked the improvements. The dining room has been re-decorated with residents choosing the colours used. Equipment is provided as per individual assessed needs, including hoists, mattresses, grab rails etc. There is two passenger lifts at the home. A call bell system is provided for every room. It was seen during the accompanied tour of the home that bedrooms were furnished and equipped to assure comfort and privacy. The furnishings within the bedrooms were arranged in order to meet the assessed needs of the resident. Rooms are centrally heated and it was seen that radiator covers are in place. A number of secondary heaters were seen attached to walls in bedrooms, and it was made known at previous visits that the Fire Safety Officer is aware that these heaters are being used in the home. On the days of the inspection visits, the premises were found to be clean and mainly free from any stale odours. The outside clinical waste bin was seen to be overflowing; therefore the lid would not close and could not be kept locked. It was malodorous and attracting flies to congregate. This concern was discussed with the registered manager and immediate action was taken to address this issue. The Laundry Room was very tidy and provides adequate facilities. The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 19 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): Standards 27,28,29 and 30 were inspected at this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a mainly well-trained, enthusiastic and supportive staff team, although nursing staff levels have not been sufficiently maintained of late. Staff training needs to be further developed to ensure that all staff have the skills and knowledge needed to meet the needs of the residents. The homes practice regarding the recruitment of staff ensures residents are protected. The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 20 EVIDENCE: The staff rota was seen, and indicated that there were not sufficient nursing staff on duty to meet the needs of the current group of residents. It was evidenced on the first day of the visit that the registered manager was working ‘hands on’ covering twelve house shifts. The rota showed that cover had not been provided for a two week holiday period. The registered manager said that a nurse from one of the other homes owned by the company proved unsuitable, and this led to the registered manager working five twelve shifts last week, and was on the rota to work six twelve hours shifts this week. As this was evidenced on the first day of the inspection visit, the registered manager contacted the group manager who arranged for additional nurse cover for the next day and extra cover for the rest of the second week of annual leave. The registered manager said that currently the home has been interviewing for a deputy manager, and following the completion of the inspection visit, the registered manager informed the Commission that a deputy manager had now been appointed and provided a copy of the new off duty rota. One of the nurses currently working at the home is to cover two additional shifts a week until a further part-time nurse can be employed. The action taken by the registered manager and the company now ensures that the nursing needs of the current group of residents can be met, and the registered manager can undertake his management role at the home. Four staff files were seen, and contained all relevant documentation as required by regulation for example application form, written references, proof of identity, CRB and POVA checks and contract of employment. The thorough recruitment procedure used should ensure the safety of the residents at the home. The AQAA documentation states that seven care staff have completed NVQ Level 2 or above and three carers are working towards NVQ Level 2 or above. The staff-training matrix indicates that all mandatory courses are undertaken; however further staff training is required to ensure that all staff have completed all mandatory training. Staff spoken with confirmed that training is ongoing at the home. People are well supported by a staff team that recognises and responds appropriately to their diverse needs and human rights. The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 21 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): Standards 31,33,35,36,37 and 38 were inspected at this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s mainly benefit from a well run home and the health, safety and welfare of service users and staff are promoted and protected. The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 22 EVIDENCE: The registered manager is a well-qualified experienced nurse, and has previous experience in a management role. Staff confirmed that they would speak with the registered manager if they had any concerns. The AQAA documentation indicates that maintenance certification is up to date, and it was evidenced that the maintenance person is completing any work that requires undertaking. The external grounds are well maintained. Although the records were not seen at this inspection visit, from past visits it is indicated that the home has an appropriate recording system in place when handling any residents personal allowance monies. Staff supervision is ongoing at the home in accordance with the requirements of regulation. The home has a quality assurance system in place and the registered manager will continue auditing as required by regulation. A person employed by the company undertakes the regulation 26 visits. People enjoy as good a quality of life as possible because the home is managed in a way that takes into account and promotes their human rights and equality and diversity needs. The registered manager confirmed at the end of the visit when feedback discussion took place; that the issues raised in relation to nurse staffing levels, moving and handling practice and maintaining daily records of the food provided would be addressed without delay. The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 23 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 3 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 2 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 3 X 3 3 3 2 The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 The Elizabeth Anne Nursing Home DS0000026092.V367756.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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