Inspection on 07/06/06 for The Elizabethan Care Home

This inspection was carried out on 7th June 2006.

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

The Elizabethan Care Home 29/08/08

The Elizabethan Care Home 14/04/08

The Elizabethan Care Home 18/05/07

The Elizabethan Care Home 30/11/05

The Elizabethan Care Home 21/04/05

The Elizabethan Care Home 28/10/04

The Elizabethan Care Home 22/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE The Elizabethan Care Home 220 Old Bedford Road Luton LU2 7HB Lead Inspector Mr Pursotamraj Hirekar Unannounced Inspection 07/06/06 11:55 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 Elizabethan Care Home DS0000045208.V297579.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 Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Elizabethan Care Home Address 220 Old Bedford Road Luton LU2 7HB 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) 01582 720010 Heritage Care Homes Ltd Miss Erin Bermingham Care Home 21 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (23) of places The Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users over the age of 65 years, not falling within any other category 21(OP), 10 of whom may have dementia DE (E) (10). No one falling within the category of DE (E) may be admitted to the home when there are 10 persons in category DE (E) already accommodated in the home. The home can accommodate a maximum of 21 service users of either sex. 30th November 2005 Date of last inspection Brief Description of the Service: The Elizabethan was registered to provide services for twenty-one older people, ten of whom who may also have dementia. Mr S Hussain had been the proprietor a number of years. He had changed the registered status to a company, Heritage Care Homes, two years ago. The company also operates two other care homes in the vicinity. The manager Miss Bermingham had been appointed several months ago. The service had improved significantly under her direction. The home was located in a pleasant residential suburb of Luton with convenient access to the towns amenities and transport links. The accommodation was distributed over three floors that were accessible via a staircase and a shaft lift. Each bedroom was for single occupancy although a few rooms were large enough to accommodate two persons who wished to share. A lounge and dining room were located on the ground floor. Toilet and bathing facilities were located on each of the floors. However, only two of the bathing facilities were in use. The garden to the front of the property was not accessible as it had a steep slope. The front entrance to the building was similarly restricted. Service users and visitors to the home therefore mostly used the door that led directly into the laundry from the side of the property. Service users could also use the patio doors that lead out from the rear lounge onto a paved area. The majority of the rear of the property was given over to a large parking area. Beyond this was a further large grassed area that was not in use. The minimum fee was £395/- and £420/- per week. The Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of the unannounced key inspection carried out on 07/06/06 over 6hours by pursotamraj hirekar. The method of inspection included review of outstanding requirements and recommendations, notified incidents, study of a sample of care plans, risk assessments, discussion with the service users’, staffs on duty, manager and observations. The manager coordinated the entire inspection. What the service does well: What has improved since the last inspection? What they could do better: The manager and the Company need to make sure that they take the action necessary to comply with the regulations. This report has highlighted areas in relation to the premises where the home has not complied with previous requirements and timescales have been extended on more than one occasion. A further short extension is made this time but further extensions to outstanding requirements will not be given. The manager must ensure that all parts of the home are kept clean, especially 2 service users’ bedrooms. Where odours cannot be stopped by cleaning then the flooring will need to be replaced. Provide a suitable ramp to the entrance door to the home and to the access via the front garden, as currently service users using wheelchairs have to enter the home via the laundry. The Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 Page 6 Provide the maintenance person with sufficient time to carry out the maintenance of the home. Repair furniture in various sites where it is chipped, worn and broken. The home should ensure night staff supervision happen as scheduled. 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 Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had ensured a comprehensive need assessment prior to the admissions of potential service users’. EVIDENCE: The home had 2 new admissions in March and April 2006. Need assessments were carried out to understand whether the home could meet the assessed needs of the service users’. The assessed needs of the 2 new service users’ were discussed with the staff members and a decision was taken to admit. Service user’s need assessment was done prior to the admission by the manager. The area of need assessment included pressure risk assessment, lifting assessment, getting up, toilet, preparing food and drinks, walking, going out of premesis, nutrition screening and body map. Personal belongings information need to be recorded. The manager had said that the service user was very reserved and was not able to speak out because of his wifes sudden death. However, the manager was trying with his son to complete the gaps in the care plan and regularise monthly care reviews and obtain signature. There was no service user for intermediate care from the date of previous inspection. The Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 Page 9 The Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had carried out comprehensive need assessments and developed individual care plans. The care plans implementation were regularly reviewed. EVIDENCE: At present the home had 18 service users’, 9 of them had dementia. The home had developed comprehensive care plans, which were based on the risk assessments and needs assessments. The care plans covered information with regard to day to day care that detail aspects such as personal care, choices of food, meal times, time to get up and go to bed, medical history and medication process, appoint with GP, dentist, chiropodist, weights, nutritional assessments, moving and handling needs, representative and next of kin. The personal care needs, whether they would like to go out with the family and the medical history was detailed in the care plan. The care plan implementation monitoring mechanisms were also in place. Service users do not take their own medication; the home had trained staffs to administer medication. The home had robust annual review process that ensures the privacy and dignity of the service users’. The Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 Page 11 On a random sample 4 service users’ were case tracked and their outcome is as follows: In the case of service user-1 the home had to serve a notice to the representative of the service user with a copy to social services for not able to meet the growing needs of the service user. Which, the home had concluded during their internal review process and the service user was moved to a suitable place. This process was carried out by the home in consultation with the service users’ representatives and the social services. Service user – 2 detailed information on family tree, dailycare, lifting assessment, incident of falls-no falls as of 25/04/06, incidence of pressure sores 17/04/06, weight, feet, eyes, GP visits, nutrition screening form, current medication and monthly care plan reviews were regular until april 2006. service user –3 was diagnised with dementia, had incidents of falls on 13/09/05 and 22/10/05, incident of pressure sore last 12/10/05, GP visits, nutritional assessment needed dieticians inputs and monthly reviews need to be regularised. Service user - 4 was diagnised dementia and had 6 falls since 10/04 the latest was on 05/05/06 and had hip replacement. Monthly reviews were regular untill 19/05/06. The Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users’ were engaged in appropriate activities and their money transanctions were managed well. The dietary needs of the service users’ were taken care. EVIDENCE: The home’s annual review and the monthly review mechanisms were in place to ensure the socio-cultural needs of the service users’ were met. The home had an activity schedule that included videos, TV, reading, exercise with ball, coffee morning, visit to dominos, sing along, music, colouring and painting, skittles, visit to park and bingo. However, not all the service users actively take part in all of these activities and there were few who enjoy. There were 3 service users who go out for shopping in the nearest market. There were 2 service users’ who look forward to meet their family members and they hardly ever visit. The service users’ family members and their representatives were encouraged to participate in the annual review and as a result few service users’ do visit their families every week or sometime every fortnight. The Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 Page 13 The home had taken appropriate initiatives to ensure the monies of the service users’ were now routed from the pension services to Luton Borough Council and then to the home, the home maintains their account. Service users’ were encouraged to have their own choice of time for going to bed, food menu, maintaining their own money, what they would like to wear. The home had carried out a nutritional assessment of all service users and their food menu was customised based on the outcomes of the nutritional assessments. Nutritional assessments were carried out as part of the needs assessment and care planning process and then followed up by every six months review. The home would carry out nutritional assessment as and when required for service users when observed that the service user’s weight was reducing. The care staff and when required dieticians professional input was taken to carry out these nutritional assessments. The Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a robust complaints policy and procedure that ensured the service users’ were protected from abuse. EVIDENCE: The home had a robust complaint policy and procedure, which was available to all the service users’ and their representatives. On an oral complaint made to the commission by a service user’s representative the service provider was asked to investigate and do a report to the commission with a copy to the complainant. The service provider had investigated and the report was sent to the commission with a copy to the service user’s representative. There was no response from the service user’s representative to the report. The Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home need to take appropriate measures to ensure the environment was clean and comfortable at the home. EVIDENCE: On a partial tour of the premises, the home was found generally clean and needed shampooing in 2 bedrooms as 2 service users’ soil their carpets quite frequently. The home needs to regularly shampoo the 2 service users’ bedrooms to avoid offensive odours. The kitchen cupboard door was fallen off and the maintenance person still not attended this for a week. 2 service users rooms’ furniture cupboard needed replacement as they were old and the locks were broken and the replacements of locks have not fixed the problem. All the wardrobes locks were fixed except 2 service user. Maintenance person services were improved after the inspection of 30/11/06 but had deteriorated since the building works at the other home was initiated since a month. This The Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 Page 16 had negative effect on the regular maintenance work of the home. However, emergency work was attended. Fire risk assessment is due for end of june 06, portable appliances testing was carried out by a company called paipass and their report dated 25/04/06 said everything was fine. The entrance to the home was inappropriate as the service users use the entrance that takes you through the laundry. A requirement was made to this effect in the previous inspection report to provide a suitable ramp. There was no evidence provided on this inspection that the registerd provider had made any attempts to make an application to the authorities concerened for the construction of ramp. The Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had a good skill mix of staffs. However, the suggesstions made by the staffs’ need to be actioned to improve the service delivery. EVIDENCE: The home had three shifts duty system; at least one senior support staff and 2 support staffs were always available for service on each shift. However, during night shift 2 support staffs were on duty. The home had a registered manager and works 40 hrs a week and was available on call 24X7. The staffs have undergone mandatory training that includes moving and handling, POVA, dementia, first aid, food and hygiene, health and safety and pressure care. 6 staffs have NVQ2 in care and 2 staffs have NVQ3 and their certificates are on their way from the college. At present, the manager was developing staffs training plans in response to the training needs of the staffs. The deputy manager who was on leave and was expected to join duty in March 2006 had not reported yet. The home had advertised internally for the post of deputy manager and the recruitment process was in progress. Discussion were held with 3 staffs on duty and the outcome is as follows: Staff member – 1 working as care assistant since 12/03 had received training first aid, moving and handling, POVA, pressure sore care. Had received staff supervision once every month and suggested an increase of staffs on shifts from 3 to 4 staffs. Staff member – 2 working as a senior carer since 10/05 had responsibilities of The Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 Page 18 medication, working with GP, district nurse, pharmacist/chemist, supervision of carers and shadow manager. Achieved NVQ2 and currently pursuing for NVQ3, received training in first aid, moving and handling, POVA, how to approach service users’ with dementia. Suggested to improve communication across staffs during change of shifts. Staff member – 3 currently working as senior carer since 05/06 and had been working over weekends since 09/03, had diploma in social work, achieved NVQ3 nursery nurse, and received training in dementia, fire, first aid, moving and handling. Staff member had suggested that the staffs working need to have more awareness about the choice of the service users’ to equip staffs for better delivery of care. At present the home had approriate staff ratio. The home had appoimted 1 carer in the month of April 2006 . 3 staffs records were seen on a random sample and found that one staff member CRB was in the name of Edwardian(sister home) dated 2003, had references, contract, training, photo and staffs supervision was regular. Staff member - RY application, CRB, contract, staff supervision and references were in order. An other staff member’s application, CRB was in the name of Heritage care home(the company), contract, staff supervision, references were in order. The Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home manager was competent and ensured the service delivery to meet the assessed needs of the service users’. However the management of some aspects of safety require further imput to ensure a safe environment is maintained. EVIDENCE: The home had a registered manager. The manager was working for NVQ4 in care. The manager has been in the care profession for 8 long years and has worked in various capacities as a domestic carer, deputy manager and now manager for over 2 years. The home had developed an in-house financial management system with regard to the monies of service users’ and followed the same. The home manages the monies of 10 service users’. The Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 Page 20 The home had developed staffs’ supervision schedule and the staffs were supervised every 2 months. However, the night staff’s supervision needed regularisation. The health and safety training needs were ensured through staffs training in POVA, moving and handling. The health and safety policy and procedures, medication policy and procedures were comprehensive. The home had taken cognisance of the requirement made in the previous inspection dated 30/11/05 and has moved 1 service user because the home was not able to meet the health care needs of the service user. As part of the annual quality assurance system the home had sent out questionnaire to relatives and family members of the service users’ for their comments about the service provision and any suggestions for improvements. The home had analysed the information provided by the family members and acted upon their suggestions. 4 service users families suggestions were acted upon which included decorating the patio with flower beds, service users’ personal money management, service users’ outings and building blocks as an activity for one service user. For example 1 service users family member was not clear about the way the service users’ money was used and how the money transaction record was maintained. The manager said she had explained the procedure how the service users’ money transactions were recorded, the service user’s family member was happy after the explanation of the procedure. The safe working practices of the home are deficient due to the noncompliance with requirements regarding the maintence of the building in particlular the replacement of broken furniture and the monitoring of the hot water to prevent scalding. Hot water temperature records needed updating as there were no records of temperature monitoring since 07/10/05. The Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X 1 X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 The Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP19 Regulation 23(2) (d) Requirement The manager must ensure that all parts of the home are kept clean, especially 2 service users’ bedrooms. Where odours cannot be eliminated by cleaning then the flooring must be replaced. Provide a suitable ramp to the entrance door to the home and to the access via the front garden. (Previous timescale of 30.04.05, 31.07.05 and 15.02.06 had not been met). Provide the maintenance person with sufficient time to carry out the maintenance of the home. (Previous timescale of 30.11.04, 30.06.05 and 15.02.06 had not been met in full). Repair furniture in various sites where it is chipped and worn (Previous timescales of 31.07.04, 31.12.04 and 15.02.06 had not been met in full) The temperature of the hot DS0000045208.V297579.R01.S.doc Timescale for action 15/07/06 2. OP22 23(2)(n) 15/09/06 3. OP19 18(1)(a), 23(2C) 15/07/06 4. OP24 16(2) 15/07/06 5 OP38 13(4) 15/07/06 Version 5.2 Page 23 The Elizabethan Care Home water system must be monitored and steps taken to ensure that service users are not at risk of scalding 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 OP36 Good Practice Recommendations The home should ensure night staff supervision happen as scheduled. The Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Elizabethan Care Home DS0000045208.V297579.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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